December 3, 2010
The Consumer Agenda Action Committee (CAAC) formed out of Leadership Academy II “Consumer Involvement in Transforming Our Mental Health System” delivered by the Advocacy Initiative Network of Maine (AIN). The group is made up of 25 LAII graduates and is open to all consumers interested in participating. During LA II the group determined that certain issues of great importance to their lives and to their recovery, as well as to other consumers across the state needed to be put forward.
The CAAC meets monthly and is supported by AIN’s contribution of staff time, technical assistance, and material resources all funded under their DHHS and SAMHSA grants for networking activities. The Wrendy Hayne Foundation donated $2000 to help with mileage reimbursement.
With the current effort to have full-managed care in our state, it seemed timely to make Peer Support as a billable service a priority issue for our group to address.
The intent of our paper is to persuade the reader to carefully consider how the service of Peer Support can be delivered while maintaining its fidelity to the principles of peer support and there-by its ability to meaningfully help peers.
Sincerely,
Members of the CAAC
Lacie Anderson
Marilyn Ashton
Carla Beaulieu
Julie Bickford
Sherry Brooks
Donald Burns
Richard Chaucer
Theresa Cyr
Donna Darling
Melinda Davis
Nancy DeRaps
Monica Elwell
Making Peer Support a Billable Service
We all want the same thing. Recovery and services that support recovery.
The role and effectiveness of peer support services and Peer Support Specialists has been well documented (see last page for a list of many resources supporting this statement).
We are asking our Department of Health and Human Services, Office of Adult Mental Health, our Department of MaineCare Services and all stakeholders working together on the managed care initiative to take into their consideration the great and current work being done through The Carter Center on peer support. We ask that our state adopt and endorse the Pillars of Peer Support and use their resources to disseminate and promote them both within our Office of Adult Mental Health, our Department of MaineCare Services and throughout and within our system of community mental health agencies. We present this position paper as a foundation to build a resolution to the challenges of implementing peer support services into the array of community support services available in our mental health system.
As our state moves toward a full managed care system this is a great opportunity to include peer support as a MaineCare billable service. But, it must be done with great care and thoughtfulness. We highly recommend using the Pillars of Peer Support as a framework for building Maine’s peer workforce.
Ideally peer support services would be paid for with General Fund dollars and/or Block Grant dollars. This would avoid the regulatory restraints of MaineCare billing. However in today’s economy there is little or no money in the General Fund. Block Grant dollars are a possible viable resource but to take enough from the Block Grant would mean supplanting other community services currently being supported with this funding.
The challenges of creating a successful peer support service system are imbedded in two distinct arenas, philosophical (culture) and tangible (regulatory).
One of the members of our group writing this paper expresses “My biggest concern about the development of Intentional Peer Support Specialist (IPSS) is the possibility that the essence of peer support…the mutuality, the willingness to have ‘difficult conversations’ and transparency between the IPSS and the person receiving the support will fade away. Having worked in the mental health field as a Daily Living Skills Specialist (DLSS) and having been a patient at a psychiatric hospital, I have observed a great deal of social distance between those in the role of ‘staff’ and those in the role of client/patient/consumer. I fear that the culture of the institutions at which IPS will be provided will either overwhelm the IPS workers with its strength or become antagonistic toward them. The philosophy is drastically different in the managed care system than it is in the Consumer movement. I wonder how those who are ‘workers’ whether they be case managers, therapists, psychiatrists, or DLSS will react to the demand to let someone with an emotional or psychiatric disability be on the ‘other side of the glass’. How can we make sure IPSS is carried out as intended without being overpowered by the medical model or the variation thereof in the IPSS work environment?”
The incorporation of Certified Peer Specialists into existing mental health service delivery systems challenges some organizations and/or professionals to reconsider their assumptions about certain professional norms, such as the capacity of peers to sustain appropriate boundaries while also intentionally using self-disclosure as part of their service approach.
Our state’s Certified Intentional Peer Support (CIPS) program’s fundamental philosophy is based on four tasks used to develop and maintain relationships. Yet a number of peers who have been employed by agencies as Case Managers, Crisis Workers, and even as Peer Support Specialists have been discouraged, if not reprimanded, for disclosing that they are peers or using their own recovery experiences to inspire and encourage others on their recovery journeys. As a result the stress of conflicting principles either cause peers to leave their positions or become co-opted. “Peer workers may react to workplace pressures and cultures by behaving more like traditional mental health workers than peers. They may adopt behaviors that reflect an ‘us versus them’ attitude. In this case peer supporters lose their peerness and with that lose the ability to meaningfully help peers on their recovery journeys”. [1]Harrington 2010
Currently the CIPS training regarding documentation is to document “When” (date) “Where” (face to face in community or over the phone), and “Time” (amount and whether paid or volunteer – nothing else. This will not work in a managed care environment. We need to figure out a way to document measurable objectives related to the client’s goals without interfering with the way peer support is delivered.
If we all want the same thing? Recovery and we know peer support is both effective and cost effective then we need a plan to work collaboratively to address the conflicts, dispel the fears, and connect the dots to promote peer support services and a peer support workforce in our state.
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[1]Steve Harrington, J.D., M.P.A. SAMHSA ADS Center Training Teleconference Peer Support and Peer Providers: Redefining Mental Health Recovery