Peer Support Services (PSS) are a valuable and highly utilized component of behavioral health services. PSS are specialized therapeutic interactions conducted by self-identified current or former consumers of behavioral health services. Specialty behavioral health care organizations (BHOs) increasingly offer PSS as part of a comprehensive service approach since peer support specialists are trained to offer support and assistance throughout the recovery and community-integration process.
In the summer of 2012, the Association for Behavioral Health and Wellness (ABHW) surveyed its members, major managed behavioral health organizations (MBHOs) that offer behavioral health and wellness services to 125 million consumers, to determine the scope of PSS that they make available to their members. A complete copy of the survey report is available online.
The survey found that a diverse scope of peer support services, including the following, were being offered:
· one-on-one support for those navigating services;
· assistance with discharge and transition issues after an inpatient stay;
· supports with ongoing wellness and recovery;
· assistance with education and employment;
· crisis support and help in building personal coping skills;
· social networking services; and,
· self-determination and individual advocacy services.
One of the survey’s most significant findings was the determination that, when PSS are offered, they are popular and highly used. Though criteria for gaining access to PSS vary among BHOs, consumer demand and needs continue play an important role in determining the shape and availability of PSS offered. Availability of PSS may also be limited by shortages of peer support providers in certain locations.
Differences in the Medicaid programs in each state mean that reimbursement for PSS varies widely. Specific examples of services that may or may not be covered by Medicaid, depending on the state, include Peer Bridgers, Whole Health Peer Coaches, Addiction Recovery Coaches, Family Peer Navigators, Family Peer Coaches, Peer Warm Lines, Self-esteem/Anger Management Coaches, and Community Support Programs. ABHW members that operate in multiple states often face such reimbursement challenges.
Another challenge identified in the survey is the absence of a national standard (other than for Certified Parent Support Providers) for training of PSS professionals. Many states specify some training guidelines, though existing PSS training programs vary in approach and requirements. The result is inconsistency, both in the content of different training programs and in the skill sets of the peer support specialists that they produce. Because so few states have established peer training models, BHOs choose to follow the five training models that are recognized by the Veterans Administration Guidelines -- the DBSA (Depression and Bipolar Support Alliance) Model, the Georgia Model, the Mental Health Association of Southeastern Pennsylvania Model, the NAZCARE Model, or the Recovery Innovations Model.
Maintaining the differentiation of roles between peer support specialists and clinicians is another important component, in order to ensure that consumers receive appropriate care. Peer Support Services are offered as an additional benefit to improve the patient’s overall health and wellness, not as a substitute for other health care services. Effective coordination of care is an essential component of a comprehensive approach that includes PSS.
Recommendations for advancing the use of peer support services
Based on the survey findings, a number of recommendations were identified, including:
- The need to ensure appropriate and consistent reimbursement and billing policies that remove administrative hurdles to the utilization of peer support services.
- The need to identify and address obstacles that impede service delivery. For example, peer hotlines are not always a reimbursable service under Medicaid yet it is a service that is sometimes requested by peers.
- The need to develop a national screening, training, and credentialing program for peer professionals to ensure uniform training and skill sets.
- The need for additional research, including peer-reviewed studies, as the basis for stronger guidance and greater market acceptance for the use of PSS as a core component of behavioral health services.
As evidenced by the wide-spread utilization of PSS among ABHW members, it is clear that this is an approach that is here to stay. Managing the growth of this important service while ensuring it meets the appropriate standards will be an essential component to the continued availability of this very popular service.
Coral Ellis is an intern with the Association for Behavioral Health and Wellness, Washington, DC. She is now completing a Master's Degree at George Washington University.