california peer specialist (ps) career pathway
DESCRIPTION
California Peer Specialist (PS) Career Pathway. State Certified Peer Specialists. Current & Future Need. Current CA Peer Specialist workforce estimate : 6,000 Peer Specialists reflect cultural , ethnic, linguistic, sexual orientation, & socio-economic diversity - PowerPoint PPT PresentationTRANSCRIPT
California Peer Specialist (PS) Career Pathway
Transitional Age Youth, Adult, Older Adult
Consumers
Family Member
Parent or Caregiver
Peer Specialists
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State Certified Peer Specialists
Current & Future Need
Current CA Peer Specialist workforce estimate: 6,000
Peer Specialists reflect cultural, ethnic, linguistic, sexual orientation, & socio-economic diversity
Given anticipated workforce shortages; Peer Specialists can fill this gap while increasing diversity in workforce
Depending on service settings, ratios range from 1:10 to 1:50 of Peer Specialists to people served in public mental health
1:25 ratio = need 39,312 Peer Specialists From DHCS Behavioral Health Services Needs Assessment (Feb. 2012) & Pillars of Peer Support 2
Future Need
Optimal workforce total of 39,312 Certified Peer/Family Specialists
To build an optimal cost-effective recovery & resiliency-based workforce in 2013, current needs is:
An increase of 33,312 Certified Peer/Family Specialists
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Peer Specialists often lack upward mobility, lack applied career ladders & graduate education
Quality, Diverse, Mental Health Workforce of Trained People with
Lived Experience
Pre-Training Workforce
K-12 education
Adapted from the coordinated health career pathway developed by Jeff Oxendine.
Career
awareness
Trauma,
mental health, &
substance use
exposure
Assessm
ent
Academ
ic preparation &
entry support
Financial &
logistic feasibility
Access to health professions
training program
Training program
retention
Internships
Financing &
Support System
s
Hiring &
O
rientation
Retention &
A
dvancement
Health Professions Education
Cultural Sensitivity and Responsiveness
No Financial support of individuals in Peer Specialist training programs
No CA scope of practice, training, supervision standards for Peer Specialists via State certification
Stigma, lack of understanding of value of peer specialist, recovery & resiliency to mental health
Uneven state distribution of and access to training in rural, small programs
Limited awareness of profession; No recognition of profession Coordination &
Support Infrastructure
Mental health professionals doubt value,
abilities of Peer
Specialists
No State Plan Amendment or mechanism to bill Medi-Cal SPECIFICALLY for ‘Peer Specialist as a Service Type’or ‘Provider type’
Lack of Internships & training for other professionals on how to work with Peer Specialists
County policies differ, few counties allow PSS to bill on existing codes
Inappropriate assignments, lack supervision
Lack funding for State certification of Peer Specialists
Background checks bar employment of Peer Specialists well qualified to serve special populations
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Peer Specialist PathwayTARGET GROUPS: Required to bepeople with lived experience with mental health challenges, includingConsumers, Family Members, Parents.
• Recipients of Behavioral Health Services
• People from Diverse Cultural & Linguistic Communities
• People in Jail & Prison Re-entry Programs
• Faith-Based Community Members• Promotoras & Health Conductors
• Adult Education Regional Occupational Programs
• Middle, High School, Community College Students
• Veterans • Career Changers, Previously
Employed Workers with Disabilities
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Barrier Recommendation
Lack of: Peer Specialist Scope of
Practice
Training Standards
Supervision Standards
State Certification of Peer Specialists through Certifying Body
Adopt WWT Stakeholder Recommendations to implement State Peer Specialists Certification
Include Consumer, TAY, Adult, Older Adult, Family member, and Parent Provider
Establish State Certifying Body
Recommendations: Identified Barriers
Recommendation: Establish Certifying Body
To be a Peer-Operated Organization &/or Existing State Organization with certifying capacity (i.e. Statewide Consumer & Family/Parent Collaborative)
To honor & vet existing trainings developed by local consumer & family organizations to retain cultural & regional diversity
To establish formal Scope of Practice, Values & Ethics, & standards for supervision of Peer Specialists in CA
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Scope of PracticeSupervised Sample Duties Include:
Provide individualized support to coach wellness, resiliency and recovery
Facilitate Wellness Recovery Action Plan (WRAP) & other Health Management groups, ex. Diabetes
Model coping skills and self-help strategies Assist in development of Individualized Educational Plan (IEP)
& related school-based services Educate, advocate & mentor families & parents in navigating
