Peer Counselors/Specialists in the Mental Health Workforce

Exploring the idea of integrating Peer Specialists into the Mental Health Team on

3A Unit or the ED at PRMC Everett

About your PRMC EverettPatient & Family Advisory Council

The Patient and Family Advisory Council provides hospital staff with valuable feedback and personal insights on the patient care experience.

The Council members represent patients, family members of patients, or members of the community.

Members are enthusiastic about the mission: “As people of Providence we reveal God’s love for all, especially the poor and vulnerable, through our compassionate service"

Provide patient & family insight into the planning

Evaluate and provide feedback for new programs, forms, and patient materials

Various committees bring the patient & family perspective to hospital departments

What is a Certified Peer Counselor/Specialist and

what do they offer?What do you already know?

Why consider PRMC a candidate for integration?

According to the State of Washington

Services they can provide

How they are integrated into the Mental Health Workforce

Why consider PRMC a candidate for Peer Counselors?

The culture of innovation in care & setting the pace by implementing effective and innovative practices

The 10th busiest ED in the United States!The 1st busiest ED in the State of Washington!Number of patients presenting with mental health

issues at admissionThe need to reduce ED wait times & recidivismPatient & Family assistance navigating and

transitioning at discharge (effective, efficient, and safe handoffs)

WA State Certified Peer Counselor

"Certified Peer Counselor" is defined by the State of WA as: a consumer* of mental health services who has met the registration, experience, and training requirements, has satisfactorily passed the examination, and has been issued a certificate by the mental health division of DSHS (DBHR- Dept. of Behavioral Health & Recovery).

WAC388-865-0107

(Washington Administrative Code)

*Consumer, as defined by WAC 388-865-0150: “A person who has applied for, is eligible for or who has received mental health services.”

DSHS/DBHR RequirementsWAC 388-865-0107 cont.

(1) In order to be certified as a peer counselor, all applicants must meet the following requirements:

(a) Be a self-identified consumer of mental health services;(b) Maintain registration as a counselor under chapter 18.19 RCW;(c) Complete specialized training provided or contracted by the mental health division; and(d) Successfully pass an examination administered by the mental health division or an authorized contractor.

Minimum ExpectationsAccording to WAC 388-877A-0340

(1) Peer support services provide a wide range of activities to assist an individual in exercising control over their own life and recovery process through:

(a) Developing self-advocacy and natural supports;(b) Maintenance of community living skills;(c) Promoting socialization; and(d) The practice of peer counselors sharing their own life experiences related to mental illness to build alliances that enhance the individual's ability to function.

Integration of Peer Counselors into the workforce throughout

the U.S.

HistoryPrograms

NationallyWA State

Integration of “Credentialed” Peers into the Workforce2001Georgia becomes the first state to certify Peer Specialists to work in the mental health system2005Washington State begins certifying Peer Counselors2007 CMS (Centers for Medicare & Medicaid Services) issues a letter stating that states may opt to provided peer-to-peer services through Medicaid2014Most U.S. states train and certify peers for the workforce

Peers being integrated into the workforce across the U.S. Hospitals & Emergency Departments CMHA’s

PACT (Program for Assertive Community Treatment), Triage/Crisis Beds, running groups, etc.

Courts Mental Health Court, Drug Court, etc.

Jails/Prisons County MH Crisis Response Detox Centers/D&A Counseling Facilities Family Advocates Veteran Support The list is growing….

The “Peer Specialist” is widely becoming considered a mental health professional alongside their Social Worker and Licensed Professional Counselor colleagues. The field is also becoming more widely integrated as a billable service.

Peer workers on the Mental Health Care Team…Do not provide therapy

They do provide resources Identify patient/peers strengthsProvide a listening ear and support patients and their family or

supportersDo not provide medical or psychiatric assessments

They do empathize and provide comfortListen for patient identified needsHelp patient & family communicate needs to hospital/agency staff

Are not a “sitter”They can ask a patient if they would like someone to “keep them

company”, and can assess a patient’s wishes to maintain a sense of safety

A common misunderstanding is that peer support workers will enter the organization with a completely different set of goals for the people receiving services

They do collaborate and problem solve with their clinical teamThey share the same priorities & ethicsThey do respond to the needs of the individual and their

supporters by offering a structure for patients to voice their needsThey participate in shared decision makingThey encourage individuals to actively participate in their

treatmentThey provide lived-experience and knowledge of the mental health

system and the barriers consumers with mental illness faceThey help identify natural supports and help with transition at

discharge

National Survey: On the Job

Year of Survey

Average hourly wage

Average weekly hours

Average years on the job

Average # peers per week served

Percentage received job training

2007 $12.13 29.5 2.8 16.7 82.7%

2014 $13.53 32.2 3.8 19.75 93.3%

Comparison of 2007 and 2014 Surveys*In 2007 the National Association of Peer Specialists (NAPS) surveyed 173 peer specialists in 35 states. In 2014, responses to an enhanced survey were gathered from 605 peer specialists in 43 states.

