When I moved to North Carolina some 6 years ago I was searching for a way to plug into the substance use disorder/behavioral healthcare world, while toiling away on certification reciprocity and soon chose Peer Support Certification as a starting point. The training was offered for free, by a managed care organization (MCO) and has appeared to be the wave of the future. For years, friends who owned out-patients had been championing Peer Support as a great tool and that influence made me glad to get the insights from the training and crew of people. It was taught by a guy with a heck of a story, Antonio Lambert, who proved to be a mentor.

More importantly, it plugged me in to the certifying agency, based within UNC-CH’s School of Social Work, the Behavioral Healthcare Resource Program (BHRP). Later I realized Peer Support had some key DHHS-DIV. of MH/DD/SAS support, who were championing the full vision of a more effective Recovery Oriented System of Care (ROSC).

Peer Support is a doorway into the whole Recovery Community snapshot, an essential component, a key linchpin. Building an effective, efficient system of care to increase outcomes with substance use disorder means honoring the truth of “lived experience.” “Nothing about us without us”, as the saying goes. Which is, by the way, a core tenet of NC’s public/not-for-profit LME/MCO model we use here for the disbursement of Medicaid behavioral health dollars. It’s written in their contracts with the state that they must have “lived experience” input into their provider network and capitation decisions. For MCO’s that doorway begins with Consumer and Family Advisory Committees (CFAC). It is odd, in a way, that we have to write about it, the concept; “If I have been there, experienced addiction/recovery, then I can be a support for you, on your journey into recovery”. “Been there” includes the experience of families dealing with other’s SUD/mental health issues.

Before I continue, let me point out that Peer Support is being successfully used in numerous venues, including the medical world. Cancer survivors are supporting those with new diagnoses. Providing support to listen/process feelings, to help them know that they are not alone, to share aspects of navigating the system, to shine a light on the road ahead whatever the path. In fact, as NC CANSO’s Laurie Coker writes, “Wake Forest University Baptist Medical Center will soon begin an initiative using Peers to educate clinicians about how to support recovery and about the role of peers in healthcare systems.” Peer Supports are motivators, allies, truth-tellers, tour guides, advocates, coaches.

Another world investing in Peer Support is our US Department of Veteran Affairs (VA). The Peer Support Training Council (PSTC), in rewriting our training manual, added a “specialization” for Military Service Member, both active or retired, to support this growth in Peer Support for our vets. This “Veteran” designation comes after completing a newly created 8-hour online training as part of the 20-hour requirement (see application requirements here). This online training is slated to begin by 7/1/2016.

Wikipedia states that, “A peer recovery support specialist (P-RSS) is an occupational title of trained individuals who engage with peers in a community-based recovery center, or outside it around any number of activities, or over the telephone as well. There are many tasks performed by peer support specialists that may include assisting their peers in articulating their goals for recovery, learning and practicing new skills, helping them monitor their progress, assisting them in their treatment, modeling effective coping techniques and self-help strategies based on the specialist’s own recovery experience, and supporting them in advocating for themselves to obtain effective services.”

This rings true and is all in the interest of removing barriers between those seeking help, those hurting and sustained recovery, which is a real thing. Recovery is a real thing.

More why’s and wherefores are worth looking at but it helps to start with some historical background.

As I read and check historical sources and facts I am motivated to remind us that the concept of one human, with experience, helping another, is as old as, well… humans. This is a more tribal outlook that we lost along the way and working Peer Support into behavioral health care and medical care is a necessary step in our healing. A central component in this shift toward ROSC is characterized by the personal recovery plan (PRP). What evolved in this country since WW2 was an acute care model toward substance use. An “expert” wrote a treatment plan that tells a client what he is supposed to do. When the client “relapsed” he was labeled “non-compliant”. Now it’s all about us participating in our own recovery, if you get my drift. Self-determination is the fact, truth, grace and beauty of recovery. We must participate in our own recovery. This newer paradigm, Recovery Community supporting an ROSC, begins with a PRP (or person-centered plan) drawn up by the individual looking for support and reviewed with a Peer Support Specialist (PSS). Individuals, supported by PSS, writing their Recovery plans. The ability to grow buy-in from the client is apparent at that point.

Here’s a link to a well-researched and annotated study of Peer Support history, from our favorite SUD historian, William White, which begins:
The History and Future of Peer-based Addiction Recovery Support Services (Executive Summary)
William L. White, MA History
“Within the addictions arena, there is a long and rich history of recovery mutual aid societies, peer-based recovery support groups, and the use of recovered/recovering people in paid service roles from which lessons can be drawn.”
But first I want to start with this transcript of a teleconference call outlining some history of Peer Support, especially mental health peer support, led by:

“Joseph Rogers, executive director of the National Mental Health Consumers’ Self-Help Clearinghouse – the sponsor of these monthly national networking teleconferences – began with a presentation on peer workers/peer specialists/people who work as peers, both in Pennsylvania and around the country. Joseph said, “I understand that some people don’t like the terms ‘peer’ or ‘peer specialist,’ but that’s what the states are calling people who are working in such positions, particularly those who receive Medicaid reimbursement to work in self-help/mutual support activities.”

