Los Angeles Regional Forum on Peer Support Services & CA State Certification: Moving Forward

Transcription

1 Los Angeles Regional Forum on Peer Support Services & CA State Certification: Moving Forward October 18, 2016 The California Association of Mental Health Peer Run Organizations (CAMHPRO) & Project Return Peer Support Network

2 Dennis Murata Acting Chief Deputy Director Los Angeles County Department of Mental Health Sally Zinman Executive Director, California Association of Mental Health Peer Run Organizations (CAMHPRO) Guyton Colantuono Executive Director, Project Return Peer Support Network (PRPNS) 2

3 Lisa St. George, MSW, CPRP, Director of Recovery Practices RI International Lucinda Dei Rossi, MPA, CPRP, Public Policy Coordinator, California Association of Social Rehabilitation Agencies (CASRA) Adrienne Shilton, MPPA, Director Intergovernmental Affairs, County Behavioral Health Directors Association of California (CBHDA) Llanette Morgan, Community Worker, LAC-DMH 3

4 4 Certification of Peer Specialists A National Look Lisa St. George, MSW, CPRP, Director of Recovery Practice February 2, 2016

5 5 When I say Peers, peer supporters, peer specialists etc. I mean. Adults with lived experience of psychiatric, trauma, or substance use challenges Adult family members of people who have lived experience, because they too have lived experience Parents/caregivers of children with behavioral health challenges

6 What is Peer Support? 6 The process of giving and receiving non-clinical assistance to achieve long-term recovery from severe psychiatric, traumatic, or addiction challenges. SAMHSA-HRSA

7 Recovery & Peer Support an Evidence Based Practice 7 In 2007 and again in 2013, when Center for Medicaid Services (CMS) issued specific information about peer support CMS has recognized peer support as a service of benefit to people. CMS stated that 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. There are specific parameters that must be met in order to seek reimbursement for PS; let s see what they are

8 Peer Support an Evidence Based Practice 8 Supervision by a mental health professional (as defined by the state) Care Coordination: Services are coordinated within the context of an individual s plan of care 2007 Training and credentialing: As defined by the state (2007, and reconfirmed in 2013) Scope: In addition to mental health and addiction support, peer support services can include support to parents/legal guardians of Medicaid-eligible children (17 and younger) during the child s recovery process (2013)

9 Each State Decides the Medicaid Reimbursable Services 9 Typical codes used in billing no matter what state: H Peer Support H Psychosocial Rehabilitation H2015 Community Support H0039 Act Team Peer Support H0025 Whole Health

10 Outcomes in Georgia 10 Results were publishedhttp:// This study indicates that: Participants had a significantly greater improvement in patient activation than those in usual care; Participants had a significantly greater improvement in rates of having one or more primary care visit; Intervention advantages were observed for physical health related quality of life (HRQOL), physical activity, medication adherence

11 Number of States Certifying Peers 11 In 2008, only 8 states certified peer support specialists. In 2014, there were 34 states that have peer certification and now there are 42 states. The purpose of certifying peers is so that they can provide services that can be reimbursed through Medicaid. The certification does not recognize peer specialists as a distinct Medicaid provider. This means that peer workers cannot hang a shingle and provide peer support to people without be employed by a Medicaid reimbursable entity. Most Medicaid reimbursable entities are clinics, FQHCs, CBOs providing treatment and care.

12 Peer Support 12 Peer support is being used to provide diverse services in many systems and organizations: In home and community services Hospital transition services Housing services Whole health coaches ACT teams Systems navigators Mental health and addiction recovery coaches System advocates Throughout the Veterans Administration Recovery Educators System liaisons

13 RI International s Peer Experience 13 RI International has provided Peer Training for 15 + years. Approximately 650 RI staff members are peers (about 2/3rds of the total team) and they all bill Medicaid. RI International has trained peers in the USA and abroad since the year Our training thoroughly covers SAMHSA s identified competencies for peer support training. We are one of the training providers in the State of California.

14 OSHPD Funding 14 RI is one of several training entities selected. Through a grant from California Office of Statewide Health Planning and Development we have trained over 575 Peer Support Specialists since July Why? Because PEER SUPPORT WORKS!

15 Outcomes 15 Significant Reduction in Hospital and ED Visits: When a crisis center opened in Ellendale, DE where the team used high levels of peer support there was a 50% reduction in ED use The same center in Ellendale, DE caused a reduction in hospitalization from 48% down to 10% hospitalization rate The use of peer supporters in Fife, Washington created reduced hospitalizations by 79% (From 202 individuals per year to 40 individuals per year)

16 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.

