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Training and Peer Support Supervision Requirements

In order to effectively meet the requirements of the Arizona Health Care Cost Containment System (AHCCCS), the Health Plan, Arizona Complete Health, must participate in development, implementation and support of trainings for contractors and subcontractors to ensure appropriate training, education, technical assistance, and workforce development opportunities. Specifically to:

  • Promote a consistent practice philosophy, provide voice and empowerment to staff and members,
  • Ensure a qualified, knowledgeable and culturally competent workforce,
  • Provide timely information regarding initiatives and best practices, and
  • Ensure that services are delivered in a manner that results in achievement of the Arizona System Principles, which include the Adult Service Delivery System-Nine Guiding Principles as outlined in Contract and Arizona Vision-Twelve Principles for Children Service Delivery as outlined in AMPM Policy 430.

The purpose of this section is to provide information to contracted providers regarding the scope of required training topics, how training needs are identified for contracted providers and how contracted providers may request specific technical assistance from The Health Plan.

Training

All behavioral health providers contracted with Arizona Complete Health are required to have access to the Relias Learning System (Relias). Relias is the Learning Management System used by the ACC/RBHA Plans and their contracted BH providers through the Arizona Associations of Health Plans (AzAHP). All agencies must manage and maintain their Relias Learning portal, including:

  • Activating and deactivating users
  • Enrollment and disenrollment of courses/events.

RELIAS PRICING

  • Behavioral Health Provider agencies with 20 or more users will be required to purchase access to Relias for a fee of $1500. This includes full site privileges, defined as a site in which the agency may have full control of course customizations and competency development.
  • ACC/RBHA Provider agencies with 19 or fewer users will be added to the AzAHP Relias Small Provider Portal with limited site privileges at no cost. Limited site privileges are defined as a site in which the courses and competencies are set according to the plan standard, with no customization or course development provided.
  • Contracted providers will ensure that before providing services to members each licensed and unlicensed staff person is qualified, knowledgeable and capable to provide services as required by AHCCCS policy and, as relevant to their job duties and responsibilities, and consistent with their contract with The Health Plan.
  • Licensed and unlicensed personnel will attend and complete all pre-service, ongoing and or annual in-service training programs described and required by specific AHCCCS policies.
  • Training in the content areas specified in ACOM policies will be completed within 90 days of the staff person’s hire date, as relevant to each staff person’s job duties and responsibilities and annually as applicable.
  • Specific situations may necessitate the need for additional trainings. For example, quality improvement initiatives that may require focused training efforts and/or new regulations that impact the public behavioral health system [e.g., the Balanced Budget Act (BBA), MMA, the Affordable Care Act (ACA) and Deficit Reduction Act (DRA)]. Additional trainings may be required, as determined by geographic service area identified needs.

The Health Plan’s subcontracted providers are required to participate in ongoing training for the following content areas as prescribed by policy or as determined to be necessary:

  • Trainings concerning procedures for submissions of encounters when determined to be needed by AHCCCS;
  • Cultural competency and linguistically appropriate training updates for staff at all levels and across all disciplines respective to underrepresented/ underserved   populations – annually;
  • Identification  and reporting of Quality of Care Concerns  and the  Quality of  Care Concerns investigations process when determined to be needed by AHCCCS,
  • American Society of Addition Medicine Patient Placement Criteria (ASAM PPC-2R) – when determined to be needed by the Contractor;
  • Child and Adolescent Service Intensity Instrument (CASII) – when determined to be needed by AHCCCS or the Contractor;
  • Disability Benefits 101, (DB-101) including Work Incentives – annually.
  • Peer, family member, peer-run, family-run and parent-support training and coaching – as required by AHCCCS AMPM 961-A and 961-B;
  • Identification  and reporting of  persons in need of Special Assistance  for individuals who have been determined to have a SMI and ensuring involvement of persons providing Special Assistance (see AMPM 320-R) as determined to be necessary by AHCCCS;
  • Workforce Development trainings specific to hiring, support, continuing education and professional development;
  • Peer, family member, peer-run, family-run and parent-support training and coaching – as required by AMPM 961-A and 961-B;
  • Identification  and reporting of  persons in need of Special Assistance  for individuals who have been determined to have a SMI and ensuring involvement of persons providing Special Assistance (see AMPM 320-R) as determined to be necessary by AHCCCS;
  • Workforce Development trainings specific to hiring, support, continuing education and professional development;
  • Specific situations may necessitate the need for additional trainings. For example, quality improvement initiatives that may require focused training efforts and/or new regulations that impact the public behavioral health system (e.g., the BBA, MMA, ACA, and DRA).  Additional trainings may be required, as determined by geographic service area identified needs.

