Improving Outcomes with Peer Support: How Peer Providers Can Benefit Transition Settings Susan Chapman, RN, PhD, FAAN, Professor, UCSF School of Nursing January 31, 2017 Steinburg Institute

Overview Who are peer providers? SAMSA study key Findings California study: peers in transitional settings Key Findings Policy issues January 2018

What is a peer provider? “A person who uses his or her lived experience of recovery from mental illness and/or addiction, plus skills learned in formal training, to deliver services in behavioral health settings to promote mind-body recovery and resilience.” (Kaplan, SAMHSA, 2008)

SAMHSA Study: Case Studies (AZ, PA, GA, TX) Peer providers found in traditional and peer run settings Policy environment key to building peer programs Medicaid billing key to sustainable funding Some states mandate use of peers Training and Certification Statewide training and certification required for billing MH and SUD trainings and certifications vary widely by state Challenges Stigma Sustainable wages Difficult career ladder

California Study: Purpose Explore care models that enhance the utilization of peer providers in California Identify and describe best practices in peer support roles for individuals with mental health or substance use disorders Focus on services and programs that employ peers to help individuals transition out of incarceration and/or hospitalization

Methods Updated literature on peers in transitional settings Report: https://healthforce.ucsf.edu/publications/review-recent- literature-peer-support-providers Little evidence on the effectiveness of peer workers in transitional settings Conducted site visits to 8 provider organizations in California Interviewed program staff: Program directors, supervisors, human resources, clinicians, peer providers Used qualitative data software to analyze interview notes and explore key themes

Programs in Transition from Inpatient Hospitalization Riverside University Health System – Behavioral Health Peer Navigation Center San Diego NAMI Next Steps Alameda County South, Mentor on Discharge TLCS (Transforming Lives, Cultivating Success) Triage Navigator (Sacramento) Los Angeles County Intensive Service Recipient and Kin through Peer

Programs in Transition from Incarceration Riverside University Health System – Behavioral Health AB109 New Life San Mateo County Service Connect TLCS (Transforming Lives, Cultivating Success) Triage Navigator (Sacramento) Santa Clara Reentry Resource Center and Faith-based Collaborative San Francisco Mentoring and Peer Support (MAPS)

Findings: Roles Roles very similar in hospital and forensic program Job titles vary but the roles are similar across settings Population served often had dual history of mental health/SUD and incarceration Peer providers were all employees of agency or department working with hospital or jail (were not direct employees) Serve as role models Provide services pre and post discharge from facility Scheduled visits and ad hoc meetings with (client, consumer, participant) in facility, community, or agency centers

Findings: Training and Certification: Perspectives Differ “Some think that for us to be valid we have to have a certification and a license—but the benefit of our roles is that we are just like the people we serve. This keeps us at a level with them. Personal experience is not a document that says, “I’m qualified.” We all have our experiences, let’s bring them together.” “There are upsides and risks to certification. We have people with amazing potential. If we can use certification to chart a path of standard training and career advancement so people can be recognized and compensated for their work so they can continue to live in this county, It would provide a structure and guidelines for supervisors, managers, and peer providers in the workplace.

Findings: Funding Grant funding SAMHSA MHSA Innovations Kaiser Permanente Community Benefits Whole person care (federal and state) Direct county funding AB 109 (Public Safety Realignment) Medicaid billing

Findings: Impact “I had a peer on my team and he could go there and talk to the client on that level and he could connect in ways that I couldn’t. It was like, “I walked where you walk; I understand and I get it.” A guy who had been chronically homeless for a while turned and said, “I want to be just like (him)!” And I said, “We can do that; you can totally do that.” They are living example of where we want people to go.” Anecdotal evidence is compelling Some programs show reductions in repeat hospitalization and incarceration in grant-required outcome reporting Long term outcomes not always measured Little published literature on peer provider in transition programs

Workforce and Program Challenges Stigma experienced by some Direct access to transitional settings Lack of sustainable funding Lack of living wages and job security Lack of career ladder No standard training and certification Funders often ask for ROI January 2018

Policy Issues Statewide certification and training standards may help address the following: Provide more opportunity for Medicaid billing Enhance the visibility and legitimacy of peer providers Assure standard and basic competencies across the state Direct access to clients prior to transition helps in making the connection with peer provider Employment and career issues Sustainable employment Support for peers in continuing their own recovery

Summary Peer provider programs in transitional settings show considerable promise in reducing re-hospitalization and recidivism More assessment on the efficacy of these programs models may help determine what models are most effective in reducing re- hospitalization and re-incarceration Peer providers are part of a team effort Evaluation should focus on team models and effectiveness of the whole team model Sustainability of funding is critical to success

Funding and Contact Information This study was funded by the California HealthCare Foundation Contact Information: Susan Chapman susan.chapman@ucsf.edu Lisel Blash lisel.blash@ucsf.edu

Questions? Previous Reports http://healthworkforce.ucsf.edu/sites/healthworkforce.ucsf.edu/file s/Report-Peer_Provider_Workforce_in_Behavioral_Health- A_Landscape_Analysis.pdf http://healthworkforce.ucsf.edu/sites/healthworkforce.ucsf.edu/file s/Education_Certification_and_Roles_of_Peer_Providers- Lessons_from_Four_States.pdf#sthash.2Ca7Kdtn.dpuf January 2018