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Peers Easing Strain Of Mental Health Workforce Issues, ACA Service Demand

Mental Health Weekly���� September 30, 2013

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In an era of health reform along with an increasing shortage of mental health workers, the employment of peers to help consumers with medication, employment and general health issues is gaining increasing importance. Georgia and Michigan state health officials, for example, are using peer support specialists as whole health and wellness coaches and as healthcare navigators in federally qualified health centers (FQHCs), respectively.

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Research shows that by using peer specialists, states can save mental health money by reducing hospitalizations and other emergency interventions, according to a Sept. 11 article appearing in Stateline, the daily news service of the Pew Charitable Trusts. The article noted that people with mental illness who are helped by peers tend to experience more thorough and longer-lasting recoveries.

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“We’re looking at the future of the public health model,” David Miller, project director for the National Association of State Mental Health Program Directors (NASMHPD), told MHW. “Having peers is absolutely critical to every aspect of our system. Mental health peers in the public health system — where mental health is considered part of public health and not a separate service — fits where we are going.”

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“We’ve seen a dramatic impact with employment, and healthcare,” Miller said. “Peers who are in better physical condition are more engaged in looking for work and keeping a job.”

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Miller cited the Transformation Transfer Initiative (TTI) grant program created by the Substance Abuse and Mental Health Services Administration (SAMHSA) to assist states in their efforts to transform behavioral health delivery systems. “There’s no reason peers can’t fill many roles in our workforce,” Miller said.

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“SAMHSA is promoting these critical initiatives by funding states to address these transformational kinds of issues,” Robert Glover, Ph.D., NASMHPD executive director, told MHW. “We are hopeful that will continue.” States are making sure to continue with their own funding, he said. State officials realize the value peers bring to their involvement in service delivery, Glover added.

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Glover noted one TTI project in Georgia that includes peer specialists working in the whole healthcare arena. “Now Georgia is the first state in the nation to be allowed reimbursement for its peers involved in whole health training,” he said. “We hope all states do the same thing. We think that’s valuable.”

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“We are delighted that CMS [Centers for Medicare & Medicaid Services] has acknowledged that and is actively [supporting] peer delivery service,” Glover said. “Now they’re funding the whole health support, which includes not just mental health, but also tobacco cessation, weight loss, exercise, lower blood pressure and a variety of other issues.”

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“Consumers and peers are invaluable to the future public mental health system,” said Glover. “Not only do they have a role to play, but they should be at the table in all aspects of our system.”

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Georgia Peers In Whole Health

On June 6, 2012, CMS approved Georgia as the first state to have Medicaid-recognized whole health and wellness peer support provided by certified peer specialists (CPSs).

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Georgia’s approved Medicaid service is delivered by peer support whole health and wellness coaches certified in Whole Health Action Management (WHAM) training — a health plan developed by peers for peers to help them improve chronic health and behavioral health conditions.

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The WHAM training is based on the curriculum developed by the SAMHSA-HRSA Center for Integrated Health Solutions, run by the National Council for Behavioral Health, to promote whole-health self-management and strengthen the peer workforce’s role in integrated healthcare delivery.

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Georgia has had several pilot programs involving CPSs throughout the state prior to implementing its health and wellness initiative, Wendy Tiegreen, director of the Office of Medical Coordination and Health System Innovation, told MHW. The Peer Support Whole Health and Wellness program began offering services to consumers with serious mental illness in January 2013, following two program pilots, she said.

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A study of the pilot was subsequently published in Schizophrenia Research. “What we learned during our study is that the individuals who were participants in the pilot and had a serious mental illness and physical health condition achieved a 67 percent positive change in their whole health [condition],” Tiegreen

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Overall, participants were asked a series of questions regarding their whole health, including sleep, diet and exercise. Forty-seven percent of individuals in the pilot indicated specifically that their physical health improved, she said.

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The program is funded partially through Medicaid reimbursement, she said. “We have a Medicaid billable service code for health and wellness,” she said. Some state funds are also available for individuals who are not enrolled in Medicaid, Tiegreen noted.

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“Georgia’s whole health program is unique because very few states are addressing this in an integrated manner,” said Tiegreen. Some states still have a behavioral health benefit that is separate from the managed general healthcare benefit, she said. Others have subcontractor agreements with vendors who provide behavioral health services separately, Tiegreen said.

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“Peers coaching people about their general health is a natural fit for peer specialists who approach services from a strength-based, recovery-oriented perspective,” she said.

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Michigan peers in FQHCs

The Michigan Department of Community Health received a TTI grant provided through NASMHPD a year and a half ago to support the work of certified peer support specialists (CPSSs) in an urban and rural federally qualified health center [FQHC], said Pamela Werner, manager of the peer support initiative for the department.

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The peers work with medical practitioners, physician assistants, doctors, nurses and diabetes educators to help individuals who have a serious mental illness and/or substance use disorder in addition to at least one physical health condition, she said.

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“The goal is to support people in self-managing their chronic conditions health and wellness classes, and with navigating the health system to improve quality of care and assisting with physical and behavioral health integration among several health systems and providers,” Werner told MHW. “The end result of the grant is to sustain the program, with the FQHC providing peer services after the funding has ended.”

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The CMS leaves it up to states to decide if CPSS services provided at the FQHC are covered by Medicaid, said Werner. An FQHC can still hire peer specialists and look for other sources of funds in its current resources, she said. Werner said she has received inquiries from other states about similar work with CPSSs.

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The Carter Center on Sept 24–25 hosted its Pillar of Peer Support conference, which included discussion on how states can expand their peer workforce in the FQHC, she said. Werner spoke and shared information about Michigan’s TTI grant and the kind of work CPSSs are doing while employed at FQHCs.

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Peers throughout Michigan are working in the physical health arena and helping consumers achieve healthy lifestyles, she said. “They’re also working in emergency rooms and co-location sites that include PCPs and behavioral health providers. Peers are working to prevent the 25-year early-death mortality rate for consumers with serious mental illness,” Werner said.

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