17 Outcomes 17 One program took peer support into the county hospital. Here are the outcomes they were tracking: After one year of peer support in the hospital units for only 3 hours per day: 36% reduction in the use of seclusion 48% reduction in the use of restraints 56% reduction in recidivism at one year

18 18 There are more outcomes Listen please

19 Thank you! Follow

20 LUCINDA DEI ROSSI, MPA, CPRP PUBLIC POLICY COORDINATOR, CALIFORNIA ASSOCIATION OF SOCIAL REHABILITATION AGENCIES (CASRA) 20

21 Peer Certification Movement in California Originally evaluated by California Network (CNMHC) Working Well Together (WWT) ( ) Training and Technical Assistance Collaborative: CNMHC, then in 2012, CAMHPRO-PEERS - California Association of Mental Health Peer Run Organizations Peers Envisioning and Engaging in Recovery Services NAMI California - National Alliance on Mental Illness - California UACF - United Advocates for Children and Families CiMH - California Institute for Mental Health 21

22 Background & Research-National & Statewide Extensive background information collected on certification resulting in 4 Reports Reviewed national data Reviewed existing practices in CA, we received 40 surveys, representing 32 counties Learned there is no statewide standard in Job tasks, Job training, job title Only standard was that someone had lived experience. 22

23 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 the summit utilizing a modified consensus model. On-going monthly teleconferences Member list has over 700 people on it. Resulted in 17 Stakeholder Recommendations for CA Peer/Family Specialist Certification, mostly reflected 23 in the former SB 614

24 Key CA Peer Specialist Vetted Documents Four Research & Stakeholder Recommendations Reports, links: Definitions Values & Code of Ethics Informational Brief Scope of Practice 17 Recommendations National Medicaid Peer Specialist Matrix Consumer, Family Member & Parent or Caregiver Peer Specialist Training Crosswalk Draft Core Content Areas & Competencies 24

25 Stakeholder Recommendation Certifying Body Composition Establish Certifying Body Identify or create a single certifying body that is Peer Operated or at a minimum peers should play a major role in granting and managing certification And or partner with an existing peer-operated entity with capacity for granting and managing certification Must be separate from training entities 25

26 Stakeholder Recommendation: Certifying Body Function Core Duties: Formal Definitions, Scope of Practice, Values & Ethics Core competencies and standardized training content Trainer and training entity qualifications Standards for supervision of peer support specialists Certification exam Certifies training entities throughout the state for trainings that meet competencies, to retain cultural & regional diversity Administers exam 26

27 Stakeholder Recommendation: Education & Experience Training 80 hours of training by approved training programs 25 optional hours for specialty emphasis whole health, forensics, co-occurring, foster care, etc. 15 hours of Continuing Education per year Recertification every three years Experience Lived experience with mental health challenges or family 6 months full time equivalent as a peer specialist, intern, or volunteer 27

28 Stakeholder Recommendation-- Supervision Policy that outlines key qualifications necessary for the Supervision of Peer Support Specialists Prefer supervisors have lived experience & expertise in peer support Define specific qualities and skills required for the supervision of Peer Specialists, that align with the values and philosophy of peer support If capacity is an issue, supervisors can be non-peers if they receive training on the role, values ad philosophy of peer support 28

29 Stakeholder Recommendations-Training to County Administrations Plan for extensive & expansive training to County BH Administrations and Staff on Values, philosophy and efficacy of peer support services County and Organizational cultures that welcome peer support specialists fully onto teams Definitions of the unique service components of peer support, separate & distinct from other disciplines and services 29

30 Defining Peer Support as a Distinct Practice A relationship of mutual learning Key principles are hope, equality, respect, personal responsibility & self-determination 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 MH service to their scope of practice. 30

31 The Case for State 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. 31

32 Benefits of Peer Support Services Research Less inpatient use More time and engagement with the community Better treatment engagement Clarke et al, 2000; Klein et al, Min et al., 2007; Landers and Zhou, 2009 Clarke et al., 2000; Min et al., 2007 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 Chinman, 2001; Klein et al, 1998; Simpson & health services House, 2002 Decreased substance use 32 Klein et al, 1998

