Shifting the Conversation - By Kris Kelly

Peer Recovery Support is the topic of conversation for many organizations and systems looking for ‘new and innovative’ ways to combat the opioid epidemic.  Although in the community, peer support has been around for centuries, the behavioral healthcare system has been slow in utilizing Peer Recovery Support Services (PRSS) to their full potential, but that is quickly changing. 

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Reviewing the work of William White, we see a history of organized, robust peer support groups dating back to the 1700-1800s within the Native American Handsome Lake Movement and the Washingtonian Temperance Society (1840), just to name a few. One of the most recognized forms of peer support, 12-Step mutual aid groups, were founded in the 1930s and are now familiar in popular culture as evidenced in mainstream media. 

Recognized by the Centers for Medicare and Medicaid in a 2007 letter to State Medicaid Directors; “Peer support services are an evidence-based mental health model of care which consists of a qualified peer support provider who assists individuals with their recovery from mental illness and substance use disorders. CMS recognizes that the experiences of peer support providers, as consumers of mental health and substance use services, can be an important component in a State’s delivery of effective treatment.” 

In Minnesota, Certified Peer Specialists (CPS) for mental health became reimbursable through Medicaid in 2009.  According to the DHS website, CPS’s are employed in agencies approved to provide peer services within the following mental health rehabilitation services: Assertive Community Treatment, Intensive Residential Rehabilitative Services, Adult Rehabilitative Mental Health Services, and Crisis Response Services. This is the same year that the MN DHS dedicated a portion of the Substance Abuse Block Grant funding to create Recovery Community Organizations (RCO) in MN.  RCO’s began training and mobilizing Recovery Coaches within their grassroots organizations, but we rarely saw them employed in behavioral healthcare settings. To date, Minnesota’s RCO’s have trained over 1000 Peer Recovery Specialists and that number is growing at an exponential rate. Minnesota is now home to 8 Recovery Community Organizations.

It wasn’t until 2018 that Peer Recovery Services for substance use disorder (SUD) were approved to become a part of the Medicaid benefit set, billable within Licensed Treatment facilities (245G), withdrawal management and Recovery Community Organizations. This is a step in the right direction and we have a ways to go before recovery support services are available on-demand, at the first call for help, without needing an assessment or having met other clinical criteria. These legislative changes increase support for the estimated 10 percent of people with a substance use disorder who receive any type of specialty treatment, we are missing the opportunity to deploy peer recovery support services in settings that provide services for the 90 percent that may never enter the doors of treatment.

Effective implementation and integration of Peer Recovery Support Services has the potential to lower healthcare costs, reduce and remove barriers to care, reduce health disparities, and provide long-term recovery management support. But Peer Recovery Support Services are more than an adjunct to clinical treatment. Involving people with lived experience in the design, delivery, and evaluation of behavioral healthcare services is an opportunity to authentically extend the continuum of care. It is a transformation of the way our system provides services. We can ask (and keep asking) the very people who have been receiving services, what parts of the system helped or hindered their recovery.