peer support services. proprietary and confidential. do not distribute. what is a certified peer...

Peer Support Services

Proprietary and Confidential. Do not distribute.

What is a Certified Peer Specialist?

• Certified through a training and certification process

• Grounded in their own recovery

• Have a lived experience

• Are a support system

• A role model for recovery and resiliency

• A provider of hope

• A translator between “doctor talk” and the consumer

• A cheerleader

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Proprietary and Confidential. Do not distribute. 3

Certified Peer Specialist TrainingTo meet the criteria to be accepted into the training, one must:

• Have a high school diploma (or equivalent)

• Be self-identified as a current or former consumer of mental health services

• Be well grounded in their own recovery

• Be at least 18 years or older


Certified Peer Specialists must:

•Successfully complete 40 hours of training Appalachian Consulting Group curriculum

•Pass a written test.

•Receive a written certification.

•Successfully complete 12 hours of continuing education units each year in order to maintain certification.


Peer Specialist Training : What is Learned and Can Be Shared

• Five Stages in the Recovery Process: Overview, Dangers, Interventions

• Using Your Recovery Story as a Recovery Tool

• The Role of Peer Support in the Recovery Process

• Creating Program Environments that Promote Recovery

• Exploring Beliefs that Promote Recovery

• Creating Relationships that Promote Recovery

• Effective Listening and the Art of Asking Questions – Part 1, 2

• Dissatisfaction as an Avenue for Change

• Facing One’s Fears• Combating Negative Self-Talk• Problem Solving with Individuals• Facilitating Recovery Dialogues• Using Support Groups to Promote

and Sustain Recovery• Peer Specialist Ethics• Power, Conflict and Integrity in the

Workplace – Part 1 , 2• Creating the Life that One Wants• Introduction to Trauma-informed

care• Cultural Competency• Introduction to Data Collection and

Documentation

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Responsibilities of Certified Peer Specialist• Provide peer support services

• Consumer advocate

• Provide information and support

• Assist consumers in regaining control of their lives

• Assist consumers in learning to utilize recovery

• Role model recovery and coping skills

• Share own recovery story

• Model mutuality in the relationship

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The Four Performance Domains:

1. Advocacy• Consumer advocate

• Advocate within system for consumer centered recovery

• Assure consumers choices define and drive their recovery plan

• Promote consumer-driven recovery plans by serving on recovery team

Knowledge skills and abilities• Explain why self-advocacy is the foundation of recovery

• Identify consumers individual support system

• Explain how to advocate within behavioral health system

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Performance Domains Continued

2. Professional Responsibility• Respond appropriately to risk indicators to assure the

consumers welfare and physical health

• Document services provisions as required by the employer

• Maintain confidentiality

Knowledge skills and abilities• Define the concept of a wellness-focused approach to

consumer recovery

• Explain the fundamental concepts related to cultural competency

• Understand the concept of accountability

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Performance Domains Continued

3. Mentoring• Serve as a role model of a consumer in recovery

• Establish and maintain “peer” relationship rather than a hierarchical relationship

• Promote social learning through shared experiences

• Assure that consumers know their rights and responsibilities

Knowledge skills and abilities• Explain the concept of mentoring

• Explain the concept of role-modeling behaviors

• Define social learning

• Define self-advocacy

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Performance Domains Continued4. Recovery Support

• Serve as an active member of the consumer’s recovery-oriented team

• Assure that all recovery-oriented tasks and activities built on the consumer’s strengths and resiliencies

• Help the consumer identify their options and participate in all decisions related to establishing and achieving recovery goals

Knowledge skills and abilities• Promote self-determination and consumer choice-driven

recovery

• State the stages of recovery

• Help the consumer develop problem-solving skills by working together to identify and discuss options

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The Work done by Peer Support Specialist

Peer Support Specialists recognize, advocate and support opportunity for:• Choice - Individuals ability to make choices are important to

each person’s recovery• Recognition of each individuals strengths and using those

strengths to accomplish one’s goals ~ FOCUS ON WHAT’S STRONG NOT WRONG!

• Connection, connection and connection• Relationship• Respect • Honoring each individual’s hopes and dreams• Supporting them moving toward recovery

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“When consumers begin to work in the mental health system as Peer Specialists, recovery is accelerated in three ways.”

• The Peer Specialists recoveryis strengthened

• Peer Specialists assist others in recovery

• Peer Specialists help the agency/system recover

*Recovery Innovations

Peer Services


Working Together

•Staff members not living with a mental disorder may be experts in treating mental illness.

•Certified Peer Specialists and their peers are the experts in living with a mental health disorder.

Both are important in the continuum of care.


