Padron Logarithm for Quantifying Related Peer Workforce Medicaid State by State Rehab Option Functions

Quantifying Peer Service Deliverables Formula for # Referrals: [(a)(b)(c)/(c/(e/f) = x][1]

Where (a) Number(s) of CPS Medicaid Service Deliverable(s) Code(s)  X  (b) Dollar Value for Fifteen Minute Billable Protocol per type of Service Deliverable[i]  X  (c) CPS Point of Contacts Per Annum Medicaid Service Deliverable / (d) FY [e.g., 15, 16, 17] / (e) number of months of service deliverable(s) =  (x) Number of necessary Referrals is dependent upon the TYPE of CPS provided service deliverable (e.g., (f) (e.g., PSR, Meds Management, Case Management, Group, F2F Peer to Peer).


(c/(e/f) = x, when:

[x = [(a)(b)(c)/(12/(e)(f)  Point of Contact Referrals as per 1) Months, and 2) Sum/anuum for FY 2015, 2016, 2017)] = d

[1] Padron & Associates Peer Services Deliverable Algorithm © 2015 All Rights Reserved.

[i] (f) PSR, Meds Management, Case Management, Crisis, Group, F2F Peer to Peer and other supports


Expert Q & A with Jen Padron and Dr. Nev Jones

Expert Q & A with Dr. Nev Jones, Stanford University

Expert Q & A with Dr. Nev Jones (Stanford University) in work with NASHMPD:

Jen Padron M.ED, ACPS, CPS, CHW, PhD(c)

Jen Padron is a nationally recognized expert on peer support and peer workforce development and is currently the Principal at Padron & Associates, based in Georgia.  The consultancy are subject matter experts in co-locating Behavioral and Physical public health care environments which directly impact the US Peer Workforce (Certified Peer Specialist Certification).  Before moving to Georgia, as Project Manager to The Hope Concept Wellness Center and Director to The HOPE Project her extensive experience as a recovery consultant and evaluation specialist supported Texas and national mental health transformative initiatives.  Recently, Jen has contracted to provide technical assistance and program development on a Latino/a-focused early intervention in psychosis (EIP) peer support development project based in Southern Methodist University in Dallas.

Q:  Given your expertise in peer support and peer workforce development, what do you think current priorities should. be for peer inclusion/support in EIP services?

 Jen Padron:  SAMHSA’s naming the Certified Peer Specialist as a Best Practice of Peer Services and Supports, paired with their recent CPS Core Competencies is fab. In order to be considered an EBP and melded into federal wordspeak, it “normalizes” a US Peer Workforce to grow and rolls-out proven Accountable Care Act public health Integration initiatives via various types of Peer Services | Supports deliverables.  It also means that CLAS must be adhered to. In other words, the CPS must ultimately adhere to National Standards for Culturally Linguistically Appropriate Services (CLAS) in Health and Health Care.  CLAS addresses and preserves multicultural, linguistic and diversity through inclusive accountability for ethnicity, religion, gender, age, geography and socioeconomic status, language and literacy, sexual identity where “orientation” and gender identity cross a binary continuum.

Q:  Not a lot of work in early intervention has focused on cultural sensitivity or culturally-informed intervention.  Why do you think such work needs to be prioritized?

