Peers Gone NationalMarcie Timmerman, MHA

Executive Director, Mental Health America of Kentucky

Email: mhaky@mhaky.orgCall or Text: 859-684-7778

www.mhaky.org

Twitter: @MarcieTimmerman @MHAKentuckyInstagram: @mhaofky

OBJECTIVES

1. Comprehend National Peer Support Certification2. Analyze Peer Support Services in your organization3. Judge when National Peer Support Certification is right for you (or your employees)4. Synthesize national and statewide trends in peer support services

Disclosures• MHA Kentucky can and does charge a fee if we proctor NCPS testing.

That fee is $35 for covering our staff and space cost for the three hours of administration. We do not profit from testing.

• MHA Kentucky accepts sponsor dollars from many corporations and organizations for events. We do so with the agreement that funds do not in any way influence our educational or advocacy content.

• I have not been paid for any of this work. I have no known financial interests in NCPS testing or any peer support programs.

Brief Introduction to MHA Kentucky

• Mission Statement• How we fit in with MHA National• B4Stage4 Philosophy• 120 by 2020 initiative• Quick explanation of the Mental Health Bell

FYI:I sometimes talk fast. Tell me to slow down if you can’t understand me.I was born a yankee. Tell me if you can’t understand my accent.ASK QUESTIONS. I’ll take pauses and breaks and breathe. Take that opportunity to ask about something you don’t understand.I’m not omnipotent nor am I omniscient. I’m not going to have every answer, but I’ll try to find one for you.My door/email/phone are always open. Ask! Tell stories about your concerns. Tell us what’s going on that worries you. Respect all people who are brave enough to share. Please keep any personal info shared here between yourself and that person.

Show of Hands….• Peer Support Specialists?• Addiction Peer Support

Specialists?• Family Peer Support Specialists?• Youth Peer Support Specialists?• Mental Health Provider (LCSW,

LPCC, MFT, PhD, MD)?• Employer – makes hiring

decisions?• Advocates?

What is Peer Support?

ACTIVITYHave you ever reached out to someone for advice on how to cope with something you know they’ve been through?What was good about that experience?Was there anything bad about that experience?How did reaching out in the first place make you feel?

Now, think about if you have an illness that people blame you for, people believe should just go away if you tried hard enough, that they don’t understand. Wouldn’t it be great to have someone to talk to who has BEEN THERE?

Peer support encompasses a range of activities and interactions between people who share similar experiences of being diagnosed with mental health conditions, substance use disorders, or both. This mutuality—often called “peerness”—between a peer support worker and person in or seeking recovery promotes connection and inspires hope. Peer support offers a level of acceptance, understanding, and validation not found in many other professional relationships (Mead & McNeil, 2006). By sharing their own lived experience and practical guidance, peer support workers help people to develop their own goals, create strategies for self--empowerment, and take concrete steps towards building fulfilling, self--determined lives for themselves.

-SAMHA Value of Peers 2017 (https://www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/value-of-peers-2017.pdf)

Peer Support has been shown to:

• Improve quality of life,• Improve engagement and satisfaction with

services and supports,• Improve whole health, including chronic

conditions like diabetes,• Decrease hospitalizations and inpatient days, and• Reduce the overall cost of services

Peer Support Workers/Peer WorkforcePeer support workers engage in a wide range of activities. These include:• Advocating for people in recovery• Sharing resources and building skills• Building community and relationships• Leading recovery groups• Mentoring and setting goals

Peer Workers Continued…Peer support roles may also extend to the following:• Providing services and/or training• Supervising other peer workers• Developing resources• Administering programs or agencies• Educating the public and policymakers

What is a Peer Support Specialist?

“Peer Support Specialist” is the term for peer workers in Kentucky.

Ages 18-35, have a mental health or substance use diagnosis

Aged 18+, have a mental health or substance use diagnosis

Aged 18+, have a family member who has received services

Kentucky Peer Support Specialist Education Requirements

Core Components of the Curriculum for Adult Peer Support Specialists (30 hours) & Family Peer Support Specialists (30 hours, prereq. Leadership Academy)

• Problem solving• Wellness recovery action plan• Stages in the recovery process• Effective listening skills• Establishing recovery goals• Using support groups to promote and sustain recovery

KPSS Requirements continuedCore Components of the Curriculum for Youth Peer Support Specialists (30 hours, prereq Leadership Academy)• System of care philosophy• Wraparound process• Youth support• Group process• Cultural and linguistic competence• Communication• Organization• Self-care• Leadership• Ethics and values

