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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 randomized controlled studies research peer providers. They are Health Navigators (The Bridge/Pacific Clinics - research by Brekke et al) and Whole Health and Wellness Coaches (Georgia Department of Behavioral Health and Developmental Disabilities – research by Cook et al). Prevention plays a key role in healthcare reform. By focusing on resiliency and whole health, peer providers can activate self-management of prevention factors, such as 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 in 2007 after the Center for Medicare and Medicaid Services (CMS) sent guidelines 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.
- CMS' Clarifying Guidance on Peer Services Policy from May 2013 states that any peer provider must "complete training and certification as defined by the state" before providing billable services.
- Beginning January 1, 2014, CMS expanded the type of practitioners who can provide Medicaid prevention services beyond physicians and other licensed practitioners, at a state’s discretion, which can 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:
- 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, outpatient, inpatient, health homes or peer wellness/respite centers.
Jefferson Center - Wellness Peer Health Coach
- AspenPointe - Peer Health Coach
- Cascadia Behavioral Healthcare - Advanced Peer Wellness Specialist
Cascadia Behavioral Healthcare
- Peer Wellness Specialist I
- Peer Wellness Specialist II
Jefferson Center for Mental Health
- Peer Health Specialist
- Wellness Peer Specialist Health Coach
The California Association of Social Rehabilitation Agencies (CASRA) with support from Integrated Behavioral Health Project and funding from the California Mental Health Services Authority announced a new toolkit, Meaningful Roles for Peer Providers in Integrated Healthcare. The toolkit provides integrated care settings with information on how to best hire, train, integrate and retrain Health-Trained Peer Support Specialists onto multi-disciplinary teams. It includes sample job descriptions for the following roles.
- Peer Support Assistant Coach – Total Wellness Program, San Mateo County (pg. 43)
- Peer Health Navigator – Pacific Clinics, Los Angeles County (pg. 44)
- Peer Specialist 1 and 2 – Manzanita Services, Mendocino County 47
- Peer Care Manager 1, Peer Care Manager 2 and Peer Care Manager Team Lead
Manzanita Services, Mendocino County (pg. 52)
- FQHC Peer Partner – Gardner Family Health Network, Inc., Santa Clara County (pg. 58)
- Wellness Peer Specialist Health Coach –SAMHSA/HRSA (pg. 60)
The Whole Health Action Management (WHAM) peer support training is an in-person, 2-day group training that equips peer providers to help the people they serve set and achieve whole health goals to improve chronic health and behavioral health conditions. The WHAM training is also available in Spanish.
What skills are peer providers are taught in the Whole Health Action Management (WHAM) 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
- The Peer Support Program Toolkit created by the Behavioral Health and Wellness Program (BHWP) at the University of Colorado provides evidence-based information to help individuals and organizations understand the value of adding peer specialists to their teams. The toolkit also provides practical tools and step-by-step instructions to plan for, implement, and sustain a successful peer support program.
- The Western Massachusetts Recovery Learning Community, in partnership with Legere Consulting and the Western Massachusetts Peer Network, has created a handbook on implementing peer roles. The handbook has two different sections. One section is written for providers who have or are in the process of implementing peer roles, while the other is intended for individuals working in those roles.
- Equipping Behavioral Health Systems & Authorities to Promote Peer Specialists/Peer 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 on how to overcome these challenges.
- For more information on the power of peer providers, check out our edition of eSolutions on The Gifts Peer Providers Bring.
- SAMHSA's Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) webinar, Ethics and Boundaries for Peer Leaders, discusses the important issue of boundaries.
- Wellness Coaching: A New Role for Peers, created by Dr. Peggy Swarbrick, discusses peer providers' roles as wellness coaches.
- The Health and Recovery Peer (HARP) Program: A Peer-Led Intervention to Improve Medical Self-Management for Persons with Serious Mental Illness, created by Dr. Ben Druss, analyzes 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 demonstrates that peer health navigators positively impact health.
- Peer Involvement in Integrated Physical and Behavioral Health Services: Promoting Wellness Through Recovery - Oriented Care, a SAMHSA webinar, outlines the principles of recovery-oriented integrated health care and discusses the roles of peers in integrated health services.
- Evolving Peer Support: Recovery Coaching, Whole Health, and System Integration, a webinar from ACMHA: The College for Behavioral Health Leadership and Magellan Health Services, presents issues relevant to the evolving nature of peer support services and integrating peers in the behavioral health system.
- 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 2013 Evolving Behavioral Health Workforce conference featured presentations on the peer workforce, including: