KEYNOTE PANEL. Karin Lettau, MS, Director of Training & Employment. Sally Zinman, Executive Director. Mario Lopez, Senior Peer Support Specialist

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1 February 23, 2016

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3 KEYNOTE PANEL Karin Lettau, MS, Director of Training & Employment California Association of Mental Health Peer Run Organizations Sally Zinman, Executive Director California Association of Mental Health Peer Run Organizations Mario Lopez, Senior Peer Support Specialist Riverside University Health System Behavioral Health Lisa St.George, MSW, CPRP, Director of Recovery Practices RI International 3

4 KARIN LETTAU, MS, DIRECTOR OF TRAINING & EMPLOYMENT CALIFORNIA ASSOCIATION OF MENTAL HEALTH PEER RUN ORGANIZATIONS /

5 Peer Certification Movement in California Originally evaluated by California Network 2004 Working Well Together A Training and Technical Assistance 2008: ocamhpro-peers - California Association of Mental Health Peer Run Organizations Peers Envisioning and Engaging in Recovery Services onami California - National Alliance on Mental Illness - California ouacf - United Advocates for Children and Families ocimh - California Institute for Mental Health 5

6 Background & Research-National & Statewide Extensive background information collected on certification resulting in 3 Research Reports oreviewed national data and interviewed content experts across the country. ocurrently at least 42 states already have certification of adult consumer providers. Plus 4 states in process of implementation o16 states have certification of parent/family partners. In CA, we received 40 surveys, representing 32 counties o Learned there is no statewide standard in job tasks, job training, job title o Only standard was that someone had lived experience. CA could be the first state in the nation to adopt certification for peer providers across the life span. 6

7 Stakeholder Process & Involvement Used multiple methods of gathering input, including Written surveys Focus groups Comment and question sessions in face-to-face meetings Webinars 4 Specialized workgroups & monthly teleconferences 165 people attended five regional stakeholder meetings 223 people attended the Statewide Summit in May, Vetted the recommendations at this meeting utilizing a modified consensus model. On-going monthly teleconferences Member list has over 700 people on it. 7

8 Defining Peer Support as a Distinct Practice A relationship of mutual learning Key principles are hope, equality, respect, personal responsibility and selfdetermination Therapeutic interactions between people who have a shared lived experience A relationship without the constraints of the traditional expert/patient or expert/family member role Peer Support is differentiated from other mental health services such as: rehabilitation, targeted case management or collateral. Key distinctions are: WHO does it and HOW the service is done. Peer Providers may also provide any other allowable mental health service to their scope of practice. 8

9 The Case for Certification Defines the service of peer support. Provides formal validation of the role of peer support. Assures that practitioners receive standardized training and demonstrate competency. Standardizes the quality of services provided by Peer Support Specialists that employers can rely on. Certification is portable to any CA county. Provides a scope of practice that service recipients can benefit from. Can be utilized as a basis for the ability to bill Medi-Cal for services provided. 9

10 Official National & State Certifications 42 States & D.C. have State Certified Peer Specialists 4 States in process of developing State protocol for certifying peers 14 States have State Certified Family or Parent Specialists Billing Medicaid for Peer Services is the primary impetus U.S. Veterans Administration Certifies Peer Specialists o Employs over 1,000 Peer Specialists (5 grades) The International Association of Peer Specialists (INAPS) develops competencies for international Peer Certification SAMHSA drafted 62 Competencies for Peer Support workers in behavioral health (2015) 10

11 Peer Specialist Training and Certification

12 Example: Georgia Certified Specialists bill Structured activities that promote socialization, recovery, wellness, selfadvocacy, development of natural supports, and maintenance of community living skills. Activities provided between and among individuals who have common issues and needs, are consumer motivated, initiated and/or managed, and assist individuals in living as independently as possible. Peer Support (H0038),Psych rehab (H2017), Community support (H2015), ACT (H0039), Health and Wellness Supports, (H0025) Whole Health o Supporting the individual in building skills that enable whole health improvements 12

