In July, 2021, we raised alarms about proposed legislation to create a Certification Board for Peer Specialists. (You can see details of that alert here: http://tiny.cc/PSBOD) The legislation came as a surprise to many people across the state, and we never could quite pin down why it was happening. It now seems clear that the move to implement a Board of this nature to oversee Peer Specialists in the state is closely tied in with the move to make the work of Peer Specialists Medicaid reimbursable.
On March 15, 2022, Governor Charlie Bake filed a new bill called, “An Act Investing in the Future of Our Health.” The Bill is 124 pages long, and covers a lot of ground.
- It’s intent is summarized in a press release available at tiny.cc/BakerBillCPS
- The full Bill can be downloaded here: https://malegislature.gov/Bills/192/S2774
Also buried in the bill—beginning on page 24— are portions that directly impact people working in peer support roles across the state. Specifically, the new Bill revives the enactment of a Certified Peer Worker Board of Registration. This new version does make one key improvement: A minimum of 25% of the Board will be made up of people who occupy peer roles, and an additional 20% of members will need to have been recipients of formal peer supports for at least one year. Meanwhile, the representation of people holding more clinical roles has been reduced to 27 to 40%. (In the prior bill, only 18% of membership would have necessarily had experience with peer support, and 45% of seats would have been occupied by people with more clinical focuses.)
That said, there’s a fair amount of wiggle room in how membership is written. For example, how is ‘Certified Addictions Recovery Coach’ being defined? It may be a ‘peer’ role, but is listed separately from ‘peer recovery coach’ which suggests it is probably not. And will the requirement for a member who is a ‘peer supervisor or educator’ mean that that person also has experience offering peer support? That is also unclear. All told, this portion of the bill appears more representative than the last version, but it continues to raise serious concerns including:
- Will the voice of people on the Board with histories of problems with substances and who’ve been engaged in peer support in that realm drown out the voice of people with psychiatric histories? In spite of the numerous individuals who struggle with both substances and issues related to psychiatric diagnosis, the way that peer support works in these different divisions can sometimes be worlds apart. Meanwhile, depending on how the different seats are filled (particularly where it says things like “shall be a family member to an individual with a mental health or substance use disorder”), the likelihood of a skew in one direction or the other seems relatively likely.
- Is the make-up of this Board equitable or discriminatory? For example, if we review the make up of the Board of Registration of Social Workers in Massachusetts will we find a similar structure? A quick review of listed membership (available at http://tiny.cc/SWBOR) reveals six seats, five of which are filled by social workers. We are awaiting further clarification from that Board.
Other concerns with the bill beyond Board membership include:
- Added Costs: The Bill references certification and re-certification costs, and likely also Continuing Education costs, too.
- Dictating Course Content: The Bill also states it will “define by regulation the appropriate standards for education, core competencies, and experience necessary to qualify as a certified peer worker.” This is of particular concern if people with psychiatric histories working in related peer supporter roles are not well represented, and/or if the Peer Supervisor/educator seat goes to someone from what is essentially a different discipline in the substance world.
- Who Gets to Be a Peer Supporter?: It should be of substantial concern to everyone that the legislation also states that candidates to become a Certified Peer Worker must “demonstrate at least 2 years of sustained recovery.” We question how “sustained recovery” might get defined. Will someone who relapsed and used a substance with which they struggle be discounted? Will someone who spent a few nights in a psychiatric facility not be seen as eligible? Will someone who still admits to struggling with suicidal thoughts be ruled out? Who will have the power to determine how this gets defined? Will it include perspectives on “compliance” with treatment orders? In reality, if this were a widespread standard, many of the best peer supporters in the nation —those who teach us that life is full of challenges and ups and downs are normal—wouldn’t be able to do the jobs they do so well. And how did we come up with “2 years” anyway?
- Who Gets Fired?: The legislation also includes the expected language about the Board being able to “to fine, censure, revoke, suspend or deny a certified peer worker authorization to practice, place on probation, reprimand or otherwise discipline a certified peer worker for violations of the code of ethics or the rules of the board” as well as “to summarily suspend a certified peer worker who poses an imminent danger to the public” and on the surface perhaps this all seems reasonable. However, again, we wonder who will get to define how those words are applied to a community of people who’ve disproportionately been impacted by discriminatory views leading to orders of force and so on?
We can’t say this enough times: The community from which Certified Peer Workers are drawn is one that has disproportionately been impacted by discriminatory views. Additionally, individuals who are a part of other marginalized communities (including non-white communities, immigrants, trans people, and so on) also routinely experience even more oppressive attitudes and actions against them when they have a psychiatric label and/or a problem with substances layered on to how they are seen.
Once again, we are being subjected to the decisions and recommendations of people who ultimately do not fully understand our work, nor the discrimination and loss of power and control many of us have already faced. And clearly, they do not understand just how critical it is to peer-to-peer support of any kind that we get to speak for ourselves, and create our own guidelines.
Unfortunately, the hearing date for this legislation has already passed, but they are still accepting written feedback. There is no set deadline for written feedback, but bear in mind that the Bill now has an extension date until June 1. We strongly encourage you to submit your feedback as soon as possible! Feedback can be directed to:
You can view the recorded hearing on this Bill at https://malegislature.gov/Events/Hearings/Detail/4257