NCPRSS cheat sheet

Peer recovery support is delivered by people with lived experience of substance use and/or mental health recovery who are trained and certified, not by clinicians delivering treatment.

Core role functions: connecting to recovery communities, modeling recovery, sharing one's own story purposefully, helping with practical problem-solving, and supporting engagement with services.

Peer support is grounded in four recovery concepts: hope, self-determination, empowerment, and the value of lived experience as evidence that recovery is possible.

Peer workers are not sponsors, case managers, or therapists; the role is non-clinical and does not include diagnosis, treatment planning, or clinical advice.

Recovery is defined as a process of change through which individuals improve health and wellness, live self-directed lives, and strive to reach full potential; it is not synonymous with abstinence-only outcomes.

Multiple pathways to recovery exist (medication-assisted recovery, 12-step, faith-based, secular, harm reduction); the peer role respects the individual's chosen pathway rather than promoting one model.

Peer support models include mutual/self-help groups, peer-run programs, peer specialists on clinical teams, and peer recovery coaches; scope and supervision differ by model.

Reciprocity is a defining feature: peer support is a two-way relationship in which both parties give and receive help, distinguishing it from expert-to-recipient service.

Certification typically requires lived experience, a training program, an exam, and continuing education; recertification cycles and ethics requirements are set by the certifying body.

Confidentiality protects all information shared in the peer relationship, including the fact that the person receives services; disclosure requires informed written consent or a legal mandate.

Standard exceptions to confidentiality: imminent danger to self or others, suspected abuse or neglect of a child or vulnerable adult, and valid court order; scope varies by jurisdiction.

Dual relationships occur when the peer has another significant role with the person (family, employer, landlord, romantic); they must be disclosed and managed, and romantic/sexual relationships are prohibited.

Role boundaries define what the peer does and does not do; boundary crossings are minor, sometimes therapeutic deviations, while boundary violations harm the person or exploit the relationship.

Self-disclosure must be purposeful, brief, and in service of the person's recovery; it is not a vehicle for the peer's own processing or for eliciting sympathy.

Peers do not accept gifts of significant value, lend or borrow money, or provide transportation without program authorization; these are common boundary risk points.

Mandated reporting duties override confidentiality promises; the peer should explain limits of confidentiality at the start of the relationship rather than after a disclosure.

Ethical decision-making follows a sequence: identify the dilemma, consult the code of ethics, seek supervision, weigh harms and benefits, act, and document.

Written and electronic records are protected; peers should not discuss persons served on social media, in public, or with anyone outside authorized team channels.

Motivational interviewing core elements: partnership, acceptance, compassion, evocation; the goal is to elicit the person's own reasons for change rather than to persuade.

OARS skills: Open questions, Affirmations, Reflections, Summaries; reflections should outnumber questions in a balanced conversation.

Change talk (desire, ability, reasons, need, commitment, taking steps) predicts behavior change; sustain talk predicts maintenance of the status quo, and the peer responds differentially.

The righting reflex - the urge to correct or advise - typically increases resistance; rolling with resistance uses reflection instead of argument.

Stages of change: precontemplation, contemplation, preparation, action, maintenance (and relapse as a stage in cyclic models); interventions are matched to stage.

Active listening includes attending, paraphrasing, reflecting feeling, and summarizing; it is demonstrated by accurate reflection, not by agreement.

Trauma-informed communication avoids confrontation and power struggles, offers choice, and asks permission before discussing sensitive topics.

Language matters: person-first, non-stigmatizing terms (person with a substance use disorder) reduce shame and support engagement; avoid labels like addict or clean/dirty.

Ambivalence is normal and expected; the peer's task is to explore both sides without pushing for a premature decision.

Linkage is an active process: warm handoffs, accompanying the person, confirming the appointment occurred, and following up - not merely providing a phone number.

Advocacy levels: individual (case advocacy for one person), systemic (changing policies or practices), and self-advocacy (building the person's own capacity to speak for themselves).

Resource categories to know: housing and shelters, food assistance, Medicaid/insurance enrollment, transportation, employment and vocational services, legal aid, and recovery housing.

Recovery housing types differ in structure and support (peer-run, sober living, Oxford House model); peers should match level of structure to the person's needs and preferences.

Release of information is required before a peer contacts another agency on the person's behalf; the person controls the scope and duration of that consent.

Barriers to linkage include transportation, stigma, waitlists, documentation requirements, and prior negative experiences; effective advocacy names and problem-solves each barrier.

Warm handoff steps: introduce the person to the receiving provider, share only consented information, confirm contact details, and schedule follow-up.

