Integrating Peer-support Services with Health Care Reform
Homeless and Housing Resource Network contributing writer Gloria Dickerson recommends opportunities for integrating peers into health care systems during the implementation of the Affordable Care Act.
Change is on the horizon for health care systems in the United States. The 2010 Affordable Care Act (ACA) was designed to improve the way Americans receive health care and access health insurance. As ACA is implemented in communities around the country, there are additional opportunities for peers1 to be integrated in the design, delivery, and evaluation of mental health services.
There is increasing respect for the unique and valuable skills of peer providers. Peers fill diverse roles and duties that require varying levels of skills. Although formal training is not always required, peer specialists can be trained, certified, and supported in their work in state mental health systems of care (Daniels et al., 2009). The establishment of Medicaid-billable peer support further emphasizes the professional role of peer specialists (Daniels, 2013).
With the introduction of ACA, peer providers will continue to expand their role in the delivery of mental health services. ACA specifically includes resources for peer involvement through provisions for Community Health Workers (CHWs) (Peers for Progress, 2002). ACA defines CHWs as individuals who promote health or nutrition within the community in which they reside by:
• Serving as liaisons between communities and health care agencies
• Providing guidance and social assistance to community residents
• Enhancing community residents’ ability to effectively communicate with health care providers
• Providing culturally and linguistically appropriate health and nutrition education
• Advocating for individual and community health
• Providing referral and follow-up services or otherwise coordinating care
• Proactively identifying and enrolling eligible individuals in federal, state, and local private or nonprofit health and human services programs (H.R. 3590).
Organizations can leverage the financial mechanisms available for CHWs by incorporating peers who have received specialized training and who use their recovery journey to support other consumers (Tobias et al., 2010). The following sections highlight two ways peers can serve as CHWs to improve the delivery of mental health care services.
Eliminate Mental Health Stigma
Stigma, the act or the fear of being discredited or devalued because of a personal attribute, can be a barrier for many individuals in accessing treatment and can stall the recovery process (New Freedom Commission on Mental Health, 2003). Stigma remains a persistent problem in mental health services and has its roots in the provider-patient relationship. Professionals and peers can be skeptical of each other’s motives, but they also remain deeply intertwined and share the burden of missed opportunities to develop services that inspire hope, impart skills, and lead to a bright future for people served in mental health and behavioral health settings.
One role of the CHWs is to serve as liaisons between communities and health care agencies. Peers can help eliminate the stigma surrounding mental health services by serving as a bridge between professionals and consumers. At a local level, peers can help other consumers navigate the health care system, accompany consumers to appointments, and help consumers develop positive relationships with their care providers.
Participate in National Dialogue
Another role of the CHWs is to advocate for individual and community health. This provides an opportunity for individuals who are served to continue to have a seat at the table in the design, delivery, and evaluation of services (New Freedom Commission on Mental Health, 2003). The national advocacy group Faces and Voices of Recovery (2013) suggests, “To ensure that these decisions are fully peer-informed and recovery-oriented, it is essential that advocates and recovery community organizations are informed and vocal participants in the decision-making process.”
One example of this national advocacy work was seen at the Pillars of Peer Support Services summits, which brought together nationally recognized experts and stakeholders from across the U.S. to identify and create consensus around factors that facilitate the use of Peer Support Services to support recovery from mental illnesses among individuals served in state systems. These national dialogues are valuable tools for improving the delivery of mental health services.
Importance of Peer Support
The integration of peer support workers into behavioral and primary health care is rapidly expanding as a quality and cost-effective service. It is up to providers, peers, and policy-makers to ensure that the movement to integrate peer support is not derailed or delayed. The work of peer providers is essential because “peer support services have the potential to improve the quality of healthcare delivery, lower healthcare expenditures, and reduce health disparities” (Peers for Progress, 2002).
Daniels, A.S., Grant, E., Filson, B., Powell, I., Fricks, L., Goodale, L. (2009). Pillars of Peer Support: Transforming mental health systems of care through peer support services. Atlanta: The Carter Center.
Daniels, A. S., Tunner, T. P., Bergeson, S., Ashenden, I., Fricks, and Powell, I. (2013), Pillars of Peer Support Summit IV: Establishing Standards of Excellence.
H.R. 3590--111th Congress: Patient Protection and Affordable Care Act. (2009). Retrieved from http://www.govtrack.us/congress/bills/111/hr359
Faces and Voices of Recovery (2013). Why Peer Integrity and Recovery Orientation Matter. Issue Brief 3. Retrieved from: http://www.facesandvoicesofrecovery.org/pdf/Health_Reform/6.14.13_Issue_Brief_No_3.pdf
New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America (2003). Executive Summary. DHHS Pub. No. SMA-03-3831. Rockville, MD: 2003.
Peers for Progress (2012). Accelerating the Availability of Best Practices in Peer Support Around the World. Retrieved from: http://peersforprogress.org/wp-content/uploads/2012/11/20121126_peers_brochure_updated_2013.pdf
Tobias, C.R., Rajabiun, S., Franks, J., Goldenkranz, S.B., Fine, D.N., Loscher-Hudson, B.S., Colson, P.W., and Coleman, S.M. (2010). Peer knowledge and roles in supporting access to care and treatment.
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1. There are many different terms used as identifiers for people with lived experiences (i.e. consumer, patient, ex-patient, survivors). It is with the utmost respect that the term “peer” is used in this writing. ↩
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