Peer Support Providers’ Services are Evidence Based

August, 2007 letter from the Administrator of Center on Medicare and Medicaid Services stated:• Peer support services are an evidence-based mental health model of care

which consists of a qualified peer support provider who assists individuals with their recovery from mental illness and substance use disorders.

Larry Davidson, Professor of Psychiatry and Director of the Program for Recovery and Community Health Yale University School of Medicine and Institution for Social and Policy Studies (Pillars of Peer Support Summit 2012)

• First generation studies showed that it was feasible to hire people in recovery to serve as mental health staff

• Second generation studies showed that peer staff could generate equivalent outcomes to non-peer staff in similar roles

• Third generation studies are investigating whether or not there are unique contributions that peer support can make

• Evidence base is growing along with expansion of peer workforce

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Optum Idaho Peer Services :

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Peer Services CPT Codes • Peer Support Services (H0038)- services initiated/offered in the community by a network

provider that is credentialed to provide peer support services. Certified Peer Support Specialist, per Optum Idaho standards Initial authorization of 16 units Medical Necessity required for authorization of additional units

• Community Transition Support Services (H2015)- services provided by a Certified Peer Support Specialist and Licensed Clinician to assist the Member in the transition from inpatient services to community-based services. This service is not provider-initiated.

Optum Idaho Discharge Coordinators will initiate service authorizations upon approval by the Member

Services will be authorized for up to 32 total units within authorization time span


Network Participation Requirements for Peer Support Services

– Credentialing Specific to Peer Support Services/ Peer Run Agency:

• Network Agency Request Form (NRF) and Agency Credentialing Application attesting to adherence to the applicable criteria

• Peer Support Specialist Addendum • Network Manager requests an audit of the peer support services program

– Required audits

• Existing In Network Agencies may be reviewed by desk top audit • Site audits required for unaccredited agencies pursuing group contracts • Compliance with the criteria for specialists, the organization’s detailed

plan for supervision, and record keeping protocols (e.g., contact notes) for peer support specialist will be reviewed during the audit.

– Approval by Optum Credentialing Committee

• Credentialing committee meets 1 time/ month

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Peer Support Staff Requirements

• Network providers are required to:– Ensure you are employing only certified staff

• Certified Peer Support Specialists with certification issued by Mountain States training program

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Peer Support Service Claims:

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CATEGORY THREE SERVICES REQUIRE PRIOR AUTHORIZATION • Claims will be denied unless you are an approved Peer Support Service Provider

Related CPT Codes from the Idaho Fee Schedule:Assessment and Treatment Plan • H0031 Behavioral Health Assessment, by a qualified paraprofessional for peer support,

family support or CBRS • H0032 Individualized Behavioral Health Treatment Plan, by a qualified paraprofessional

for peer support, family support or CBRS

Peer Services • H0038 Peer Support by a qualified Peer Support Specialist • H2015 Community Transition Support Services by a licensed clinician and a qualified

Peer Support Specialist (initiated by an Optum Idaho network provider at the request of an Optum Idaho Discharge Coordinator or Intensive Care Manager)


Submitting Prior Authorization Requests for Peer Support Services

First Month of Service:• Like all category 3 services, service is attached to the member.• Provider faxes/emails authorization request form to Optum.• Optum authorizes 16 units of Peer Support Services for up to 30 days upon

receipt of complete and accurate request.• Incomplete or inaccurate forms will be returned to provider.• After receiving complete and accurate request, Optum has two business days to

create authorization for services. • Provider will receive confirmation of authorized services.• Notice of authorizations are automatically sent out and are available on Provider

Express within 24 hours.

After Initial Authorization:• Once initial authorizations for Peer Support Services are exhausted, additional

units will require a full clinical review by an Optum Idaho Care Manager.

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Links

This is a link in Provider Express:

https://www.ubhonline.com/

Clinical tab > bottom of page Recovery & Resiliency Toolkit

This is a link to the Office Of Consumer and Family Affairs:

http://www.consumerandfamilyaffairs.org/

Training tab

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Additional Tools For Peer Support SpecialistsSupporting and creating evidence based, best practice opportunities and initiatives:

• WRAP® - Wellness Recovery Action Planning

• WHAM- Whole Health Action Management

• Trauma Education and Trauma-informed peer support

• Shared Decision Making Education and Practices

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Martha Ekhoff

Director of

Member & Family [email protected]

208-914-2234

Amanda Lehto

Certified Peer [email protected]

208-914-2013

Amy Wernsing

Family Support [email protected]

208-914-2236

Thank You

mailto:[email protected]



peer support services. proprietary and confidential. do not distribute. what is a certified peer...

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