Peer Support Counseling: A Growing Reimbursable Trend for Health Care Reform in Indian Country
Tribal Communities Might Lose Their Voice in Creating a National Standard
There is a growing trend of patient care in the mental health profession known as peer support services in which certified counselors have first-hand life experience related to those patients they serve. This effective treatment methodology, which has proven effective in the mental health field over the past several years is gaining considerable ground and funding as a reimbursable practice in the healthcare industry.
Because these peer-based services are reimbursed by Managed Care Organizations (MCOs) such as Medicaid and other private insurance companies, these MCOs, national mental health coalitions, policy-makers, and the Federal government are now working to create a national standard of peer support-based care.
According to Jimi Kelley, (Quapaw/Cherokee) Family Support Specialist Trainer and spokesperson on behalf of the Society of Truth, an initiative of the First Nations Behavioral Health Association (FNBHA), a national standard of care for Peer Support Services should not be implemented without addressing the culturally influenced health care methodologies in Indian Country.
“Native mental health care providers have concerns about creating a national federal standard because they have always had a negative impact on Native communities,” says Kelley.
At a December 2012 meeting at the Substance Abuse and Mental Health Services Administration (SAMHSA) offices in Rockville, Maryland, Kelley, the only Native representative at the meeting, met with other national health coalition leaders to discuss peer-based healthcare and the possible national standard of care that could be implemented.
At the meeting, Kelley explained Native leaders should be allotted a voice at the proverbial national health care table in creating such a standard. “The meeting did address very key angles,” he says. “However, at the conclusion of the meeting was the decision that many more voices need to be included in the discussion. Now is the time for tribal entities to come forward and voice their needs on the National healthcare stage.”
Kelley said that because of the provisions for Tribal communities within Health Care Reform, Tribal communities are in a unique position to benefit from peer support and that the federal government currently recognizes that evidence based practices do not meet the needs of Tribal communities.
According to Kelley, many programs report higher success rates when behavioral health programs are integrated with cultural and traditional practices (as covered in the Urban Indian Health Institute's 2012 Report on Urban Indian Health). “We need to advocate for a window or provision for the integration of these models for Peer Support in Native programs,” he said.
“Whereas everybody agrees on a certain set of standards or ethics: such as a peer support counselor is not allowed to sleep with their client. In terms of community needs such as cultural or spiritual integration, we need to have the room to be able to implement these things for healing to be effective in our community,” he explained.
“I have two examples in an urban and reservation environment. The St. Regis Mohawk Tribe is a perfect example as they have a spiritual counselor on staff who functions in both a counseling role on the clock, but can do ceremonies off the clock. At the Los Angeles County Urban Indian Health Center, they include traditional crafts, drumming, etcetera, as part of the peer mental health program,” he said.
With everything considered, Kelley says that even if the needs of Native communities were not addressed in the creation of a national standard, all would not be lost.
“Federally recognized tribes would still have a leg to stand on in a worst case scenario due to provisions in the healthcare reform act under subtitle K and because of their federal status and their own relationship with the federal government including SAMHSA,” he says.
In the end, Kelley he will advocate to ensure that Medicaid and other Federal entities direct more funding toward Community-Based Practices in the areas of mental health, substance-abuse, suicide prevention and domestic violence programs and will ensure that Native communities be allowed to decide their own standards, should the national standard not meet the needs of Native communities.
“At this time, since we cannot guarantee any other program a way in, we are putting out the word that right now we are the ones asked to address issues related to Peer Support in Native communities,” says Kelley.
“We will do our best to take your needs, opinions, and standards to the table and keep in touch with folks to let them know progress, updates, and issues that come up.”
For more information visit the FNBHA website at http://www.fnbha.org/ or contact Jimi Kelley directly:
Jimi Kelley (Quapaw/Cherokee)
Family Support Specialist Trainer / Consultant – First Nations Behavioral Health Organization