Libraries for Health pilot embeds peer specialists in public libraries to support community mental health

St. David's Foundation and partner organizations said on a NNLM Region 1 webinar that a Libraries for Health pilot placed trained peer specialists inside 10 public libraries across a five-county area of Central Texas to expand access to mental-health supports for adult patrons.

"The data that we've collected thus far shows that this initiative works," said Abena Sante, senior program officer at St. David's Foundation, describing a program that began in January 2022 and "officially concluded" its pilot phase in summer 2025. The pilot paired peer specialists with library staff to offer one-on-one support, support groups, wellness programming and resource navigation.

Dr. Lindsey Ayer, a clinical psychologist and senior behavioral scientist at RAND, said peer specialists—people with lived experience who in Texas must meet state certification requirements—provided nonclinical supports, led groups and helped make "warm handoffs" to clinical care when appropriate. "Peer specialists were the heart of L4H, still are," Ayer said, adding that specialists received weekly supervision and training in active listening, advocacy and resource navigation.

The project emphasized flexibility: some libraries integrated mental-health themes into existing programs, others created new programming (book clubs, mindfulness or yoga classes), and many used grant funds for staff training such as Mental Health First Aid or ASSIST suicide-prevention training. Libraries also developed resource guides and circulating wellness kits. Ayer said the pilot prioritized co-design with libraries so each site could "make it their own."

Melinda Hodges, who led the Buda Public Library during the pilot, described a local focus on reducing isolation after the COVID-19 pandemic and using activity-based events and a cohort model that let libraries share lessons. "Our focus was to work on reducing isolation and getting people more connected with each other," Hodges said. Buda ran hobby and volunteer fairs, wellness fairs and "Self-Care Saturdays" and used peer specialists for appointments, outreach and support groups.

Panelists discussed funding and sustainability: some libraries absorbed peer roles into operating budgets, others relied on grants and friends-of-the-library fundraising. Ayer noted that Medicaid reimbursement for peer-support work exists in some states but can involve bureaucratic hurdles. "Diversifying your funding so you're not relying on a single source" was offered as a resilience strategy.

Speakers addressed scope and safety questions during a closing Q&A. When asked about liability and staff refusal to administer naloxone, Hodges said her municipal library relied on city insurance and legal counsel, and panelists emphasized that administering naloxone was not central to the Libraries for Health model. Dr. Sandra Smith, a certified reentry peer specialist who helped provide peer specialist training for the pilot, clarified that peer specialist roles and certifications vary by state: "Texas actually has four different peer specialists—mental health, family partners, reentry and substance use," she said, urging implementers to check state rules.

The panel also cautioned about online services and artificial intelligence. Ayer and other speakers said virtual peer support expanded during COVID but often requires approval for Medicaid reimbursement and must be implemented with appropriate training and oversight. They flagged privacy risks for youth using chatbots and urged libraries to vet digital tools.

Panelists made a toolkit available (QR code and links were shared in the webinar chat) with worksheets, checklists and example materials to help other libraries assess readiness, set SMART goals, select activities and measure outcomes. The hosts also noted continuing-education credit information and offered contact details for follow-up questions.

The webinar concluded with presenters encouraging libraries to adapt the model to local capacity and partnerships and to collect data to document impact. For more information, presenters said the toolkit and evaluation materials are available via the NNLM Region 1 resources and the webinar chat.