State Policy Facilitators and Barriers to Maximizing the Potential of the Certified Peer Workforce for Behavioral Health: A Mixed Methods Study
Open Access DepositedThe United States is experiencing a behavioral health (BH) crisis, which has been exacerbated by the COVID-19 pandemic. Provider-related challenges have contributed to the lack of access to BH care in the United States, including challenges related to attracting, retaining, and developing the BH workforce. In the last three decades, the growth of the peer workforce has helped mitigate the BHworkforce shortage: as individuals with lived experience of mental illness and/or substance use disorder, peers augment the clinical work of licensed specialists, enhance quality of care and improve BH patients’ access to resources. However, significant policy and funding challenges stand in the way of maximizing the full potential of the peer support workforce. This sequential, mixed methods study aimed to 1) determine the availability of peer support services and the characteristics associated with providing these services at mental health facilities, and 2) examine how state policies related to peer eligibility, training and certification, roles and practice patterns, and working conditions; and state policy contexts, processes, and actors, either help or hinder the certified peer workforce in select high, mid-range, and low penetration states. Results showed that peer support provision varied by state, census region, facility ownership and type, and payment types accepted. Quantitative findings underscored the lack of reimbursement for peer support services by private insurers, and the absence of these services among private, for-profit mental health facilities compared to government-owned and private, non-profit facilities. Qualitative findings highlighted the influence of state policy “champions” in promoting the peer profession, and the pervasiveness of stigma that undermines peer compensation and peers’ ability to practice with fidelity to the role. Findings also showed that high penetration at the state level did not necessarily correlate to policies that support the recruitment, training, certification, and equitable working conditions of the certified peer workforce. States at all penetration levels have overcome policy barriers and implemented policies to support the peer workforce. While they were influenced by unique social, political, geographical contexts, these states’ policy content and processes could potentially be replicated in other states to develop the peer workforce, promote the profession, and increase access to peer services. In addition to establishing a more robust, national dataset on the peer workforce, federal agencies must take the lead in increasing workforce investments, first and foremost by enabling viable Medicaid and Medicare reimbursement rates for peer support services, and by funding continuous peer workforce development. Private insurers must follow their lead and reimburse for peer support services at rates that can retain and support the growth of the peer workforce.
- All rights reserved
Notice to Authors
If you are the author of this work and you have any questions about the information on this page, please use the Contact form to get in touch with us.