MEDICAID-FUNDED PEER SUPPORT SERVICES AND THE TRAINING AND CERTIFICATION OF PEER SPECIALISTS Building a Recovery House

RecoveryandTransforming Mental Health Care FOUNDATION Consumer Values and Leadership Training and Certification of Peers External Review and Recovery Plans Under Construction: Evolving Roles of CPSs Evaluation As Tool for Change Barriers to Recovery and Seeking Solutions SouthCarolina Hawaii Mental Health and Medicaid Partnerships

Overview President’s New Freedom Report “Consumers who work as providers help expand the range and availability of service and supports that professionals offer. Studies show that consumer-run services and consumer- providers can broaden access to peer support, engage more individuals in traditional mental health services, and serve as a resource in the recovery of people with a psychiatric diagnosis. Because of their experiences, consumer-providers bring different attitudes, motivations, insights and behavioral qualities to the treatment encounter.”

Overview President’s New Freedom Report “Consequently, consumers should be involved in a variety of appropriate service and support settings. In particular, consumer-operated services for which an evidence base is emerging should be promoted.”

Consumer Values and Leadership Foundation of Consumer Values and Leadership Advocacy Training in governance Setting Priorities Establishing Relationships with Key Leaders Foundation Section 1: Consumer Values & Leadership

Mental Health and Medicaid Relationships Medicaid Overview created as a medical assistance program in 1965 with Title XIX of the Social Security Act Medicaid is the single largest fund source (almost 20%) of all mental health services delivered in the United States (GAO, 2000) FIRST FLOOR SECTION 2: Mental Health and Medicaid Relationship Foundation Section 2: Mental Health and Medicaid Relationships

Mental Health Block Grant as Stimulus Federal funding designed to stimulate mental health service system development and innovation Consumer directed activities meet block grant requirements  Peer Supports and other consumer provided services are major components of a comprehensive service system as required in Criterion 1 of the State Plan  Peer specialist training and certification address workforce development and training requirements included in Criterion 5 of the State Plan

Candidates for certification training will: –Identify themselves as former or current consumer of mental health or dual diagnosis services and are well- grounded in their own recovery –Hold a High School diploma or GED (including diploma earned in Special Education) –Demonstrate basic reading comprehension and written communication –Have demonstrated experience with leadership, including advocacy and or creation/implementation of peer-to-peer services Training & Certification of Peers

The Recovery Process Onset of Illness Life is Limited Change is Possible ChangeActions for Change The Role of Services in the Recovery Process The Role of Peer Support in the Recovery Process The Role of Documentation in the Recovery Process Training & Certification of Peers

The Role of Services in the Recovery Process Treatment Services Rehabilitation Services Person is disabled by the symptoms of the illness. Task- to decrease the emotional distress by reducing the symptoms. “shock and denial” Developing Rehabilitation Readiness Person is not ready to make a commitment to change. Task- to instill hope and rebuild a positive self- image “despair” Setting an Overall Rehab Goal Person begins to believe that their life can be different. Task – to empower the person to participate in his/her recovery. “hope and courage” Functional Assessment Person is willing to explore what it will take to make some changes. Task – to help the person identify strengths and needs in terms of skills, resources and supports. “the will to do” Direct Skills Teaching Person is willing to take responsibility for their actions. Task – to help the person use his or her strengths and to get the skills, resources and supports needed. “responsible action”

Training & Certification of Peers The Peer Support Institute Other Key Components Code of Ethics Mediation for Recovery Training Continuing Education Technology Support Recovery Support Specialists The Peer Support Institute

Overcoming Barriers Changing Hearts Changing Heads

Peer Support and Hospitalization Data New enrollments in FY03 to Peer Supports (not in that service in FY02) FY02 hospital admissions, and FY04 hospital admissions Definitions Consumer assigned to Peer Supports group if received service during FY03 Analysis New Peer Supports Consumers Of consumers receiving Peer Support services, 15% were admitted to hospital at least once during FY02, while only 10% were admitted to hospital at least once during FY04 Of those hospitalized in FY02, 84% showed a reduction in the number of hospitalizations from FY02 to FY04. Of those 84% who showed a reduction, the average number o f hospitalizations went from 1.81 to 0.25.

Peer Supports Employment & Functioning (DLA) Data Assessment data on consumers enrolled in Peer Supports in FY04 Definitions A Peer Supports matched pair is an initial assessment matched to the last available follow-up available during an FY04 enrollment in Peer Supports Analysis based on those consumers with available matched pairs Analysis Of consumers receiving Peer Supports services, 8% were employed at the time of initial assessment, and 9% were employed at the time of the last follow-up. Of consumers receiving Peer Supports services, 49% showed at least some statistically significant improvement in functioning on the DLA between their initial and last available follow-up assessment (compared to 45% of all adult mental health consumers). 29% of Peer Supports consumers showed at least some statistically significant improvement in functioning (compared to 18% of all adult mental health consumers).

Cost Comparison Peer Supports Billing rate = $6.12/ Hour Psychosocial Rehabilitation Billing rate= $11.13/ Hour

State MHA / University Collaboration Medical College of GA Research Institute This contract is the first of a planned three- year project to evaluate Georgia’s peer support and consumer directed services and replication. This will strengthen the state’s position as a national leader in consumer directed recovery services and provide valuable information to us as we plan for our own service system transformation. It will also give the Division an opportunity to impact the training and preparation of future mental health professionals with the possibility of increasing the availability of psychiatrists and psychologists who can work within our public mental health system.

State MHA / University Collaboration Medical College of GA Research Institute Contract developed based on proposal from MCG/Dr. Peter Buckley Contractor will conduct evaluation of Georgia’s Peer Specialist Certification and Training Contractor will identify “key ingredients” for successful development/ implementation of Peer Centers Contract includes development and testing of curriculum module to train psychiatry and psychology residents in the value of strength based recovery and partnering with peers to assist individuals to achieve recovery in the mental health practice area

State MHA / University Collaboration Medical College of GA Research Institute Contractor will develop and implement a practicum opportunity to expose psychiatry and psychology residents in clinical practice to consumer co- management with an emphasis on recovery, through partnership with a Certified Peer Specialist Contractor will develop recommendations and a plan for potential Medicaid and third party insurance billing for peer support services provided by peer specialists working within psychiatric practices Contractor will develop publication strategy to disseminate information and service data on Georgia recovery based best practice services

Chris Marshall Center for Mental Health Services Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road, Room Rockville, MD Phone: Contact Information Larry Fricks State of Georgia Department of Human Resources Division of Mental Health, Developmental Disabilities & Addictive Disease 2 Peachtree Street, NW, 22 nd Floor Atlanta, Georgia Phone: Cherry Finn State of Georgia Department of Human Resources Division of Mental Health, Developmental Disabilities & Addictive Disease 2 Peachtree Street, NW, 23 rd Floor Atlanta, Georgia Phone:

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