[NYAPRS Enews] ACMHA: Peer Operated Services and the Journey towards Integration

[Harvey Rosenthal]

NYAPRS Note: Here's a very thoughtful and timely piece on the tremendous
application of innovative peer services to the current focus on
integrated mental and physical health care by Laura Van Tosh and Peggy
Swarbrick. Both will be at next week's ACMHA Conference in Santa Fe
(http://www.acmha.org/summit_agenda_2010.shtml) and Peggy will be a
keynoter and presenter at NYAPRS' April 21-2 Executive Seminar on
Systems Transformation in Albany
(http://www.nyaprs.org/PDF/NYAPRS_ES_bro_10_D.pdf). 

 

ACMHA: The College for Behavioral Health

CULTIVATING LEADERS FOSTERING INNOVATION

 

Peer Operated Services and the Journey towards Integration

Laura Van Tosh, ACMHA Member

Peggy Swarbrick, PhD, OTR, CPRP, Collaborative Support Programs of New
Jersey

ACMHA Arm Chair Reflection   February 2010

 

Brief History of Peer Operated Services

Consumer (also referred to as peer) run programs have a long history of
providing alternative services to persons who have a mental illness.
This history spans over 40 years with the establishment of drop in
centers which provided a safe haven for people experiencing mental
health difficulties who were otherwise marginalized from society. Later,
these programs varied in size and scope with many meeting the need for
advocacy, innovative service delivery systems, and the introduction of
newly created positions in the field to assist people with similar
challenges.

 

Integration and Behavioral Health Care

Integration is not a new idea; however, it has become part of the
current dialogue within the health care reform debate currently
underway. Integration, as it pertains to behavioral health care brings
forward the necessity for the care system to consider the whole person,
meaning the necessary preventive, medical, and recovery-oriented
services one might need, and to coordinate this care within a medical
home. Integration has definite benefits for consumers whose whole care
has been limited or non-existent. The potential marriage between
behavioral health care with primary care shows great promise, yet the
mental health field has not examined integration's impact on those
various parts of the delivery system, including consumer (peer) operated
services.

 

New Challenges for Peer Operated Services

Integration offers new opportunities and peer operated services should
position themselves by being proactive, and ready to partner and
collaborate. Peer operated services could benefit from a close
examination towards integration, similar to other providers as they move
towards supporting

integration and integrated community service, while at the same time
working hard to remain faithful to the many characteristics which set
peer operated services apart from non-peer operated services. 

This may be a challenge but is not impossible. Peer operated services
will need to re-examine the focus of services, unmet needs in the
community and realign services in order to be effective in working
collaboratively with partners and stakeholders. Peer operated services
will need to adjust and

be prepared to work within a new framework. They will likely need to: 

*         compete with non-POS for funding

*         overcome limitations of some services

*         be open to collaboration and partnerships rather than
remaining on an island

 

Whole Health and Wellness Focus

Peer operated services will need to clarify a focus (whole health and
wellness) and be sure peer providers are competent (training,
accountability and infrastructure supports). Some key roles or
opportunities for peer operated services include:

*         front line workers (an ideal job for entry-level peer
providers) who can help people by

*         providing mentoring, hope, and time with practical assistance

*         mid-level workers who can apply rehabilitative counseling
techniques, deliver well ness

*         management and self care strategies as well as help people
understand and access

*         community resources

*         specialists who have some combination of unique knowledge and
skills in areas ranging from

*         financial education to benefits management to supported
employment and education, etc.

*         Needless to say, many specialist roles are well oriented to
front-line peer providers, such as

*         dual recovery coaches, peer well ness coaches, supported
parenting workers, etc.

 

Financing Concerns

Some of us worry that integration may mean providing "more for less" or
another scenario where certain valuable services may not easily adapt to
the shift to a new model of care. Mental health funding streams may be
new or ones the field is accustomed to might be in for noticeable
change.

Peer operated services, for example are primarily grant-funded either
through state mental health funding streams, federal sources, or within
the private sector. Very few peer operated services have been able to
successfully transition to Medicaid financing for a number of reasons
outside the scope of this article. Public financing may become less
available as well when integration combines services and billing. What
will come of peer operated services which are in fact non-medical yet
life-saving?

Peer operated services developers, managers, and leaders have suggested
these services are "promising practices" to be recognized and supported
by government and others. However, these services have not been deemed
as evidence-based practices and may not carry the weight needed to

garner long-term support through traditional funding streams. Utilizing
the numerous inherent strengths of peer operated services, developers,
managers, and leaders should develop a game plan to be prepared for the
inevitable changes to come.

 

Changing Populations

Within the context of integration, "customers" of peer operated services
will have different needs than in the present era of peer run programs.
They may have physical needs that require partnerships with clinics and
others in the health sector. The economic status of the populations we
serve may require added knowledge of health care benefit programs beyond
the usual mental health system. And, these "customers" may require more
focused advocacy to ensure health care needs in addition to basic mental
health services are addressed. Peer operated services managers will need
to negotiate with primary care providers and be savvy to the new
partnerships within the health care marketplace. New programs run by and
for peers may need to be developed to address the whole health concerns
of service recipients.

 

Next Steps for Peer Operated Services

Developers, managers, and leaders of peer operated services will likely
face new requirements within the context of integration. This could
include identification of outcome measures; partnerships with the health
care sector; and a willingness to adapt to the changing health care
landscape. National consumer/survivor technical assistance centers,
currently funded by SAMHSA, will need to broaden their efforts to
support state and local endeavors. Their knowledge of and understanding
of integration will undoubtedly make the transition easier for peer
operated services and the people they serve. State and local mental
health and addictions authorities have a role as well. These entities
should consider the valuable role of peer operated services in this new
era of partnership and collaboration.


http://www.acmha.org/content/events/arm_chair_reflections/Van_Tosh_Peer_
Operated_Services_101909.pdf 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://kilakwa.net/pipermail/nyaprs_kilakwa.net/attachments/20100315/a0d8c06f/attachment.html>