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Sarah Flinspach

Project Assistant, National Council for Mental Wellbeing

CCBHCs: Are you ready to grow your peer services?

April 18, 2017 | Population Health | Comments
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It takes more than sunshine and water for a robust Certified Community Behavioral Health Clinic (CCBHC) peer services program to sprout.

CCBHCs: Redefining Behavioral Health Care

CCBHCs are a new provider type in Medicaid tasked with utilizing innovative and creative strategies to increase Americans’ access to behavioral health care services. Beginning in 2017, CCBHCs will be established in eight states participating in the Excellence in Mental Health Act demonstration: Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon, and Pennsylvania.

Peer services are one of the nine required services that CCBHCs must offer their clients. Since 2007, SAMHSA and the Centers for Medicare and Medicaid Services (CMS) have promoted the use of Medicaid for peer services. Including this unique service option in CCBHC requirements will expand on the momentum to offer peer services through Medicaid.

Per CCBHC definitions, peer support services are “designed and delivered by individuals who have experienced a mental or substance use disorder and are in recovery.” A peer provider combines their lived experience with formal training to support their clients.

SAMHSA notes that peer providers are uniquely positioned to help CCBHC clients because their lived experience enables them to  relate to what their clients’ experiences. They can serve as role models for CCBHC clients, offering strength and hope that recovery is possible.

Trained peers also contribute to organizational efficiency. They deliver supportive services that enhance medical and behavioral health care, such as integrated care wellness coaching, broadening the reach of the behavioral health workforce. . Peers make it possible for organizations to do more with limited resources—an important factor for CCBHCs operating within a fixed daily or monthly payment rate.

How do peers fit into CCBHC services?

The guidance is clear: “the CCBHC is responsible for peer specialist and recovery coaches, peer counseling, and family/caregiver supports” (see Criteria 4.J). CCBHCs must either employ peers to offer services directly or contract with a peer-run organization as a designated collaborating organization (DCO). Staffing plans must involve peer staff, and staff trainings must include information about the role of peers and families in clients’ recovery and wellness journeys. CCBHCs are required to utilize peer staff to increase accessibility and availability of services, including telehealth/telemedicine.

CCBHCs are required to incorporate peers in these specific areas of treatment:

  • Facilitating peer-run drop-in centers
  • Providing crisis services and support
  • Addressing the impact of trauma and incorporating trauma-informed approaches into CCBHC’s practices (for more on trauma-informed care and CCBHCs read, CCBHCs: Are you embracing the urgency to become trauma-informed?)
  • Easing the transition from emergency departments, detox, or residential settings to a safe community setting through peer bridge services
  • Providing care coordination

How can CCBHCs enhance their peer services and support their peer workforce?

Regardless of whether you are looking to grow your peer services or you are just planting the seeds, to succeed as a CCBHC, it is important to provide adequate support to your peer providers and to take steps to ensure they are an integral part of your staff. Here are a few considerations as you develop your peer support services:

  • In your hiring process, include questions that highlight how peers’ lived experience of recovery promotes hope, connection, and trust in a way that activates clients’ self-management
  • Clear job descriptions for peer providers are essential to support their training competencies and incorporate CCBHC expectations and accountability
  • Emphasize ongoing, quality supervision that embraces the uniqueness of the peer workforce while clarifying their roles on treatment teams
  • Conduct staff trainings on the role of peer providers including competencies they gained in training and the importance of using their lived experience
  • Promote a strength-based recovery culture by establishing ongoing formal feedback channels for peer input

Cultivating a robust peer services program will not happen overnight. But, with the proper knowledge and tools, CCBHCs will be able to provide the right environment for their peer program to blossom and become a meaningful aspect of their comprehensive service offerings.

If you have any questions or for more information, please contact Sarah Flinspach at