The Critical Support Role Peer Support Specialists Can Play in Holistic Health Care
By Chad Stage M.A., Manager of Behavioral Health Programs, Emtiro Health
Over the years, the idea of who exactly comprises a “Health Care Team” has evolved a great deal. Historically, one might describe their Care Team as simply a physician and perhaps a nurse. However, as health care continues to evolve there is an increased emphasis on treating the “whole person” by addressing not only physical ailments, but psychological and social needs as well. With that shift in emphasis, the definition of a Care Team has become more inclusive of a multitude of health care professionals including, but not limited to, specialists, behavioral health clinicians, and pharmacists. All of these potential Care Team members typically work with the patient in a clinical setting; however, 90% of health care happens outside clinic walls. So, what happens to a patient’s treatment plan once they leave their doctors office? This is precisely where the use of Peer Support Specialists (PSS) can be a vital part of the Care Team by supplementing in-office visits with critical support in the community setting.
The International Association of Peer Supporters defines a PSS as “someone with personal experience of recovery from behavioral health, substance use, or trauma conditions who receives specialized training and supervision to guide and support others who are experiencing similar behavioral health, substance use, or trauma issues toward increased wellness.” PSS’s bring with them shared experiences that can provide guidance and hope to a patient who may be struggling with the confidence to overcome poor health behaviors, social needs, or knowledge of complicated systems such as Social Services, Disability, or Behavioral Health.
The difference in care between a patient with and without a PSS might best be understood through an illustrative example. That is why we’ve created the following fictional scenario about Thomas, a 55-year-old male with several chronic conditions.
The Story of Thomas, without a PSS:
Thomas presents to his primary care physician for an annual physical. He suffers from multiple chronic conditions including Chronic obstructive pulmonary disease (COPD), Congestive heart failure (CHF), uncontrolled diabetes, and substance use disorder (SUD). During his physical, Thomas is met by several clinic staff members from medical assistants to nurses and administrative staff. Thomas is asked to fill out numerous medical forms and screenings, most of which he doesn’t fully read or understand due to his literacy level. Thomas is eventually greeted by his physician who sits on a stool behind a computer and asks a series of questions related to Thomas’ chronic conditions, current health, medications, etc. At the conclusion of this brief barrage of questioning, Thomas has indicated that he continues to smoke (with his oxygen) and has not been checking his blood sugar or filling his medications, as he spends most of his income on alcohol and cigarettes. In addition, Thomas scored a 12 on his PHQ-9, up significantly from the 5 he scored last year, and he reports that his referral to Behavioral Health from 3 months ago was never followed up on. Thomas leaves his doctor’s appointment with a stack of papers from the receptionist including information about his diagnosis and a detailed treatment plan which includes another referral to Behavioral Health. He feels hopeless and unsure of what steps to take to resolve his multiple health and social needs.
The Story of Thomas, with a PSS:
The same exact scenario as above plays out during Thomas’ annual physical exam except in this scenario, the practice has PSS as part of their follow up for high-risk patients.
Thomas still leaves his appointment feeling hopeless and confused on how to accomplish his treatment goals. However, that afternoon he gets a call from his assigned PSS who wants to schedule a time to meet with him to discuss his needs as well as how he has overcome similar obstacles in the past and then develop a unique treatment plan. Over the course of the next few weeks, Thomas meets with his PSS in the community and locates community resources that he previously did not know existed such as a local agency that provides low-cost medical supplies so he can afford his diabetic strips. The PSS follows up with the behavioral health agency, ensuring Thomas is able to schedule an appointment. The PSS even attends Thomas’ first behavioral health session with him as a support. In addition to connecting Thomas successfully with his behavioral health provider, the PSS helped Thomas locate a local Alcoholics Anonymous (AA) meeting and has been attending meetings with Thomas for the past several weeks. The PSS has not only assisted Thomas is addressing some of his health goals, but he has increased Thomas’ confidence that he can overcome many life barriers he may face in the future.
In these two scenarios, it is easy to see how without that follow up in the community from someone who has lived experience and knowledge of local resources and who has successfully navigated the complicated healthcare system, Thomas could have very well left his doctor’s office and his treatment plan would have found its way to the nearest trash receptacle. It is likely then that at his next appointment, things would have continued to deteriorate for Thomas. But with the help of a PSS, someone who could relate to him and support him, Thomas’ outcomes were improved tremendously.
It is not just primary care practices that are beginning to find ways to incorporate PSS’s as part of their care delivery model. PSS’s can be found in hospitals, ED’s, Behavioral Health agencies, community-based organizations, LME/MCO’s, and care management providers. This increase in PSS’s across multiple healthcare settings is encouraging. According to the North Carolina Certified Peer Support Specialist Program website, there are currently 3,890 PSS’S in North Carolina (NC). And according to the University of North Carolina, 20% of the NC certified peer population is actively seeking employment in the field.
Number of Certified Peer Support Specialists by County in North Carolina. Source: North Carolina’s Certified Peer Support Specialist Program (NCCPSS)
Emtiro has made a concerted effort to recognize the importance of unconventional support staff in the development of our care management model. Our model of care management strives to achieve the CDC suggested improvements in population health (e.g. Community Integrated Healthcare System 3.0 see graph below), the “Triple Aim” of achieving better care, better health for communities and lower costs. Nurse care managers under Emtiro’s model will not only have access to many specialized staff with expertise from pharmacy, nutrition, behavioral health, community health workers, housing, but peer support specialists as well. We believe that this approach to care management will allow for our nurse care managers to delegate tasks based on patient needs, which will help us achieve the “Triple Aim.”
As North Carolina moves toward managed care of Medicaid and value-based contracting, the role of PSS’s will continue to grow. Furthermore, the need to provide patients with support during the 90% of health care that occurs outside the clinic, as illustrated in the scenario above, will become a vital need of health care providers and agencies across the health care landscape.