Use of Peers in Hospital Settings. Manish Sapra, MD, MMM Keirston Parham, CPS, CWF

Transcription

1 Use of Peers in Hospital Settings Manish Sapra, MD, MMM Keirston Parham, CPS, CWF 1

2 Who is a Peer Support Specialist? Individual with lived experience of mental illness or substance use disorder Progressed in their own recovery Willing to self-identify as a peer Willing to assist other individuals Trained in providing peer support 2

3 WPIC Outpatient Peer Positions Psych Rehab 6 Re:solve Crisis Walk-in/Phone 5 CTT, Community Treatment Team 3 Mobile Meds 1 DEC, Diagnostic & Evaluation Center (Psych ER) 2 3

4 WPIC Inpatient Peer Positions Child/ Adolescent -- 1 Comprehensive -- 2 Adolescent/ Young Adult ACABS, Child and Adolescent Bipolar Spectrum Services -- 1 Merck Unit -- 1 TRU, Transitional Recovery Unit/ CRU, Comprehensive Recovery Unit -- 4 Dual Diagnosis -- 1 General Adult -- 2 Geriatrics -- 1 Trauma -- 1 ECT, Electroconvulsive Therapy -- 1 Peer Navigators

5 Characteristics of Recovery 1) The reawakening of hope 2) Achieving understanding and acceptance 3) Engagement and active participation in life 4) Active coping 5) Reclaiming a positive sense of self 6) Developing a sense of meaning and purpose 7) Each person s recovery is a journey that is individual and unique 5

6 Peer Support: Our Common Thread We ve experienced a variety of mental health issues. We ve sought treatment for our mental health and/or co-occurring disorder. We ve experienced ups and downs with our recovery. We practice on-going personal wellness recovery. We ve developed an interest in serving others who have similar experiences with mental health or co-occurring disorders treatment. We have an interest in on-going education, training, supervision and advocacy to better serve others (CPS), (CRS), (CWF), etc. 6

7 Peer Specialist Exhortations Inspire hope (identify strengths) Identify barriers to recovery and treatment Smart goals (motivational interviewing) How to? When to? Community (return to fellowship and healthy relationships) 7

8 Scope Recovery Management Help consumers to identify recovery goals Identify barriers to achieving recovery goals Help consumers develop strategies to meeting recovery goals Supports/ Resources Assists consumers in identifying natural supports and resources in the community Educates consumers on how to utilize them in the recovery process Advocate Advocate for consumers Actively participate in staff meetings, treatment team meetings, etc. and appropriately interject the consumer viewpoint and recovery goals Recovery Maintenance Monitor consumer progress with recovery goals Provide feedback as appropriate to consumer, family members, and clinical staff 8

9 Scope Mental Health Advance Directive (MHAD) Explain the use and procedure for completing of MHADs to consumers based on UPMC policy Peer Specialists facilitate workshops and provide one on one support in consumer completions Wellness Recovery Action Plans (WRAP) and Personal Medicine Assist consumers with understanding their WRAP plans Assist consumers with incorporating personal medicine into their recovery Crisis Support/ Planning/Management Assist consumers in identifying triggers that lead to crisis situations Participate in crisis planning and crisis management, per site supervisor Model effective coping techniques and self-help strategies for consumers in crisis 9

10 Use of Peer Navigators in Engaging Consumers Suffering from Co-Occurring Substance Use Disorders Goals: Increase initiation and ongoing engagement of individuals with Substance Use Disorders (SUD) into treatment Reduce avoidable emergency room visits, reduce repeat hospitalizations, and reduce overall cost for payers and providers 10

11 Use of Peer Navigators in Engaging Consumers Suffering from Co-Occurring Substance Use Disorders In Allegheny County, SUD is among the top 3 causes of repeated admissions (defined as 5 or more admissions in fiscal year 2014) 1 Heart failure 969 Mental health disorders 927 Alcohol/substance abuse disorders PA s Super-Utilizers of Inpatient Hospital Care : research brief, PA Health Care Cost Containment council 11

12 12 Background and Development of Concept Launched through the federal Adult Medicaid Quality Grant Program: Measuring and Improving Quality of Care a two-year grant program designed to support state Medicaid agencies Review of data showed low participation rates in substance use disorder treatment Initial discussion focused on using interventions in the ED such as SBIRT

13 Funding Organizations Aetna Better Health Community Care Behavioral Health Organization Gateway Health United HealthCare Community Plan of PA UPMC for You, Inc. Aetna 13