ADHS Public Health Licensing required training must be completed and documented in accordance with Public Health Licensing requirements (see applicable provisions of A.A.C. Title 9, Chapter 10. And the ADHS Public Health licensing website).

15.4.1 Children

Medicaid reimbursable HCTC services for children are provided in professional foster homes licensed by the DES/Office of Licensing, Certification and Regulation which must comply with training requirements as listed in A.A.C. R6-5-5850.  All agencies that recruit and license professional foster home providers must provide and credibly document the following training to each contracted provider:

  • CPR and First Aid Training; and
  • 18 hours of pre-service training utilizing the HCTC to Client Service Curriculum.

The provider delivering HCTC services must complete the above training prior to delivering services. In addition, the provider delivering HCTC services for children must complete and credibly document annual training as outlined in A.A.C. R6-5-5850, Special Provisions for a Professional Foster Home.

15.4.2 Adults

Medicaid reimbursable HCTC services for adults are provided in Adult Therapeutic Foster Homes licensed by ADHS Public Health Licensing, and must comply with training requirements as listed in applicable sections of A.A.C. Title 9, Chapter 10:

  • Protecting the person's  rights;
  • Providing behavioral health services that the adult therapeutic foster home is authorized to provide and the provider delivering HCTC services is qualified to provide;
  • Protecting and maintaining the confidentiality  of clinical  records;
  • Recognizing and respecting cultural differences.

Recognizing, preventing or responding to a situation in which a person:

  • May be a danger to self or a danger to  others;
  • Behaves in an aggressive or destructive manner;
  • May be experiencing a crisis situation;
  • May be experiencing a medical emergency;
  • Reading and implementing a person's treatment plan; and
  • Recognizing and responding to a fire, disaster, hazard or medical emergency.

In addition, providers delivering HCTC services to adults must complete and credibly document annual training as required by A.A.C. Title 9, Chapter 10

Community Service Agencies (CSAs) must submit documentation as part of the initial and annual CSA application indicating that all direct service staff and volunteers have completed training specific to CSAs prior to providing services to members. For a complete description of all required training specific to CSAs, see AMPM Policy 961, Peer, Family and CSA Training, Credentialing and Oversight Requirements.

The Health Plan will make available to providers any policies, procedures, and contact information that identify how providers can access additional training and/or technical assistance specific to the trainings required by this policy and/or other types of applicable training resources.

The contracted providers will designate a training contact as key personnel and point of contact to implement and oversee compliance with the training requirements, and training plan.

  • This person will attend the monthly Training Contact meeting held the 3rd Thursday of each month, 10:00 to 11:00 AM, hosted by The Health Plan.

This person will monitor and maintain the Relias learning management system.

Contracted providers will develop, implement and submit an Annual Workforce Development and Training Plan that describes the training and workforce development priorities for the year. The training plan will be submitted on October 31st as specified in The Health Plan contract.

