Improving Outcomes with Peer Support How Peer Providers
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Improving Outcomes with Peer Support: How Peer Providers Can Benefit Transition Settings Susan Chapman, RN, Ph. D, FAAN, Professor, UCSF School of Nursing January 31, 2017 Steinburg Institute 1
Overview §Who are peer providers? §SAMSA study key Findings §California study: peers in transitional settings §Key Findings §Policy issues 2 January 2018
What is a peer provider? “A person who uses his or her lived experience of recovery from mental illness and/or addiction, plus skills learned in formal training, to deliver services in behavioral health settings to promote mind-body recovery and resilience. ” (Kaplan, SAMHSA, 2008) 3
SAMHSA Study: Case Studies (AZ, PA, GA, TX) § Peer providers found in traditional and peer run settings § Policy environment key to building peer programs • Medicaid billing key to sustainable funding • Some states mandate use of peers § Training and Certification • Statewide training and certification required for billing • MH and SUD trainings and certifications vary widely by state § Challenges • Stigma • Sustainable wages • Difficult career ladder 4
California Study: Purpose § Explore care models that enhance the utilization of peer providers in California § Identify and describe best practices in peer support roles for individuals with mental health or substance use disorders § Focus on services and programs that employ peers to help individuals transition out of incarceration and/or hospitalization 5
Methods § Updated literature on peers in transitional settings • Report: https: //healthforce. ucsf. edu/publications/review-recentliterature-peer-support-providers • Little evidence on the effectiveness of peer workers in transitional settings § Conducted site visits to 8 provider organizations in California § Interviewed program staff: • Program directors, supervisors, human resources, clinicians, peer providers § Used qualitative data software to analyze interview notes and explore key themes 6
Programs in Transition from Inpatient Hospitalization 5 programs: § Riverside University Health System – Behavioral Health Peer Navigation Center § San Diego NAMI Next Steps § Alameda County South, Mentor on Discharge § TLCS (Transforming Lives, Cultivating Success) Triage Navigator (Sacramento) § Los Angeles County Intensive Service Recipient and Kin through Peer 7
Programs in Transition from Incarceration § Riverside University Health System – Behavioral Health AB 109 New Life § San Mateo County Service Connect § TLCS (Transforming Lives, Cultivating Success) Triage Navigator (Sacramento) § Santa Clara Reentry Resource Center and Faith-based Collaborative § San Francisco Mentoring and Peer Support (MAPS) 8
Findings: Roles § Roles very similar in hospital and forensic program § Job titles vary but the roles are similar across settings § Population served often had dual history of mental health/SUD and incarceration § Peer providers were all employees of agency or department working with hospital or jail (were not direct employees) § Serve as role models • Provide services pre and post discharge from facility • Scheduled visits and ad hoc meetings with (client, consumer, participant) in facility, community, or agency centers 9
Findings: Training and Certification: Perspectives Differ § “Some think that for us to be valid we have to have a certification and a license—but the benefit of our roles is that we are just like the people we serve. This keeps us at a level with them. Personal experience is not a document that says, “I’m qualified. ” We all have our experiences, let’s bring them together. ” § “There are upsides and risks to certification. We have people with amazing potential. If we can use certification to chart a path of standard training and career advancement so people can be recognized and compensated for their work so they can continue to live in this county, It would provide a structure and guidelines for supervisors, managers, and peer providers in the workplace. 10
Findings: Funding § Grant funding • SAMHSA • MHSA Innovations • Kaiser Permanente Community Benefits § Whole person care (federal and state) § Direct county funding § AB 109 (Public Safety Realignment) § Medicaid billing 11
Findings: Impact “I had a peer on my team and he could go there and talk to the client on that level and he could connect in ways that I couldn’t. It was like, “I walked where you walk; I understand I get it. ” A guy who had been chronically homeless for a while turned and said, “I want to be just like (him)!” And I said, “We can do that; you can totally do that. ” They are living example of where we want people to go. ” § Anecdotal evidence is compelling § Some programs show reductions in repeat hospitalization and incarceration in grant-required outcome reporting § Long term outcomes not always measured § Little published literature on peer provider in transition programs 12
Workforce and Program Challenges § Stigma experienced by some § Direct access to transitional settings § Lack of sustainable funding § Lack of living wages and job security § Lack of career ladder § No standard training and certification § Funders often ask for ROI 13 January 2018
Policy Issues § Statewide certification and training standards may help address the following: • Provide more opportunity for Medicaid billing • Enhance the visibility and legitimacy of peer providers • Assure standard and basic competencies across the state § Direct access to clients prior to transition helps in making the connection with peer provider § Employment and career issues • Sustainable employment • Support for peers in continuing their own recovery 14
Summary § Peer provider programs in transitional settings show considerable promise in reducing re-hospitalization and recidivism § More assessment on the efficacy of these programs models may help determine what models are most effective in reducing rehospitalization and re-incarceration • Peer providers are part of a team effort • Evaluation should focus on team models and effectiveness of the whole team model § Sustainability of funding is critical to success 15
Funding and Contact Information This study was funded by the California Health. Care Foundation Contact Information: Susan Chapman susan. chapman@ucsf. edu Lisel Blash lisel. blash@ucsf. edu 16
Questions? Previous Reports § http: //healthworkforce. ucsf. edu/sites/healthworkforce. ucsf. edu/file s/Report-Peer_Provider_Workforce_in_Behavioral_Health. A_Landscape_Analysis. pdf § http: //healthworkforce. ucsf. edu/sites/healthworkforce. ucsf. edu/file s/Education_Certification_and_Roles_of_Peer_Providers. Lessons_from_Four_States. pdf#sthash. 2 Ca 7 Kdtn. dpuf 17 January 2018
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