14 Peer Navigator Project Two Year Pilot Program in Allegheny County, PA Multiple Payers agreed upon the interventions and funding of the project Built upon Project Engage model of care at Christiana Care Health System Project initiated at three hospitals within University of Pittsburgh Medical Center (UPMC) health care system UPMC Mercy, UPMC McKeesport, and UPMC East Peer Navigators (PN) at these hospitals will engage patients suffering from SUD, use engagement strategies including motivational interviewing, build oneto-one rapport with patients, and help refer them to appropriate treatment programs. PNs will follow up via phone contact and coordinate continuing care 14

15 Linkage with Community Outreach Recovery Specialist (CORS) CORS works with four local hospitals to identify members who have medical admissions in which untreated and co-occuring substance use is the driver of their admission (MA patients) Referral Process -- Peer Navigator asks patient for permission to make referral to CORS staff. Peer Navigator contacts CORS after Peer Navigator consult for support during stay and for CORS to assist patient post-hospital discharge Can be revisited at different points during care and follow-ups 15

16 16 Peer Navigator Project

17 17

18 Challenges in Implementation Integrating peers on hospital units This is a new concept for most of the non-behavioral health community Medical staff are uncertain of how peers can be of assistance Some of the ancillary benefits of integrating PNs with medical staff include: 1. Patients with disruptive behavior engage better in the medical setting with PNs than with medical/nursing staff. 2. Patients give more honest history about substance use to PNs than to doctors. 3. PNs are an extra set of eyes on an intoxicated patient. They can help lower fall rates. 4. PNs help patients with some basic needs like getting coffee and taking them to restrooms. This also helps the PNs build rapport. 5. Peers are a support system for hospital staff. 18

19 Challenges in Implementation Marketing/Advertising the new service to medical staff was a challenge Use of s and newsletters; in-house TV monitors 2. Posters in the ED and staff areas to remind staff to use the PN service 3. Meetings with hospital leadership to get buy-in 4. PNs and project leaders attend staff meetings and clinical rounds 5. Find natural allies/ champions; medical and nursing staff members who are helpful from the start 6. Recovery Round Table discussions with pizza; ask nurses if they have any patients in recovery 7. Get back to telling success stories ( remember that guy last week ). This creates hope.

20 20 Peer Navigator Contact

21 David Gardner, Peer Navigator Specialist Meet David Peer Navigator for UPMC Mercy David Gardner s efforts can help support those of us caring for patients with substance use disorders. 1. Ask your patient if they d like to talk with someone about their drinking or drug use. 2. Call, text, or David with the patient s first name and last initial, room number and MRN#. 3. David will meet with the patient and help him or her seek help. David at gardnerd2@upmc.edu or call or text him at

22 Referral Sources Referrals come from a variety of sources including MDs Counselors Psychiatrists RNs Patient Requests Social Workers The majority of consults are from Social Workers 22

23 Peer Navigator Project Data Analysis Since the start of the program, PNs have met with 2415 unique individuals and facilitated follow-up referrals for 914 individuals 2215 individuals received a follow-up visit by the PN, either during their hospital stay or via a phone call post discharge. 23

24 East Mercy McKeesport Jameson Horizon # of Individuals Seen # Coordinated with SUD

25 Peer Navigator Project Data Analysis To analyze the impact of the program we studied the utilization rate of ED and inpatient medical services for all individuals seen between 5/1/2015 and 4/30/2016. We compared the use of these services 9 months before and after the PN intervention in the same population. 892 unique individuals were seen during this 1 year period. These individuals were predominantly male (64%) and Caucasian (79%). The average age of the sample was 47. The common primary diagnosis at their index PN service were mental illness (24%), diseases of the circulatory system (10.5%), diseases of the digestive system (10.1%) or for injury/poisoning (9.6%). We saw a higher effect at UPMC Mercy and UPMC East. 25

26 12 Month Analysis Analyzed utilization rates for 9 months before and after the index visit with the PN N= number of unique individuals seen by PNs between 5/1/2015 to 4/30/2016 N Total Inpatient Discharges₁ Total ED Visits₂ Before After % Change Before After % Change East % % McKeesport % 1,321 1,638 24% Mercy % % ₁Includes psychiatric & non-psychiatric inpatient admissions to all UPMC hospitals attributed to individuals in the study sample ₂Includes ED visits to all UPMC hospitals attributed to individuals in the study sample 26

27 Peer Navigator Project Data Analysis This project specifically aims at decreasing repeat visits to acute care settings. We defined individuals with high utilization as persons with either 3 or more inpatient visits or 3 or more ED visits in 9 months prior to index visit. We again found a higher impact at Mercy and East. 27

28 28 High Utilization Group Analyzed utilization rates for 9 months before and after the index visit with the PN N₁= number of unique individuals with 3 or more inpatient discharges in the 9 months before PN intervention N₂= number of unique individuals with 3 or more ED visits in the 9 months before PN intervention N₁ Total Inpatient Discharges₁ N₂ Total ED Visits₂ Before After % Change Before After % Change East % % McKeesport % % Mercy % % Total % % ₁Includes psychiatric & non-psychiatric inpatient admissions to all UPMC hospitals attributed to individuals in the study sample ₂Includes ED visits to all UPMC hospitals attributed to individuals in the study sample

