Roles of Peer Providers in Integrated Health
Billing for Peer Provided Services
Strengths Peer Providers Add to the Integrated Health Workplace
Tips for Promoting Roles of Peer Providers in Integrated Health
Sample Job Descriptions
Whole Health Action Management Training
Who Are Peer Providers?
A peer provider (e.g., certified peer specialist, peer support specialist, recovery coach) is 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 resiliency.
In primary care, peer support services have traditionally been limited to an informal or volunteer role of connecting people living with chronic conditions, such as diabetes, in sharing knowledge and experiences with each other. More recently, peer support roles have evolved to include community health workers, peer coaches, and more. Peer Support in Primary Care Settings focuses around four core functions and enhances primary care by providing self-management around chronic conditions.
In integrated health, an emerging key role for peer providers are interventions that result in the activation of whole health self-management by those in recovery from behavioral health and chronic health conditions (Druss et al. 2010; Brekke et al. 2012). Growing national recognition of this critical role of self-management to promote resiliency and whole health resulted in creating a federally-funded peer-delivered training called Whole Health Action Management (WHAM) developed by the SAMHSA-HRSA Center for Integrated Health Solutions operated by the National Council for Behavioral Health.
Pioneered by Dr. Peggy Swarbrick in behavioral health as wellness coaching, there are two primary roles in which peer providers are being researched in randomized controlled studies for whole health self-management interventions. They are Health Navigators (The Bridge/Pacific Clinics - research by Brekke et al) and Whole Health and Wellness Coaches recently approved for a CMS service in Georgia called peer whole health and wellness (Georgia Department of Behavioral Health and Developmental Disabilities – research by Cook et al). Prevention plays a key role in health care reform and by focusing on resiliency and whole health, peer providers can activate self-management of prevention factors researched in mind-body medicine like stress management to promote health and longevity.
In the field of behavioral health, Medicaid billing for peer support services began in Georgia in 1999, and quickly expanded nationally after the Center for Medicare and Medicaid Services (CMS) sent out guidelines in 2007 to states on how to be reimbursed for services delivered by peer providers. In 2012, Georgia was approved as the first state to bill for a peer whole health and wellness service delivered by WHAM trained peer providers.
Medicaid's Clarifying Guidance on Peer Services Policy, May 1, 2013 states that any peer provider must "complete training and certification as defined by the state" before providing services.
Beginning January 1, 2014, CMS is expanding the type of practitioners providing Medicaid prevention services beyond physicians and other licensed practitioners at a state’s discretion which could include peer providers.
Peer providers bring unique strengths and qualities to the integrated care team. These strengths include:
- Personal experience with whole health recovery that includes addressing wellness of both mind and body
- Insight into the experience of internalized stigma and how to combat it
Compassion and commitment to helping others, rooted in a sense of gratitude
- Can take away the “you do not know what it’s like” excuse
- Experience of moving from hopelessness to hope
- In a unique position to develop a relationship of trust, which is especially helpful in working with people in trauma recovery
- A developed skill in monitoring their illness and self-managing their lives holistically
Support a strong peer workforce by considering the following tips:
- Program readiness by all staff and service recipients trained on the role of peer providers and how to promote an agency culture of strength-based, holistic self-management
- Financial sustainability by ensuring peer services meet criteria for reimbursement like Medicaid billing with clear guidelines on how to bill
- Address boundary issues i.e. peer providers receiving services outside agency they work for, or if peer providers choose to continue receiving services where they work their files kept confidential to only approved staff
- Peer providers complete formal training that teaches them implementation of holistic self-management skills
- Peer providers have clear job descriptions
- Supervisors trained on role of peer providers and how to support them
- Peer providers create personal self-management tools like a Wellness Recovery Action Plan (WRAP) to promote their ongoing recovery and whole health
Job descriptions for peer providers working in integrated health should be tailored to the service setting they work in whether on treatment teams, out-patient, in-patient, health homes or peer wellness/respite centers. Following are some sample job descriptions from SAMHSA PBHCI grantees:
Here are sample job descriptions from SAMHSA PBHCI grantees:
The Whole Health Action Management (WHAM) Peer Support Training is an in-person, 2-day group training that equips peers to help the people they serve set and achieve whole health goals to improve chronic health and behavioral health conditions. The WHAM Training is now available in Spanish.
What are skills Peer Providers are taught in the Whole Health Action Management (WHAM) specialty training to become whole health coaches?
- Engage in person-centered planning to identify strengths and supports in 10 science-based whole health and resiliency factors
- Write an achievable whole health goal and weekly action plans
- Participate in peer one-to-one and peer support groups to create new health habits
- Elicit the Relaxation Response to manage stress
- Engage in cognitive skills to avoid negative thinking
- Know basic whole health prevention screenings and how to prepare for them
- Use shared decision-making skills for more engaging meetings with doctors and other health professionals
For more information on the Power of Peer Providers, check out our eSolutions The Gifts Peer Providers Bring.
Wellness Coaching: A New Role for Peers, created by Dr. Peggy Swarbrick, discusses peer providers' roles as wellness coaches.
SAMHSA's BRSS TACS webinar, "Equipping Behavioral Health Systems & Authorities to Promote Peer Specialists/Recovery Coaching Services" includes information on challenges experienced by peers in the workforce, by behavioral health programs and behavioral health systems and authorities along with recommendations.
The Health and Recovery Peer (HARP) Program: A Peer-Led Intervention to Improve Medical Self-Management for Persons wit hSerious Mental Illness, created by Dr. Ben Druss, analyzed the effectiveness of peer providers facilitating self-management.
A Pilot Test of a Peer Navigator Intervention for Improving the health of Individuals with Serious Mental Illness demonstrated that Peer Health Navigators positively impacted health.
Peer Involvement in Integrated Physical and Behavioral Health Services: Promoting Wellness through Recovery-Oriented Care People with mental and substance use disorders often have co-occurring chronic medical conditions and complex health needs. Fully integrated medical and behavioral health care establish effective linkages between physical and behavioral health services within a single location. This webinar outlines the principles of recovery-oriented integrated health care and discusses the roles of peers in integrated health services, drawing from examples of innovative health services supported by SAMHSA's Primary and Behavioral Health Care Integration (PBHCI) Program. Original Air Date: February 28, 2013.
The Evolving Behavioral Health Workforce conference, 2013 featured presentations on the peer workforce.