Certification Matters: The Relationship between State Certification and the Availability of Peer Support Services

Background and Purpose

The number of peer support workers has grown exponentially during the past decade. In 2005, it was estimated that the peer workforce was slightly more than 10,000. In 2016, conservative numbers estimated the peer workforce to hover around 25,000; other sources say it is around 40,000.  Despite these discrepancies in estimates, nomenclature describing peer supporter titles, tasks, and certification requirements are inconsistent across the 42 states that have a process to certify peer supporters. These individuals offer hope, identification, companionship and social support to others experiencing similar challenges, and practice through the lens of personal lived experience dealing with challenges associated with mental health and substance use issues. Peer supporters are interspersed to varying degrees among staffing patterns in agencies providing what are referred to as behavioral health services. A topic that is often discussed yet underrepresented in research is an agency’s planning of viable funding for peer supporter positions. As states deal with the complexities of Medicaid Managed Care and Restructuring and its implications for reimbursing specific peer support services, hiring peer supporters who are certified becomes both a significant and contentious issue. Albeit the philosophical clash between proponents of peer supporter certification and grassroots pioneers who systematically oppose commodification and monetization of this type of natural support, we examine the relationship between state certification of peer support and the availability of those services and control for other organizational characteristics that could account for the relationship.

Methods 

Data: Data for this study were drawn from the 2014 National Mental Services Survey (N-MHSS), which provides information about the service characteristics and the clients served at mental health organizations throughout the United States. The sample for this study consisted of 13,176 organizations.

Measures: The primary outcome of interest for this study was the provision of peer support. The independent variables measured payer sources (Medicaid, Medicare, cash/self-payment, private insurance), ownership (private non-profit, private-for-profit organizations, and public owned), organization settings (hospitals, community centers, residential treatment, and other), and if the organization was in a state that offers peer support certification.

Analysis: Logistic regression models were conducted to examine the relationship between the independent variables and the availability of peer support services at the mental health organizations.

Results

Descriptive results show that nearly 27% of mental health organizations reported offering peer support services. The findings of the multivariate analysis show that self-payment, Medicare, Medicaid, ownership, and organization settings were positively and significantly associated with the provision of peer support services. Conversely, private insurance and state certification were negatively and significantly associated with the provision of peer support services.

Conclusion:

The findings demonstrate that certification in the state is negatively related to peer support provision at the national mental health service organizations even after controlling for organization characteristics. This finding reveals that certification may be a barrier to employing peer supporters. As social workers, we play a central role in advocating for policy changes that ensure clients have access to peer support and other services that may assist their recovery.