VIEW FROM THE BOARD: Consumers as an integral part of the workforce
Consumers and Family Members as Part of the Workforce
by Susan Bergeson
Many systems are beginning to embrace the use of consumer and family members as a valuable part of the work force. Research from one study presented at the 40th National Council Mental Health and Addictions conference revealed that peers who have "been there were able to form stronger therapeutic bonds than most professionals. Analysis done by Optumhealth Behavioral Solutions shows a 51-78% reduction in hospitalization costs when using Peer Bridgers in several markets and a nearly 2 million dollar reduction in hospitalization by using peer-run respite in one market alone. Other research has shown that using peers resutled in a reduction in hospitalization, increases in adherence, decreases in isolation and increases in empowerment.
According to Chinman, Young, Hassell, Davidson in the April 2006 edition of
The Journal of Behavioral Health Services and Research, consumers are addressing patient and treatment systems along a continuum ranging from reducing social isolation, to reconnecting with treatment, to activation through skill development, to supplementing existing treatment as a way to compensate for overburdened providers, to helping to navigate a fragmented system, to reframing treatment around recovery.
Services provided by consumers who are trained and certified currently can be billed through Medicaid in 26 states. Managed care organizations are looking carefully at consumer and family run services as a viable addition to their networks offering consumer choices along with alternative, adjunctive and cost-saving services.
Despite the promise of peer and family providers and despite what early evidence is showing, peer and family members face a wide range of barriers when seeking to be a part of the behavioral health workforce.
Barriers we need to overcome:
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Only 26 of 50 states currently allow reimbursement for peer services through Medicaid despite Medicaid's assertion that "Peer support services are an evidence-based mental health model of care..." (Center for Medicaid Services, letter to states, August 2007)
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Supervisors often do not know how to use peers or how to supervise them well. Far too often peers are relegated to filing and other administrative work rather than being asked to contribute to the power of peer engagement.
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Systems struggle with issues of confidentiality and acceptance of peers as part of a treatment team.
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There is no career path for peers employed in systems which leaves consumers and family members stuck in low paying, dead end jobs.
Recently consumer and mental health commissioners in the 26 states who do bill Medicaid for peer support gathered at the Carter Center and identified the key elements of success in engaging peers as a part of the workforce in these states. The resulting document outlining these success factors or pillars of peer support can be accessed
http://pillarsofpeersupport.org/
While we celebrate the value of employing peer and family members as a part of the behavioral health workforce, we need to work to ensure these positions are accepted and supported within the system so that the unique talents of these individuals can be maximized to benefit the healthcare system.
Selected References
Chinman, Lucksted, Gresen R, et al: Early experiences of employing consumer providers in the VA.
Psychiatric Services 59:13151321, 2008
Copeland, M. E. (2004). Self-determination in mental health recovery: Taking back our lives. In J. Jonikas & J. Cook (Eds.), UIC NRTCs National Self-Determination and Psychiatric Disability Invitational Conference: Conference Papers (pp. 68-82). Chicago, IL: UIC National Research and Training Center on Psychiatric Disability.
Corring, D. (2002). Quality of life: Perspectives of people with mental illnesses and family members.
Psychiatric Rehabilitation Journal 25 (4).
Center for Medicaid Services
August 15, 2007 Letter to States http://www.cms.gov/SMDL/downloads/SMD081507A.pdf
Edmunson, E., Bedell, J., et al., (1982). Integrating skill building and peer support in mental health treatment: The early intervention and community network development projects. In E. Jeger and R. Slotnick (eds.)
Community Mental Health and Behavioral Ecology. New York: Plenum Press, 127-139.
Kaufmann, C., Ward-Colesante, M. and Farmer, M. (1993). Development and evaluation of drop-in centers operated by mental health consumers,
Hospital and Community Psychiatry 44(7), 675-678.
Van Tosh, L. and del Vecchio, P. (2000). Consumer-operated self-help programs: A technical report. Rockville, MD: Center for Mental Health Services.
Yanos, P., Primavera, L., and Knight, E. (2001). Consumer-run service participation, recovery of social functioning, and the mediating role of psychological factors.
Psychiatric Services, 52(4), 493-500.
ANNAPOLIS COALITION UPDATES: Competency Tools Released
The Annapolis Coalition played a central role in developing a set of core competencies for direct care workers. These competencies are cross-disability in nature, relevant to jobs in multiple health and human service sectors. Funded by the Alaska Mental Health Trust Authority and produced in collaboration with the WICHE Mental Health Program, the Competencies were released in January of 2010.
The Annapolis Coalition played a central role in developing the
Alaskan Core Competencies for direct care workers, which were released in 2010. Funded by the Alaska Mental Health Trust Authority, these competencies are cross-disability in nature, relevant to jobs in multiple health and human service sectors. Just released is a set of six Assessment Tools designed specifically for use with these competencies. These tools promote a
Collaborative Competency Building approach in which an employee and supervisor work cooperatively to identify the worker's strengths, the skills in need of improvement, and the plans to improve those skills.
The six tools include: an Employee Self-Assessment; Skill Building Plan; competency Logbook; 360 Degree Feedback form; Performance Review; and Portfolio Guide.
Visit the
Alaskan Core Competencies page to read more.
The Child and Youth Evidence-Based Practices Consortium has shared a recent report with the Annapolis Coalition. The report presents findings of a survey of programs and individuals hiring or supervising child mental health services about the perceived practice readiness of masters level graduates. It provides very interesting and thought provoking observations about the perceived effectiveness of pre-clinical training.
ABSTRACT
As the field of behavioral child and youth health struggles with closing the research to
practice gap and implementing evidencebased treatments (EBPs)
with proven efficacy in practice environments we must contend with the question of whether clinicians are suitably trained to take on the challenge of delivering EBPs. Increasing urgency for the implementation of EBPas in behavioral health is creating difficulty with the hiring of clinicians who are suitably prepared to work in an evidence-based environment. A survey was developed to explore gaps in this area, with a view to future discussions and actions on the part of behavioral healthcare providers and institutions of higher learning. METHOD: An electronic survey was distributed using snowball sampling techniques throughout the US and Canada, and made available for 5 months. The survey was target to individuals who have supervisory and/or hiring responsibilities and, who are involved in providing child and youth mental health services within the child and youth mental health sector, juvenile justice sector, or child welfare sector. RESULTS: 589 respondents completed the survey (US 84.1%; Canada 15.6%). CONCLUSIONS: (1) Many areas of knowledge, skill, and competency are regarded as necessary for effectiveness on the job, and most are learned on the job. Few areas of knowledge, skill, and competency are learned in academic programs, and MA trained clinicians are arriving on the job unprepared. (2) Preparation for evidencebased practice falls largely on the shoulders of CYMH provider organizations that have varying capacity to fulfill onthejob workforce preparation due to cost and clinical service imperatives. (3) Dialogue between provider organizations and institutions of higher learning is minimal, and are mainly related to teaching or practicum logistics. Attempts to advocate for changes in curriculum are barely noticed in most instances. (4) Fewer than 3% of the new MA clinician workforce are perceived to be very prepared for clinical practice in child and youth behavioral healthcare. Recommendations are made for providers, institutions of higher learning, and researchers.