Book excerpt: Mental health disorders are common among individuals incarcerated in prison and are associated with a host of negative outcomes both during and after incarceration. Unfortunately, the prison environment involves unique challenges for traditional mental healthcare (e.g., distrust, limited autonomy over treatment), which can prevent individuals from accessing care. Additionally, staff shortages and competing responsibilities make it so the Wisconsin Department of Corrections (DOC) is unable to offer mental healthcare to every individual in need. To address this widespread need for mental health services and challenges with traditional mental healthcare, the Wisconsin DOC implemented the Certified Peer Specialist (CPS) Program, which trains incarcerated individuals with mental health difficulties, substance use disorders, and/or a history of trauma to provide support to their peers. Limited research suggests positive effects of peer support in the US, but mainly anecdotal reports are available and suggest positive effects in carceral settings. The purpose of this dissertation was to 1) evaluate the effectiveness of the CPS program at improving critical DOC-defined outcomes (conduct reports, clinical observation placements, rate of recidivism) for individuals who participated compared to those who did not, and 2) evaluate whether there were facility-wide positive effects of the CPS program (e.g., overall reductions in restrictive housing placements, clinical observation placements, or conduct reports). Because participation in the CPS Program was not randomized, quasi-experimental methods (i.e., Propensity Score Matching, Time Series analysis) were used to estimate the effects of the program. Aim 1 analyses revealed that CPS Program participation was associated with reductions in major conduct reports and rates of recidivism, and for individuals involved in the CPS Program, attending more sessions with a CPS Provider was associated with fewer total and major conduct reports. Aim 2 analyses revealed facility-wide reductions in restrictive housing placements at three facilities, but facility-wide impacts on clinical observation placements were mixed. These results suggest overall positive effects of the CPS Program for individuals who receive peer services and have far-reaching policy implications for the use of peer support in carceral settings.