KPSS requirements continuedCore Components of the Curriculum for Kentucky Family Leadership Academy

(15 hours) (prerequisite for both potential Family and Youth Peer Support Specialists)

• Leadership roles• Communication skills• Decision-making skills• Dealing with conflict• Effective advocacy• Collaboration and partnerships

Find out more in Kentucky:• Peer Specialist Introductory Test Curriculum criteria, sample exams,

and more: Dept. of Behavioral Health & Developmental Disabilities https://dbhdid.ky.gov/dbh/pss.aspx

• MHANKYSWOH: https://www.mhankyswoh.org/peer-support• Kentucky STARS www.kystars.org• Bridgehaven Center for Peer Excellence

http://www.bridgehaven.org/peer-support-training/• Consumer Conference May 2020, Clarion Hotel in Lexington

A few precious points…..

• You can be a Peer Specialist and NOT intend to enter the peer workforce.

• You can offer peer support and NOT be a peer specialist (we suggest training, however).

• Peers who perform Medicaid and Medicare billable services need to be peer specialists and have supervision.

Where are we, nationally?• Between 2008 and 2018, over 30 state Medicaid programs added peer support as

a covered service. There are a number of common services across the country -drop-in centers, respite facilities, warm lines, and self-directed care programs. But there’s still a lot to be done – adolescent/young adult peer support is only covered by Medicaid in seven states. Peer support programming for families is on the rise as a reimbursable service. There are also opportunities to expand peer support in a way that is tailored to people with intellectual disabilities, physical health concerns/chronic diseases, older adults, and the LGBTQ+ community.

• It is important to make sure that as the peer support field grows, it is done in a meaningful way. There is a lot of power in being an evidence-based practice that, by nature, focuses on human connection – and a tremendous amount of potential to reach the subsets of the population who need that the most.

• Thanks to the leadership of peers and the growing evidence around the practice over the past decades, the peer workforce has grown to over 24,000 supporters working in all 50 states and U.S. territories.

• Considered an evidence-based practice by the Substance Abuse and Mental Health Services Administration (SAMHSA), peer support is Medicaid reimbursable in over 41 states.

• From the criminal justice system to housing services to hotlines, peers model recovery and contribute to the lives of others.

What we know nationally….

• Across the four states, peer providers were employed in a variety of settings and sectors, including non- and for-profit organizations and government agencies. Some organizations were peer run and staffed. Clinical settings included mental health clinics, detox and rehabilitation centers, crisis stabilization units, and psychiatric hospitals. Non-clinical settings included peer-run respites, community centers, supportive housing, and sobering houses. Many peer providers spent most of their time meeting with consumers in the community or at a facility, such as a jail, prison, or probation center; mental health, family, or drug court; or hospital or primary care clinic. Typical job duties included leading wellness groups, teaching classes, case management, and one-on-one services, including referrals to housing, jobs, and other resources; financial counseling; wellness coaching; accompanying consumers to appointments; and emotional support provided in-person or telephonically. Documentation accounted for a significant portion of time for peer providers in Medicaid-billable positions. https://www.sciencedirect.com/science/article/pii/S0749379718316052

Concerns from the peer workforce….• Part-time nature (varying reasons)• Low wages• Multi-step career ladders are almost nonexistent• Require time to facilitate their own recovery• Need robust mental health benefits if full-time• Workplace stigma still exists for those not working in peer-operated

facilities• Certification encourages standardization and professionalism that may

enhance peer provider status and wages and ensure higher quality care.• Some peer provider advocates have concerns that certification and

professionalization might harm the essence of peer provision and limit entry into the field

• Differing training and certification standards across states mean that peer providers cannot easily transfer their credentials to another state.

• Twenty-five states offer reciprocity through the International Certification & Reciprocity Consortium, which is largely used for SUDpeer providers.

Peer Support in the Future• MHA peers have been moving into the private sector and have the

potential to be integrated into all areas of health. • The private health sector offers a wide array of work opportunities for

qualified peer support workers including working in private practice alongside mental health professionals, primary care, Emergency Departments, and supervision roles.

• As more people learn about peers and the importance of recovery-oriented systems, peers will play a central role in supporting people living with mental health conditions and helping to empower them to live meaningful lives in the community.

Now and more in future?

