1. 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

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

3. 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)

4. 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

5. 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

6. Methods Updated literature on peers in transitional settings
Report: 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

7. 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

8. 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)

9. 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

10. 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.

11. 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

12. 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

13. 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

14. 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

15. 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

16. Funding and Contact Information
This study was funded by the
California HealthCare Foundation
Contact Information:
Susan Chapman
Lisel Blash

17. Questions? Previous Reports
s/Report-Peer_Provider_Workforce_in_Behavioral_Health- A_Landscape_Analysis.pdf
s/Education_Certification_and_Roles_of_Peer_Providers- Lessons_from_Four_States.pdf#sthash.2Ca7Kdtn.dpuf
January 2018