33 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 Dickson, et al, 2013 empowerment (Family to Family) Reduced anxiety, improved problem-solving, improved Lucksted, et al, 2013 coping and knowledge (Family to Family, sustained at 9 months) 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 McKay et al, 1999 continuation 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 maintain contact with other parents and to obtain additional therapy for their child 33 Deblinger et al, 2001

34 ADRIENNE SHILTON, MPPA, DIRECTOR OF INTERGOVERNMENTAL AFFAIRS COUNTY BEHAVIORAL HEALTH DIRECTORS ASSOCIATION OF CALIFORNIA 34

35 CA State Peer Certification SB 614 California

36 Senate Bill 614 Mark Leno (D) intro d February, 2015-Pulled in August, 2016 Called peer, parent, transition-age, and family support specialist certification program Sponsored by CBHDA Statewide 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 have administered 36

37 Definition of Recovery Recovery is a process of change where: an individual improves his or her health and wellness, lives a self-directed life, and strives to reach his or her full potential. 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) 37

38 SB 614 and Cultural Responsiveness 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.

39 SB 614 Certif. Requirements as of 8/31/15 were Be at least 18 years of age. Have/had a primary diagnosis of mental illness, substance use disorder, or both, which is self-disclosed. (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 & advocacy skills. Have a strong dedication to recovery. 39 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 Grandfathering-in process TBD

40 SB 614 (Leno-D) Continued Would have amended Medicaid State Plan allowing Medi-CAL billing to include peer and family support specialist as Provider TYPE and as Provider Service 40

41 Supporters Included 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

42 What s Next? 42

43 A Cultural Perspective on Peer Certification Llanette Morgan Community Worker, LAC-DMH 43

44 KEYNOTE 44

45 Ashely Flores TAY Peer Associate Director, Project Return Peer Support Network (PRPNS) Board Member, California Youth Empowerment Network (CAYEN) Angelica Garcia Adult Peer Associate Director, Project Return Peer Support Network (PRPNS) Ruth Tiscareno Parent Peer Community Worker, LAC-DMH Harold Turner Family of Adult Peer Director of Programs-NAMI Urban Los Angeles 45

46 Constituency Panel 46

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48 How does Peer Support work in Los Angeles County? Helena Ditko, LCSW, Program Director, Office of Consumer and Family Affairs, LAC DMH

49 How would State Peer Specialist Certification Help LA County? Ruth Hollman, Executive Director Self-Help & Recovery Exchange SHARE!

50 How Would State Peer Certification help Los Angeles County? Ruth Hollman Founder/Executive Director SHARE! the Self-Help And Recovery Exchange

51 State Peer Certification would: 1. Include Evidence-based Peer Specialist Training it works 2. Increase Employment for all mental health consumers 3. Increase Culturally-competency of every one in the MH system 4. Reduce Stigma 5. Brings thousands into Recovery

52 Evidence-based Peer Specialist Training Self-help Support Groups WRAP Intentional Peer Support Helper Therapy Principle Critical Time Intervention SHARE! Innovations

53 Self-help Support Groups Cut the rehospitalization of mental health consumers by 50 percent Reduce the number of days spent in the hospital by one third Reduce significantly the amount of medication needed to treat mental illness Move large numbers of people out of the system as become self-supporting Participants are more likely to collaborate with clinical staff regarding taking medications Reduce drug and alcohol abuse

54 Self-help Support Groups Reduce demands on clinicians time Increase empowerment Provide community support the suspected reason that people in developing countries recover from schizophrenia at nearly twice the rate that they do in developed countries Reduce criminal behavior Increase family resources and reduce family stress Increase consumer satisfaction

55 Helper Therapy Principle The person who is perceived as helping gets more out of the interaction than the person being helped Peers can be helped by the people they serve. Professionals in general are the helpers.

56 Critical Time Intervention Helps vulnerable people during times of transition in their lives by strengthening their network of support in the community. Transitions are hard. Peer providers can help bridge the transitions, often better than clinical staff.