The Workforce Development Plan (WFD) will include the following:

  • Short- and long-term strategic WFD capacity and capability requirements (e.g. addressing health professional shortage areas, and integrated care);
  • Forecast of anticipated workforce capacity (size, job types, etc.) and capability (skills and workforce support) needs;
  • Specific WFD goals;
  • Description of the actions to be taken to implement WFD initiatives, such as programs to recruit ACC Members to seek employment in various roles within the ACC health care system; and
  • Description of how stakeholders, Members, families, and the general public will be involved in the development and implementation of the WFD plan.

Contracted providers will ensure:

  • All ACC required training content or competency descriptions are incorporated into the appropriate orientation, education, or training program, and evaluation processes and are made available to provider personnel,

Providers have processes for documenting training, verifying the qualifications, skills, and knowledge of personnel, and retaining required training, and competency transcripts and records.

The State has developed training requirements and certification standards for Peer Support Specialists/Recovery Support Specialists providing Peer Support Services, as described in the AHCCCS Covered Behavioral Health Services Guide. Peers serve an important role as providers, and AHCCCS and AzCH-CCP expects consistency and quality in peer-delivered services and support for peer-delivered services statewide.

15.10.1 Additional Information

People who have achieved and sustained recovery can be a powerful influence for individuals seeking their own path to recovery. By sharing personal experiences, peers help build a sense of self-worth, community connectedness, and an improved quality of life.

Peer services are supported on a statewide and national level. The Centers for Medicare and Medicaid Services (CMS) issued a letter to states recognizing the importance of peer support services as a viable component in the treatment of mental health and substance abuse issues. In the letter, CMS provides guidance to states for establishing criteria for peer support services, including supervision, care-coordination and training/credentialing.

15.10.2 Peer Support Specialist/Recovery Support Specialist Qualifications

Individuals seeking to be certified and employed as Peer Support Specialists/Recovery Support Specialists must:

  • Be, or have been, a recipient of behavioral health services or substance abuse services and has an experience of recovery to share, and;
  • Meet the requirements to function as a behavioral health paraprofessional, behavioral health technician, or behavioral health professional.

Individuals meeting the above criteria may be certified as a Peer Support Specialist/Recovery Support Specialist by completing training and passing a competency test through an AHCCCS/Office of Individual and Family Affairs (OIFA) approved Peer Support Employment Training Program. AHCCCS/OIFA will oversee the approval of all certification materials including curriculum and testing tools. Certification through AHCCCS/OIFA approved Peer Support Employment Training Program is applicable statewide.

Some agencies may wish to employ individuals prior to the completion of certification through a Peer Support Employment Training Program. However, required trainings must be completed prior to delivering services. An individual must be certified as a Peer Support Specialist/Recovery Support Specialist or currently enrolled in a AHCCCS/OIFA-approved Peer Support Training Program under the supervision of a qualified individual (see Section 15.10) prior to billing Peer Support Services.

15.10.3 Peer Support Employment Training Program Approval Process

A Peer Support Employment Training Program must submit their program curriculum, competency exam, and exam-scoring methodology (including an explanation of accommodations or alternative formats of program materials available to individuals who have special needs) to AHCCCS/OIFA, and AHCCCS/OIFA will issue feedback or approval of the curriculum, competency exam and exam scoring methodology in accordance with Section 15.10.

Approval of curriculum is binding for no longer than three years. Three years after initial approval and thereafter, the program must resubmit its curriculum for review and re-approval. If a program makes substantial changes (meaning change to content, classroom time, etc.) to its curriculum or if there is an addition to required elements (see Section 15.10.5) during this three-year period, the program must submit the updated curriculum to AHCCCS/OIFA for review and approval.

AHCCCS/OIFA will base approval of the curriculum, competency exam and exam-scoring methodology only on the elements included in AHCCCS AMPM Policy 96 (PDF). If a Peer Support Employment Training Program requires regional or culturally specific training exclusive to a GSA or tribal community, the specific training cannot prevent employment or transfer of Peer Support Specialist/Recovery Support Specialist certification based on the additional elements or standards.