systems & community services Liaison to services for wellness needs, community resources,
groups & natural supports
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Recommendation: Service Settings
Examples of Service Settings:
Crisis Respite Houses & Crisis Residential Hospitals & Outpatient Programs Housing & Employment Programs Primary Care Wellness Coaching Wellness Centers Homeless Forensic Programs (AB109) Full Service Partnerships/Integrated Service Teams Peer-Run Programs
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Recommendation: State Certification Education & Experience
State Certification 80 hours of training by accredited programs with testing Additional 25 hours of training for specialty emphasis in
whole health, forensics, co-occurring, foster care, etc. Continuing Education requirements for re-certification
Experience Lived experience with mental health challenges or family 6 months of full time peer specialist internship, work or
volunteer
Training Timelines Average time from starting training program to State
Certification would be under 1 year
Sample Core Competency Domains
1. Wellness, Recovery, & Resiliency 2. Interpersonal Communication & Collaborative
Documentation Practices 3. Professional Role Competencies (Law, Ethics, Boundaries)4. Integrated & Whole Health Services 5. Trauma Informed & Substance Use Service Competencies6. Diversity & Cultural Responsiveness 7. Systems Competencies & Navigation8. Effecting Change: Education & Advocacy9. Professional Development & Self Care10.Wellness Coaching, Natural Supports, & Local Resources
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Recommendations: Identified Barriers
Barrier Recommendation
Lack funding for California State Certification of Peer Specialists
Use MHSA WET dollars to fund & establish CA Peer Specialist Certification & initial funding of Certifying Body
Explore ongoing sources to fund certification expense
One source may be Certification fees paid by local agency/county
Recommendations: Identified Barriers
Barrier Recommendation
No financial support for individuals in Peer Specialist training programs
Develop Peer Specialist Stipend program using MHSA WET funds to support completion of training & internships for Certification
Explore ongoing sources to fund certification expense
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Recommendations: Identified Barriers
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Barrier Recommendation Lack CA State Plan
Amendment or mechanism to bill Medi-Cal for Peer Support Services as a ‘Service type’ or Peer Specialist as a ‘Provider type’
Amend State Plan to create a NEW Medi-Cal (Medicaid) billing ‘service’ & ‘provider’ type, specifically for Peer Support
Develop/promote other billing mechanisms for Medicare & other payors
Recommendations: Identified Barriers
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Barrier Recommendation
Lack of recognition of Peer Support Services as a unique service
Develop policy statement on peer support as distinct from other disciplines to maintain the integrity of peer specialist services (R12)
Recommendations: Identified Barriers
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Barrier Recommendation
Under existing Medi-Cal codes, few CA Counties currently allow Peer Specialists to bill (under Rehab. Option, Targeted Case Management)
Lack of knowledge about recovery & resiliency based documentation practices
Provide CMHDA training on PS job classifications, documentation practices, to allow peer specialists to bill based on promising practices in counties already securing federal reimbursement for existing codes
Train staff to use collaborative documentation & CMS-approved recovery/resiliency-oriented language in documentation
Recommendations: Identified Barriers
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Barrier Recommendation
Limited awareness of profession
Lack of recognition of Peer & Family Specialist Profession
Develop State Certification to legitimize profession
Establish a Peer Specialist Consortium or Professional Association
Fund a plan for extensive & expansive training on the values, philosophy & efficacy of peer support to MH system (R10)
Recommendations:Identified Barriers
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Barrier Recommendation
Stigma & Discrimination
Fund a plan for extensive training on the values, philosophy & efficacy of peer support to MH system (R10)
Partner with CalMHSA to leverage statewide anti-stigma campaign to impact Behavioral Health professionals & service providers
Employ multiple Peer Specialists in diverse programs and teams
Recommendations: Identified BarriersBarrier Recommendation
Retention Barriers
Work assignments outside of Peer Specialist role
Lack of supervision or effective supervision
Certifying Body to collaborate with Peer Specialist Providers to finalize Scope of Practice & Supervision Standards
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Recommendations: Identified Barriers
