Peer Providers in Behavioral Health and Substance Abuse Treatment

Team: Joanne Spetz (UCSF), Susan Chapman (UCSF), Lisel Blash (UCSF), Krista Chan (UCSF), Kimberly Mayer (California Institute for Behavioral Health Solutions), and Victor Kogler (California Institute for Behavioral Health Solutions)

 

A peer provider is someone who has experiential knowledge of the healing process of recovery from mental health or substance abuse challenges, either from their own experience, or as a parent or family member, and works with clients who have these challenges. Different factors have contributed to the development of paid peer staff—also called Peer Specialists and/or Peer Counselors—in the mental health and substance abuse treatment fields in the United States. As of 2012, 23 to 35 states were providing certification for Peer Support Specialists, and 4 or 5 states providing Family Support Specialist certification, primarily focused on mental health services. State certification titles and requirements vary across states.

 

For this study, we will conduct case studies in 3 states that exemplify best practices in peer provider training, employment, and reimbursement for both Mental Health (MH) and Substance Abuse (SA) peer providers. We will examine:

  1. Which states have implemented CMS-approved billing for peer providers in MH and SA, and what billing approaches they use;
  2. The models of care in states with successful practices in peer provider employment in MH and SA;
  3. The skills and training required of peer providers to provide care, and for certification;
  4. The roles and functions of the peer provider in MH and SA care teams;
  5. The impact of implementing peer provided services on the roles and responsibilities of other members of the healthcare team;
  6. How well accepted MH and SA peer providers are by other members of the healthcare team; and
  7. How the implementation of peer provided services impacts the level of service integration.

 

Reports

The Peer Provider Workforce In Behavioral Health: A Landscape Analysis

Peer providers provide direct support to those in mental health (MH) or substance use disorder (SUD) recovery. The key distinction between peer providers and traditional providers is the ability to draw from lived experience and experiential knowledge. Peer providers have traditionally worked as volunteers, but changes in treatment modalities and recognition of the importance of long-term recovery support have led to a professionalization of the role, including formalized training and certification, and the potential for paid employment.

In The Peer Provider Workforce in Behavioral Health: A Landscape Analysis, UCSF Health Workforce Research Center authors Lisel Blash, MS MPA, Krista Chan, BA, and Susan Chapman, PhD present a review of the published and gray literature on a variety of emerging topics concerning use of peer providers in MH and SUD services. The landscape analysis covers:

  1. Peer Provider Roles, Organizational Settings, and Models of Care
  2. Integration of Peer Providers into Traditional Care
  3. Evidence of Efficacy of Peer Support
  4. Policy and Financial Infrastructure for Peer Support, including Billing, Reimbursement, and Sources of Funding for Peer Support Programs
  5. Training and Certification for Peer Support

Among the authors’ findings:

  • Peer providers work in a number of support roles in a variety of settings, both in community and residential/in-patient facilities
  • Both mental illness and addiction are stigmatized identities, marked by social exclusion and shame. This stigma creates challenges in employing peer providers alongside non-peer colleagues, especially in traditional treatment settings and the friction between traditional and recovery-oriented systems of care is an additional barrier to integrating peer providers.
  • Concerns have been raised that standardization and professionalization of the role might jeopardize the special components of peer support that speak to lived experience, despite the potential benefits of such professionalization, including expansion of roles, greater capacity to serve people in need, and paid employment.

The authors advocate for more rigorous research to help establish the efficacy of peer support, and which peer support interventions may provide the most benefit.

 

Peer Provider Workforce In Behavioral Health: Landscape Analysis With Individual State Case Studies

Peer providers provide direct support to those undertaking mental health (MH) or substance use disorder (SUD) recovery. The key distinction between peer providers and traditional providers is the ability to draw from lived experience and experiential knowledge. Peer providers have traditionally worked as volunteers, but changes in treatment modalities and recognition of the importance of long-term recovery support have led to a professionalization of the role, including formalized training and certification, and the potential for paid employment.

In a series of complementary reports: The Peer Provider Workforce in Behavioral Health: A Landscape Analysis, a synthesis titled Education, Certification, and Roles of Peer Providers: Lessons from Four States and the accompanying State Case Studies: Arizona, GeorgiaTexas,and Pennsylvania, UCSF Health Workforce Research Center authors Susan Chapman, Lisel Blash, Krista Chan, Joanne Spetz, along with California Institute for Behavioral Health Solutions authors Kimberly Mayer and Victor Kogler present a review of the published and gray literature on a variety of emerging topics concerning use of peer providers in MH and SUD treatment services and case studies on best practices in providers in four states. Among the authors’ findings:

  • Peer providers work in a number of roles in a variety of settings, including, community, residential/in-patient facilities, and forensic settings
  • Medicaid billing authorization is key to the growth of peer provider employment and sustainable funding
  • Class action lawsuits and strong consumer advocacy have expanded behavioral health access and use of peers
  • The required hours of training, curriculum, and certification vary widely by state
  • There are challenges in acceptance from non-peer colleagues and the stigma of lived experience
  • There is little consistent data available on employment numbers and work settings

Concerns have been raised that standardization and professionalization of the role might jeopardize the special components of peer support that speak to lived experience, despite the potential benefits, including expansion of peer roles, greater capacity to serve people in need, and paid employment.

The authors advocate for more rigorous research to help establish the efficacy of peer support, and which peer support interventions may provide the most benefit.