57 SHARE! Innovations 30 Effective Practical Tools for Peer Specialists that are not based on power, judgment or authority, but Love and Persuasion Plan for Success Volunteer-to-Job 42 % of MH consumers had jobs in the first year 78% included family members in MH decisions who hadn t before 93% felt this program respects my cultural needs and the greatest diversity of any of the programs studied

58 Increase Employment for all mental health consumers Peer Specialists get jobs MH consumers get jobs because of the peer services

59 Increase Culturally-competency Certified Peer Specialists come from all ethnic, racial, cultural, religious, orientation, etc. Training is relatively short, so we have more workers who can inform their colleagues about cultural issues and provide better services. People go back to school to become clinical staff

60 Reduce Stigma Los Angeles DMH has higher stigma against MH consumers than the general public Having Certified Peer Specialists working with clinicians reduces stigma as people with the lowest stigma personally know people with MH issues General public will see Certified Peer Specialists as an important occupation

61 Brings thousands into Recovery Peers are great role models who show others that there is a path Peer models can serve many more people Each consumer is also a provider in peer interventions

62 Conclusion State Peer Certification would: 1. Provide Evidence-based Peer Specialist Training 2. Increase Employment for all mental health consumers 3. Increase Culturally-competency of every one in the MH system 4. Reduce Stigma 5. Brings thousands into Recovery

63 SHARE! Advanced Peer Training FREE training offered to those who volunteer or work in the mental health system Apply now: and talk to Emily Take an application from me today

64 Heidi Strunk, Advocacy Coordinator, Karin Lettau, MS, Director of Training & Employment 64

65 Agenda From individual programs to big picture lifting the practice of peer support to a recognized certified profession, with standardization and billing. Advocacy avenues Templates and how-to s Action Planning Intro to breakout groups and questions 65

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67 Peer Specialist Training and Certification 2014

68 Advocacy Avenues Individual Agency or Group County Regional State Letter, to, or meeting with lawmaker, gov t official, or to Editor Unless contracts prohibits Often prohibited CBHDA Rally, Sit-in Info & input webinars Media, social media 68

69 Our State System OSHPD Heath Planning & Dev. State Legislature Senate & Assembly Governor CA BH Directors Association (CBHDA) State Health & Human Svcs (CHHS) MH Services Oversight & Accountability Commission (MHSOAC) Dept. of Public Health (CDPH) Dept. of Health Care Services (DHCS) Office of Health Equity (OHE) CA MH Planning Council (CMHPC) Mental Health & Substance Use Services CA Health Facilities Financing Authority

70 CBHDA Association of County BH Directors Advocates regarding county issues Collaborates with State agencies to improve services CMHPC Dir. of DHCS appoints members Evaluates services & public policy Makes recommendations to the Legislature Reviews & approves OSHPD Workforce Development 5 year Plan & Budget MHSOAC Governor appoints Reviews County MHSA Plans Approves County INN plans Advises Legislature & Governor Refers critical issues to DHCS Training & Technical assistance regarding PEI, INN & CPP Administers crisis triage grants Sets PEI & INN regulations

71 Who Do We Advocate To? State Agencies Your CA district Assembly Member and Senator Find your CA representatives Enter your street address Your State Assembly Representative State Senate Representative 71

72 Advocacy Toolbox Public comment, written comment online, committee/board membership, Social Media (Facebook, twitter ) Template for support letters from individuals and/or organizations to legislators (packet) Link to How-tos on CAMHPRO website How to Write Op-Eds and Letters to the Editor How to write fact sheets and action alerts How to Visit a Policymaker How to Organize a Rally Action Plan Template Sample 72

73 How to Track a Legislative Bill CA Legislative Info.website Go to Bill Information, enter bill number or key word Click on bill # View Tabs Click on Track Bill Register for notice of changes to bill address only required Create password to log in 73

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75 Questions/Contributions ALERT: Monthly Update on Status of State Peer Certification Webinar 2 nd Thursday each month at 12pm Next webcall is November 10, 2016 Please register once for ongoing reminders, at: register/

76 Collaborative Group Tasks (45 minutes) Pick a recorder who will take notes and record in Action Plan. Pick a reporter to report out for 3 minutes max. Discuss depending on your group: A. What can your organization and or organizations working together do to actively support State Peer Certification? Or B. What can you as the county or counties working together do to actively support State Peer Certification? Or C. What can you as individual advocates working together do to actively support State Peer Certification? Task: Develop Collaborative Action plan Report Outs 76

77 Group Report Outs (3 minutes each) Please share your action plan 77

78 Thank you for your participation! Per you will receive a survey monkey link with less than 10 questions to answer. Please help us by doing this by next Tuesday, October 25, It will take you less than 1 minute to complete. Thanks Before you leave Please complete your Forum Evaluation Form to give us. Thank you! 78