• Peers in Emergency Response roles• Peer Respite Centers (Nebraska’s Honu Home & Keya House)• Self-Directed Care Program (peers support + psych rehab)• Mental Health Court staff• Case management decision teams• Operating smoking cessation courses• Telehealth?

ACTIVITY/DISCUSSIONWhere is Peer Support used in your organization?How are peer specialists treated by others at the organization?What areas do you need to work on as an organization in regards to peer support?Are there ways Peer Specialists can be better utilized in your community?Do Peer Specialists have ways to maintain their own recovery while working in your environment?How should Peer Support Specialists expand in the future?

How Are Other States Doing Peer Support?

• https://www.mentalhealthamerica.net/conditions/mha-peer-programs

Why a national certification?• Professionalism• Personal advancement• Skill set that will able to transfer between states• “Limited peer growth” and “low pay” cited as

common issues with peer workforce – higher education allows for increases in pay and professional growth

• Lose professional credentials and devaluation of work experience if move from one state to another.

Why? Continued…

Peer support specialists are in demand across systems and sectors. Despite peer support’s rapid growth and success in improving lives and outcomes, peers support specialists remain underutilized and underpaid and often lack opportunities for career advancement. What’s more, the lack of a uniform, high standard across the US has prevented peer support from expanding to work with commercial health insurance, private health systems, and practitioners. This means many people who want to stay in the field often leave due to a lack of opportunities and living wages.

National Peer Support Certification: What is It?

• A certification test offered online that can be administered in a proctored office (like mine!) or completely online through a portal

• The high standards let peers show their expertise and experience, which opens new career paths and more opportunities to transform lives and services.

NCPS: What is it NOT?

• NOT a replacement for state-level certification• NOT the same curriculum as Kentucky’s state-level certification• NOT required for jobs in most of the country• NOT a full solution to the need for a professional association and

further training opportunities

QualificationsTo become an MHA NCPS, you must have:• A minimum of 18 months documented experience (3,000 hours);• A minimum of a High School Diploma/GED;• In-depth knowledge of 6 domains of practice (Foundations of Peer Support;

Foundations of Healthcare Systems; Mentoring, Shared Learning, and Relationship Building; Activation and Self-Management; Advocacy; and Professional and Ethical Responsibilities);

• Prior state certification requiring a minimum of 40 hours of peer support training OR completion of an MHA approved training and employment in a peer role; and

• A passing score on in-person moderated examination (or online exam)

What’s On The Test?The MHA NCPS exam is a 125 item, multiple choice exam assessing knowledge and skills across six performance domains and 55 competencies, as follows: 1. Foundations of Peer Support (12 competencies) 2. Foundations of Healthcare Systems (12 competencies) 3. Mentoring, Shared Learning and Relationship Building (9

competencies) 4. Activation and Self-Management (11 competencies)5. Advocacy (4 competencies)6. Professional & Ethical Responsibilities (7 competencies)

Foundations of Peer Support = 26 Items Total Items per Competency 1. Describe the civil and human rights foundations from which the peer support movement arose, including issues related to prejudice,

discrimination, and stigma associated with behavioral health conditions. 2

2. Develop a working knowledge of the terms “peer support”, “peer”, and “recovery” as established by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the International Association of Peer Specialists (iNAPS). 2

3. Develop a working knowledge of the recovery process, stages of change, and recovery capital. 2

4. Develop a working knowledge of the SAMHSA and iNAPS guiding principles, practice guidelines, and core values of peer support. 2

5. Describe how peer support is shifting care from an illness model to a recovery model. 2

6. Develop a working knowledge of the holistic nature of recovery as it pertains to physical, behavioral, social, spiritual, and environmental determinates of health. 2

7. Compare and contrast the concept of recovery as it is used across behavioral and physical health environments. 2

8. Compare and contrast the current role of peer support services in public healthcare systems vs. the emerging market for peer support services in private/commercial healthcare systems. 2

9. Explain how peer support services can help individuals address barriers to recovery (such as stigma or social isolation) and learn tonavigate complex healthcare and other human service systems. 3

10. Explain the impact of trauma on an individual’s physical and behavioral health. 3

11. Explain the core principles of trauma-informed care. 2

12. Describe how to provide peer support services that reflect trauma-informed care principles and strategies. 2

Foundations of Healthcare Systems = 26 Items Total Items per Competency

1. Develop a working knowledge of the concepts of “whole health”, “wellness”, and “holistic healthcare”. 2 2. Describe a variety of healthcare settings and how peer support services can be integrated in these settings, including primary care

settings, in-patient settings, emergency departments, crisis stabilization, mobile crisis teams, respite, psychosocial rehabilitation, outpatient behavioral health programs, peer-run programs, and the professionals who may serve in these settings (i.e., psychiatrists, psychologists, therapists, primary care physicians.) 2

