What You Need to Know about State Peer Specialist Certification in California

December 31, 2013
Written by Sharon Kuehn

California trails 31 states in the US where peer specialists are an essential service component in the public behavioral health system. The goal of having peer specialists State certified with consistent standards for training, recognized as valuable and legitimate members of the provider community, and able to bill for their unique services is long overdue.

Here are some things you may not already (but need to) know about peer support:

1. Peer support is effective and cost-effective. Recovery outcomes are greatly improved when peer support specialists are available to provide nonjudgmental connection, mutuality, and a friendly listening ear to persons seeking support. Multiple studies have shown the effectiveness of peer support. According to a study by Mowbray & Tan (1993), studies of consumer-run drop-in centers show high satisfaction and increased quality of life, enhanced social support and problem-solving. Further, Klein, Cnaan, & Whitecraft (1998) found that in a study of one-to-one peer support program for persons with co-occurring mental health and substance use challenges, participants had fewer crisis events and hospitalizations, improved social functioning, greater reduction in substance use, and improvements in quality of life compared to a non-matched comparison group.

And it turns out peer specialist services are cost-effective, too. According to Larry Davidson (2012), the state of Georgia saw a 55% reduction in costs in mental health care for those who utilized peer support services, corresponding to a $2.5 million savings per year on average. Locally, peer mentors have produced mad-love Returns on Investment of up to and over 400%!

2. Recovery takes place in relationships. According to Wikipedia, a “common aspect of recovery is said to be the presence of others who believe in the person's potential to recover, and who stand by them. While traditional mental health professionals can offer a particular limited kind of relationship and help foster hope, relationships with friends, family and the community are said to often be of wider and longer-term importance. Others who have experienced similar difficulties, who may be on a journey of recovery, can be of particular importance. Those who share the same values and outlooks more generally (not just in the area of mental health) may also be particularly important. It is said that one-way relationships based on being helped can actually be devaluing, and that reciprocal relationships and mutual support networks can be of more value to self-esteem and recovery. “

3. Recovery is self-determined and, like empowerment, comes from inside of a person. It is not caused by interventions, as much as by creating spaciousness around the person to increase their ability to envision change. It is supported by the presence of caring, connected, non-judgmental peers who add the critical element of recovery relationships, or people who “believe in me.”

4. Now is the time. Healthcare reform is here. The Triple Aim requires healthcare, under the Affordable Care Act, to provide “better services, better outcomes, lower costs.” We can demonstrate the value of peer specialists by paying livable wages and still achieve tremendous cost savings in each county by increasing the use of peer support specialists.

Given the clearly positive outcomes, it may seem hard to believe that legislators haven’t rushed to implement the certification. The challenge is that mental health services in California are not centralized.

The challenge of implementing a new program or legislation statewide in a county-based system so decentralized, is that it can take quite some time. It has taken years so far to build the current momentum; and stakeholder input, education and advocacy efforts are still taking place. (See the Working Well Together (WWT) Draft Recommendations for State Peer Specialist Certification below)

And while the hurdles can sometimes be discouraging, there is encouraging news! There is still time for your voice to be heard. Everyone’s voice can be a voice for peer support if each and every person can speak up. WWT hosts monthly stakeholder web calls to hear input as we negotiate a process of dialogues with each of the involved state health agencies. The advocacy groups want to make sure that when peer specialist certification is implemented, it’s done well, with a consistent focus on peer values and leadership in every step of the process.

5. You can add your voice to the growing demand for a statewide structure to promote effective peer-provided recovery services in California. Our state must invest in the implementation of a certifying body to guide the practice of peer support so that we can fully harness the power of peers. [WWT Peer Certification Stakeholder Web Calls will be held on Wednesdays, 12-1 pm, on January 15 and 29, February 19, March 19, April 16, and May 21, 2014. Look for a posting of the webinar registration links here soon]

OSHPD and the Planning Council need to hear from you: Add another ‘0’ to the budget for Consumer and Family Employment. Match the language in the values statement with the budget actions in the 5 Year WET Plan. There is no reason that funding for peer certification should not be at the level it demands and every reason to fully support peer certification.

WWT Draft Final Stakeholder Recommendations regarding Certification of Peer Support Specialists (June, 2013)

Recommendation 1
Develop a statewide certification for Peer Support Specialists, to include:
• Adult Peer Support Specialists
• Young Adult Peer Support Specialists
• Older Adult Peer Support Specialists
• Family Peer Support Specialists (Adult Services)
• Parent Peer Support Specialists (Child/Family Services)

