California Peer Specialist (PS) Career Pathway

Transitional Age Youth, Adult, Older Adult

Consumers

Family Member

Parent or Caregiver

Peer Specialists

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State Certified Peer Specialists

Current & Future Need

Current CA Peer Specialist workforce estimate: 6,000

Peer Specialists reflect cultural, ethnic, linguistic, sexual orientation, & socio-economic diversity

Given anticipated workforce shortages; Peer Specialists can fill this gap while increasing diversity in workforce

Depending on service settings, ratios range from 1:10 to 1:50 of Peer Specialists to people served in public mental health

1:25 ratio = need 39,312 Peer Specialists From DHCS Behavioral Health Services Needs Assessment (Feb. 2012) & Pillars of Peer Support 2

Future Need

Optimal workforce total of 39,312 Certified Peer/Family Specialists

To build an optimal cost-effective recovery & resiliency-based workforce in 2013, current needs is:

An increase of 33,312 Certified Peer/Family Specialists

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Peer Specialists often lack upward mobility, lack applied career ladders & graduate education

Quality, Diverse, Mental Health Workforce of Trained People with

Lived Experience

Pre-Training Workforce

K-12 education

Adapted from the coordinated health career pathway developed by Jeff Oxendine.

Career

awareness

Trauma,

mental health, &

substance use

exposure

Assessm

ent

Academ

ic preparation &

entry support

Financial &

logistic feasibility

Access to health professions

training program

Training program

retention

Internships

Financing &

Support System

s

Hiring &

O

rientation

Retention &

A

dvancement

Health Professions Education

Cultural Sensitivity and Responsiveness

No Financial support of individuals in Peer Specialist training programs

No CA scope of practice, training, supervision standards for Peer Specialists via State certification

Stigma, lack of understanding of value of peer specialist, recovery & resiliency to mental health

Uneven state distribution of and access to training in rural, small programs

Limited awareness of profession; No recognition of profession Coordination &

Support Infrastructure

Mental health professionals doubt value,

abilities of Peer

Specialists

No State Plan Amendment or mechanism to bill Medi-Cal SPECIFICALLY for ‘Peer Specialist as a Service Type’or ‘Provider type’

Lack of Internships & training for other professionals on how to work with Peer Specialists

County policies differ, few counties allow PSS to bill on existing codes

Inappropriate assignments, lack supervision

Lack funding for State certification of Peer Specialists

Background checks bar employment of Peer Specialists well qualified to serve special populations

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Peer Specialist PathwayTARGET GROUPS: Required to bepeople with lived experience with mental health challenges, includingConsumers, Family Members, Parents.

• Recipients of Behavioral Health Services

• People from Diverse Cultural & Linguistic Communities

• People in Jail & Prison Re-entry Programs

• Faith-Based Community Members• Promotoras & Health Conductors

• Adult Education Regional Occupational Programs

• Middle, High School, Community College Students

• Veterans • Career Changers, Previously

Employed Workers with Disabilities

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Barrier Recommendation

Lack of: Peer Specialist Scope of

Practice

Training Standards

Supervision Standards

State Certification of Peer Specialists through Certifying Body

Adopt WWT Stakeholder Recommendations to implement State Peer Specialists Certification

Include Consumer, TAY, Adult, Older Adult, Family member, and Parent Provider

Establish State Certifying Body

Recommendations: Identified Barriers

Recommendation: Establish Certifying Body

To be a Peer-Operated Organization &/or Existing State Organization with certifying capacity (i.e. Statewide Consumer & Family/Parent Collaborative)

To honor & vet existing trainings developed by local consumer & family organizations to retain cultural & regional diversity

To establish formal Scope of Practice, Values & Ethics, & standards for supervision of Peer Specialists in CA

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Scope of PracticeSupervised Sample Duties Include:

Provide individualized support to coach wellness, resiliency and recovery

Facilitate Wellness Recovery Action Plan (WRAP) & other Health Management groups, ex. Diabetes

Model coping skills and self-help strategies Assist in development of Individualized Educational Plan (IEP)

& related school-based services Educate, advocate & mentor families & parents in navigating

systems & community services Liaison to services for wellness needs, community resources,

groups & natural supports

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Recommendation: Service Settings