Jen Padron:  Priority #1. In simple terms, the backstory on Recovery, is still that she is the orphan child of the clinically medical based psychiatric and psychological community globally. More than the majority of early interventions center around people identified as living with a schizophrenia affective disorder. There are numerous longitudinal studies having ease in quantifying where something as “new” as the CPS does not. If you want Recovery-based look at time tested work coming out of Boston University, University Pennsylvania, Temple University, Rutgers University, Yale University, the University of Southern California, the University of Missouri-St. Louis, the work of Pat Deegan, Mary Ellen Copeland, Steve Harrington, Sheri Mead and Chris Hansen, Dan Fisher, Peggy Swarbrick, Mark Salzer, John Brekke, Laysha Ostrow, Lauren Tenney, Ron Manderscheid and others. It is interesting to me but makes total sense that most, if not all of innovative and emerging work around Recovery, the CPS, Recovery Coach, Community Health Worker Promotora is being developed by peer-led interest groups who are carefully tucked into national oversight behavioral and health leadership organizations (e.g., ACMHA College for Behavioral Health Leadership’s Peer Leadership Interest Group) and initiated MCO Integration initiatives are rolling out (in ’15-’16) an array of CPS service deliverables that will grow a US Peer workforce exceeding the recognized state’s Medicaid Rehabilitation Option billing model (e.g., Psychosocial Rehabilitation, Medications Management, Case Management).  As well, the national consumer related TACs, funded by SAMHSA are doing excellent work (e.g., BRSS TACS, Peer Link, MHA National, The National Self-Help Consumer Clearinghouse/MHASP).

Q:  How do you see peers in particular contributing to culturally-informed services, including planning and evaluation?

Jen Padron:  The National Consumer Technical Training and Assistance Centers (TACs) are producing quality and worthwhile mentionable Youth and Peer-Led initiatives regionally and nationally.  For example, the SAMHSA ADS Center work around social inclusion and SAMHSA / CMHS’ campaign on whole health and wellness (e.g., 10X10, National Wellness Week, National Wellness Month, Million Hearts) accomplished much to hallmark leadership in the myriad of regionally and nationally centric communities in multiculturalism, cultural linguistic diversity and stigma reductive measures directing social change efforts (e.g., Gitane Williams, Craig Lewis, Tracy Love, Sharon Cretsinger, Tina Minkowitz, Adam Slosberg, Daphne Klein, Diane Engster, Lauren Tenney, Leah Harris, Amy Smith, et al.). The Psychiatric Rehabilitation Association produced outstanding psychiatric multicultural principles under the direction of Lisa Razzano, Peter Ashenden, and Boston University’s Sargent College.  Gender and women’s studies prevailing thought centers on Hope, WRAP(R), IPS (R), eCPR (R), and the CPS core competencies (SAMHSA, 2015) guarantee a culturally-informed, sustainable community and trauma informed recovery oriented system of care.

Peer Services in Behavioral Health Care Integration Workshop, June 14-17, 2015 (University of Wisconsin-Stout)

The Certified Peer Specialist in Behavioral Health Care Integration

I’m presenting “Peer Services in Behavioral Health Care Integration” with Heidi Levy, MA (Community Access, NY) at the University of Wisconsin-Stout’s National Institute on Rural Alcohol and Drug Abuse Conference 2015.  We will present a Certified Peer Specialist centric triage model of care offering a peer services | supports portfolio of public health care service deliverables in co-located behavioral and physical health care environments.

Individuals with shared life experience of mental diversity play a vital role (e.g., Certified Peer Specialist) of providing peer services and supports in the mental health and behavioral health care settings (SAMHSA, 2013). The Certified Peer Specialist is effective in promoting behavioral change in service recipients they serve by increasing utilization rates and providing significant reductions in hospital admissions and re-admissions (Fedder, Chang, Curry, 2003).

The Certified Peer Specialist (CPS) provides for behavioral and physical wellness health coaching supports in an integrated setting (Swarbrick, M. (2013); Manderscheid, R (2013). The CPS is the vehicle that the US Peer workforce will initially exemplify the multitude of roles and is the only available source provider for peer services and supports where service deliverables are sustainably funded by the Medicaid and Manage Care Organization (MCO) peer supports in the ACA market. This is a public/private health care sustainable funding model.  Peer Services | Supports are a win/win wellness and whole health solution in today’s ACA environment utilizing peer-driven services (Vestal, C. 2013) to co-locate in behavioral and physical integrated care environments.

The Medicaid 1915 Community waiver, 1115 Medicaid waiver, and state by state Rehabilitation Option funding options offer direct solutions for viable peer supports via physical and behavioral health integrated delivery systems of care. The March 2014 DOL advent offering peer services supports a state and federal billing provides for additional sustainability.

