Description of the Innovative ActivityCertified peer support specialists (CPSSs) in two FQHCs offer support to individuals with co-occurring medical and mental health/substance abuse diagnoses, with a particular focus on those with mental health conditions deemed to be mild or moderate in nature. After receiving referrals from health center providers, the peer specialists meet with individuals to discuss medical and behavioral health needs, serve as wellness coaches, develop wellness plans, provide educational information and links to community services, offer emotional support, and facilitate the provision of medical care (e.g., by scheduling appointments). Peer specialists also run support groups and may accompany individuals to group support meetings and doctor appointments. They document all services provided in an electronic medical record accessible to all providers. Key components of the program include the following:
- Placement in FQHCs catering to patients with mild/moderate mental health issues: Two peer specialists are placed in each of two FQHCs in Michigan: Hackley Community Care Center, a 31-provider center in urban Muskegon, and MidMichigan Community Health Services, a rural center in Houghton Lake with seven primary care providers. These centers tend to care for many patients with mental health conditions deemed to be mild or moderate in nature, and hence do not qualify for State-funded behavioral health services within community mental health centers. To be eligible for State certification, the peer specialists must be at least 18 years of age, hold a high school diploma or equivalent, have a mental health diagnosis and/or a co-occurring substance use disorder, have had the mental health diagnosis for at least a year, be clean and free of substance use for at least a year, and currently receive or have previously received services from an FQHC.6 Those hired in the centers spend a few weeks getting used to the environment and the job duties before undergoing formal training and certification, as described below.
- Formal training and certification: After several weeks getting familiar with the FQHC, the peer specialists complete a 56-hour training program designed and run by the Michigan Department of Community Health. An amalgamation of existing training courses, the curriculum covers Whole Health Action Management (WHAM, a self-management training program and peer support group model developed by the National Council for Behavioral Health); Wellness Recovery Action Planning (WRAP, a tool that aids in the development of a customized care and self-management plan); disease-specific training on topics such as diabetes, trauma-informed care, and smoking cessation; group facilitation; housing outreach; and other topics that allow the peer specialists to address a variety of mental health and medical needs. The training culminates with a 4-hour exam; those who pass receive three community college credits and State certification as a peer support specialist.
- Referral of eligible individuals: CPSSs receive client referrals from physicians, psychologists, nurses, and medical assistants in the FQHC, either in person or via e-mail within the FQHC’s electronic medical record system. To be eligible for CPSS services, individuals must have at least two diagnosed chronic conditions—one medical condition and one behavioral health (mental illness and/or substance abuse) disorder. After receiving a referral, the CPSS reviews the individual’s medical record and invites him or her to schedule a face-to-face visit. In some cases, providers make the referral in real time by asking the CPSS to join an ongoing medical visit.
- Support services based on trust and rapport: Each CPSS works between 16 and 40 hours a week, providing approved peer support services as defined by the State’s Medicaid program.6 CPSSs seek to quickly build trusting relationships with individuals, using their own life experiences and recovery journeys to relate to them in ways that other providers cannot. Offered in individual and group settings, CPSS services supplement and complement the care offered by medical providers, as outlined below:
- One-on-one support: The CPSS provides one-on-one support to individuals related to recovery and self-management of chronic medical conditions.
- Health navigation: The CPSS helps individuals schedule appointments for medical care and other needed services. The CPSS may also accompany individuals to doctor appointments, the pharmacy, social worker visits, and support group meetings (e.g., Alcoholics Anonymous, Narcotics Anonymous). The CPSS also identifies and helps connect individuals to needed community-based resources and benefit programs.
- Care plan development and monitoring: The CPSS as part of the team addresses specific goals in the medical record and writes progress notes on the services provided. In working with the person individually, WRAP is used as a wellness tool and self-management plan. Over time, the CPSS discusses the individual’s progress towards the WRAP plan to identify ways to prevent and overcome challenges related to achieving physical and mental health goals.
- Support groups: The CPSS facilitates weekly support groups on a variety of topics, including WHAM, WRAP, smoking cessation, diabetes care, and physical activity and fitness.
- Documentation and communication with providers: CPSSs document services provided to individuals in the electronic medical record, thus allowing other providers to remain aware of what services the individual has received. CPSSs and providers also communicate about the individual's needs and progress during informal personal discussions and through e-mail.
Context of the InnovationThe Michigan Department of Community Health is responsible for health policy and management of Michigan’s health, mental health, and substance use care systems, with a special focus on addressing the needs of vulnerable and underserved populations. The Michigan Primary Care Association promotes, supports, and develops community-based primary care for Michigan residents. The Michigan Primary Care Association is composed of 39 health center organizations that provide quality, affordable, comprehensive primary and preventive health care for more than 600,000 Michigan residents at more than 230 sites located in both rural and urban communities across the State.
Michigan was one of the first States to approve Medicaid reimbursement for peer specialist services. Since 2005, the Michigan Department of Community Health has sponsored a training and certification program for peer specialists; to date, 1,234 individuals have been certified. The impetus for this program came from Michigan Department of Community Health leaders, who recognized that people receiving primary care at FQHCs often had unmet needs related to mental health and substance abuse, with the problem being particularly acute for those with conditions deemed to be mild or moderate in nature. To offer services that are currently not Medicaid reimbursable in Michigan, a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Association of State Mental Health Program Directors was written.
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