We’ll come back to Medicaid and the payment of Peer Supports but my posting of this transcript is because mental health (MH) advocates are really the ones who got all this going. In my gut, from my experience I do feel and believe, as ‘The Anonymous People’ states,“There is nothing that impacts American life more than addiction.” AND I do have to champion all the mental health advocates who led the way into not just advocacy for mental health rights and services but the creation of contemporary Peer Support. That is the snapshot over the past few years that I have seen. Those out there suffering from mental illness diagnosis were taking charge of their recovery, becoming informed, getting support and treatment, and organizing as a group. They led the way into full-on advocacy and this was instrumental to the momentum now in place. I am proud of them and the work they have done and intend to do an article later this year with leaders of the MH advocacy world based in NC.

Back to our history; the first state that organized and got funding through Medicaid for peer-to-peer activities was Georgia. They are the ones who came up with the term “peer specialists.” This is an important “rub”. In NC, Medicaid pays for Peer Support services but most people who suffer from SUD aren’t on Medicaid, particularly in this state. One barrier we need to remove directly, one line-item we really need to add to the budget in an efficient, well-designed ROSC, is a payment stream for Peer Support that is comprehensive. While we’re at it lets add Recovery Coaches to the same line item. There are multiple locations we can place these workers; For example, hospital emergency rooms. That would begin to “putty” up the cracks of our siloed system and increase outcomes.

Now onto my friends at BHRP; Tara Bohley, Program Coordinator and Clinical Assistant Professor, and her compatriot, Ronald L. Mangum, Clinical Assistant Professor. Those two are a potent team. There is something like 40 states that now have a certification process and NC is one of them. The state gave the task to BHRP and Tara and Ron shepherd that. I say shepherd because all of it, all the words and curriculum and final oks came from and through Peer Support Specialists with lived experience. We wrote it, they supported us and superb support it is. I got to know Tara and Ron working on the Peer Support Training Council (PSTC). That was created by Flo Stein, MPH, Deputy Director, Division of MH/DD/SAS and champion of all things ROSC and BHRP, to update a training curriculum as a guide for the training systems out there, to advance the standards of the programs. A great melding of professional and peer-run, if you ask me.

THAT has been a real pleasure, though it seemed a daunting task during the early days. A great crew of Peer Support Specialists and lived experience champions all, came together and we worked hard to consensus a tool for guidance into the future. Though the core curriculum is completed we are continuing on with numerous tasks we identified as important. It has been wonderful working with this crew, getting to know each another as we strive to do good work. It’s rewarding to build relationships through this process. It reminds me of a favorite quote of mine, from 12 Step literature, “The conscience of an informed group is God’s Will on Earth”. HUGE wisdom for all of us there.

Besides Flo, Tara and Ron’s measured guidance, the Council’s current membership includes; Ken Blackman, Gin Monroe, LaToya Harris-Freeman, Wes Rider, Susan Hall, Lyn Legere, Richie Tannerhill, Laura Brower, Ken Schuesselin, Rosemary Weaver, and yours truly. Previous members have included; Emery Cowan, Joan Kaye, both on loan from the DHHS; Cherene Allen-Caraco, Jessica Herrmann and Tommy Crawford.

Reviewing history with Ron Mangum, for perspective, he gave me the list, from 2007, of the very first role-delineation study to develop the standards of the first rendition of the forty-hour course to be Peer Support Certified. Over three days, in Winston-Salem, they came up with 3-4,000 (no kidding) items that distilled down into the final domains that needed to be utilized. In the interest of honoring our forbearers, that group included: P. Wesley Rider, Virginia Monroe, (you’ll notice they are on the current council, those two put in some time!), Gladys Christian, Stephen Pocklington, Rev. Dorothy O’Neal, Obie Johnson Jr., Kim Franklin, Dorothy Best, Debbie A. Webster, Megan American horse, April Llenzg, Lloyd Parsons, Bonnie Schell, Carl Noyes, Tom Hanson, Shirley Hart.

Just like when they receive an Oscar, I hope I didn’t miss someone.Our thanks and gratitude to everyone for your service!

The linked BHRP website, with additions and improvements continuing as we speak, has mucho data including a county-by-county number of specialists. NC reports 1834 specialists certified by BHRP (at time of publication). A crew ready to spring into action built to make a difference in the lives of those who need it! The site has information on the requirements to apply, locations of trainings, job postings and much more. There are instructive videos on what peer support work is like and look to see more added in the future.Allow me to add that the new standards created by the PSTC, for the NC Peer Support Specialist Certification Training added areas of focus around ethics and boundaries, substance use disorders, trauma-informed practices and cultural competence and awareness. This brought the total domains to nine. In addition, course developers are being asked to more thoroughly develop a training of their trainers and to register their trainers with the state.Lastly, it now requires all trainers to be certified as Peer Support Specialists in NC.I could write about how integration of healthcare-behavioral and medical-is another wave of the future, with medical “hubs”. Here’s an article from the NC Council of Community Programs – see page 6. And how it demands Peer Support to be more than just a savings for insurance companies, but Hey, this is more links and acronyms that one body needs in a day so I’ll stop there and leave you with: Thanks for staying (peer) supportive out there.