Behavioral Health and Peer Support

HOW 

Action Items

1. Assess your intake practices to first determine whether your mental health screening is sufficient to identify people who may benefit from support services. Here is an example of a mental health screening for women in jail (page 13).
2. Offer supportive services (behavioral health counseling or peer support) to your pregnant and postpartum patients. They have the right to refuse services!
3. Determine whether you have someone on staff who has the expertise to be either a behavioral health provider or peer support specialist. If so, discuss integrating this care into their role.
   1. If there is no one with this training and expertise on staff, contact your health care provider (contract) to discuss including these services in your RFP.
   2. You may also want to contact your local health department to discuss services that they may be able to provide. If all else fails, you can find an outside behavioral health provider and peer support specialist by searching the internet.
4. If using an outside provider, consider putting a memorandum of understanding (MOU) in place. (See MOMCARE Memorandum of Understanding)
5. Behavioral health and peer support can be delivered in person or via telehealth. Determine which arrangement works best for your needs and the provider. There are things to consider for each modality (on-site, off-site, telehealth).
6. Discuss with staff how to integrate behavioral health and peer support services into your daily workflow. Things to consider are timing, frequency, and location of sessions.
7. Embed processes into your reentry planning to link pregnant patients with OUD to behavioral health, psychiatric, and peer support services in the community upon release.

Jails must have protocols in place at intake for all pregnant and postpartum individuals with OUD (and those without!) to undergo a mental health screening at intake. Mental health screenings should also incorporate a suicide risk assessment. The screening alerts staff to who needs an urgent mental health referral. A more detailed assessment of perinatal depression, history of sexual abuse, intimate partner violence, and other trauma, should be done at the provider visit. Here is an example of a mental health screening for women in jail (page 13).

Some pregnant patients with OUD may meet the criteria for a clinical diagnosis, others may not, but everyone should have the option to participate in behavioral health counseling. Therapy should be provided by a professional with behavioral health expertise like a psychiatrist, psychologist, or licensed clinical social worker. Sometimes, the medication prescriber can also provide counseling.

Peer support is provided by a peer recovery specialist who is someone with lived experience with substance use and incarceration, and is trained to assist others with their recovery. It may be hard to find a peer recovery counselor who also has pregnancy experience, but any experience with addiction, incarceration, and recovery is helpful.

Therapists/counselors and peer specialists can be community providers who come to the jail to provide services or they can be employed by the jail. Oftentimes, these individuals are involved in facilitating reentry. Jails with limited capacity to provide therapy or recovery support onsite should consider using telehealth to deliver interventions.

All therapeutic and recovery support services should be voluntary, trauma-informed, recovery-focused, and patient-centered focusing on the needs the patient is concerned with. Interventions can be delivered in a group or individual format. Some patients may be favorable to one or the other.

WHY 

Most pregnant patients with OUD have significant behavioral health needs. The majority have experienced some form of trauma and many have mental health diagnoses such as major depression, bipolar disorder, post-traumatic stress disorder, anxiety, and other conditions. Oftentimes these conditions are related to their addiction.

Counseling and supportive services can help pregnant patients achieve long-term recovery and prevent relapse. However, MOUD (methadone and buprenorphine) should not be withheld if there is no access to counseling at your facility or if the patient declines counseling. MOUD is effective as a standalone treatment.  

Psychosocial support for recovery can come from both behavioral health counseling and peer support. These are two different things. Behavioral health counseling is treatment by a trained professional (e.g. Psychologist, Licensed Clinical Social Worker) using an evidence-based practice like cognitive behavioral therapy (CBT), motivational interviewing or group therapy.

Benefits of behavioral health counseling:

• Process trauma and root causes of substance use
• Bring awareness to and help correct maladaptive behaviors
• Develop healthy coping skills
• Build interpersonal skills
• Referrals to resources

Peer support is when someone uses their lived experience of recovery from mental illness and/or addiction in conjunction with skills learned from formal training to guide others on their path to recovery. Peer recovery is meaningful to many patients because they are receiving guidance from someone who knows what they are going through!

Benefits of peer recovery support:

• Helps the patient feel understood
• Enhances motivation for change because they see success in the peer counselor
• Helps identify recovery goals, pathways, and plans without the fear of judgment
• Referrals to resources that the peer counselor may be familiar with from personal experience

Both behavioral health counseling and peer support are beneficial to pregnant patients with OUD in jail.

Psychiatric care is specialized care from a trained clinician who can prescribe medications for people with mental health diagnoses, including depression, bipolar disorder, schizophrenia, and others. Patients often need both therapy and medications. Most psychiatric medications are safe in pregnancy, but some are not. It’s important that pregnant patients not stop their psychiatric medications just because of pregnancy, and that they are on appropriate formulations.

• National Institute of Justice, Correctional Mental Health Screen for Women (p. 13)
• University of California San Francisco, Edinburgh Perinatal Depression Scale
• SAMHSA’s Treatment Improvement Protocol (TIP) 41, Substance Abuse Treatment: Group Therapy
• Implementing telehealth in jails (BJA COSSUP, Aug 2020)

This webinar explains the essential elements for developing a jail-based telehealth program and shares lessons learned from a telehealth program in several Michigan jails.

• Making changes: cognitive behavioral interventions in jails and community corrections – Bureau of Justice Assistance Comprehensive Opioid, Stimulant, and Substance Abuse Program (Feb 2021)

This webinar describes how jails can use cognitive behavioral interventions to reduce recidivism and focuses on CBIs for substance use disorders. It highlights how CBI programs and practices have been implemented and monitored.

• Peer Support Roles in Criminal Justice Settings – Substance Abuse and Mental Health Services Administration (SAMHSA)

This document provides details on the different types of peer support that are useful in correctional settings and beneficial to people with criminal justice involvement. It includes best practices for recruiting, hiring, and retaining peer support staff in criminal justice settings.

• Peer integration into medication-assisted treatment (MAT) and other jail-based treatment programs – Bureau of Justice Assistance Comprehensive Opioid, Stimulant, and Substance Abuse Program (June 2021)

This webinar describes how peer support is integrated into jail-based MOUD including organizational changes, training peer specialists, stakeholder partnerships and program outcomes.

• Webinar: Implementing telehealth in jails (BJA COSSUP, Aug 2020)