Effective September 23, 2003, representatives from DHHS informed SCDMH that this draft of the Peer Support Service Regulation will have additional changes. They will be issuing a Medicaid Bulletin shortly, which will define the Peer Support Service more explicitly for implementation later this fall.
Peer Support Services are provided to support the recovery of individuals with mental illnesses.
1) Services are directed toward achievement of specific goals as defined by the individual and specified in the Individualized Treatment Plan (ITP).
2) Services are multi-faceted and include:
a. crisis management support
b. skills training
c. coordination and linkage with other necessary services and resources
3) Services are delivered by trained self-identified individuals with mental illness.
4) Services are person-centered with a recovery focus.
5) Services are provided one-to-one, in groups, with team members in community settings, or the individualís natural environment.
6) Services are coordinated and delivered in partnership with the individualís receiving service.
Peer Support Services will be rendered by A Peer Support Specialist certified by DMH under the supervision of a Mental Health Professional (MHP).
1) The MHP shall assure that the Peer Support Specialist provides services in a safe efficient manner in accordance with accepted standards of clinical practice.
2) The MHP will assure that the Peer Support Services are rendered in accordance with certification training standards for Peer Support Specialists as established by the South Carolina Department of Mental Health.
3) The following standards for Peer Support Specialists must be met:
a. The Peer Support Specialist will possess a high school degree or GED equivalent.
b. The Peer Support Specialist will be a current or former consumer of services as defined by:
Having had a serious mental illness which meets the Federal
definition and having received treatment for it
ii. Self-identifying as a current or former consumer.
c. A Peer Support Specialist will have the following experiences and abilities:
i. One (1) year active participation in the local or national mental health consumer movement;
ii. Demonstrates recovery expertise (knows how to support others in recovery) and has the ability to demonstrate own effort at self-directed recovery.
d. A Peer Support Specialist will be required to complete and pass a certification training program approved by the South Carolina Department of Mental Health.
Standard: Staff/Consumer Ratio
Peer Support Services will be rendered to individuals one-to-one or in groups no larger than ten (10) consumers to each staff member.
Peer Support Services will be supervised by an MHP. The following standards must be met:
1) The MHP must be available for supervision and spend as much time necessary at the service site to assure individuals are receiving services in a safe, efficient manner in accordance with acceptable standards of practice.
2) The MHP is required periodically to attend and chair a staffing meeting with the Peer Support Specialists during which administrative and individual treatment issues are considered.
3) The MHP will specify services that address specific program content and assess individual needs.
a. The MHP is required to make a minimum of one (1) evaluation no later than 6 months after admission and then annually (every 12 months) thereafter to monitor the recovery of the consumer and the focus of Peer Support Services provided.
b. The MHP evaluation may be billed separately as Mental Health Assessment.
Peer Support Services are structured and scheduled activities that promote community socialization, recovery, self-advocacy, development of natural supports, and maintenance of community living skills. Individuals actively participate in decision-making, program development and goal-setting. Peer Support Services facilitate the development of self-help skills. Services are directed toward achievement of specific goals defined by the individual and specified in the Individual Treatment Plan (ITP) authorized by a Physician. Peer Support Services are specialized therapeutic interactions by trained paraprofessionals who are current or former users of mental health services.
Building on the unique therapeutic relationship between the Peer Support Specialist and the individual, and the individualís family unit as requested and defined by the individual, services emphasize the acquisition, development, and expansion of rehabilitative skills needed to move forward in recovery. Peer Support Specialists offer individuals hope that recovery from major mental illnesses and trauma is possible. Services are needed to provide support and encouragement to individuals and their families when individuals first begin to receive services, during intake and assessment, while adjusting to medications, through relapse and during discharge planning. Peer Support Services emphasize personal safety, self worth, introspection, confidence, growth, connection, boundary setting, planning, self advocacy, personal fulfillment, the helper principle, crisis management, meaningful activity and work, and effective communication skills.
Service content includes assisting the individual during structured therapeutic activities promoting the following:
Self Help: Cultivating the individualís ability to make informed, independent choices. Helping the individual develop a network of contacts for information and support who have been through similar experiences.
Self Improvement: Planning and facilitating actual practical activities leading to increased self worth and improved self concepts.
System Advocacy: Assisting
the individual with writing a letter or making a telephone call about an
issue related to mental illness or recovery. Talking about what i
Individual Advocacy: Discussing concerns about medication or diagnosis with the Physician or Nurse at the individualís request. Helping the individual get appropriate treatment when requested. Guiding the individual toward a proactive role in their own treatment.
Crisis Support: Assisting the individual with the development of a crisis plan, or a Psychiatric Advance Directive. Learning to recognize the early signs of relapse and how to request help to head off a crisis. Learning how to use a crisis plan. Learning how to use less restrictive, hospital alternatives. Learning how to divert from using the emergency room. Learning how to divert from jail to a more appropriate alternative.
Housing: Assisting the individual with learning how to maintain stable housing or learning how to change an inadequate housing situation.
Social Network: Assisting the individual with learning about the need to get out of unhealthy personal relationships, learning how to start a new relationship (such as going to a movie with a new friend, meeting someone new at a social gathering), and learning how to improve communications with family members. Facilitating the individualís attendance at a peer support group or advocacy group, or receiving one-to-one peer counseling.
Education/Employment: Assisting the individual in gaining information about going back to school or job training. Learning about going back to full-time paid work. Learning about going back to part-time paid work. Facilitating the process of asking an employer for reasonable accommodation for psychiatric disability (mental health day, flex time, etc.).
Developing a Mental Health Wellness Recovery Action Plan.
Treatment Planning and Periodic Review of the ITP
1) Peer Support Services will be included in the individualís treatment plan.
2) Goals will be personalized, action-oriented, and measurable.
3) The Peer Support Specialist will participate in treatment planning and review pertinent to the individualís recovery and community maintenance.
In addition to meeting the documentation requirements in the Medical Records section of this Manual, the following requirements must be met:
1) Peer Support Services will be listed as the service rendered on the CSN.
2) Peer Support Services can be billed when provided concurrently with the following services:
MH Clubhouse Services
Skills Training and Development Services
Program Evaluation and Outcome Criteria
Individuals receiving Peer Support Services will be monitored and reviewed periodically and annually using a variety of measures: participatory action research processes, consumer and other stakeholder advisory board reports, focus groups with service participants, program suggestion box results, program satisfaction surveys, and DMH system-wide surveys will produce outcome measures in the following areas for Peer Support Services:
1. Satisfaction with Services: Individuals will be satisfied with Peer Support Services, as evidenced by consumer perception of care.
2. Access to Services: Individuals will demonstrate high access to services as documented by MHSIP, or a MHSIP-like instrument.
3. Clinical Outcomes: Individuals receiving Peer Support Services will maintain, or improve, their functioning as evidenced by a combination of the consumerís measure of outcome (e.g., MHSIP) and a clinical measure, such as the GAF.