The Role of Certified Community Behavioral Health Clinics in Enhancing Access to Peer Delivered Services

Background: Peer support workers (PSWs), individuals in recovery who support others experiencing similar challenges, are important contributors to person-centered, comprehensive care. Drawing from their lived experience, PSW’s are uniquely able to engage individuals in services, instill hope, and help sustain service-users’ motivation towards recovery. However, fully integrating PSWs into the behavioral health workforce has been hampered by organizational and cultural barriers, including insufficient reimbursement for peer delivered services, stigma from behavioral health providers, and a lack of clearly defined job descriptions.

The recent development and expansion of Certified Community Behavioral Health Clinics (CCBHCs), an emerging model of comprehensive, coordinated behavioral health care, provides new opportunities to incorporate PSWs into routine service delivery and increase access to peer delivered care. CCBHC criteria stipulate the inclusion of PSWs as core members of care teams. CCBHCs also receive enhanced payment that may address reimbursement barriers for peer support work. We examined changes in the delivery of peer services within one large clinic as it transitioned from a community mental health clinic to a CCBHC.

Methods: This study utilized administrative data that included all outpatient services delivered by a single clinic in the year before and after CCBHC implementation. The clinic completed 183,977 visits to 10,385 adults clients in 2017, and 187,538 visits to 10,710 adults adult clients in 2019. We first examined changes in the number of visits delivered by PSWs both across and within programs in the years before and after CCBHC implementation using chi square analyses. Utilizing linear regression models that controlled for client demographics, we also identified changes in the average annual number of PSW visits per client before and after CCBHC implementation.

Results: The number of annual visits by PSWs significantly increased from 5,999 to 7,312 following implementation (X²= 293.89, p<.001). The number of peer visits within the clinic’s outpatient substance use (X²= 402.12, p<.001) and transitional age youth (TAY) support programs (X²=104.26, p<.001) significantly increased, however, visits within the assertive community treatment program decreased (X²= 7.08, p<.01). Overall, clients’ average number of annual PSW visits did not significantly change following CCBHC implementation; however, individuals with substance use disorders (ß=.24, p<.01) and specifically those with opioid use disorders (ß=1.30, p<.001) experienced increases in the average number of PSW visits following implementation. Visits with PSWs among individuals with serious mental illness (SMI) and TAY did not significantly change.

Conclusion: Findings suggest that CCBHC implementation increased overall organizational capacity to deliver peer supported services, although PSW service expansion may be targeted more specifically towards individuals with substance use disorders rather than those with serious mental illness. This is consistent with the CCBHC model’s emphasis on increasing access to treatment for opioid use disorders, and findings highlight the central role PSWs are playing in the expansion of these services. Training and certification for PSWs must therefore be responsive to the ways in which this workforce is being integrated into newly emerging models of community mental health.