Peer Specialists Beginning to Boost Florida`s Service System

In a state with traditionally low public funding support for addiction treatment and uneven quality of care, peer specialists are beginning to make a difference in bolstering substance use service systems. Progress has been particularly strong in Florida's northeast and north central regions, but that soon could extend into other areas due in part to state legislation that is expected to be signed into law.

Pilot efforts launched through government grants have largely been responsible for the growth of peer support services in the region of Florida where behavioral health care is overseen by managing entity LSF Health Systems. Peer specialists are making inroads working directly with hospital emergency department staff and with first responders on the streets during overdose calls, says Christine Cauffield, CEO of LSF Health Systems (a division of Lutheran Services Florida).

“Peers serve as a critical component to an interdisciplinary treatment team,” Cauffield tells Addiction Professional.

Their role in Florida is expected to be clarified further through state legislation (House Bill 369) that was adopted overwhelmingly in this year's just-completed session and will take effect in July pending Gov. Ron DeSantis's signature. Among its assortment of provisions, the legislation will require peer specialists to be state-certified in order to provide state-funded support services, and will reduce the number of prior criminal offenses that make an individual ineligible to become a certified peer specialist. The latter has been seen as a considerable impediment to expanding the peer specialist workforce in Florida.

Succeeding in new settings

LSF Health Systems was able to see the first major inroads for peers in its region around 2015 when a grant from the federal Health Resources and Services Administration (HRSA) allowed it to partner with Jacksonville University to establish a curriculum for certifying peer specialists.

“We graduated 55 peer specialists in the first year,” says Cauffield. A subsequent grant is allowing for the training of an additional 70 peers each year. “The peers are also assigned a mentor to help connect them with the workforce,” Cauffield says.

She adds that treatment programs are eager to introduce peers into their operations, Besides the fact that their services can be reimbursed, “The [research] literature fully supports that peers are an integral part of the treatment team, and often the linchpin for encouraging people to enter treatment,” she says.

A pilot effort funded by the city of Jacksonville is allowing peers to play a major part in the response to the opioid crisis. A partnership with Gateway Community Services has established Project Save Lives, in which peers are placed in hospital emergency settings as the first main contact point for an individual who has been rescued from an overdose. An effort that was launched at Ascension St. Vincent's in Jacksonville is now being expanded to three more hospitals, says Cauffield. She points out that convincing hospital staff of peers' potential ability to engage patients in follow-up treatment took some time at first.

“Hospital systems are not accustomed to credentialing a non-clinical individual,” Cauffield says. But with return visits to the ER now down considerably at the pilot site, the outlook among hospital personnel is changing. To break through the initial resistance, “You need a champion” in a high-ranking role at the hospital, she says, such as the medical director or the CEO.

“Even if the person refuses to go into formal treatment, they can choose to engage in peer services,” Cauffield says. Around 40% of patients at the ER take this option, which at least leaves the door open for an outpatent or inpatient treatment referral later.

The regional authority also has received a grant from insurer Florida Blue to allow peers to accompany emergency response workers on calls, with the mission of that effort going beyond the scope of the opioid crisis alone.

Adopted legislation

The new legislation affecting the peer workforce adopts the state's traditional definition of a peer, which is an individual with at least two years of recovery from a substance use or mental health disorder who is using his/her lived experience to serve others. Cauffield says the law was a major priority of the state's association of managing entities for behavioral health services.

She says the legislation will ease the process of hiring peer specialists by standardizing and shortening the procedures for conducting background checks on these individuals. Some nonviolent felony offenses, such as burglary offenses, will no longer immediately disqualify an individual in recovery from becoming certified as a peer specialist.

“In the past it was taking at least six months for the background screening, and then if someone was denied it would take another six months for an appeal process,” Cauffield says. “The provider then had to find someone else to fill an opening, and the peer needed work.” Under the new legislation, peer specialists will be able to join the employing organization during the review process.

The legislation, which is soon expected to be signed into law, also clarifies some provisions related to recovery housing in the state. It includes a new requirement that most community housing operated by licensed treatment centers will have to become a state-certified recovery residence in order to be eligible for referrals from the treatment facility.