Examples of Service Settings:

Crisis Respite Houses & Crisis Residential Hospitals & Outpatient Programs Housing & Employment Programs Primary Care Wellness Coaching Wellness Centers Homeless Forensic Programs (AB109) Full Service Partnerships/Integrated Service Teams Peer-Run Programs

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Recommendation: State Certification Education & Experience

State Certification 80 hours of training by accredited programs with testing Additional 25 hours of training for specialty emphasis in

whole health, forensics, co-occurring, foster care, etc. Continuing Education requirements for re-certification

Experience Lived experience with mental health challenges or family 6 months of full time peer specialist internship, work or

volunteer

Training Timelines Average time from starting training program to State

Certification would be under 1 year

Sample Core Competency Domains

1. Wellness, Recovery, & Resiliency 2. Interpersonal Communication & Collaborative

Documentation Practices 3. Professional Role Competencies (Law, Ethics, Boundaries)4. Integrated & Whole Health Services 5. Trauma Informed & Substance Use Service Competencies6. Diversity & Cultural Responsiveness 7. Systems Competencies & Navigation8. Effecting Change: Education & Advocacy9. Professional Development & Self Care10.Wellness Coaching, Natural Supports, & Local Resources

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Recommendations: Identified Barriers

Barrier Recommendation

Lack funding for California State Certification of Peer Specialists

Use MHSA WET dollars to fund & establish CA Peer Specialist Certification & initial funding of Certifying Body

Explore ongoing sources to fund certification expense

One source may be Certification fees paid by local agency/county

Recommendations: Identified Barriers

Barrier Recommendation

No financial support for individuals in Peer Specialist training programs

Develop Peer Specialist Stipend program using MHSA WET funds to support completion of training & internships for Certification

Explore ongoing sources to fund certification expense

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Recommendations: Identified Barriers

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Barrier Recommendation Lack CA State Plan

Amendment or mechanism to bill Medi-Cal for Peer Support Services as a ‘Service type’ or Peer Specialist as a ‘Provider type’

Amend State Plan to create a NEW Medi-Cal (Medicaid) billing ‘service’ & ‘provider’ type, specifically for Peer Support

Develop/promote other billing mechanisms for Medicare & other payors

Recommendations: Identified Barriers

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Barrier Recommendation

Lack of recognition of Peer Support Services as a unique service

Develop policy statement on peer support as distinct from other disciplines to maintain the integrity of peer specialist services (R12)

Recommendations: Identified Barriers

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Barrier Recommendation

Under existing Medi-Cal codes, few CA Counties currently allow Peer Specialists to bill (under Rehab. Option, Targeted Case Management)

Lack of knowledge about recovery & resiliency based documentation practices

Provide CMHDA training on PS job classifications, documentation practices, to allow peer specialists to bill based on promising practices in counties already securing federal reimbursement for existing codes

Train staff to use collaborative documentation & CMS-approved recovery/resiliency-oriented language in documentation

Recommendations: Identified Barriers

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Barrier Recommendation

Limited awareness of profession

Lack of recognition of Peer & Family Specialist Profession

Develop State Certification to legitimize profession

Establish a Peer Specialist Consortium or Professional Association

Fund a plan for extensive & expansive training on the values, philosophy & efficacy of peer support to MH system (R10)

Recommendations:Identified Barriers

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Barrier Recommendation

Stigma & Discrimination

Fund a plan for extensive training on the values, philosophy & efficacy of peer support to MH system (R10)

Partner with CalMHSA to leverage statewide anti-stigma campaign to impact Behavioral Health professionals & service providers

Employ multiple Peer Specialists in diverse programs and teams

Recommendations: Identified BarriersBarrier Recommendation

Retention Barriers

Work assignments outside of Peer Specialist role

Lack of supervision or effective supervision

Certifying Body to collaborate with Peer Specialist Providers to finalize Scope of Practice & Supervision Standards

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Recommendations: Identified Barriers

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Barrier Recommendation

Mental Health professionals doubt the value & abilities of Peer Specialists

Develop a plan for welcoming environments that embrace the use of multi-disciplinary teams incorporating Peer Specialists fully (R11)

