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An Assessment of Innovative Models of Peer Support Services in Behavioral Health to Reduce Preventable Acute Hospitalization And

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An Assessment of Innovative Models of Peer Support Services in Behavioral Health to Reduce Preventable Acute Hospitalization And U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy AN ASSESSMENT OF INNOVATIVE MODELS OF PEER SUPPORT SERVICES IN BEHAVIORAL HEALTH TO REDUCE PREVENTABLE ACUTE HOSPITALIZATION AND READMISSIONS December 2015 Office of the Assistant Secretary for Planning and Evaluation The Office of the Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the Secretary of the Department of Health and Human Services (HHS) on policy development issues, and is responsible for major activities in the areas of legislative and budget development, strategic planning, policy research and evaluation, and economic analysis. ASPE develops or reviews issues from the viewpoint of the Secretary, providing a perspective that is broader in scope than the specific focus of the various operating agencies. ASPE also works closely with the HHS operating agencies. It assists these agencies in developing policies, and planning policy research, evaluation and data collection within broad HHS and administration initiatives. ASPE often serves a coordinating role for crosscutting policy and administrative activities. ASPE plans and conducts evaluations and research--both in-house and through support of projects by external researchers--of current and proposed programs and topics of particular interest to the Secretary, the Administration and the Congress. Office of Disability, Aging and Long-Term Care Policy The Office of Disability, Aging and Long-Term Care Policy (DALTCP), within ASPE, is responsible for the development, coordination, analysis, research and evaluation of HHS policies and programs which support the independence, health and long-term care of persons with disabilities--children, working aging adults, and older persons. DALTCP is also responsible for policy coordination and research to promote the economic and social well-being of the elderly. In particular, DALTCP addresses policies concerning: nursing home and community- based services, informal caregiving, the integration of acute and long-term care, Medicare post-acute services and home care, managed care for people with disabilities, long-term rehabilitation services, children’s disability, and linkages between employment and health policies. These activities are carried out through policy planning, policy and program analysis, regulatory reviews, formulation of legislative proposals, policy research, evaluation and data planning. This report was prepared under contract #HHSP23320100026WI between HHS’s ASPE/DALTCP and Westat. For additional information about this subject, you can visit the DALTCP home page at https://aspe.hhs.gov/office-disability-aging-and-long-term- care-policy-daltcp or contact the ASPE Project Officer, Joel Dubenitz, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. His e-mail address is: [email protected]. AN ASSESSMENT OF INNOVATIVE MODELS OF PEER SUPPORT SERVICES IN BEHAVIORAL HEALTH TO REDUCE PREVENTABLE ACUTE HOSPITALIZATION AND READMISSIONS Westat December 2015 Prepared for Office of Disability, Aging and Long-Term Care Policy Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services Contract #HHSP23320100026WI The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. TABLE OF CONTENTS ACKNOWLEDGMENTS ............................................................................................................ iv ACRONYMS ............................................................................................................................... v EXECUTIVE SUMMARY .......................................................................................................... vii 1. ENVIRONMENTAL SCAN REPORT .................................................................................... 1 Peer Support Services........................................................................................................ 2 Key Definitions of Terms Used in This Report .................................................................... 2 The Role of Peer Support Services in Health Care ............................................................. 3 Peer Support Services as Part of the Larger Health Care Service Systems ....................... 5 Peer Support Services as an Evidence-Based Service ...................................................... 7 Limited Research Findings ................................................................................................. 9 State-Level Training and Certification for Peer Specialists ............................................... 12 Peer Support Services and Health Care Utilization and Outcomes ................................... 14 A Proposed Typology of Peer Support Services for the Reduction of Preventable Hospitalizations and Emergency Department Utilization ......................... 16 Crisis Services and Alternatives to Acute Hospitalization ................................................. 16 Peer Programs to Support Level of Care Transitions ........................................................ 18 Community-Based Peer Support Services Programs to Promote Recovery Supports ..................................................................................................................... 19 Conclusions -- Environmental Scan .................................................................................. 20 2. SITE SELECTION ............................................................................................................... 21 3. FOUR SITE VISIT CASE STUDIES .................................................................................... 24 George Mental Health Consumer Network, Inc. ............................................................... 25 New York Association of Psychiatric Rehabilitation Services, Inc. .................................... 30 Optum, Pierce County Regional Support Network ............................................................ 35 Recovery Innovations ....................................................................................................... 41 4. CASE STUDY FINDINGS AND CONCLUSIONS ............................................................... 46 Crisis Respite Programs ................................................................................................... 47 Level of Care Transition Programs ................................................................................... 48 Community-Based Recovery Supports ............................................................................. 49 Results from Site Visits ..................................................................................................... 50 Service Models for Peer Support Programs ...................................................................... 50 Funding Models for Peer Support Services ...................................................................... 52 Health Systems Integration .............................................................................................. 53 Program Outcomes .......................................................................................................... 54 Conclusions ...................................................................................................................... 56 REFERENCES ......................................................................................................................... 57 i APPENDICES APPENDIX A. National Expert Panel .............................................................................. A-1 APPENDIX B. Key Informants ........................................................................................ A-2 APPENDIX C. Peer Support Services Programs -- Brief Case Studies ........................... A-3 Baltic Street, AEH, Inc. ...................................................................... A-3 Georgia Mental Health Consumer Network, Inc., Peer Support, Wellness and Respite Centers ......................................... A-5 Housing Options Made Easy, Inc. ...................................................... A-7 Mental Health Association of Southeast Pennsylvania ...................... A-9 New York Association of Psychiatric Rehabilitation Services, Inc. Peer Services ......................................................... A-11 Optum, Pierce County Regional Support Network ........................... A-13 Projects to Empower and Organize the Psychiatrically Labeled......................................................................................... A-15 Recovery Innovations ...................................................................... A-17 ii LIST OF FIGURES AND TABLES FIGURE 1. Peer Services Providers Address Unmet Patient and Clinical Service System Factors ....................................................................................................... 5 FIGURE 2. Overview of the Impact of PSS on Hospitalization and ED Utilization ................... 15 TABLE 1. RCTs of PSS with Mental Health and Co-occurring Mental Health and Substance Abuse Service Recipients that have Measured Health Care Utilization Outcomes .................................................................................... 10 TABLE 2. Quasi-Experimental Studies
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