certification of consumer, youth, family and parent peer support services regional forums working...
TRANSCRIPT
Certification of Consumer, Youth, Family and Parent
Peer Support Services
Regional ForumsWorking Well Together
Welcome and Orientation to the Day
O Welcome and IntroductionsO Review of the National Certification
EffortsO Medi-cal Billing and Peer ProvidersO Review of Peer Provider Training and
Employment in CaliforniaO Gathering Stakeholder InputO Barriers/Challenges and SolutionsO Final Thoughts and Comments
Comfort AgreementO What do you need to feel most
comfortable in the meeting process today?
PurposeO Gather stakeholder input for the
development of recommendations to the state on peer certification
Overall Project Process O Initiated by CNMHC workgroup called the
Peer Support CoalitionO Work transitioned to Working Well
TogetherO Monthly teleconferencesO Research reportO Five meetings throughout the stateO Consolidate feedback from these
meetings and prepare a final reportO Reconvene in one statewide meeting,
May 2013, to review recommendations
Data Collection for the Report
O Developed a survey for data collection on training and employment practices
O Contacted all counties/entities in California (59)
O Received 40 responses, representing 32 counties
O Reviewed raw data from the Pillars of Peer Support Report I for national data
O Made individual contacts with some statesO Reviewed OptumHealth draft reportO Reviewed website informationO Interviewed content experts
Defining Peer Providers
O For this report and today’s meeting, the term Peer Provider refers to people with lived experience as consumers, family members, parents and youth.
The Reason for Certification
O Certification provides formal validation of the role of peer providers.
O It seeks to standardize the quality of services provided by peers.
O It provides information on competencies to employers.
O It provides a scope of practice that consumers and family members can benefit from.
The Reason for Certification
O Separate from this, certification can be attached to the ability to bill Medi-Cal for services provided.
National Certification Efforts
O Up to 35 states are currently providing certification for consumer peer support specialists
O 4-5 states provide a family peer support certification
O Nationally, the main reason for pursuing certification has been connected to billing Medi-Caid for services provided by peers.
General Medi-Caid Information
O The Federal level of the Centers for Medi-Care and Medi-Caid services provide broad guidelines for flexibility and innovation among the states.
O States develop a plan for the provision of all Medi-Caid services.
O The State Plan is a negotiation between many state departments and the state Center for Medi-Care and Medi-Caid Services.
General Medi-Caid Information
O The State Plan for mental health services is a negotiation with the Department of Health Care Services and CMS.
O Services provided to people with serious mental illness or emotional disorders are called Specialty Mental Health Services.
Billing for Specialty Mental Health ServicesO Specialty Mental Health Services can
be provided through a number of options or waivers.
O Most of the states that bill for Peer Support Services do so through the Rehabilitation Option (one way to provide Specialty Mental Health Services)
State Plan
Specialty Mental health
Amendments Waivers
Rehab Option
TCM Managed Care
Research and
Demon-stration
Guidelines from CMS Regarding Peer SupportO The Federal CMS established
guidelines for the provision of peer support in 2007.
O It acknowledges Peer Support Services as an “evidence-based model of care”
O Guidelines coveredO SupervisionO Care CoordinationO Training/Credentialing
Strategies Used for Billing for Peer Provider
ServicesO Creation of a distinct provider typeO Creation of a distinct serviceO Utilization of existing service typesO Development of peer support
agenciesO Peer services provided as part of a
capitated rate within managed care entities
Certifying BodiesO Three examples of types of certifying
bodiesO Most common is through the
Department of Mental HealthO Private consumer and family
organizationsO Universities
Certification StandardsO Varies across the country
O For training, the range is 40-100 hoursO CEU’s: 12 hours annually to thirty
hours every two yearsO Supervision provided by a qualified
mental health professional (defined by each state)
O Care Coordination: Requirement of coordination of the multi-disciplinary team in all cases
Questions and Comments
The California State Plan
O California uses the Rehabilitation Option as its state plan for Specialty Mental Health ServicesO Also utilizes a Targeted Case Management
waiver and a Managed Care waiverO The state plan outlines the service
type, components within it and who can provide it
O For most service types, there is a category of provider type called “Other Qualified Provider”
Other Qualified Provider
O Qualifications of an “other qualified provider” areO Being 18 years of ageO High school diploma or equivalent
O Important to understand two things:O Not everyone can provide each
component of a service (scope of practice guidelines)
O County mental health directors may set their standards higher than what is currently in the state plan
Other Qualified Provider
O Both CMS and DMH have stated that the term “other qualified provider” is, in part, intended to mean Peer Providers.
O Typically, the scope of practice for Peers would be Rehabilitation Services and Targeted Case Management, but could include other types of services as well.
Current Practice in California
Current information to date indicates that there are nine counties billing Medi-Cal for services
provided by peers
O City of BerkeleyO San MateoO RiversideO Marin
O El DoradoO GlennO San DiegoO SonomaO Mono
Questions and Comments
Training of Peers in California
O California does not have a statewide certification of peer providers
O It does have several organizations that provide training/certificationO Consumer-operated training
organizationsO Parent Provider training organizationsO Community Colleges and Universities
Training of Peers in California
O Some counties train peer providers by using standard in-house trainings
O Training (including internship hours for some) ranges from 12– 480 hours
Samples of California Certificate Programs
O Family Youth RoundtableO Peer Support Certification (Children’s
System of Care)O Recovery Innovations
O Peer Employment TrainingO United Advocates for Children and Families
O Parent Partner 101, Educate, Equip and Support
O San Francisco City CollegeO Community Mental Health Worker
O SPIRIT, Contra Costa CollegeO Peer Mentoring Certificate
Curriculum ContentO A crosswalk of eight curricula: what
do the curricula for training peer providers have in common?