1.1 Require Peer Support Specialists to practice within the adopted Peer Support Specialist Code of Ethics.
1.1.1 Seek final approval of Peer Support Code of Ethics by the Governing Board of Working Well Together. (See Appendix 1 for Draft Values and Ethics)
1.2 Develop or adopt standardized content for a state-wide curriculum for training Peer Support Specialists. (See Appendix 2 for Curriculum Content Crosswalk)
1.3 Require a total of 80 hours of training for Peer Support Specialist Certification.
1.3.1 55-hour core curriculum of general peer support education that all peer support specialists will receive as part of the required hours towards certification.
1.3.2 25-hours of specialized curriculum specific to each Peer Support Specialist category.
1.4 Require an additional 25 hours of training to become certified in a specialty area such as forensics, co-occurring services, whole health and youth in foster care.
1.5 Require six months full-time equivalent experience in providing peer support services.
1.5.1 This experience can be acquired through employment, volunteer work or as part of an internship experience.
1.6 Require 15 hours of CEU’s per year in subject matter relevant to Peer Support Services to maintain certification.
1.7 Require re-certification every three years.
1.8 Allow a grandfathering-in process in lieu of training.
1.8.1 Require one year of full-time equivalent employment in Peer Support Services.
1.8.2 Require three letters of recommendation. One letter must be from a supervisor. The other letters may come from co-workers or people served.
1.9 Require an exam to demonstrate competency.
1.9.1 Provide test-taking accommodations as needed.
1.9.2 Provide the exam in multiple languages and assure cultural competency of exam.

Recommendation 2
Identify or create a single certifying body that is peer-operated and/or partner with an existing peer-operated entity with capacity for granting certification.

Recommendation 3
Include Peer Support as a service and Peer Support Specialist as a provider type within a new State Plan Amendment.

3.1 Seek adoption of the definitions of Peer Support Specialist providers and Peer Support services by the Governing Board of Working Well Together for use within the State Plan Amendment. (See Appendix 3 for Draft Definitions)
3.2 Maintain the ability for people with lived experience to provide services as “other qualified provider” within their scope of practice, including but not limited to rehabilitation services, collateral and targeted case management.
3.2 Acknowledge that there are important and non-billable services that Peer Support Specialists can and do provide.

Recommendation 4
Include in the State Plan the ability to grant site certification for peer-operated agencies to provide billable Peer Support Services.
4.1 Allow for peer-operated agencies to provide other services billable under “other qualified provider” within their scope of practice, including but not limited to rehabilitation services, collateral and targeted case management.

Recommendation 5
Address the concern that current practice of documentation for billing may not be aligned with the values and principles of Peer Support and a wellness, recovery and resiliency orientation.
5.1 Engage with partners such as Department of Health Care Services and the California Mental Health Director’s Association in order to develop an action plan to advocate for the use of CMS-approved recovery/resiliency-oriented language in documentation.

Recommendation 6
Investigate the options for broadening the definition of “service recipient” to include parents and family members of minors receiving services so that Peer Support Services can be accessed more easily.

Recommendation 7
Convene a working group consisting of Working Well Together, the Mental Health Directors, the Office of Statewide Healthcare Planning and Development (OSHPD) and the Department of Health Care Services to develop buy-in and policies that will create consistency of practice regarding Peer Support Services across the state.

Recommendation 8
Develop standards and oversight for the provider/entity that provides training of Peer Support Specialists.
8.1 Allow for multiple qualified training entities.
8.2 Training organizations must demonstrate infrastructure capacity that will allow for peer trainers.
8.3 Training must be provided by either individuals with lived experience or by a team that includes individuals with lived experience.

Recommendation 9
Establish qualifications for who may supervise Peer Support Specialists.
9.1 Engage with the Mental Health Directors to develop a policy that outlines key qualifications necessary for the supervision of Peer Support Specialists.
9.2 Preferred supervisors are those individuals with lived experience and expertise in peer support.
9.3 Due to capacity issues, supervisors may include qualified people who receive specific training on the role, values and philosophy of peer support.
9.4 Recognize and define the specific qualities and skills within supervision that are required for the supervision of Peer Support Specialists. These skills should align with the values and philosophy of peer support.

Recommendation 10
Develop a plan to provide extensive and expansive training on the values, philosophy and efficacy of peer support to mental health administration and staff.

Recommendation 11
Develop a plan to ensure that welcoming environments are created that embrace the use of multi-disciplinary teams that can incorporate Peer Support Specialists fully onto mental health teams.

Recommendation 12
Develop a policy statement that recognizes and defines the unique service components of peer support as separate and distinct from other disciplines and services in order to maintain the integrity of peer support services.

Recommendation 13
Develop a policy statement and plan that supports the professional development of Peer Support Specialists that allows the practitioner to maintain and hone his/her professional values, ethics and principles.

Recommendation 14
Develop a plan for funding the development of certification.
14.1 Work with the Office of Statewide Healthcare Planning and Development to utilize
state-wide monies from the MHSA Workforce, Education and Training fund.
14.2 Investigate other potential funding sources.
14.3 Develop recommendations for funding of components of certification such as financial assistance with training, exam and certification fees.

Recommendation 15
Seek representation on committees and workgroups that are addressing civil service barriers to the employment of Peer Support Specialists.

Recommendation 16
Work with Mental Health Directors to seek agreement on a desired workforce minimum of Peer Support Specialists within each county to more fully actualize the intent of the MHSA.

Recommendation 17
Develop state-wide models that can inform county leadership on the development of career ladders for Peer Support Specialists that begin with non-certified Peer Support Specialists and creates pathways into management and leadership positions.