29 Patient Satisfaction Survey Question 1 Question 2 Question 3 Total Surveys Mercy = 259 McKeesport = 104 East = 68 Question Mercy McKeesport East Question 1: How beneficial was your time with the Peer Navigator? Question 2: How has this encounter increased your awareness of there being a potential health or safety issue with your current substance usage pattern? Question 3: How would you rate your likelihood of changing (decreasing) your substance use pattern based on what you have learned today? Question 4: How would you rate your likelihood of your seeking follow up services to assist you with changing 29 your current substance use pattern?

30 Staff Satisfaction Survey If you have consulted the peer navigator service, how likely would you be to consult it in the future? (n=280) 30

31 Staff Satisfaction Survey selected comments Offers an insight that is useful to help us take care of the patients that trust us to do so. Patients find him very helpful as well and they report that he helps with their experience when admitted. Excellent. Patients actually bond more with the peer navigator than with the other health care professionals. It is a very helpful service. It is very beneficial to patients struggling with addiction. 31

32 Staff Satisfaction Survey selected comments Very resourceful. A blessing to all the patients he comes into contact with. People feel hope after spending time with him. Actively engages patients regarding treatment, addiction and available options for services on discharge. Get personable service readily available to patients with great resources. 32

33 Press Coverage Featured on CNN Could peer-recovery coaches help fight drug addiction? - CNN.com Featured on 90.5 WESA Counselors Say Addiction Recovery Isn't About Putting The Drugs Down Featured in New Castle News s/peer-navigator-program-pairsformer-current-addicts David Gardner, Dana Grant and Amber Scire work as peer specialists in drug and alcohol recovery at UPMC 33

34 The Fine Awards for Teamwork Excellence in Health Care 34 Jewish Healthcare Foundation, Fine Foundation Announce Winning Teams for 2017 Fine Awards Focused on Breakthroughs in Mental Health, Substance Use Treatment, May 18, 2017 (Pittsburgh, PA) The Jewish Healthcare Foundation (JHF) and The Fine Foundation announced winners for the 2017 Fine Awards for Teamwork Excellence in Health Care. The 2017 Fine Awards recognize and provide a financial award to teams of professionals in western Pennsylvania who provide innovative, quality improvement-centered treatment for mental health and substance use problems. JHF and The Fine Foundation recognized two behavioral health crises that could not be ignored an explosion of opioid dependence, and emergencies that strain a beleaguered mental health system that lacks sufficient human and capital resources to meet the need, particularly among adolescents, says JHF President and CEO Karen Wolk Feinstein, PhD. We want to champion new care models that can quickly become the gold standard in addressing these crises, locally and nationally. The Fine Award winners will also help spread excellence and innovation across generations by coaching and mentoring JHF s multidisciplinary Patient Safety Fellows. The 2017 Fine Award winners were selected by a panel of independent judges following a request for applications from teams in Allegheny, Beaver, Butler, Washington, and Westmoreland counties. The winning teams were chosen based on their submitted project s level of innovation, sustainability, and spread of best practices within and beyond their respective organizations. $20,000 Award Winners: Western Psychiatric Institute and Clinic (WPIC) of UPMC (Tie) Peer Navigation Project: Embedding Peer Recovery Support in Acute Care Settings. WPIC developed a pilot project which trained peer navigators who help patients suffering from a substance use disorder transition to the next level of care and coordinate post-discharge care. The peer navigators (individuals who have been in stable recovery for at least two years) were deployed at three UPMC hospitals, with the goal of reducing repeat visits to acute care among high-utilization patients. In the nine months following implementation of the peer navigator model, inpatient discharges decreased by 42% (compared to the nine months before implementation) and emergency department visits declined by 18%. The peer navigator model was expanded to two additional UPMC hospitals. Reference:

35 Key Recommendations Get buy-in from senior leadership early on. Strong broad-based institutional commitment behind the new service is important as this will help with several roadblocks on the way. Hiring peers with good interpersonal skills and high functioning level in their previous positions was a key asset to this program. Invest in training of the peers. This builds high level of professionalism. Create high visibility by use of internal advertising to the staff. Create a wellness group for the peers. 35

36 Key Recommendations Make the workflow seamless. Easy and quick access to peers helps utilization of peer services by staff. Create opportunities for cross-learning among peers. Continue to provide ongoing trainings and supervision. Create opportunities for growth, including a career ladder, for peer recovery specialists. 36

37 Rural Public Psychiatry Fellowship Program ruralpsych.pitt.edu 37