O The following training organizations were reviewed:O 3 consumer-operated organizationsO 2 family/parent provider organizationsO 2 community collegesO 1 statewide curriculum
Curricula CrosswalkO Sixty-two discreet topic areas
condensed into 17 broader categoriesO 70% of the curriculum content areas
occur in at least half of the curricula reviewed suggesting a fair degree of overlap
O Particular services and practices were condensed into a category called “Practices”.O Some of these are geared towards
specific populations or type of agency
Employment of Peer Providers in California
O Of the 32 counties, 31 are employing consumers/family members either directly or through CBO’s
O 21 counties directly hire into civil service positions
O Great diversity exists in job qualifications
Job QualificationsO Lived experience or lived experience
strongly preferred is the most common qualification
O Only five counties require completion of a recognized training program in addition to lived experience (even when excellent peer provider training opportunities exist in the county)
Job QualificationsO The requirement of job experience
ranges from six months to four yearsO Driver’s licenses were required in
three instancesO A background check was only
mentioned once
Scope of PracticeO Scope of Practice is the defined range
of responsibility and practice guidelines that determine the boundaries within which a professional practices.
O The survey asked about peers providing three types of supportO Individual O Group O Crisis
Scope of PracticeO The majority of peer providers are
providing individual and group support services.
O There were a significant number of “single” responses, indicating variety and uniqueness in job responsibilities.
O In the Pillars of Peer Support data, individual, group and crisis support received the highest number of responses.
SettingsO Peers work in a wide variety of settings.O Most commonly, outpatient clinics,
consumer-run organizations and FSP’s.O There were also a significant number of
“single” responses in this category.O Nationally, the Pillars data indicate that
peers most often work in ACT, community support programs and outpatient clinic settings.
County ClassificationsO There are 27 civil service
classifications in use for peer providers
O Two counties have step levels for advancement in these positions
O The majority are using existing codes vs. creating new coded positions
Questions and Comments
National Certification Programs
O Reviewed two national certification programs:O Certified Psychiatric Rehabilitation
PractitionerO Certified Alcohol and Drug Counselor
O Common elements are:O FeesO Test-basedO CEU’sO Work/volunteer experience requiredO Code of ethics
The Infrastructure of Certification Programs
O Develop standards/competenciesO Develop ethical standardsO Manage ethical violations and revocation
of certificationO Determine and vet curriculumO Determine eligibility for sitting for the
examO Develop exam questions, initial and
ongoingO Review applications
The Infrastructure of Certification Programs
O Administer the examO Provide oversight and management
of feesO Develop CEU requirementsO Audit CEU’sO Manage re-certificationO Actively engage in advocacy for
certificate holders with education and employment sectors
Important Considerations
O Statewide certificationO Development of a guild organizationO Selecting a certifying bodyO Identifying a core curriculumO Identifying core competenciesO Measurement criteriaO CEU’s
Important Considerations
O Statewide Certification, continuedO Funding
O FeesO Possible use of Workforce Education
and Training money
O Federal Guidelines for certification to bill Medi-CalO Care coordinationO Supervision requirements
Important Considerations
O The Role of Governing BodiesO Department of Health Care ServicesO Centers for Medi-Care and Medi-Caid
ServicesO Influential Groups
O California Mental Health Directors Association
O Mental Health Services Oversight and Accountability Commission
O Peer Provider Groups
Important Considerations
O SustainabilityO Funding to administer and manage
the certification programO Greater use of peer billingO Statewide MHSA WET money
O Peer-operated agenciesO Certified sites
Important Considerations
O PortabilityO A statewide certification is valid in
any California countyO Employability
O Civil service regulations will continue to be a barrier
O Certification does not guarantee that counties will accept and employ peer providers
Important Considerations
O Career Ladder OpportunitiesO Build into the certification process
mechanisms for advancement (Peer Specialist I, II, III, and beyond)
O Grandfathering-in decisionsO Rural and Small County Issues
O Access to training resources and pools of traineesO Regionalization
O Increasing peer-operated services
Important Considerations
O Health Care ReformO Primary care and behavioral health
care services will be closely linkedO Primary care may be the “health care
home” for people receiving medi-cal
O The health care field recognizes the strong evidence base for peer supportO As more medi-cal recipients move into
services, peer support specialists will be needed
Important Considerations
O Health Care ReformO Peer Support Services will be needed
to:O Provide outreach and engagementO Assist with access to servicesO Bridging activities to assist with
maneuvering in the new systemO Education of primary care providersO Implementation of wellness and
prevention strategies
Important Considerations
O The stakeholder groups can monitor work towards certification using the Best Practices outlined by the Pillars of Peer Support Report.
Questions and Comments
Stakeholder Survey
Focus Groups
Barriers/Challenges to Certification
Possible Solutions
Final Thoughts and Comments