3. Understand the role of healthcare professionals that may be members of an individual’s care team, including psychiatrists, psychologists, therapists, primary-care doctors/nurses, specialty-care doctors/nurses, community health workers, case managers, and other professionals. 2

4. Describe a variety of traditional (such as CBT, DBT, Medication Management, etc.) and non-traditional healthcare services (such as yoga, nutritional management, music, art or drama therapy, etc.). 2

5. Describe how to assist other healthcare team members to learn about the process of recovery, the concept of resiliency, and the relationship between person-centered, selfdirected care and achievement of whole health goals. 3

6. Develop a working knowledge of actions and techniques that will assist the individual to identify, use, and strengthen their natural resiliency skills when dealing with symptoms and stressors. 3

7. Develop a working knowledge of the social determinates of health and how these factors can impact an individual’s health and well-being. 2

8. Develop a working knowledge of primary risk factors and the associated prevention/early intervention strategies that will help the individual navigate risk and promote health and well-being. 2

9. Describe how to learn about different therapeutic/clinical treatment modalities included in the individual’s care plan in order to tailorpeer support services to help the individual achieve whole health goals. 2

10. Develop a working knowledge of common methods to pay for healthcare services (including public and private/commercial payers and appeals processes) in order to help the individual navigate and choose between options. 2

11. Develop a working knowledge of available healthcare benefits for individuals living with debilitating behavioral health conditions inorder to help the individual navigate and choose between options. 2

12. Demonstrate a basic knowledge of medical language and chart/record documentation standards in order to communicate effectively with members of the care team and help the individual understand clinical situations and/or terminology. 2

Mentoring, Shared Learning and Relationship Building = 21 Items Total Items per Competency 1. Effectively and appropriately share relevant parts your own recovery story, and, with permission, other stories of recovery to convey and inspire

hope that recovery is possible in a manner that keeps the focus on the individual receiving services, not the peer specialist. 2

2. Describe how to establish, negotiate, and maintain appropriate interpersonal limits and boundaries that are necessary to promote effective peer support services. 2

3. Assist the individual to articulate their personal strengths, needs, preferences, and goals related to health, home, education, purpose, and the larger community. 3

4. Use shared-learning strategies and other adult learning techniques to help the individual learn about available health, wellness, and recovery supports and services. 2

5. Use shared-learning strategies and other adult learning techniques to help the individual learn the life skills they identify as necessary to achieve their whole health goals. 2

6. When possible, effectively use technology to engage and provide peer support services to individuals living in rural or remote settings or experiencing other barriers to traditional “face-to-face” interaction. 2

7. Use effective communication skills that demonstrate acceptance, respect, empathy and non-judgement in order to learn what the individual receiving services has to say about their life, their strengths, and their hopes for recovery in order to tailor peer services as necessary to help the individual engage in the recovery process and achieve their whole health goals. 3

8. Recognize and understand your own personal values, culture, and spiritual beliefs; how they may contribute to your own judgments, biases, and beliefs about others; and how to respond if they inhibit your ability to effectively serve another individual. 2

9. Recognize and respect the individual’s personal values, cultural, and spiritual beliefs and how these play a role in achieving their whole health goals. 3

Activation and Self-Management = 25 Items Total Items per Competency 1. Develop a working knowledge of the concepts of “activation” and “self-management” of whole health goals. 2

2. Assist the individual to develop decision making strategies and function as an active member of his or her own recovery team, to include the selection of traditional and nontraditional recovery strategies, supports, and providers. 3

3. Assist the individual to identify and take actions necessary to develop behaviors that support achievement of their whole health goals. 2

4. Help the individual learn how to access and navigate formal and informal community resources and services. 2

5. Help the individual to anticipate and avert or safely manage any re-experience of symptoms of his or her condition(s) to ensure continued wellness. 3

6. Help the individual to respond to any setbacks on their recovery journey as an opportunity for learning additional techniques or strategies to achieve and maintain their whole health goals. 3

7. Identify indicators that the individual may be re-experiencing symptoms of his or her condition(s) and provide early intervention strategies to avert crisis and/or the need for intensive services. 2

