This is the fifth in a series of seven articles about the Travis County Forensic Mental Health Project. This series of articles was named the Best Series of Articles – General Interest by the State Bar of Texas‘ Division III Stars of Texas Bars Awards.
The Travis County Forensic Mental Health Project delivered its recommendations to the Travis County Commissioners in March 2023. The goal of these recommendations is to provide solutions other than jail to address mental health and substance abuse disorders in the county.
Recommendation #4
The Project’s fourth recommendation is to increase the number of certified peer support specialists (CPSSs) in Travis County.
A peer support specialist is defined by Texas Health and Human Services as someone “with lived experience from mental illness or addiction. By combining this experience with skills learned in formal training, peer specialists deliver services in behavioral health settings to support long-term recovery.”1
Peer support services can be covered by Medicaid if the support specialist is certified by the Texas Certification Board (TCB).
The Travis County Sheriff’s Office (TCSO) currently has one CPSS employed through the Via Hope program. This program also offers up to two unpaid internship positions.
Integral Care has up to six CPSS positions available.
The Austin State Hospital has several CPSSs employed, as well as a director of peer support services.
“To a person unfamiliar with the system, this current (number of CPSSs) may seem sufficient,” the recommendation document says.2 “However, each certified peer is most effective with a caseload of roughly 20 individuals or less.”
The Project analyzed data from the Texas Institute for Excellence in Mental Health and found “roughly 880 certified peers through the Texas Certified Board, and there are roughly 30,000 certified peers nationally, according to Mental Health America.”3
“(30,000) represents less than half a full-time employee per 100,000 people in Texas,” the document says.
TCSO estimated they would need eight to 12 additional CPSSs to meet the needs of the jail population and those transitioning from jail to the community upon release.
Via Hope’s pilot CPSS program at TCSO was rated very favorable, according to a survey of 29 inmates at the Travis County jail.4
Based on a scale of 0-100, the mean ratings for TCSO’s CPSSs were:
95.97 – how well the inmates felt heard and understood
96.48 – how much they felt they could talk about the things they wanted to talk about
97.79 – how well they felt supported
94.07 – working with the CPSSs overall
“The National League of Cities reported that Wayne County, Michigan’s Third Circuit’s peer supports resulted in a recidivism rate below 10 percent compared to more than the 30 percent in the remaining jurisdictions,”the document says.5
The most effective CPSSs are those who have experiences similar to the people they’re working with, the document says. One issue with increasing the number of CPSSs in Travis County is disqualification based on criminal history.
“Precluding people who have served time in jail or prison, and have successfully re-entered the community, eliminates those individuals with the most relevant experience to the current project goals,” the document says. “Currently, an individual who was previously incarcerated is unable to apply to become a certified peer specialist until at least three years have passed from release, with some being prohibited for up to 10 years, depending on the conviction.”
Many of the requirements to become a CPSS are guided by the Texas Administrative Code.
TCB has proposed creating an exceptions committee, consisting of active CPSSs, who will review exception requests submitted by individuals who have undergone and failed the background checks required to become a CPSS.
TCB would request the individual submit a certification exception request to the board, which would note the date of receipt and forward the request to the chair of the proposed exceptions committee.
The chair of the committee would then contact the committee members to schedule a time to discuss and review the exception request before deciding whether to approve the application for exception.
The proposed exceptions committee would consider the following factors in deciding whether to approve an exception application:
• The age of the offense (length of time since the offense occurred);
• The level of severity of the offense;
• Prior offenses of the same nature; and
• Other relevant information, such as character references. References must be individuals with direct specific knowledge of character of the person in question. The letters must speak to demonstrated rehabilitation since the offense.
If approved, TCB would notify the applicant in writing, along with the next steps to complete an application for certification.
If denied, TCB would notify the applicant in writing, along with the steps to file an appeal.
If the applicant intends to appeal the decision, the individual must respond to the determination letter indicating their intent to appeal within 10 business days of receiving the determination letter from TCB. If the person does not respond within this timeframe, their right to appeal will be waived.
Appeals take place before TCB’s Executive Committee/Appeals Review Committee. The committee has five business days from receipt of the appeals form to review the case to determine the appropriateness of the decision.
If the appeals committee finds the exception committee’s decision was reasonable, the applicant will be notified in writing within three business days.
If the exception committee’s determination was not reasonable and the exception should be approved, the applicant will be notified within three days.
The decision of TCB’s Executive Committee/Appeals Review Committee will be final.
“We recommend that the county review the criminal background requirements for certified peer specialists in a jail setting and adjust to decrease the prohibitive nature of such requirements,” the document says.
Currently, the Texas Administrative Code does not allow TCB to certify or renew the CPSS application of individuals convicted or placed on community supervision for the following offenses:
• Capital offenses
• Sexual offenses involving minors
• Felony sex offense involving adult client
• Multiple felony sex offenses involving any adult
• First-degree homicide6
The Code allows TCB to certify or renew the CPSS applications of individuals convicted of the following offenses to apply to become CPSSs after 15 years have passed:
• Kidnapping
• Arson
• Homicide (lesser degrees)
• Felony sex offense involving any adult
• Attempting to commit kidnapping or arson
The Code allows individuals convicted of the following offenses to apply to become CPSSs after 10 years have passed:
Any felony that results or might result in physical harm to others or animals
The Code allows individuals convicted of the following offenses to apply to become CPSSs after five years have passed:
• Class A misdemeanor alcohol and drug offenses
• Class A misdemeanor offenses that result or might result in physical harm to others or animals
• Felony alcohol and drug offenses
• Any other unlisted felony
The Code allows individuals convicted of the following offenses to apply to become CPSSs after three years have passed:
• Class B misdemeanors that result or might result in physical harm to others or animals
The Project only recommends lessening the requirements for individuals convicted of 10-year offenses or less. How those requirements should be lessened is not specified.
“Experiences from other organizations and centers suggests that for every $1 invested in peer support specialists, about $2 are saved from the overall system,” the document says, citing a document from Mental Health America.7
If this recommendation is implemented, the Project suggests the county also track these investments to understand where savings occur in order to make the best decisions regarding reinvestment to perpetuate the expanded CPSS program.
As noted previously,8 the ability to make these types of assessments will be critically reliant on improved data management and technology.
ENDNOTES
4 https://utexas.app.box.com/s/pbfneya9awzgu3g43wxpy3byfkcsu5p7
5 https://www.nlc.org/wp-content/up4 loads/2020/10/Peers_Support_Brief_v3.pdf
6 RULE §354.3201 subsection (d) (e)
7 https://www.mhanational.org/sites/default/files/Evidence%20for%20Peer%20Support%20May%202019.pdf
8 Decriminalizing Mental Health in Travis County, Part 1, Austin Lawyer (July/Aug. 2023)