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A Closer Look: Q&A with Tom Hill

Tom HillTom Hill is director of programs at Faces and Voices of Recovery, a national association of recovery oriented organizations. Faces and Voices of Recovery recently published a brief advocating for the inclusion of peer recovery support services (PRSS) in states’ essential health benefits, the services that will be reimbursed or covered by the new state health insurance exchanges required by the Affordable Care Act. Mr. Hill discussed the purpose and positive outcomes of PRSS with us.

How do peer recovery support services (PRSS) differ from clinical services?

The primary objective of peer work is to help others initiate and achieve long-term recovery from addiction and to enhance quality of life, health, and wellness. PRSS are distinct and separate from professionally delivered clinical treatment. Peer workers are not counselors, don’t engage in therapeutic activities, and don’t pathologize or diagnose. Peer work does not focus on abating symptoms, but on promoting the tools that will help an individual to achieve recovery. Essential to the peer equation are qualities of mutuality, relationship-building, and a flattened hierarchy. Peer workers do not “ do for,” but rather “do with.” They lead and guide, provide access and navigation to resources, act as a bridge to the community, and assist in administering a self-actualized and self-administered recovery plan.

Why is it important that peer recovery support services be identified as essential health benefits (EHBs)?
Other health disciplines have successfully used peer workers to help individuals and families manage chronic conditions such as HIV, cancer, diabetes, and hypertension. PRSS build on this tradition by addressing addiction as a similar chronic condition and helping to support recovery during the long haul. PRSS are offered before, during, after, and in lieu of treatment. This means that they are delivered across the continuum of care, coexisting with clinical services and/or operating as a menu of supports in community settings. Overall, they improve recovery outcomes and reduce health care costs, preventing relapse and curtailing visits back to costly settings such as treatment, emergency rooms, and jails/prisons.
Recovery advocates are currently working in their states to expand the menu of services offered in EHBs to include PRSS (see attached issue brief).

What particular challenges do peer recovery support services face when it comes to implementation?
As states, institutions, systems, and providers are gearing up for health reform, PRSS have surfaced on everyone’s radar screen.  Because PRSS are a new component of the system, they are frequently misunderstood. As everyone is concerned with cost savings, there has been a tendency to view PRSS as “cheap treatment” and peer workers as “Counselor, Jr.” The prevailing attitude is that peer workers can be folded into an existing workforce, rather than a transformative element that can improve the way that business is currently conducted.
Qualities of peer integrity and recovery culture are essential ingredients of PRSS and need to be honored and protected in order for peer work to be effective. For one thing, we need to ensure that peer workers are valued and appropriately employed (either as volunteers or as paid workers) and deployed. Also, as PRSS become commoditized in a new business environment of health reform, we need to be vigilant that they do not become professionalized or move towards a clinical orientation.

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