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Barrier Recommendation
Mental Health professionals doubt the value & abilities of Peer Specialists
Develop a plan for welcoming environments that embrace the use of multi-disciplinary teams incorporating Peer Specialists fully (R11)
Leverage statewide anti-stigma campaign to impact Behavioral Health service providers
Encourage MH graduate programs to cover the value, role, & integration of Peer Specialists
More exposure to Peer Specialists in psychiatric residency
Recommendations: Identified Barriers
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Barrier Recommendation
Lack Internships & lack of training for other professionals on how to work with Peer Specialists
Train other professionals on the distinctly unique role & value of Peer Specialists
Develop Internships in CBOs, clinics, health organizations
Incentivize internships for Peer Specialists & agencies by developing a State-funded stipend program as part of the Peer Certification process
Recommendations: Identified Barriers
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Barrier Recommendation
Uneven & lack of access to training programs in rural, small counties
Fund & implement statewide certification for Peer Specialists
Identify Certifying Body Establish statewide Curriculum
Standards Implement Training Programs Ensure linguistic & cultural
Access
Recommendations: Identified Barriers
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Barrier Recommendation
Employment background checks bar employment of Peer Specialists well qualified to serve special populations
Educate HR on alternative methods of screening for qualified peer specialists
Look at promising models from other states
Work with committees & state agencies to address civil services barriers to the employment of Peer Specialists (R15)
Recommendations: Identified Barriers
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Barrier Recommendation
Lack of opportunities for Peer Specialists to advance to higher paying positions
Establish certification & new reimbursement for Peer Specialist Services
Develop Career Ladder opportunities for peer specialists to advance into management & leadership & to cross pathways to licensed professions
Value lived experience in all behavioral health professions
Highlight/promote counties successful with ladders
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Ladder DESCRIPTION - QUALIFICATIONS Job Classification(s)
1 a optional
Lived Experience & Middle School &or High School mental health track
High School Peer/Family Specialist Volunteer/Intern
1 b Lived Experience & Community College mental health certificate or
Peer-run organization’s training
Apprentice, InternPeer/Family Specialist Volunteer
2 Lived Experience & Proposed Basic State Certificate training--55 hours plus 25 for category of peer
specialist—Young Adult, Consumer, Older Adult, Family, Parent/Caregiver
Peer/Family Specialist Intern
3 Above + Pass Certification Testing with 6 months full time equivalent peer specialist work
or volunteer
Certified Peer/Family Specialist
4 a Lived Experience, work experience as Certified Peer Specialist
Certified Peer/Family Specialist Journeyman
4 b optional
Lived Experience + above, Specialization Certificate requires additional 25 hours training and exam for
Co-occurring SU, Forensic, Crisis, Veteran, Foster Care, Whole Health, etc
Certified Whole Health PS Certified Co-occurring SU Peer Specialist, etc.
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Ladder Description, Qualifications Job Classification(s)
5 Lived Experience & Work experience as Certified Peer/Family Specialist
Senior Certified Peer/Family Specialist, Supervising Senior Certified, Certified Whole Health Peer/Family Specialist
6 Work experience as Senior Certified Peer/Family
Support Specialist
Manager, Administrative Systems Level Certified Peer/ Family Specialist, Director Consumer &/or Family Affairs
7 Lived experience & BA, BS in psychology, sociology,
rehab counseling
Psychiatric Technician, Rehabilitation Counselor, Employment Specialist
8 Lived experience & MA, MS in psychology, sociology,
social work, rehab counseling
Rehabilitation Counselor II, Employment Specialist, Social Worker or MFT, psychologist
9 Lived Experience & MA, MS Social Work, MFT, MA, MS in Psych or Rehab Counseling
Licensed Provider with Lived Experience Certified Peer/Family Specialist
10 Lived Experience & LCSW, LPCC, LMFT, etc.
Supervising Licensed Provider with Lived Experience
11 Lived ExperienceDoctorate
Educator/Researcher/Psychiatrist with lived experience
Peer Specialists & Affordable Care Act
USA Today on September 11, 2013:
“Peers May Ease Mental Health Worker Shortage Under Obamacare”http://www.usatoday.com/story/news/nation/2013/09/11/stateline-mental-health/2798535/
“It’s not- like you might think- that you don’t have the money to offer recovery support services, but rather that you don’t have the money NOT to offer them.”
Quote from Keith Humphreys, Pillars of Support 201226
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