Creating The Peer Support Workforce
Earlier this year, the North Carolina Department of Health and Human Services (DHHS) created a new service definition—care manager extender—that pays for the services of people with lived experience and family members in supporting the work of case managers. The new service system role has an estimated annual base salary of $47,000 and assumes they will perform between 20% and 40% of the case management activities for consumers.
With this change, North Carolina joins 39 other states that allow Medicaid billing for any type of peer support services. Of those states, 23 states allow peer support reimbursement for individuals with addiction and mental health disorders, 12 allow for mental health only, and four allow for addiction only.
As acceptance of peers as a formal and reimbursed part of the service delivery system—along with coaches, digital navigators, and more—grows, the question for organizations serving consumers eligible for peer services is how to create a peer workforce—and make sure they are ready for the new role. This was the focus of our July 14 OPEN MINDS Circle Elite Executive Roundtable, “The Evolution Of Peer Mentor Training Programs For People With I/DD — A North Carolina Case Study,” featuring Optum’s Senior Director of Behavioral Health, Medicaid Complex Population Development, Tracy Sanders, and Kelly Friedlander at Community Bridges Consulting Group.
In North Carolina, they have created a peer mentor program to develop the peer workforce. The pilot, launched in March of 2021, began with a two-week window for applications resulting in a total of 100 people with I/DD submitting applications. To be eligible for the pilot, the participants were required to demonstrate their familiarity with community I/DD resources, effective communication skills, basic reading/writing skills to review materials and keep notes, time management skills, ability to use technology (Zoom, Microsoft Word, and email), a high school diploma or equivalency, and were able to attend all training sessions. Fifteen participants with I/DD age 18 or older were selected for the pilot group. All 15 individuals continued through completion and stated that they would recommend the training to colleagues. The pilot included 12 weeks of class instruction led by four instructors (including two individuals with I/DD), held virtually, with regular testing assessments. The development of the peer mentor training curriculum was written and funded by Optum and each participant received a $300 stipend.
In setting up a peer support program, the speakers stressed the importance of three key factors—understanding state statutes, recruit partners for the program funding, and create a program evaluation process.
Understanding state statutes. Every state has different rules for coverage of peer support. The role of peers, the consumers served by peers, the specific services provided by peers, service reimbursement, and credentialing requirements are often different.
“What do you have to be to be a professional peer mentor? What are your states specific statutes? What’s the education level?” noted Ms. Sanders. “There was a great deal of discussion about requiring, for example, a GED or high school education to become a certified peer. Do you have to have references? Do you have to go through continuing education requirements to be certified? You have to have a practicum in place.”
Recruit partners for program funding. Peer mentor programs may or may not be funded by Medicaid. If not, it is important to develop a model and a budget—and find partners to help to cover the costs.
“We could not have done this without the amazing support of the National Association of Counsels and Developmental Disabilities, they helped us connect to local I/DD counsels, who played a fundamental role in participating in this pilot,” stated Tracy Sanders.
Create a program evaluation process. Demonstrating the efficacy of peer mentor program is important for payer confidence in the peers and for continued funding. The evaluation protocol and data gathered should be part of the initial program design
“As we all know data is extremely important, especially when we are trying to prove something as a promising practice,” stated Kelly Friedlander. “[Data] Told us what aspects of the training were beneficial and which aspects we needed to reevaluate.”
We’re likely to see increased coverage of the issues related to peer support professionals and peer support services—credentialing, reimbursement, scope of practice, and more—in the future. There are predictions that peer support professionals will make up 25% of the behavioral health workforce in the near future. And, peer support services have jumped the digital divide and become increasing common in digital behavioral health service delivery. This is part of the current reevaluation of roles and responsibilities in service delivery across the health and human service delivery system.
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