Leverage statewide anti-stigma campaign to impact Behavioral Health service providers

Encourage MH graduate programs to cover the value, role, & integration of Peer Specialists

More exposure to Peer Specialists in psychiatric residency

Recommendations: Identified Barriers

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Barrier Recommendation

Lack Internships & lack of training for other professionals on how to work with Peer Specialists

Train other professionals on the distinctly unique role & value of Peer Specialists

Develop Internships in CBOs, clinics, health organizations

Incentivize internships for Peer Specialists & agencies by developing a State-funded stipend program as part of the Peer Certification process

Recommendations: Identified Barriers

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Barrier Recommendation

Uneven & lack of access to training programs in rural, small counties

Fund & implement statewide certification for Peer Specialists

Identify Certifying Body Establish statewide Curriculum

Standards Implement Training Programs Ensure linguistic & cultural

Access

Recommendations: Identified Barriers

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Barrier Recommendation

Employment background checks bar employment of Peer Specialists well qualified to serve special populations

Educate HR on alternative methods of screening for qualified peer specialists

Look at promising models from other states

Work with committees & state agencies to address civil services barriers to the employment of Peer Specialists (R15)

Recommendations: Identified Barriers

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Barrier Recommendation

Lack of opportunities for Peer Specialists to advance to higher paying positions

Establish certification & new reimbursement for Peer Specialist Services

Develop Career Ladder opportunities for peer specialists to advance into management & leadership & to cross pathways to licensed professions

Value lived experience in all behavioral health professions

Highlight/promote counties successful with ladders

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Ladder DESCRIPTION - QUALIFICATIONS Job Classification(s)

1 a optional

Lived Experience & Middle School &or High School mental health track

High School Peer/Family Specialist Volunteer/Intern

1 b Lived Experience & Community College mental health certificate or

Peer-run organization’s training

Apprentice, InternPeer/Family Specialist Volunteer

2 Lived Experience & Proposed Basic State Certificate training--55 hours plus 25 for category of peer

specialist—Young Adult, Consumer, Older Adult, Family, Parent/Caregiver

Peer/Family Specialist Intern

3 Above + Pass Certification Testing with 6 months full time equivalent peer specialist work

or volunteer

Certified Peer/Family Specialist

4 a Lived Experience, work experience as Certified Peer Specialist

Certified Peer/Family Specialist Journeyman

4 b optional

Lived Experience + above, Specialization Certificate requires additional 25 hours training and exam for

Co-occurring SU, Forensic, Crisis, Veteran, Foster Care, Whole Health, etc

Certified Whole Health PS Certified Co-occurring SU Peer Specialist, etc.

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Ladder Description, Qualifications Job Classification(s)

5 Lived Experience & Work experience as Certified Peer/Family Specialist

Senior Certified Peer/Family Specialist, Supervising Senior Certified, Certified Whole Health Peer/Family Specialist

6 Work experience as Senior Certified Peer/Family

Support Specialist

Manager, Administrative Systems Level Certified Peer/ Family Specialist, Director Consumer &/or Family Affairs

7 Lived experience & BA, BS in psychology, sociology,

rehab counseling

Psychiatric Technician, Rehabilitation Counselor, Employment Specialist

8 Lived experience & MA, MS in psychology, sociology,

social work, rehab counseling

Rehabilitation Counselor II, Employment Specialist, Social Worker or MFT, psychologist

9 Lived Experience & MA, MS Social Work, MFT, MA, MS in Psych or Rehab Counseling

Licensed Provider with Lived Experience Certified Peer/Family Specialist

10 Lived Experience & LCSW, LPCC, LMFT, etc.

Supervising Licensed Provider with Lived Experience

11 Lived ExperienceDoctorate

Educator/Researcher/Psychiatrist with lived experience

Peer Specialists & Affordable Care Act

USA Today on September 11, 2013:

“Peers May Ease Mental Health Worker Shortage Under Obamacare”http://www.usatoday.com/story/news/nation/2013/09/11/stateline-mental-health/2798535/

“It’s not- like you might think- that you don’t have the money to offer recovery support services, but rather that you don’t have the money NOT to offer them.”

Quote from Keith Humphreys, Pillars of Support 201226

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