The peer supports the person's choices even when the peer disagrees; advocacy means amplifying the person's voice, not substituting the peer's judgment.

Documentation of referrals should record the resource, date, outcome, and any follow-up needed, using objective language.

Recovery plans are person-directed: the person identifies goals and the peer supports the process; the plan is not imposed by the peer or the program.

SMART criteria: Specific, Measurable, Achievable, Relevant, Time-bound; goals are broken into small, actionable steps to build early success.

Recovery capital framework: social (relationships, family), physical (health, housing, money), human (skills, education, health literacy), and cultural (values, beliefs, belonging).

The plan should address multiple life domains: housing, health, relationships, employment/education, legal issues, and recovery supports, plus a relapse/crisis plan.

A relapse prevention plan names personal triggers, early warning signs, coping strategies, and specific people or places to contact when risk rises.

Goals are reviewed and revised on a set schedule or at milestones; progress is measured by the person's own definition of success, not only by abstinence.

Strengths-based planning inventories existing skills, supports, and past successes before identifying gaps.

Documenting goals should capture the person's own words where possible, the target date, responsible parties, and the review date.

Suicide risk screening asks directly about thoughts, plan, intent, means, and prior attempts; asking about suicide does not increase risk.

Risk factors include prior attempt, substance intoxication, access to lethal means, recent loss, isolation, and hopelessness; protective factors include connection, reasons for living, and engagement in care.

Imminent danger (plan plus intent plus means) requires immediate escalation to emergency services or a crisis team per program protocol; the peer does not manage this alone.

De-escalation techniques: reduce stimulation, speak calmly and slowly, maintain safe distance, offer choices, avoid arguing with delusions or confronting the person.

Overdose response: recognize signs (pinpoint pupils, slowed breathing, unresponsiveness), call emergency services, administer naloxone if available and trained, and support breathing.

A safety plan is developed collaboratively and includes warning signs, coping strategies, people and places for distraction, people to ask for help, and means restriction.

Peers must know their program's crisis protocol: who to call, when to call 911, how to document, and what follow-up is required after a crisis.

After a crisis, debriefing and re-engagement are part of the peer role; continuity of contact reduces the risk of disconnection from care.

The peer's own safety is part of the plan: never enter an unsafe environment alone, and use program procedures for high-risk situations.

Cultural humility is a lifelong process of self-reflection and openness to the person's cultural identity, contrasted with claiming cultural competence as a finished state.

Culture shapes beliefs about substance use, mental health, help-seeking, family roles, and stigma; the peer asks rather than assumes.

Health disparities and historical mistrust (e.g., from coerced treatment or discriminatory practices) affect engagement; acknowledging them builds credibility.

SAMHSA's six trauma-informed principles: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and attention to cultural, historical, and gender issues.

Trauma-informed practice assumes widespread trauma prevalence, avoids re-traumatization, and recognizes that survival behaviors may look like resistance or non-adherence.

Universal precautions in trauma-informed care mean applying trauma-informed approaches to everyone rather than screening first and treating only those with a trauma history.

Language access and interpretation services are required for limited-English-proficiency persons; family members, especially children, should not be used as interpreters.

Identity factors to consider include race, ethnicity, gender identity, sexual orientation, disability, religion, age, and immigration status, and their intersection.

Microaggressions, stereotyping, and assumptions about a person's background damage the working alliance and should be acknowledged and repaired when they occur.

Documentation standards: objective, timely, factual, and written in the person's own words where possible; avoid opinion, labels, and speculation.

Progress notes typically record date, contact type and duration, the person's reported status, interventions used, progress toward goals, plan for next contact, and signature.

Confidentiality applies to records: store securely, share only with consent, and follow program retention and destruction policies.

Supervision serves three functions: administrative (procedures, documentation), educational (skills and knowledge), and supportive (emotional strain, vicarious trauma).

The peer should bring boundary dilemmas, ethical questions, and high-risk situations to supervision promptly rather than resolving them alone.

Vicarious trauma, burnout, and compassion fatigue are occupational risks; signs include cynicism, detachment, and intrusive thoughts, and they are addressed through supervision, peer support, and self-care planning.

Continuing education and recertification are required to maintain certification; peers should track CE hours and renewal deadlines set by their certifying body.

Scope of practice defines what the peer is authorized to do; working outside it (e.g., diagnosing or giving clinical advice) is both an ethical and a certification risk.

Accurate, contemporaneous notes protect the person, the peer, and the program, and support continuity of care across team members.