13 Benefits of Peer Support Services Research Less inpatient use Clarke et al, 2000; Klein et al, Min et al., 2007; Landers and Zhou, 2009 More time and engagement with the community Clarke et al., 2000; Min et al., 2007 Better treatment engagement Craig et al., 2004; Sells et al., 2006; Felton et al., 1995 Greater satisfaction with life Felton et al., 1995 Greater quality of life Klein et al., 1998 Greater hopefulness Cook et al., 2010 Better social functioning Klein et al., 1998 Fewer problems and needs Craig et al., 2004; Felton et al., 1995 Decreased symptoms Increased coping skills Increased life satisfaction Chamberlin, et al, 1996; Humphreys, 1997; Raiff, 1984; Davidson, et al 1999 Reduces overall ongoing need for mental health services Chinman, 2001; Klein et al, 1998; Simpson & House, 2002 Decreased substance use Klein et al, 1998

14 Benefits of Parent/Family Peer Support Services Research Improved youth functioning and lower parental stress Becker and Kennedy, 2003 Improved family member s ability to cope and feelings of empowerment (Family to Family) Reduced anxiety, improved problem-solving, improved coping and knowledge (Family to Family, sustained at 9 months) Dickson, et al, 2013 Lucksted, et al, 2013 Reduction of parental stress Davis and Spurr, 1998; Treacy, 2005 Reduced symptoms of anxiety and depression Davis and Spurr, 1998; Sonuga-Barke, et al, 2001 Significant decreases in behavioral problems of the child Davis and Spurr, 1998; McCleary and Ridley, 1999; Sonuga-Barke et al, 2001 Increased engagement in service initiation and continuation McKay et al, 1999 Decreased symptoms or severity of illness of the child Barret et al, 2004; Cohen and Mannarino, 2008; Feinfeld and Baker, 2004; Pavuluri et al, 2004; Pfeffer et al, 2002; Shortt et al, 2001; Valderhug et al, 2007 Decreases in negative parental reactions as well as more likely to Deblinger et al, 2001 maintain contact with other parents and to obtain additional therapy for their child

15 SALLY ZINMAN, EXECUTIVE DIRECTOR CALIFORNIA ASSOCIATION OF MENTAL HEALTH PEER RUN ORGANIZATIONS 15

16 Senate Bill 614 introduced in 2015 by Senator Mark Leno (D) Called peer, parent, transition-age, and family support specialist certification program odhcs would create Certification by July, 2017 osponsored by CBHDA ostatewide certification for: Adult peer specialists, 18 years of age or older Parent peer support specialists Transition-age Youth Peer Support Specialists (18 or older) Family Peer support specialists Department of Health Care Services (DHCS) would administer 16

17 SB 614 Certification as of 8/31/15 Amendments Be at least 18 years of age. Have/had a primary diagnosis of mental illness, substance use disorder, or both, which is selfdisclosed. (or to be family member of adult or parent of child/youth) Have received/is receiving MH services, substance use disorder services, or both. Be willing to share his or her experience of recovery. Demonstrate leadership and advocacy skills. Have a strong dedication to recovery. Agree to uphold and abide by a code of ethics. Successful completion of the curriculum and training requirements for peer/family support specialist. Pass a certification exam approved by DHCS for peer/family support specialist. Successful completion of required continuing education, training, & recertification

18 SB 614 (Leno-D) Continued Would amend Medicaid state plan allowing Medi-Cal billing to include peer and family support specialist as Provider TYPE and as Provider Service Could use Mental Health Services Act funds, and WET resources to develop and administer Program Could enter into exclusive or nonexclusive contracts on a bid or negotiated basis, including contracts for the purpose of obtaining subject matter expertise or other technical assistance. Contracts may be statewide or on a more limited geographic basis. 18

19 Move it Forward PASS SB 614 Although legislators may want changes in the bill: odefining Guideline Resources otrainers Qualifications osupervision Requirements ofunding 19

