Process improvement for behavioral health

Assign Peer Buddies


Clients start treatment without being connected to other people in the treatment community.


Assign peer buddies or mentors to help new clients connect with someone who knows what they’re going through, and to help orient them to the agency as well as introduce them to others.

Featured Stories

Women’s Recovery Association in Burlingame, California increased intensive outpatient continuation from 33 percent to 80 percent over the course of a year. They developed an orientation program for new patients, which included a handout written by an individual who had been through the program. New patients also were connected with a peer mentor who oriented them to the program. For more information, see the change bulletinBuddy LetterMentee Information Sheet, and A Day in the Life.

Vanguard in Arlington, Virginia reduced unplanned discharges from 11 percent to 6 percent during the first 14 days by introducing a welcome committee that included three people who accompanied each new residential patient for the first three days, to provide encouragement, have meals together, explain reasons for rules, and bond. For more information, see the case study and change bulletin.

Lessons Learned

  • Acting as a peer buddy or mentor also serves to remind more senior clients about the progress they have made.
  • A system of peer buddies may help relieve counselors of some of their workload, for example, giving new clients a tour of the agency.
  • Have peer buddies let counselors know when a client is at risk for leaving.

Tracking Measures

Cycle Measure

No-show rate for treatment sessions

Data Collection form

No-show Tracking Spreadsheet



  • 1. Select a particular group that clients attend soon after admission.
  • 2. Collect baseline data for the no-show rate for this group.
  • 3. Decide on system for selecting peer buddies—for example, choose people who have been in treatment for a specified time or having clients or counselors nominate peer buddies.
  • 4. Create a clear set of expectations and train the peer buddies that you have selected.


  • 5. Assign peer buddies to new clients joining the selected group for the next two weeks.
  • 6. Track and calculate the no-show rate for the selected group.


  • 7. Check the fidelity of the change. Was the change implemented as planned?
  • 8. Evaluate the change:
    • Did the no-show rate for the selected group decrease?
    • How did clients like having a peer buddy?
    • How did peer buddies like their role?
    • What feedback did the peer buddies provide?


  • 9. Adjust the type or amount of mentoring the peer buddies are expected to provide or the peer buddy training and re-test this promising practice for an additional two weeks.

Repeat this series of steps until all new clients are matched with a peer buddy when they begin treatment.

More Stories

Perinatal Treatment Services in Seattle, Washington increased continuation from 80 percent in December to 100 percent in January, and 87.5 percent in February and March in their residential program by creating a peer sister program, offering clients who had participated in treatment for 90 days this esteemed position in the community. After clients were in treatment for 30 days, they were given an evaluation form to provide feedback about how supported they felt by their peer sisters and how well rules and policies were explained to them. A peer of the month was selected and rewarded with lunch with the staff.

Fayette Companies in Peoria, Illinois enhanced peer support at admission and revised the role of their peer sponsors. Staff members report feedback from peer sponsors about concerns and suggestions at weekly staff meetings. For more information, see the change bulletin.