15.10.4 Competency Exam

Individuals seeking certification and employment as a Peer Support Specialist/Recovery Support Specialist must complete and pass a competency exam with a minimum score of 80% upon completion of required training. Each Peer Support Employment Training Program has the authority to develop a unique competency exam. However, all exams must include at least one question related to each of the curriculum core elements listed in Section 15.10.4.  Individuals credentialed in another state must submit their credential to AHCCCS/Office of Individual and Family Affairs. The individual must demonstrate their state’s credentialing standards meet those of AHCCCS prior to recognition of their credential.

15.10.5 Peer Support Employment Training Curriculum Standards

A Peer Support Employment Training Program curriculum must include, at a minimum, the following core elements:

  • Concepts of Hope and Recovery:
    • Instilling the belief that recovery is real and possible;
    • The history of the recovery movement and the varied ways that behavioral health issues have been viewed and treated over time and in the present;
    • Knowing and sharing one’s story of a recovery journey and how one’s story can assist others in many ways;
    • Mind- Body-Spirit connection and holistic approach to recovery; and
    • Overview of the Individual Service Plan (ISP) and its purpose.
  • Advocacy and Systems Perspective:
    • Overview of State and national behavioral health system infrastructure and the history of Arizona’s behavioral health system;
    • Stigma and effective stigma reduction strategies: countering self-stigma; role modeling recovery and valuing the lived experience;
    • Introduction to organizational change- how to utilize person-first language and energize one’s agency around recovery, hope, and the value of peer support;
    • Creating a sense of community; the role of culture in recovery;
    • Forms of advocacy and effective strategies – consumer rights and navigating behavioral health system; and
    • Introduction to the Americans with Disabilities Act (ADA).
  • Psychiatric Rehabilitation Skills and Service Delivery:
    • Strengths based approach; identifying one’s own strengths and helping others identify theirs; building resilience;
    • Distinguishing between sympathy and empathy; emotional intelligence;
    • Understanding learned helplessness; what it is, how it is taught and how to assist others in overcoming its effects;
    • Introduction to motivational interviewing; communication skills and active listening;
    • Healing relationships – building trust and creating mutual responsibility;
    • Combating negative self-talk; noticing patterns and replacing negative statements about one’s self, using mindfulness to gain self-confidence and relieve stress;
    • Group facilitation skills; and
    • Introduction to Culturally & Linguistically Appropriate Services (CLAS) Standards; creating a safe and supportive environment
  • Professional Responsibilities of the Peer Support Employee and Self Care in the Workplace:
    • Qualified individuals must receive training on the following elements prior to delivering any covered services:
      • Professional boundaries & ethics- the varied roles of the helping professional; Collaborative supervision and the unique features of the Peer Support Specialist/Recovery Support Specialist;
      • Confidentiality laws and information sharing – understanding the Health Insurance Portability and Accountability Act (HIPAA)
      • Mandatory reporting requirements; what to report and when;
      • Understanding common signs and experiences of mental illness, substance abuse, addiction and trauma; orientation to commonly used medications and potential side effects;
      • Guidance on proper service documentation; billing and using recovery language throughout documentation; and
      • Self-care skills and coping practices for helping professionals; the importance of ongoing supports for overcoming stress in the workplace; resources to promote personal resilience; and, understanding burnout and using self-awareness to prevent compassion fatigue, vicarious trauma and secondary traumatic stress.

Some curriculum elements include concepts included in required training. Peer Support Employment Training Programs must not duplicate training required of individuals for employment with a licensed agency or Community Service Agency (CSA)[6]. Training elements in this section must be specific to the Peer Support Specialist/Recovery Support Specialist’s role in the public behavioral health system and instructional for peer support interactions.

Supervision is intended to provide support to Peer Support Specialists/Recovery Support Specialists in meeting treatment needs of Members receiving care from Peer Support Specialists/Recovery Support Specialists. Supervision provides an opportunity for growth within the agency and encouragement of recovery efforts.

Agencies employing Peer Support Specialists/Recovery Support Specialists must provide supervision by individuals qualified as Behavioral Health Technicians or Behavioral Health Professionals. Supervision must be appropriate to the services being delivered and the Peer Support Specialist/Recovery Support Specialist’s qualifications as a Behavioral Health Technician, Behavioral Health Professional or Behavioral Health Paraprofessional. Supervision must be documented and inclusive of both clinical and administrative supervision.

Individuals providing supervision must receive training and guidance to ensure current knowledge of Evidenced Based Practices in providing supervision to Peer Support Specialist/Recovery Support Specialists.

[6] While peer support employment training programs must not duplicate training required of licensed agencies or CSAs, it is possible that licensed agencies and/or CSAs may consider training completed as part of the peer support employment training program as meeting the agencies’ training requirements.

15.10.6 Process for Submitting Evidence of Certification

Agencies employing Peer Support Specialists/Recovery Support Specialists who are providing peer support services are responsible for keeping records of required qualifications and certification. The Health Plan will ensure through audits that Peer Support Specialists/Recovery Support Specialists meet qualifications and have certification, as described in this provider manual.

AHCCCS/Office of Individual and Family Affairs has developed training requirements and certification standards for Family Support roles providing Family Support Services, as described in the AHCCCS Covered Behavioral Health Services Guide. AHCCCS and The Health Plan recognizes the importance of the Certified Family Support role as a viable component in the delivery of integrated services and expects statewide support for these roles. AHCCCS and The Health Plan expect consistency and quality in parent/family delivered support of integrated services in both the Children’s and Adult Systems statewide.

15.11.1 Parent/Family Support Provider and Trainer Qualifications

15.11.1.1 Children’s System

Individuals seeking certification and employment as a Parent/Family Support Provider or Trainer in the children’s system must:

  • Be a parent or primary caregiver with lived experience who has raised or is currently raising a child with emotional, behavioral, mental health or substance abuse needs; and
  • Meet the requirements to function as a behavioral health professional, behavioral health technician, or behavioral health paraprofessional.

15.11.1.2 Adult System

Individuals seeking certification and employment as a Parent/Family Support Provider or Trainer in the adult system must:

  • Have lived experience as a primary natural support for an adult with emotional, behavioral, mental health or substance abuse needs; and
  • Meet the requirements to function as a behavioral health professional, behavioral health technician, or behavioral health paraprofessional.

Individuals meeting the above criteria may be certified as a Parent/Family Support Specialist by completing training and passing a competency test through an AHCCCS/OIFA approved Parent/Family Support Training Program. AHCCCS/OIFA will oversee the approval of all certification materials including curriculum and testing tools. Certification through AHCCCS/OIFA approved Parent/Family Support Employment Training Program is applicable statewide.

15.11.2 Parent/Family Support Provider Training Program Approval Process

  • A Parent/Family Support Provider Training Program must submit their program curriculum, competency exam, and exam-scoring methodology (including an explanation of accommodations or alternative formats of program materials available to individuals who have special needs) to AHCCCS/OIFA. AHCCCS/OIFA will issue feedback or approval of the curriculum, competency exam, and exam-scoring methodology.
  • Approval of curriculum is binding for no longer than three years. Three years after initial approval and thereafter, the program must resubmit their curriculum for review and re-approval. If a program makes substantial changes (meaning change to content, classroom time, etc.) to their curriculum or if there is an addition to required elements during this three-year period, the program must submit the updated content to AHCCCS/OIFA for review and approval no less than 60 days before the changed or updated curriculum is to be utilized.
  • AHCCCS/OIFA will base approval of the curriculum, competency exam, and exam-scoring methodology only on the elements included in this policy. If a Parent/Family Support Provider Training Program requires regional or culturally specific training exclusive to a GSA or specific population, the specific training cannot prevent employment or transfer of family support certification based on the additional elements or standards.

15.11.3 Competency Exam

  • Individuals seeking certification and employment as a Parent/Family Support Provider must complete and pass a competency exam with a minimum score of 80% upon completion of required training. Each Parent/Family Support Provider Training Program has the authority to develop a unique competency exam. However, all exams must include questions related to each of the curriculum core elements listed in subsection 15.11. Agencies employing Parent/Family Support Providers who are providing family support services are required to ensure that their employees are competently trained to work with their population.
  • Individuals certified or credentialed in another state must submit their credential to AHCCCS/OIFA. The individual must demonstrate their state’s credentialing standards meet those of AHCCCS prior to recognition of their credential. If that individual’s credential/certification doesn’t meet Arizona’s standard the individual may obtain certification after passing a competency exam. If an individual does not pass the competency exam, the Parent/Family Support Provider Training Program shall require that the individual complete additional training prior to taking the competency exam again.

15.11.4 Parent/Family Support Provider Training Curriculum Standards

A Parent/Family Support Provider Employment Training Program curriculum must include the following core elements for persons working with both children and adults:

  • Communication Techniques:
    • Person first, strengths-based language; using respectful communication; demonstrating care and commitment;
    • Active listening skills: The ability to demonstrate empathy, provide empathetic responses and differentiate between sympathy and empathy; listening non-judgmentally;
    • Using self-disclosure effectively; sharing one’s story when appropriate.
  • System Knowledge:
    • Overview and history of the Arizona Behavioral Health System: Jason K., Arizona Vision and 12 Principles and the Child and Family Team (CFT) process; Guiding Principles for Recovery-Oriented Adult Behavioral Health Services and Systems, Adult Recovery Team (ART), and Arnold v. Sarn; Introduction to the Americans with Disabilities Act (ADA); funding sources for behavioral health systems,
    • Overview and history of the family and peer movements; the role of advocacy in systems transformation,
    • Rights of the caregiver/enrolled member
    • Transition Aged Youth: Role changes when bridging the Adult System of Care (ASOC) and Children’s System of Care (CSOC) at transition for an enrolled member, family and Team.
  • Building Collaborative Partnerships and Relationships:
    • Engagement; Identifies and utilizes strengths;
    • Utilize and model conflict resolution skills, and problem solving skills,
    • Understanding individual and family culture; biases; perceptions; system’s cultures;
    • The ability to identify, build and connect individuals and families, including families of choice to natural, community and informal supports;
  • Empowerment:
    • Empower family members and other supports to identify their needs, and promote self-reliance,
    • Identify and understand stages of change and
    • Be able to identify unmet needs.
  • Wellness:
    • Understanding the stages of grief and loss; and
    • Understanding self-care and stress management;
    • Understanding compassion fatigue, burnout, and trauma;
    • Resiliency and recovery;
    • Healthy personal and professional boundaries.

Some curriculum elements may include concepts that are part of AMPM/ACOM policies and the Behavioral Health Practice Tool on Unique Needs of Children, Youth and Families Involved with Department of Children’s Services. Credentialed Parent/Family Support Provider training programs must not duplicate training required of individuals for employment with a licensed agency or Community Service Agency (CSA). Training elements in this section must be specific to the Family Support role in the public behavioral health system and instructional for family support interactions.

15.11.5 Supervision of Certified Parent/Family Support Providers

Agencies employing Parent/Family Support Providers must provide supervision by individuals qualified as Behavioral Health Technicians or Behavioral Health Professionals. Supervision must be appropriate to the services being delivered and the qualifications of the Parent/Family Support Provider as a Behavioral Health Technician, Behavioral Health Professional, or Behavioral Health Paraprofessional. Supervision must be documented and inclusive of both clinical and administrative supervision.

Individuals providing supervision must receive training and guidance to ensure current knowledge of best practices in providing supervision to Parent/Family Support Providers.

15.11.6 Process of Certification

Agencies employing Certified Parent/Family Support Providers who are providing family support services are responsible for keeping records of required qualifications and certification.