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: http://www.uwstout.edu/profed/nri/