Boots on the Ground: Mental Health Peer Support Specialist

Photo by Joel Muniz at Usplash

For years, the evidence was there: peer support programs helped stabilize those with mental illness and substance use disorders. Forty-eight states had adopted the model. Why was California so behind?

Perhaps it required a pandemic and the rearing of a mental health crisis to make it happen. Former State Sen. Jim Beall had tried twice before. Both times it was vetoed by California Gov. Gavin Newsom. On the third try, SB 803 was finally signed and on Sept. 25, 2020 enacted. California became the 49th state to have a Peer Support Specialist Certification Program.

Since then, California Mental Health Services Authority CalMHSA and various other agencies including CAMPRO (California Association of Mental Health Peer Run Organizations),  California Alliance for Child and Family Services, and NAMI California  have been working jointly to launch the program between May 2022 and July 2022.

“I think it will grow,” retired State Sen. Beall said optimistically. “My perception is throughout the mental health community we will have boots on the ground for mental health services, and an army of peer support that is trained.”

For the first time in the state’s history, parents, peers, caregivers, and family members are being recognized and potentially compensated for a job they understand intimately. Payment will come through Medi-Cal funding, and the certified Peer Support Specialist will be a new code in the billing system.

Adrienne Shilton, Director of Public Policy for the California Alliance of Child and Family Services, said, “When the [SB 803] was first drafted, it had all these different categories and then it became collapsed into one. We wanted to make sure the family member was not lost.”

She emphasized that each group brings a specific perspective to the situation. No one peer is more important than another, Shilton said.

The final law has four specializations: 1) Family member, Peer, Parent, Caregiver; 2) Crisis; 3) Justice Involved; and 4) Unhoused. All specialties require individuals to have “lived experience with the process of recovery from mental illness, substance use disorder, or both,” according to the program requirements. The first specialty to be trained will be the family, peer, parent, and caregiver group.

Peer Support Specialist Qualifications

To become a certified Peer Support Specialist, an individual needs to complete 80 hours of curriculum and training requirements that include 17 core competencies. To be certified, the person needs to pass a statewide exam. This is the track for those who currently do not work in the mental health sector as a peer support employee or who won’t satisfy the grandfathering provisions.

For individuals who are peer support employees as of Jan. 1, 2022, and work at various mental health agencies or nonprofits, there are grandfathering provisions in place through December 2022. These individuals are required to have work experience hours, 20 hours of continued education, and have completed a peer training. They also will need three recommendations and are required to pass a statewide exam.

All individuals must have a high school diploma or equivalent degree and be at least 18 years old.

The certification training was developed to bring mental health and substance use disorders together because the teaching concept of recovery is unique to mental health, said Lucero Robles, Director of Quality Assurance and Compliance for California Mental Health Services Authority.

Robles, a licensed clinical social worker, said they did receive some complaints about the degree requirement. But she explained that this is a federal mandate, since a portion of the program’s funding comes from the federal government to California for Medi-Cal.

Robles noted that counties had to opt into the program, which Santa Clara County did. Each county will work out an agreement with the California Department of Health Care Services (DHCS) for peer support Medi-Cal reimbursement.

It’s the DHCS that establishes the certification requirements, and it’s CalMHSA that administers the certification program, including the standardized exam for statewide certification.

Pumping Up the Workforce

NAMI California Director of Workforce Community Engagement Ragini Lal said, “We worked closely with CalMHSA to build off of NAMI’s core competencies, values, and goals.”

Lal said classroom training will have two instructors—one who focuses on peer support and one who focuses on family support—and they will teach classes together. This will enable the students to see the situation from different points of view.

“For example, conflict resolution looks different for a parent engaging with a child than a peer engaging with a friend,” she said.

CALMHSA is still working to finalize the statewide exam. However, vendor contracts for Peer Support Specialist training should be awarded shortly. NAMI California is one of the vendors who applied. Once the vendors are selected, the training will be done through remote learning. Robles is hopeful it can begin in May.

It’s important to note that individuals working in nonprofits such as NAMI’s peer support programs are not required to become certified to continue their work. The same is true for those who facilitate family support groups. This option is available to individuals with lived experience who wish to take on more rigorous training and work toward certification. These individuals, once completing all the requirements, would become part of a statewide registry. This registry enables individuals to work anywhere in the state with an organization in need of peer support services that can be reimbursed through Medi-Cal.

It will be a new position in the mental health workforce sector and the Santa Clara County Behavioral Health Services Department. Some workforce options might involve assisting a mobile crisis unit team, helping someone in need of supportive housing, or supporting an individual in need of substance use treatment or dealing with a severe mental illness.

David Mineta, CEO of Santa Clara County-based Momentum for Health, said such a program can’t come soon enough for the struggling mental health workforce. There is a 46% vacancy for clinicians industrywide, he said. With the passage of the peer support specialist program, professionals working in the mental health sector have some encouragement.

“This is such a moment in time that requires thinking outside the box. We need to make changes to help people faster and quicker,” he said. 

To learn more about the Peer Support Specialist Certification program, click CalMHSA