*2014 International Association of Peer Supporters (iNAPS). A Report on U.S. Peer Support Provider Levels of Education, Compensation, and Satisfaction: A Comparison between 2007 and 2014.

The Evidence

Outcomes Effectiveness

Studies have concluded that the use of Peer Support…Reduces hospital readmissionsImproves patient transition from care to

discharge and into community support, care, and resources

Significantly reduces substance abuse issuesImproves communication with providersIncreases engagement with careReduces symptomsIncreases hopeDecreases suicide

“In programs which hire [peer workers], numerous, desirable attributes and abilities of [peer] employees have been noted … system knowledge, ‘street smarts’, responsiveness, coping strategies, patience & flexibility, relational emphasis, issues identification, engagement abilities, role modeling, advocacy against stigmatization, and educational activity with co-workers.”

(Van Tosh, 1993, Dixon et al, 1994)

Washington:*Pilot* Program

Serving individuals in the EDOctober 2014 Peer* Review Report**Report summarizing the outcomes of pilot programs NOT covered by Medicaid utilizing MHBG (Mental Health Block Grant) Federal Grant funding managed by DSHS/DBHR.

* The “Peer” reviewers here were Mental Health Profession colleagues, not “Peer Counselors”

** DSHS submitted the following report to assist the Division of Behavioral Health & Recovery (DBHR) in meeting the requirements set forth by the SAMHSA-awarded Community Mental Health Block Grant (MHBG) “Funding Agreement”, ensuring WA State is in compliance with Section 1943 of Title V of the Public Health Service Act.

Summary of ProgramProgram location:Good Samaritan Hospital ED, Puyallup, WA (MultiCare)

Program Description:Program serves any individual in the ED experiencing a crisis and referred by the ED physicians.

Program Goal:The goal of this innovative program is to provide the individual a “better experience” and reduce recidivism.

Staff: Mental Health Professionals + Certified Peer Support Specialist

Staff work collaboratively with ED staffStaff able spend more time with the

patient, families, and support systemsObjectives are to educate and connect

them to appropriate resourcesPeer perspectives and risk assessment

are done simultaneously (which is unique to this program)

Peers focus additionally on educating ED & hospital staff to work with individuals in mental health crisis and their support systems

Hospital provides an office for staff located in a visible location in the ED

Summary of OutcomesThese services assist persons when they need peer support

The services reduce the need for hospitalization by providing education & support

Final Rating on a 5 point scale:

4.75Reviewers were in agreement:

“This program is valuable, and consideration should be

given to expand this program to other hospitals.”

Program developed a strong relationship with hospital staff & auxiliary services

Use of peers increased patient and family understanding of the ED process

Peers scheduled when hospital anticipated serving high volumes of persons with mental health needs

Summary Cont….These services assist persons when they need peer support

The services reduce the need for hospitalization by providing education & support

Final Rating on a 5 point scale:

4.75Reviewers were in agreement:

“This program is valuable, and

consideration should be given to expand this

program to other hospitals.”

Peers assisted in reducing anxiety of family and patient

Focus was on identifying current & future needs of patients

Peers visible and available in the ED

Ability to follow-up with patients after discharge

With the program success atGood Samaritan ED

A similar Peer Specialist ED program started at St. Joseph's Hospital in Tacoma last month with a contract

between Optum (Pierce Co. RSN), the Franciscan Healthcare group and

Greater Lakes Mental Health!!

Current support of Peer Support ProgramsGOVERNMENTSTATEACA

FundingGood Samaritan ED programOct 2011 ~ Sept 2012 budget $200,000

Federal Revenue Source = $90,000

Medicaid Revenue Source =$110,000

Healthcare ReformThe Affordable Care Act of 2010 (aka

“Obamacare”) definition of the “Modern Mental Health Services System” includes:Expansion of services and Workforce

Development to include peer/family specialists in mental health care

Implement Practices which have proven to be “promising” and effective and “evidence-informed”

Who are the possible stakeholders?

ProvidersPayers

Employerspatients

Stakeholders? This is only a preliminary overview. Further in-depth investigation is required to identify stakeholders.

Providers Payers/FundingPRMC

ED Staff3A Staff

County?DMHP’sSno. Co. Human

Services Involuntary Treatment Team

PRMCCountyRSNDSHSSAMHSA

MHBG

Stakeholders? This is only a preliminary overview. Further in-depth investigation is required to identify stakeholders.

Those served directlyPatients with mental

health issuesFamily membersOther Patient Support

System members

Others affectedCMHC’sPatient’s existing PCP &

psychiatric providersOther ProvidersLaw EnforcementCity & CountyAdvocacy Organizations

Questions/SummaryWould a peer specialist be effective in the PRMC ED or 3A Unit?• What are the unique contributions the peer role could bring to our

organization?• Does the Peer Specialist role fit into priorities of the hospital &

the staff of each department?• What would make it a good experience?• What additional information is needed?

What do you anticipate could be some challenges? What concerns do you have?• What can we do to address those concerns?

Next Steps?• Action Items?• Responsible persons?• Follow-up and due dates?