The Shootings

Last year’s Orlando shootings followed by the November National 2016 Elections were tantamount to the events that informed my going underground and to a better footing of safety in a dangerous terroristic world changing, shifting, abandoning, losing me.

The Depression ensued and it was terrible.

Winter came and left.

Spring came and left.

Summer was a wash.

Tonight’s Halloween and my forever lover and I will meet beneath the silvery islip of Luna tonight, hence.

I’m returning to Orlando the 1st week of December to meet with my Shaman for cleansing and visioning.

I didn’t believe I could go into the city again.

I didn’t believe I could go away like I did and like how I have been doing.

Hiding from the Trump Administration and seeing the world prepare for implosion is something now akin to a cigarette with 4 AM hot coffee. They are together, one and for always it seems now. He’s the shit under shoe that won’t wash away. He’s stink.

My world is changing again.

You must not ever stop being whimsical.

And you must not, ever, give anyone else the responsibility for your life.

Mary Oliver, Upstream (2016).

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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: http://www.uwstout.edu/profed/nri/

WHITE PAPER: US PEER LEADERSHIP AND WORKFORCE DEVELOPMENT

be a voice not an echo

White Paper US Peer Leadership and Workforce Development 

NACBHDD Newsletter February 2014

Hardin, P., Padron, J., (2014). Ed., Dr. Ron Manderscheid; White Paper: US Peer Leadership & Workforce Development

Thanks to the following individuals for their subject matter expertise and assistance in the writing and resourcing for this paper:

Steve Harrington | Sharon Kuehn |Dale Jarvis | Harvey Rosenthal| Iden Campbell McCollum | Jennifer Maurer | Joseph Rogers | Adam Slosberg | Lauren Spiro | Lisbeth Riis Cooper | Magdalena Caballero-Phillips | Mark Salzer | Peggy Swarbrick | Ron Manderscheid |Larry Davidson | John Brekke | Gitane Williams |  Mary Jo Mather | BRSS TAC | Peter Ashenden |  Sue Bergeson | The Meadows Foundation | Denise Camp | Donna Bishop | Frank A. Aquino, Jr. | Gordon Espes | Trenda Hedges | William Irvin | Joelene Beckett | Joe Powell | Ken Minkoff | John de Miranda| Rachel Whitmire |Sabra Alderete | Wendy Latham | Tammy Heinz | 

Executive Summary

The future is here. 2014 is the year of the peer. In economics, the cycle of poverty is the “set of factors or events by which poverty, once started, is likely to continue unless there is outside intervention.” (Wikipedia, 2014)  People with mental health, substance abuse and physical health challenges represent a large portion of individuals living in chronic poverty. The implementation of the Affordable Care Act (ACA) and the health activated social movement provide the integrated health community an exceptional opportunity to provide outside intervention.

Workforce Development Plan

Creating a national Lived Experience Workforce Development plan can establish and legitimize the lived experienced service provider as a healthcare occupation and should be recognized by the United States Department of Labor (DOL) as a billable healthcare provider category through the Centers for Medicare and Medicaid Services (CMS) and managed care organizations (MCO). OptumHealth, an innovative MCO, implemented a Peer Services project in New York and Wisconsin both of which are producing remarkable outcomes. The Peer Services preliminary program evaluation results (July 2013) show members who received Peer Services:

  • Have a Significant Decrease in the number of behavioral health hospital admissions
  • Have a Significant Decrease in the number of behavioral health inpatient days
  • Have a Significant Increase in outpatient behavioral health visits
  • Have Significantly Decreased total behavioral health care costs.

An integrated study with funding and support from both the National Institute for Mental Health (NIMH) and the National Institute for Health (NIH) is needed. Health outcome measures should reflect the whole person. Physical and mental health are equally important components contributing to an individual’s quality of life. We need research funded to study the outcomes for both the individual serviced and the peer providing services to legitimize the impact of including and developing this emerging workforce. We need quantifiable evidence from studies examining to what degree implementing a peer workforce career ladder:

  • Increases access to care
  • Reduces cost
  • Improves participant outcomes
  • Improves provider outcomes

 

US Peer Leadership & Workforce Development Releases Today

be a voice not an echo

Executive Summary [Excerpt]

The future is here. 2014 is the year of the peer. In economics, the cycle of poverty is the “set of factors or events by which poverty, once started, is likely to continue unless there is outside intervention.” (Wikipedia, 2014)  People with mental health, substance abuse and physical health challenges represent a large portion of individuals living in chronic poverty. The implementation of the Affordable Care Act (ACA) and the health activated social movement provide the integrated health community an exceptional opportunity to provide outside intervention.

Workforce Development Plan

Creating a national Lived Experience Workforce Development plan can establish and legitimize the lived experienced service provider as a healthcare occupation and should be recognized by the United States Department of Labor (DOL) as a billable healthcare provider category through the Centers for Medicare and Medicaid Services (CMS) and managed care organizations (MCO). OptumHealth, an innovative MCO, implemented a Peer Services project in New York and Wisconsin both of which are producing remarkable outcomes. The Peer Services preliminary program evaluation results (July 2013) show members who received Peer Services:

  •   Have a Significant Decrease in the number of behavioral health hospital admissionsv  Have a Significant Decrease in the number of behavioral health inpatient days
  •   Have a Significant Increase in outpatient behavioral health visits
  •   Have Significantly Decreased total behavioral health care costs.

An integrated study with funding and support from both the National Institute for Mental Health (NIMH) and the National Institute for Health (NIH) is needed. Health outcome measures should reflect the whole person. Physical and mental health are equally important components contributing to an individual’s quality of life. We need research funded to study the outcomes for both the individual serviced and the peer providing services to legitimize the impact of including and developing this emerging workforce. We need quantifiable evidence from studies examining to what degree implementing a peer workforce career ladder:

  •   Increases access to care
  •   Reduces cost
  •   Improves participant outcomes
  •   Improves provider outcomes

 

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