PRSS-SUD Recertification Application

West Virginia Certification Board for
Addiction and Prevention Professionals
436 12th Street Suite C, Dunbar, WV 25064
Phone 304-768-2942
Email: wvcbapp@wvcbapp.org

Two-Year Recertification Instructions

After the initial certification period, renewal of the PRSS is required every two years. During each two-year cycle, recertification will require 20 contact hours of WVCBAPP approved education which needs to be in the following domains:
- Advocacy
- Mentoring/Education
- Recovery/Wellness Support
- Ethics (of the 20 hours needed for renewal, 6 hours must be in IC&RC Peer Recovery (PR) Code of Ethics)
If you have all of the necessary continuing education hours but miss the deadline for submission of your application for recertification, you have a 90-day grace period within which you may submit your application with a $75 late fee. You have a 90-day grace period to get the required materials to us with the late fee; however, education hours may not be acquired during this period. Should the grace period expire, a new initial application must be submitted and the exam will have to be retaken.

After the recertification date expires, the individual will no longer hold a PRSS and no further use of the PRSS is permitted until the individual has recertified.

An Applicant for a two-year recertification should submit the following documents and fees.

1. Completed PRSS-MH Recertification Application
2. Signed Code of Ethics Statement
3. Signed Statement of Personal Recovery
4. Documentation of 20 contact hours of WVCBAPP approved education in the different domains mentioned above which must include six (6) hours in IC&RC Peer recovery (PR) Code of Ethics for the two-year recertification cycle.
5. $100 renewal fee if received by 8/30 of the year of recertification. Enclose an additional $75 late fee is if application is sent after 8/30 of the year of recertifcation.

*All fees are non-refundable. Checks or money orders should be made payable to: WVCBAPP and mailed to 436 12th St. Suite C, Dunbar, WV 25064.

Online payments are accepted at www.wvcbapp.org using PayPal or by submitting with this form.

*Additional information about initial applications or recertification can be located in the credential's manual available online at: www.wvcbapp.org.
PRSS-MH Recertification Application

West Virginia Certification Board for Addiction and Prevention Professionals
Date*

MonthDayYear
Date
Has any of the information below changed?*

YesNo
Name*

First Name Last Name
Preferred Name, Maiden, or Nickname:
Optional
Date of Birth*

MonthDayYear
Date
E-mail*
example@example.com
Phone Number*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Highest Education Level*
Certification Currently Held (select all that apply)*

PRSS-SUDPRSS-MHAADCADCPSI or PS2CCJPCSCSPRSSCSPRSS-CLOther
License Currently Held:*

LPCLICSWBSWLSWMD/DOMFTRNLPNNot applicableOther
PRSS-MH Certification Number:*
Current Employment:
Current Employer*
Name of Current Employer or NONE if not Employed
Position*
Statement of Personal Recovery – PRSS-MH

Requires 2 years (24 months) of a stable state of recovery from a mental health condition.

This statement affirms that individuals serving as Mental Health Peer Recovery Support Specialists have successfully navigated their own recovery journeys and are currently in a stable state of recovery. They have achieved the ability to manage their personal challenges in a way that does not interfere with their professional responsibilities or the quality of support they provide to others.

I, the undersigned individual, affirm that I have successfully pursued my own personal mental health recovery experience involving a mental health disorder and are in a stable state of recovery.

I further affirm that, in the event I experience a recurrence of mental health symptoms that may interfere with or impair my functioning as a Peer Recovery Support Specialist in Mental Health (PRSS-MH), I will take the following steps:

1.         Seek appropriate therapeutic care to address the symptoms.

2.         Notify WVCBAPP in writing of my condition and its potential impact on my professional duties.

3.         Refrain from providing services as a Mental Health Peer Recovery Support Specialist until I can resume such responsibilities in a safe and effective manner.

I affirm ongoing supervision provided at least one hour a week by an organization’s documented and qualified supervisory staff while I am working or volunterring in the capacity of a PRSS.

This statement is made truthfully and voluntarily as part of my ongoing commitment to ethical and responsible practice.
Are you currently providing services as a PRSS directly with clients?*

Yes, and I have met the 1 hour per week supervision requirement.Yes, and I HAVE NOT met the 1 hour per week supervision requirement.No, I am not working directly with clients in the PRSS role.
My present period of continued recovery is Years* and months* .
If less than 24 months of continued recovery, was the reoccurrence of symptoms reported to WVCBAPP as required?
Ethical Code of Conduct Peer Recovery

It is the policy of the West Virginia Certification Board for Addiction Professionals to promote and safeguard the quality, effectiveness and competence of Peer Recovery through the insistence of adherence to its Code of Ethics by all WVCBAPP certified Peer Recovery specialists.

The ethics committee develops and recommends an ethical code of conduct for adoption by the Board of Directors. Currently, the Board has adopted the code of conduct adhered to by IC & RC located at
https://www.wvcbapp.org/ethics.

The ethics committee has jurisdiction over all matters of violation and misconduct by WVCBAPP certified peer recovery specialists in the state of West Virginia. It immediately and thoroughly investigates such charges and makes recommendations to the Board of Directors for appropriate action.

I hereby attest that I have read, understand, and will adhere to the IC&RC Peer Recovery Code of Ethics and including, a subsequent change to the code of ethics that is duly approved by the IC&RC Board of Directors at a regularly scheduled Board Meeting.

It is my responsibility to remain current and comply with the code of ethics for this and other credentials awarded by my credentialing body throughout the life of the credential.
Ethical Code of Conduct*

I agreeI disagree
Upload Certificates for 20 hours of CEUs including 6 hours of ethics and current Mental Health First Aid certificate.*

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How will you be paying the fee?*
The grant has expired.
Pay Fees via PayPal DO NOT CHECK THESE BOXES IF YOU ARE NOT PAYING USING THIS FORM!
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PRSS-MH Recertification FeeRecertification fee can be paid here, on our website, or via mail. All payments made via PayPal are charged an 8% processing fee.
$108.00

Late/Rush Processing FeeInclude after 8/30 of your recertification year. This can also be paid on our website or via mail. All payments made via PayPal are charged an 8% processing fee.
$81.00

Total

$0.00
If PayPal was used, what agency or name is on the account?:
Example Jon Dower or FMRS Health Systems
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PRSS-MH Recertification Application

Current Employment: