Workforce Development, Training and Peer Support Supervision Requirements

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.

*Refer to your Health Plan Contract for all training requirements.

This following information applies to care providers contracted with the Health Plan for the Arizona Health Care Cost Containment System (AHCCCS), Arizona Complete Care Plan and Regional Behavioral Health Authority (RBHA). It discusses the requirements, expectations, and recommendations in developing the workforce. The initiatives align with Workforce Development Policy ACOM 407 and ACOM 407 Attachment A. 

The Health Plan Workforce Development Operation (WFDO) implements, monitors, and regulates Provider WFD activities and requirements. In addition, the Health Plan evaluates the impact of the WFD requirements and activities to support Providers in developing a qualified, knowledgeable, and competent workforce.  

In collaboration with AHCCCS, the Arizona Workforce Development Alliance (AWFDA) ensures that all course content is culturally appropriate, has a trauma informed approach and is developed using adult-learning principles and guidelines. Additionally, it is aligned with company guidelines and WFD industry standards, the Substance Abuse and Mental Health Services Administration (SAMHSA) core competencies for WFD, federal and state requirements and the requirements of several agencies, entities, and legal agreements. 

Workforce Groups

AZ Workforce Development Advisory Committee – ACC, ACC-RBHA (AWFDAC – ACC, ACC-RBHA) is comprised of leaders, stakeholders, and experts who provide guidance and director on strategic items important to the ongoing partnerships and success around the use of Relias solutions and services, as well as Workforce Development initiatives. The Committee is responsible for maintaining a working relationship and alignment with statewide goals and objectives, as well as providing input to AHCCCS on policies and initiatives related to Workforce Development.

Arizona Association of Health Plans (AzAHP) unites the companies that provide health care services to the almost two million people that are members of  AHCCCS. AzAHP offers valuable training programs through our AZ Workforce Development Alliance – ACC, ACC-RBHA, and supplies assistance and resources to enhance the long-term care workforce through our ALTCS Workforce Development Alliance.

AS Workforce Development Coalition (AWFDC) is organized by the WFD Department at AHCCCS, the AzAHP and includes members from the MCOs. This group represents ACC, ALTCS, DCS CHP, DES/DDD, and RBHA lines of business. Together, the Coalition ensures initiatives across the state of Arizona align with all lines of business.

AZ Workforce Development Alliance (AWFDA) A name given to the WFD Administrators from each Contractor that jointly plan and conduct WFD activities for a particular line of business.  

Currently there are four WFDAs:

• The AWFDA – ACC, ACC-RHBA includes the WFD Administatros from ACC, ACC-RBHA, and DCS CHP Contractors. In addition to conducting join WFD planning, the ACC, ACC-RHBA, DCS CHP AWFDA collectively manages the contract between the AzAHP and the Learning Management System (LMS) vendor.
• The AWFDA -ALTCS includes WFD Administrators from the DDD and ALTCS E/PD Contractors.
• The AWFDA – DCS CHP includes the WFD Administrators from AHCCCS, DCS, and Mercy Care.
• The AWFDA – DD includes WFD Adminstrators from Mercy Care and UHCCP.

AWFDA – ACC, ACC-RBHA Provider Forums

The AWFDA—ACC/RHBA consists of representatives from the AzAHP, Relias, and the Workforce Development Administrators from all seven ACC, ACC-RBHA Health Plans. Providers are encouraged to attend the virtual AWFDA—ACC, ACC-RBHA provider forum on the second Thursday of each month for up-to-date information on WFD related topics, including: WFD initiatives, professional development, training, Relias, and opportunities to receive technical assistance. To review previous forums, you may access the recordings at the AzAHP website.

Prevention of Abuse and Neglect

• The Provider workforce shall have access to and be compliant with all workforce training and/or competency requirements specified in federal and state law, AHCCCS policies, guidance documents, manuals, contracts, plans such as network development, quality improvement, corrective action, etc., and/or special initiatives.
• Providers shall have processes for documenting training, verifying the qualifications, skills, and knowledge of personnel; and retaining required training and competency transcripts and records.

Residential Care (24-Hour Care Facilities) Annual Requirements

• Crisis prevention/de-escalation employee training for all member-facing employees prior to serving members. For facilities where restraints are approved, a nationally approved restraint training for all member-facing employees. This curriculum should include non-verbal, verbal, and physical de-escalation techniques.

Division of Licensing Services (DLS) Required Training 

• DLS agencies must be aware of all training requirements to be completed and documented based on all additional licensing or accrediting licensing agencies. This includes the Bureau of Medical Facilities Licensing (BMFL) / Bureau of Residential Facilities Licensing (BRFL), Joint Commission, grant requirements and other entities, as applicable.

Community Service Agencies (CSAs) 

• CSAs must submit documentation as part of the first and annual CSA application. The documentation must show that all direct service employees and volunteers have completed CSA training before providing services to members. For a list of all required CSA-specific training, see the AMPM Policy 961-C – Community Service Agencies.

Child and Adolescent Level of Care Utilization System (CALOCUS)

• Employees completing the CALOCUS assessments are required to have training in CALOCUS prior to using the assessment tool with members when assessing for the determination of which children may require high needs case-management. On-going competency assessments are also required to evaluate a staff member’s knowledge and skills. 
• Any other trained provider (PCP, specialty provider, etc.) working with children and adolescents is also able to conduct the CALOCUS assessment and trained providers can coordinate with the health home to share the assessment results for care coordination purposes.
• To ensure the proper identification of children and adolescents with complex needs and appropriate levels of care, AHCCCS has contracted with Deerfield Behavioral Health (Deerfield) to license the Child and Adolescent Level of Care Utilization System (CALOCUS) and Level of Care Utilization System (LOCUS) software, as well as access to online training for those who have familiarity with instruments that measure level of service acuity instruments. The agreement includes the licensing of both CALOCUS/LOCUS online, though AHCCCS is currently only requiring the use of the CALOCUS. This also includes licensing of the integrated Electronic Health Record (EHR) products, with the intent that providers include the assessment in their data feeds into the Health Information Exchange (HIE).
  • Providers can implement LOCUS/CALOCUS in one of two ways. 
    • The first is via the web-based version which can be accessed at locus.azahcccs.gov. 
    • The second is via an EHR integration. 
  • Regardless of which option you choose, you must first reach out to Deerfield and sign their end user license agreement as soon as possible. There is no cost associated with this agreement. Matthew Monago will be your contact at Deerfield and his email is mmonago@journeyhealth.org. Please be sure to identify your organization as an AHCCCS provider when emailing.
• Per AHCCCS communication on 10/8/21: “Due to discussions between AHCCCS, the Arizona Complete Health (WFD) Administrator, members of the American Academy of Child and Adolescent Psychiatry (AACAP) and American Association of Community Psychiatrists, it has been determined that individuals who have previously taken the CASII training, will also need to complete the CALOCUS training. This will ensure consistent alignment with AHCCCS contractual requirements for CALOCUS training, establish a baseline level of CALOCUS understanding for those that administer the tool, and enhance efforts to maintain fidelity to CALOCUS administration.”  
  • For Children’s Providers serving children in the Department of Child Safety Comprehensive Health Plan, Arizona Complete Health asks to prioritize the completion of the CALOCUS for youth that are either living in a DCS funded Qualified Residential Treatment Program (QRTP) or are being considered to go into a QRTP.
  • If there are questions regarding CALOCUS training requirements related to the AHCCCS contract, provider agencies should be instructed to please reach out to the Contract Compliance Officer at the contracted Health Plan.
• Monitoring Process
  • All Health Plans will monitor the CALOCUS certification process. Each Health Plan will run Relias reports to monitor those who have completed, as well as have not completed the requirement in the 30-day time frame. These reports will then be compared to the Deerfield completion report, ensuring fidelity to this AHCCCS requirement. In addition to the 30-day time frame, employees must also meet the 2.5-hour minimum time commitment when attending the training through Deerfield. 

*It is suggested that those who have completed the Deerfield CALOCUS training prior to July 1, 2022, also be enrolled and marked complete in the training plan for monitoring, tracking, and record transferability.

• Provider Agency Requirements
  • All child and adolescent provider agencies who meet the requirements for the CALOCUS training will need to do the following:
    • Enroll employees who are required to take the Deerfield CALOCUS training in the *AZAHP – CALOCUS Training Requirement (30 Days) training plan in Relias. 
    • Once the employee has been enrolled and completes the CALOCUS training through Deerfield the provider agency’s supervisor/administrator will mark them complete in the Relias CALOCUS Training Requirement module.
    • Once all steps have been completed, the employee will have met the requirements for CALOCUS certification.

Network Workforce Data Collection

It is the responsibility of the Contractor to produce a Network Workforce Development Plan for each line of business. A portion of this data will be supported by the Provider Workforce Development Plan (as applicable to LOB), the AZ Healthcare Workforce Goals and Metrics Assessment, and any additional means that are identified.

AZ Healthcare Workforce Goals and Metrics Assessment (AHWGMA)

Arizona Complete Health requires that all contracted provider types listed at (the AHWGMA link below) complete the AZ Healthcare Workforce Goals and Metrics Assessment annually to fulfill the requirements from ACOM 407 & ACOM 407 Attachment A.  To meet this requirement, all Health Plans and lines of business have collaborated extensively to create a single provider survey that will be disseminated from one source (AZAHP vs. multiple assessments being disseminated and duplicated). Refer to the AHWGMA (link below) for the most up-to-date information, including a list of required Provider Types and a link to the assessment.

AHWGMA Webpage

ADHOC Initiatives

Arizona Complete Health will promote optional WFD initiatives with ACC and ACC-RBHA Providers that support the growth of business practices, improve member outcomes, and increase the competency of the workforce.

Workforce Development Technical Assistance Needs

The Arizona Complete Health Workforce Development Administrator is available to provide technical assistance for various workforce development related needs. Technical Assistance needs could include:  

• P-WFDP Guidance
• Recruitment Assistance
• Competency Review
• Workforce Development Goal Review
• Career Path Development
• Training Needs
• Metrics Review
• Relias
• Technology Assistance
• Network Capacity Review
• Cultural Competency
• Diversity/Equity/Inclusion Support
• Community Resources
• Other

For additional information on the P-WFDP requirement, training plans and the provider forums, or discuss technical assistance needs, please reach out to our Training and Workforce Development Team at AzCHTrainingDepartment@azcompletehealth.com.

The Arizona Workforce Development Alliance (AWFDA), under the provider types listed at the link below, ensure that all employees who work in programs that support, oversee, or are paid by the Health Plan contract have access to Relias and are enrolled in the AzAHP Training Plans listed below. This includes, but is not limited to, full time/part time/on-call, direct care, clinical, medical, administrative, leadership, executive and support staff. 

Deliverables by Provider Type: https://azahp.org/azahp/azahp-accrhba-awfda/resources-2/

Exceptions:   

• Any staff member(s) hired for temporary services working less than 90 days is required to complete applicable training at the discretion of the Provider.   
• Any staff member(s) hired as an intern is required to complete applicable training at the discretion of the Provider.  
• Any Independent Contractor (IC) is required to complete applicable training at the discretion of the Provider.   
• Behavioral Health Hospitals  
• Federally Qualified Healthcare providers (FQHCs), may request exemption from their contracted Health Plan(s). Exemptions may be granted on a case-by-case basis and will take into account the following: Portion of AHCCCS Members enrolled in the network and served by that provider, geographic area serviced, and number of other service providers in the surrounding area.   
• Housing Providers  
• Individually Contracted Practitioners  
• Prevention Providers  
• Transportation Providers   

Agencies must manage and maintain their Relias Learning portal. This includes activating and deactivating users as well as enrollment and disenrollment of courses/events.     

To request access to Relias, please contact the AzCH-CCP Workforce Development Administrator at AzCHTrainingDepartment@azcompletehealth.com for further assistance. The request should include the following information:    

• Provider Agency Name    
• Contract Start Date    
• Address    
• Key WFD Contact    
  • Name   
  • Phone Number    
  • Email Address    
• Contract Type (ACC)    
• AHCCCS Provider Type
• Number of Users (# of employees at the agency who need Relias access)    
• List of Health Plans provider is contracted with (if known)      

BH provider agencies with 20 or more users will be required to purchase access to Relias Learning for a one-time fee of $1500 for full-site privileges. A full site is defined as a site in which the agency may have full control of course customizations and competency development.

Provider agencies with 19 or fewer users will be added to AzAHP Relias Small Provider Portal at no cost with limited-site privileges. A limited site is defined as one in which the courses and competencies are set-up according to the standard of the plan with no customization or course development provided. This can be done by contacting workforce@azahp.org.      

Provider agencies that expand to 20 or more users will be required to purchase full site privileges to Relias Learning immediately upon expansion.      

*Fee is subject to change if a Provider requires additional work beyond a standard sub-portal implementation.   

AzAHP Core Training Plans

AzAHP–Core Training Plan (90 Days) 

1.       *AHCCCS - Health Plan Fraud

2.       *AHCCCS - NEO - Employment Rehabilitation

3.       *AzAHP - AHCCCS 101

4.       *AzAHP - Client Rights, Grievances, and Appeals

5.       *AZAHP - Cultural Competency in Health Care

6.       *AzAHP - Quality of Care Concern

7.       Basics of Corporate Compliance

8.       HIPAA: Basics

9.       Integration of Primary and Behavioral Healthcare

The above Training Plan is set to auto-enroll all NEW Relias users in your system who have been assigned one (or more) of the 7 Health Plans under the “Plan” field in their user profile. If the employee hired has a previous account under another agency, please ensure that you have their transcripts transferred (there is a job aid available at www.azahp.org). 

AzAHP –Core Training Plan (Annual) 

1.       *AHCCCS - Health Plan Fraud

2.       *AZAHP - Cultural Competency in Health Care

3.       *AZAHP - Quality of Care Concern

4.       Basics of Corporate Compliance

5.       HIPAA: Basics

6.       Preventing, Identifying, and Responding to Abuse and Neglect

The above Training Plan is set to auto-enroll all Relias users in your system who have been assigned one (or more) of the 7 Health Plans under the “Plan” field in their user profile.  

Reporting Requirements – AWFDA Quarterly Reports

The AzAHP Workforce Development Alliance (AWFDA) will run Quarterly Learner/Course Status Reports on the two AzAHP Training Plans: *AzAHP – Core Training Plan (90 Days) & *AzAHP – Core Training Plan (Annual).  The goal for Providers is to hold a 90% (or higher) completion rate for this group of courses, within the specified reporting period. Reporting time frames for this initiative are listed below:  

• 01/01-03/31 – AWFDA will run this report on 4/30
• 04/01-06/30 – AWFDA will run this report on 7/31
• 07/01-09/30 – AWFDA will run this report on 10/31
• 10/01-12/31 – AWFDA will run this report on 1/31

Disclaimer: If any of these dates falls on a weekend or holiday, the AWFDA reserves the right to run the report on the following business day.

Provider agencies falling at 75% or below on the above completion reports will be required to have at least 1 Relias Administrator/Supervisor from their agency complete the course titled: *AzAHP – Navigating & Managing Your Relias Portal.

Provider agencies falling below 90% on the above completion reports may be subject to corrective action and/or sanctions (including suspension, fines, or termination of contract) by their contracting Health Plan(s).

Provider Workforce Development Plan (P-WFDP)  

The purpose of the P-WFDP is to encourage Provider organizations to work together and ensure members receive services from a workforce that is qualified, competent, and sufficiently staffed. The P-WFDP shall include a description of organizational goals, objectives, tasks, and timelines to develop the workforce. The overall approach and philosophy to Workforce Development is to ensure a comprehensive, systematic, and measurable structure that incorporates best practices at all levels of service delivery and utilizes Adult/Children’s Guiding Principles, Adult Learning Theories/Methods, Trauma-informed Care, Equitable Services and Culturally Competent practices. All training initiatives, action steps, and monitoring procedures outlined in the P-WFDP are to include targeted efforts for all employees (e.g., direct care Providers, supervisors, administrators, and support staff) who are paid by, partially paid by, or support an agency’s Health Plan contract(s).   
 

The ACC, ACC-RBHA Providers, under the provider types listed at the link below, complete the annual P-WFDP. The P-WFDP Template is provided for this deliverable by the AWFDA—ACC, ACC-RBHA to providers. P-WFDP's will be submitted between 2/1 – 2/28, annually. Early and late submissions will not be accepted unless an extension was received and granted by the deadline, determined by the AWFDA—ACC, ACC-RBHA.

• Extension Requests: must be submitted to the AzAHP email before the date specified by the AWFDA—ACC, ACC-RBHA for each year. Non-submittals are subject to contracted health plan policies as it pertains to the P-WFDP deliverable.
• Exemption Requests: Federally Qualified Healthcare Providers (FQHCs), may request an exemption from their contracted Health Plan(s). Exemptions may be granted on a case-by-case basis and will consider the following: Portion of AHCCCS Members enrolled in the network and served by that Provider, the geographic area serviced, and the number of other service Providers in the surrounding area. Exemption requests must be submitted on/before December 31st and will be reviewed by the Alliance.
  
  

Required ACC, ACC-RBHA Provider Types (XLS) 

Failure to submit your completed annual P-WFDP deliverable by the annual due date may result in corrective action and/or sanctions (including suspension, fines, or termination of contract). 

The statewide Child and Family Team (CFT) Facilitator Course initiative and the two associated Train-the-Trainer (TtT) courses are for Providers who serve children and adolescents in the Children’s System of Care (CSOC) and have employees who facilitate CFT’s.  

Initiative 1: CFT Facilitator Course

·         The CFT Facilitator Course is 2 days in length, is intended for in-person delivery, and meets all AHCCCS and Health Plan training requirements for individuals who will be leading/facilitating CFT sessions.

·         It is expected that provider agencies be prepared to train this course in-house, which enables providing complimentary agency-specific processes, procedures, and protocols, thus creating a robust learner-centric experience for attendees and future CFT facilitators.

·         Once an agency has an employee who has become a CFT Champion, by successfully completing the TtT session (noted below), the requirement is for the CFT Champion to train the 2-day CFT Facilitator course to newly hired employees at the provider agency. Employees who already meet the existing CFT Facilitator training requirement need not attend the new course; however, each provider agency may make their own determination otherwise.

·         All provider agencies shall utilize the AHCCCS approved training curriculum (ACOM 580, Section F # 2), which is made available to the CFT Champion upon completion of their CFT Facilitator TtT session.

Initiative 2: CFT Facilitator Train the Trainer (TtT)

·         The CFT Facilitator TtT session is approximately 6 hours in length and is delivered via virtual instructor-led training. TtT sessions are offered throughout the year. These sessions are intended for employees who will be delivering the 2-day CFT Facilitator course in-house in their own agency. These identified employees will be known as “CFT Champions.”

·         CFT Champions who participate in the TtT session must be seasoned employees who possess skills equivalent to lead training sessions and must have completed CFT training requirements already in place and must be competent in CFT facilitation. It is left to the discretion of each provider agency to verify trainer competency. Presumption will be that participants have been internally vetted as competent by their provider agency prior to enrollment.  

Initiative 3: CFT Supervisor Training

·         The CFT Supervisor Training is approximately 5 hours in length, is intended for in-person delivery, and is for leaders who supervise employees who facilitate CFT’s. The CFT Supervisor Training is required for all new and existing leaders. Once the agency has a CFT Champion who successfully completes the CFT Supervisor TtT session (as noted below), this training will provide guidance to leaders related to coaching CFT Facilitators on CFT Practice and the identified competency measurements (ACOM 580, Section G # 1).

Initiative 4: CFT Supervisor Train the Trainer (TtT)

·         The CFT Supervisor TtT session is approximately 2.5 hours in length and will be delivered via virtual instructor-led training. CFT Supervisor TtT sessions will be offered throughout the year. These sessions are intended for employees who will be training the CFT Supervisor Training Course in-house within their own agency. These identified staff will be the same CFT Champions that took the CFT Facilitator TtT.

AzAHP – CFT Champion Certification Process

·         An *AZAHP- CFT Champion Certification training plan has been created in Relias for the identified CFT Champions meeting the above noted requirements.

o   Agency leadership will need to enroll the identified CFT Champion(s) in the training plan.

o   Within the training plan there are three module requirements:

o   *AzAHP- CFT Overview (a self-paced course expected to be completed before attending the TtT session),

o   *AZAHP- CFT Facilitator TtT, and

o   *AZAHP- CFT Supervisor TtT.

·         If the identified CFT Champion has taken CFT Overview in the last two years, they will not have to take it again and will be given credit automatically in Relias.

Initiative 5: Triannual CFT Collaborative Sessions

·         In addition to CFT Champions attending TtT Facilitator Courses, delivering the 2-day CFT Facilitator Training, and CFT Supervisor Training; CFT Champions are required to attend triannual CFT Collaborative Sessions. During these sessions CFT Champions will meet with Health Plan Trainers and leaders to discuss as a group, best practices, challenges, and opportunities for growth and development regarding CFT administration and implementation.

Training and Supervision Expectations

·         Provider agencies who have employees that are designated to facilitate/lead CFT’s shall be trained in the elements of the CFT Practice Guide, complete an in-person, AHCCCS approved CFT facilitator curricula, and demonstrate competency via the Arizona Child and Family Team Supervision Tool.

·         The CFT Supervision Tool must be completed within 90 days, and facilitators must maintain or enhance proficiency within six months as attested to by a supervisor, and annually thereafter (AMPM 580 (F),  Attachment C & D).

Monitoring Process  

·         CFT Champion Certification

o   All agencies who are required to have CFT Champions will be tracked in Relias.

o   Workforce Development will maintain a list of all CFT Champions and their provider agencies.

Arizona Child and Family Team Supervisions Tool (AMPM 580 (F),  Attachment C & D).  The supervision tool requirements will be tracked in Relias via the CFT Competency Evaluation Tool for all employees who facilitate/lead CFT’s.

Employees completing assessments of substance use disorders and subsequent levels of care must complete the American Society of Addiction Medicine (ASAM) criteria-specific training. This training is required before staff may use the assessment tool with members. They must also complete any approved substance use/abuse course every year. The assessment should align with the most recent ASAM criteria. 

15.8.1 Children

Medicaid reimbursable TFC 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 TFC Curriculum.

The provider delivering TFC services must complete the above training prior to delivering services. In addition, the provider delivering TFC 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.

15.8.2 Adults

Medicaid reimbursable Behavioral Health Treatment Home (BHTH) 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 adult BHTH 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 BHTH services to adults must complete and credibly document annual training as required by A.A.C. Title 9, Chapter 10
• Residential Care (24-Hour Care Facilities) Annual Requirements:
  • Crisis prevention/de-escalation training for all member-facing staff prior to serving members.
  • For facilities where restraints are approved, a nationally approved restraint training for all member-facing staff. This curriculum should include non-verbal, verbal and physical de-escalation techniques.

Division of Licensing Services (DLS) Required Training: DLS agencies must be aware of all training requirements to be completed and documented based on all additional licensing or accrediting licensing agencies. This includes the Bureau of Medical Facilities Licensing (BMFL) / Bureau of Residential Facilities Licensing (BRFL), Joint Commission, grant requirements and other entities, as applicable.

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 Arizona Association of Health Plans (AzAHP)Provider Forum webinar held the 2^nd Thursday of each month, 11:00 to 12:30 PM, hosted by the AzAHP Workforce Alliance.
• This person will monitor and maintain the Relias learning management system for their agency.

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 the health plan expects consistency and quality in peer-delivered services and support for peer-delivered services statewide.

15.11.1 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 use disorder issues. In the letter, CMS provides guidance to states for establishing criteria for peer support services, including supervision, care-coordination and training/credentialing.

15.11.2 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 use disorder 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 (PSETP). The OIFA Alliance will oversee the approval of all certification materials including curriculum and testing tools. Certification through the OIFA Alliance approved Peer Support Employment Training Program is applicable statewide.

Some agencies may wish to employ individuals prior to the completion of certification through a PSETP. 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 OIFA Alliance Peer Support Training Program under the supervision of a qualified individual (see Section 15.10) prior to billing Peer Support Services.

15.11.3 Peer Support Employment Training Program Approval Process

The OIFA Alliance oversees the PSETP process including the setting of requirements, terms, and conditions for recognition. Members of the OIFA Alliance will determine all PSETP applications and evaluate all submitted training materials prior to issuing or withholding approval.

A PSETP 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 the OIFA Alliance , and the Alliance  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 the OIFA Alliance  for review and approval.

The OIFA Alliance  will base approval of the curriculum, competency exam and exam-scoring methodology only on the elements included in AHCCCS AMPM Policy 963. If a PSETP 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.

15.11.4 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 PSETP 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 15.11.5.  AHCCCS/DCAIR, OIFA, recognizes credentials issued in states outside of Arizona that comply with CMS’s requirements, as specified in SMDL #07-011. Individuals credentialed in another state shall submit their credential to AHCCCS/DCAIR, OIFA, via email at oifa@azahcccs.gov.

15.11.5 Peer Support Employment Training Curriculum Standards

A PSETP 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 use disorder, 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.  Providers must ensure:

• Maintenance of policies and procedures to establish the minimum professional, educational and/or experiential qualifications for BHPPs and BHTs,
• Maintenance of policies and procedures to establish the minimum required amount and duration of supervision for Peer Support Specialists/Recovery Support Specialists qualifying as BHPPs and BHTs (4 hours minimum per year),
• Supervision is documented and inclusive of both clinical and administrative supervision, and
• Supervisors of Peer Support Specialists/Recovery Support Specialists have access to training and ongoing learning relevant to the supervision of Peer Support Specialists/Recovery Support Specialists and the delivery of peer support services.

Agencies shall ensure that their staff employed as a Peer Support Specialists/Recovery Support Specialists have access to a minimum of four hours of continuing education and ongoing learning, relevant to peer support, per year, with at least one hour covering ethics and boundaries relates to the practice of peer support.

15.11.6 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.

15.11.7 Support for Curriculum Development and Additional Resources

In accordance with AHCCCS AMPM 963 section H3, the Health Plan has designated our Administrator of Individual and Family Affairs as SME regarding Peer Support Employment Training. The Administrator of Individual and Family Affairs is authorized to request a review of any contracted providers’ curriculum they are using to credential their Peer/Recovery Supports. It is expected that all requested material will be provided within 14 business days of the request. The Administrator of Individual and Family Affairs is available to contracted Peer Support Employment Training providers for guidance and feedback to further develop and enhance their curricula. Please contact Advocates@azcompletehealth.com for support.

AHCCCS/DCAIR 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.

15.12.1 Parent/Family Support Provider and Trainer Qualifications

15.12.1.1 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 use disorder needs; and
• Meet the requirements to function as a behavioral health professional, behavioral health technician, or behavioral health paraprofessional.

15.12.1.2 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 use disorder 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/DCAIR OIFA approved Parent/Family Support Training Program. AHCCCS/DCAIR 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.

15.12.2 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/DCAIR 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/DCAIR OIFA for review and approval no less than 60 days before the changed or updated curriculum is to be utilized.
• AHCCCS/DCAIR 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.

15.12.3 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/DCAIR 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.

15.12.4 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.

15.12.5 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.

15.12.6 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.

15.12.7 Support for Curriculum Development and Additional Resources

In accordance with AHCCCS AMPM 964 section H3, the Health Plan has designated our Family Support Advisor, Brenda Replogle, as SME regarding Family Support. Please contact her at breplogle@azcompletehealth.com for support. The AzCH-CCP Family Support Advisor is authorized to request a review of any contracted providers’ curriculum they are using to credential their Family Supports. It is expected that all requested material will be provided within 14 business days of the request.AzCH-CCP Family Support Advisor is available to provide curriculum resources and ongoing TA upon request.