Tips on Peer Roles for Providers Implementing Adult Community Clinical Services (ACCS)

For those not in the know, about a decade ago, the Massachusetts Department of Mental Health (DMH) moved to a ‘Community Based Flexible Supports’ (CBFS) model of providing residential and other primary adult mental health services. Whatever you make of the success (or lack thereof) of that model, things are on the move again. Now CBFS will become ACCS: Adult community Clinical Services. Providers who are interested in holding and implementing the new ACCS contracts have already placed their bids, and now everyone’s waiting to hear back.

 

Although few people seem to fully understand what the new model will look like (check out this effort at an explanation through the DMH website if you’re interested in more details: goo.gl/cG9JcW), one thing is clear: it will look different. One of the easier to understand differences is related to peer roles.

 

For the first time ever, DMH has taken a stand on what ‘peer role’ means. The new contract insists that people in peer roles not be used to administer medications, manage rep-payeeships, or engage in any kind of work that is not consistent with the Certified Peer Specialist Code of Ethics. However, some organizations have remained confused about what to do with peer roles according to the new arrangement. Here’s some points to bear in mind:

 

1. The ACCS materials from DMH talk a lot about ‘harm reduction’ in relation to problems with substances. However, harm reduction is also a useful concept that bears far more exploration in relationship to psychiatric drugs (and drug withdrawal), self-injury and many other experiences related to psychiatric diagnosis and/or the focus of the mental health system.

2. Despite popular interpretation, the ACCS contract does NOT require a peer support structure that leaves people in peer roles isolated on separate teams. In fact, it leaves the door wide open to create one centralized peer support team with peer supervisors who have worked in peer roles themselves and operate strictly within a peer-to-peer structure.

3. In fact, the ACCS contract is extremely clear in differentiating between peer roles, direct care, and clinical staff. This means that—unlike with direct care roles– a clinically trained supervisor is NOT required. One best practice model of peer support that fits neatly within the ACCS model as described by DMH in the Request for Response (RFR) document is to create a peer support team with peer supervisors, and then to assign some of those peer supporters to be connected to specific clinical teams.

4. DMH’s emphasis in the ACCS RFR on the need to identify strategies for hiring and retention in peer roles also lends itself best to a structure where there is a centralized peer team with peer supervisors. One of the top reasons that people in peer roles burn out or quit is feeling isolated or experiencing a lack of support to do their job with integrity and in accordance with their Code of Ethics.

5. Watch out! Peer Specialists, Family Partners, and Recovery Coaches are NOT interchangeable, even though the ACCS RFR suggests that the provider can decide which of them they hire, so long as they meet the total ratio required. Family Partners are ‘peers’ with family members. While there may be a role for a few Family Partners on an ACCS team, it’s hard to imagine the presence of several Family Partners without violating the rights and privacy of the adults actually receiving ACCS services or pulling resources away from the peer support that those in services will find most useful. Meanwhile, Recovery Coaches are not required to have their own experience with problems with substances, and so Recovery Coaching is not always peer support at all.

 

Peer Specialists also often have a mix of experiences with psychiatric diagnosis, trauma, and substances increasing their ability to support a diversity of issues. Providers should be really cautious about swapping out too many ‘peer’ roles for Family Partners or Recovery Coaches.

 

6. The training requirements listed in the ACCS contract require certification within a six month period. However, that doesn’t necessarily mean that the training has to be the Certified Peer Specialist training. Another option may be the Intentional Peer Support training (currently used by Maine as their primary peer certification process). This only requires a proposal to DMH. The worst they can say is no! (This is also a great opportunity to re-evaluate training for all roles. Don’t let the highly clinical nature of the ACCS contract stop you from being creative!)

7. This is also an opportunity to re-evaluate your Human Rights set up. Some organizations use peer supporters as their human rights officers specifically because the peer supporters aren’t supervised by the managers who may be overseeing a house where there’s a complaint. This can help prevent Human Rights Officers who feel afraid to pursue complaints because they relate to the person supervising them.