Mitigating rising health care costs and a fundamental shift in reimbursement is occurring. “Patients” and organizations, alike, are inherently required to transition from an episodic, fee-for-service model of reimbursement to a new model that reimburses and encourages money in the pocket wellness and care across the health service continuum.

A wellness focus on prevention and coached self-activated management of chronic conditions that our population experiences with early intervention and prevention, care experience will improve, providers will be better able to deliver quality care seeing an overall reduction in costs.

Workforce Trends

The professional workforce in the future will be smaller, and the work itself will be different than it is today. Projections for nursing shortages and primary care physician shortages have been published widely, and the shortage of primary care physicians will only be exacerbated by increased demand for their services by 2014. This is due to the aging population, the addition of an estimated 32 million patients into the system as a result of ACA, and the increasing movement of chronic disease care into the ambulatory arena.

To function as seamless efficient teams, all health care professionals (both current and future) must be trained in inter-professional educational and cross-trained settings. This represents a major challenge for our centers of professional education to innovate in the redesign of both pre-clinical and clinical curricula.

The US Certified Peer Specialist (CPS) certification currently operates and is managed by an irregular un-uniform state by state “Recovery Waiver” Medicaid reimbursement mechanism limited to local mental health authorities clinical supervising teams offering psychosocial rehabilitation, medication compliance monitoring and various kinds of community resource linkage.

Technical, training and assistance services are commonly provided regionally by the State, or an oversight body requiring application for certification, certification training and continuing education training. Advanced trainings (e.g., Intentional Peer Support (IPS); Emotional CPR (eCPR); Trauma Informed Peer Support, Social Change and Trauma Healing; Mental Health First Aid (MHFA); Whole Health and Action Management (WHAM); Wellness Recovery Action Plan (WRAP) and other peer-led supports are offered without federal oversight or a national standardizing of core competencies or a national credentialing body.

As of April 2014, 39 states and the District of Columbia have established programs to train and certify peer specialists and 7 states are in the process of developing and/or implementing a program.  Appalachia Consulting (Fricks & Powell, 2015) contracted proprietary CPS curricula is used in 23 states.  Recovery Resources (Harrington, 2015) free CPS curricula is broadly used by the Department of Veterans Affairs and a limited number of states.  Recovery Innovations/Recovery Opportunities (Ashcraft, 2015) contracted and proprietary CPS curricula is also broadly used.  Fewer states utilize an in-state developed CPS curricula. There is minimal CPS certification reciprocity between particular states requiring application and testing to acquire state certification.

This unique rural alcohol and drug abuse conference provides participants the opportunity to personally interact with other rural alcohol and drug abuse professionals, federal agency representatives and nationally known institute faculty and resource individuals while accessing the latest in evidence-based practices for the improvement of rural services.

Co-sponsored by:

  • National Rural Alcohol and Drug Abuse Network, Inc. (NRADAN)
  • Scaife Family Foundation
  • SAMHSA: Substance Abuse and Mental Health Services Administration
  • SAMHSA: Center for Substance Abuse Treatment
  • US Department of Justice-Bureau of Justice Assistance
  • National Association of Drug Court Professionals
  • Wisconsin Council on Problem Gambling
  • Cenpatico/Centene Corporation

To register for “Peer Services in Behavioral Health Care Integration Workshop” and the conference, see:

US Peers Present the Case for Peer Support | Services on Capitol Hill

Dr. Ron ManderscheidAlan Doederlein, President of National Depression and Bipolar Support Alliance (DBSA), Lisa Goodale, DBSA Vice President and Director of Training and Texan Veterans Administration Certified Peer Specialist (CPS) Olga Wuerz, and Dr. Larry Davidson, from Yale, presented the research evidence.

For more information, see the Behavioral Healthcare, April 30, 2015 article, “US Peers Present the Case for Peer Support, Services on Capitol Hill” by Dr. Ron Manderscheid.

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