Cover: Early Implementation of California's Peer Support Specialist Certification Program

Early Implementation of California's Peer Support Specialist Certification Program

Perspectives of Clinical Administrators, Peer Support Specialists, and Service Users

Published Feb 29, 2024

by Joshua Breslau, Graham DiGuiseppi, Wendy Hawkins, Shona Olalere, Alison Athey, Nicole K. Eberhart

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Research Questions

  1. How has MPSS certification and Medi-Cal reimbursement affected integration of MPSSs into behavioral health care?
  2. Is there early evidence of an effect of the MPSS program on service user outcomes?
  3. What are the early lessons learned about MPSS integration in care? What would make the program more successful?

In September 2020, California enacted the Peer Support Specialist Certification Program Act (California Senate Bill 803), which established a framework for Medi-Cal Peer Support Specialist (MPSS) training and certification to work in the state's specialty behavioral health systems. The certification program is still in its early stages of implementation, with the first MPSS certifications issued in September 2022. To inform continual improvement of the program and help design future comprehensive evaluations, California Mental Health Services Authority requested RAND to conduct an evaluation of the early implementation of the program. Researchers found several positive outcomes for peer specialists along with concerns regarding testing and pay.

Key Findings

  • All three groups of respondents (administrators, PSSs, and service users) voiced positive opinions about PSSs. Service users described being made to feel more comfortable in treatment settings and receiving valuable support from the PSSs with whom they work.
  • Administrators and MPSS respondents credited the certification program with providing a greater understanding of the MPSS role among clinical staff and MPSSs alike. The improved understanding of the MPSS role, according to all three groups of respondents, contributed to greater confidence among MPSSs in delivering services.
  • Administrators perceived greater ability to coordinate the work of MPSSs with that of the clinical team, and MPSSs reported increases in job responsibilities, including greater autonomy in managing their caseloads.
  • Views on the impact of certification on careers were mixed. Some MPSSs saw the certification as an important career milestone, and some program administrators said certification would influence their decisions in hiring. There were some reports that certification had led to wage increases. However, other respondents, among both administrators and MPSSs, emphasized that the certification program has yet to have an influence on MPSSs' careers.
  • Although respondents acknowledged positive impacts of certification for MPSSs, they were generally in agreement that it is too early to assess the impact of certification on service user outcomes.
  • MPSSs reported a variety of challenges they encountered while taking the required training and the MPSS certification exam. These challenges included gathering the required documentation, the cost of the training and the test, and stress related to the taking the test.

Recommendations

  • Work with program directors and MPSSs to develop best-practice guidelines for involving peers in a variety of clinical teams.
  • Examine the certification training and examination process for opportunities to remove barriers and improve quality.
  • Monitor the certified peer workforce over time.
  • Examine the impact of certified peers on continuity of care, treatment engagement, and use of acute behavioral health care.

Research conducted by

This research was funded by California Mental Health Services Authority (CalMHSA) and the California Department of Health Care Services and carried out within the Access and Delivery Program in RAND Health Care.

This report is part of the RAND research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.