20 Life Cycle SB 614 (Leno-D) Introduced February, /1/15 Passed Senate unanimously, ordered to Assembly 7/14 Passed Assembly Health Committee, re-referred to Assembly Appropriations 8/27 Passed Assembly Appropriations Committee with amendments 9/1 Second reading on Assembly Floor, ordered to 3rd Reading 9/3/15 Ordered to Assembly inactive file o Stays in Assembly for this year s legislative cycle this is a 2-year legislative period o Bill was scheduled to be active now but it is stalled o Negotiations with CA Health & Human Services are at a stand-still 20

21 Supporters Include County Behavioral Health Directors Association of California (sponsor) Association of California Health Care Districts California Association of Mental Health Peer-Run Organizations California Association of Social Rehabilitation Agencies California Council of Community Mental Health Agencies California State Association of Counties Disability Rights California National Alliance on Mental Illness California Pacific Clinics Peers Envisioning and Engaging in Recovery Services (PEERS) REMHDCO Sacramento County Board of Supervisors SEIU California Steinberg Institute Western Center on Law and Poverty United Advocates for Children & Families

22 MARIO LOPEZ, SENIOR PEER SUPPORT SPECIALIST RIVERSIDE UNIVERSITY HEALTH SYSTEM BEHAVIORAL HEALTH 22

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24 SB 614 and Cultural Responsiveness The Legislature finds and declares Certification at the state level can encourage: oincrease the number, diversity, and availability of peer providers and peer-driven services.

25 It is the intent of the Legislature that the peer, parent, transition-age, and family support specialist certification program achieve all of the following Encourage employment to reflect the culture, ethnicity, sexual orientation, gender identity, mental health service experiences, and substance use disorder experiences of the people whom they serve. Senate Bill (h) 25

26 Definition of Cultural Responsive To have a set of congruent behaviors, attitudes, and policies that come together in a system or agency that enables that system or agency to work effectively in cross-cultural situations. 26

27 Culturally Responsive System the importance of language and culture Understand cross-cultural relations knowledge and acceptance of dynamics of cultural differences expansion of cultural knowledge adaptation of services to meet culturally unique needs to provide services in culturally competent manner 27

28 Recovery is a process of change This process of change recognizes cultural diversity and inclusion, and honors the different routes to resilience and recovery based on the individual and his or her cultural community (L) 28

29 Riverside County Diversity RACE/ETHNICITY OTHER 23.90% 24% CAUCASIAN 28.00% 28% NATIVE AMERICAN 0% AFRICAN AMERICAN 10.70% 11% HISPANIC ORGIN 36.20% 36% ASIAN/PI 0.90% 1%

30 LISA ST.GEORGE, DIRECTOR OF RECOVERY PRACTICES RI INTERNATIONAL /

31 RI International RI International has provided Peer Training for 15 + years Approximately 650 RI staff members are peers (about 2/3rds of the total team) they bill Medicaid RI International has trained peers in the USA and abroad since the year 2000 Through a CA grant we have trained over 325 Peer Support Specialists and supported the employment of over 264+ individuals in systems and organizations since July 2014 in CA. Our training thoroughly covers SAMHSA s identified competencies for peer support training Why? Because PEER SUPPORT WORKS! 31

32 State Certification for Peer Supports! Certifying Peer Support Specialists ensures that the peer supports working in the fields of mental health care, substance misuse care, and co-occurring MH/Substance Misuse meet a professional standard. It also paves the way for Peer Supporters to bill Medicaid services while working in organizations. It is meeting a standard set by SAMHSA. It will support the continued growth of the unique discipline of peer support. It will allow more jobs to be created. 32

33 Outcomes Significant Reduction in Hospital and ED Visits: orrc Ellendale, DE: 50% reduction in ED use orrc Ellendale, DE: reduction in hospitalization from 48% down to 10% hospitalization rate othe use of peer supporters in Fife, Washington created reduced hospitalizations by 79% (From 202 individuals per year to 40 individuals per year) 33

34 hospitalizations # persons hospitalized 0 Pre Peer Bridger Peer Bridger An RI International Peer Bridger program in Pierce County, Washington has demonstrated wonderful outcomes in reductions in hospitalizations and the numbers of individuals hospitalized. Peer Support creates great outcomes.

35 QUESTION AND ANSWER 35