8. Assist the individual to develop and activate self-management plans, advanced directives, recovery prevention strategies, and crisis prevention strategies. 2

9. Provide on-going support to assure the individual is engaged in long-term, recoveryoriented self-management. 2

10. Provide access to a range of activation and self-care tools and resources that the individual may find useful in achieving their whole health goals. 2

11. Help the individual learn how to locate and evaluate the effectiveness of online activation tools and resources like phone apps, twitter feeds, discussion boards, and interactive programs. 2

Advocacy = 9 Items Total Items per Competency 1. Demonstrate a working knowledge of relevant rights and laws to

ensure that the individual’s rights are maintained. 2 2. Promote self-determination and person-centered services when

communicating with other members of the individual’s care team. 2 3. Help the individual develop self-advocacy skills. 3 4. Identify and communicate gaps in the service system to supervisors

or others in a position to respond to the unmet needs of individuals being served. 2

Professional and Ethical Responsibilities = 18 Items Total Items per Competency 1. Maintain confidentiality in accordance with state and federal laws. 3 2. Document service provision in accordance with agency policies and procedures. 2 3. Perform all job duties in accordance with federal and state rules and regulations. 3 4. Perform all job duties in accordance with published codes of ethics and professional

conduct for credentialed peer support specialists. 3 5. Seek supervision as necessary and appropriate to competently perform the job duties

of a peer support specialist in a manner that reflects the guiding principles and core values of the peer support movement, regardless of employer. 2

6. Practice personal safety and self-care. 3 7. Understand and explain the peer specialists’ scope of service (i.e., know what you can

and cannot do as a credentialed peer specialist). 2

Content details & study tips:

https://flcertificationboard.org/wp-content/uploads/MHA-NCPS-Training-and-Test-Self-Assessment-1.pdf

How Do I Take It?

• Florida Certification Board handles the registration and proctoring responsibilities.

• Once accepted to take the test, you can decide if you want to do the online portal in a quiet space with a reliable internet connection OR take it at the MHA Kentucky office in Lexington (other states have additional testing sites).

How to Prepare

STRONGLY suggest the Self-Assessment Checklist!https://flcertificationboard.org/wp-content/uploads/MHA-NCPS-

Training-and-Test-Self-Assessment-1.pdf

There are NO official trainings for this test.If you’re interested in taking it, let us know at MHA Kentucky and we’ll

try to form study groups when it’s possible (in-person or online).

Cost of the Test

• Application to take the test is $225• The exam itself is another $200

What we want is for peer specialists to have employers with professional development budgets from which these fees can be paid. We know most peer specialists are receiving low wages and/or surviving on a fixed income.

Benefits to EmployersThe NCPS certification assures employers that they are getting the most experienced and knowledgeable peers in the workforce no matter where they are. With a focus on skills, knowledge of systems, and whole health, NCPS peers demonstrate their ability to work across settings and on multidisciplinary teams. By utilizing peers with the NCPS certification, those receiving support have access to peers at the cutting edge of a field that improves quality of life, engagement with services, and comorbid health conditions while decreasing depression, substance abuse, and re-hospitalization rates. Employers who invest in NCPS peers improve outcomes for those they serve, lowers costs by reducing the use of the highest levels of care, and create opportunities to improve the lives of more individuals who are struggling with mental health challenges and trauma.

Questions for Employers• Do you have an established peer support workforce?• Are you near a state border where accepting NCPS is especially helpful for

recruitment?• How do your peer specialists feel about their work? Several resources available

for assessment. MHAKY can serve as a neutral consultant if that’s helpful.• Do you have opportunities for peer specialists to advance?• Is there a way you can encourage peers to continue individual growth in their

current professional capacity?• How realistic is an increased pay structure for peer specialists? • Are there advocacy-related items we should be working on to address that?• Is covering fees for NCPS a benefit you can reasonably offer?

Discussion

Questions?

Additional Resources

• Center for Peer Support at MHA https://www.mentalhealthamerica.net/center-peer-support

• Value of Peers by SAMHSA 2017 https://www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/value-of-peers-2017.pdf

• Core Competencies for Peer Workers, SAMHSA https://www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/core-competencies_508_12_13_18.pdf

• The Peer Workforce, MHA https://www.mentalhealthamerica.net/peer-workforce#Supervision

• Peer Support Research and Reports: https://www.mentalhealthamerica.net/conditions/peer-support-research-and-reports