Giving the Young People What They Want: A Policy Framework for Youth Peer Support

By Kayla Tawa, Emily Kim, and Marissa Howdershelt

The existing mental health system is failing to meet the needs of young people, particularly Black, brown, and Indigenous young people, 2SLGBTQIA+ young people, and young people with disabilities. Within the current mental health system, they often experience the effects of institutionalized racism such as harsher treatment, stigmatization, and professionals minimizing their mental health symptoms. The current mental health system is also experiencing a workforce shortage, with many young folks unable to access care, particularly in mental health deserts—geographic areas with no or limited access to mental health services like psychologists and counselors.  

Youth peer support offers a solution to both these problems: peer support is a non-clinical practice rooted outside of Western medicine that taps into a new provider workforce – peers. Research shows peer support is an effective and equitable practice.

Despite the promise of youth peer support, it remains unavailable to most young people and is generally concentrated in grant-funded programs. In an ideal scenario, young people would be able to easily access youth peer support services in a variety of locations, including schools, community centers, and more.

To better understand the current policy landscape of youth peer support, we conducted 14 in-depth interviews with multiple stakeholders, including experts in peer support policy, peer supporters, and state officials who run peer support offices. Through these interviews, we identified the key barriers to expanded youth peer support and developed a set of best practices states can implement to expand youth peer support.  

One of the biggest concerns we heard from interviewees was the fear of peer support being coopted by medical models, meaning peer support will exist in name but will not be practiced as it was intended. Because Medicaid is designed around clinical practices and thereby forces non-clinical practices to adopt certain procedures to get reimbursed, Medicaid currently facilitates the cooptation of peer support. This paper seeks to answer how a non-clinical practice like youth peer support can be reimbursed by Medicaid without it being incorporated into a medicalized model. Receiving Medicaid reimbursement for youth peer support without youth peer support being coopted requires states to explore creative payment options under Medicaid.  

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