PEER SPECIALISTS & THE PATIENT EXPERIENCE. Marta Durkin, LMSW VP OF BEHAVIORAL HEALTHCARE Melissa Jillson, LMSW DIRECTOR, BEHAVIORAL HEALTHCARE

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1 PEER SPECIALISTS & THE PATIENT EXPERIENCE Marta Durkin, LMSW VP OF BEHAVIORAL HEALTHCARE Melissa Jillson, LMSW DIRECTOR, BEHAVIORAL HEALTHCARE

2 HISTORY OF COMPANY Established in 1978 and incorporated in 1979 as a not-for-profit human service agency in Madison County Moved Administrative Offices to Syracuse, NY Assumed activity from former Consolidated Industries Assumed operational authority for former OPCC Established service presence in the State of Florida, and Texas Acquired Yost, Inc., a national Employee Assistance Provider Received DOH approval to provide Traumatic Brain Injury Services and become an Early Intervention/Early Education provider (EI/EE) Received DOH approval to become Licensed Home Care provider, and expanded EI/EE services into Mid-Hudson Region and NYC Received OMH approval to embed Primary Care into Brownell Center and to expand the Clinic into Monroe County Approved to provide BH HCB Services, expand services into Ulster County and re-establish service presence in Florida. Chartered originally to operate in Madison County, Liberty Resources is now chartered in all of New York State, Texas, and Florida.

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4 MEDICAID REDESIGN IN NYS April 2014, Governor Cuomo announced that NYS and CMS finalized agreement on the MRT Waiver Amendment. Allows the state to reinvest $8B of the $17.1 B in federal savings generated by MRT reforms. The MRT Waiver Amendment will: - Transform the state s Health Care System - Bend the Medicaid Cost Curve -Assure Access to Quality Care for all

5 MEDICAID REDESIGN TEAM Recognized the importance of supportive housing services and set aside $86 million to expand access to supportive housing initiatives for high need and high cost Medicaid recipients. MRT Affordable Housing Work Group agreed that significant savings could be generated by expanding opportunities to high-cost/high frequency Medicaid users through the development of supportive housing pilot initiatives.

6 RE-THINKING CRISIS Breaking the Cycle Crisis Hospital Hospital Home Crisis

7 PEER RECOVERY SPECIALISTS Who are Peer Recovery Specialists? What do they do?

8 PEER RECOVERY SPECIALIST ROLES Promote health and wellness activities Provide 24-hour crisis/hospital diversion using Intentional Peer Support Assist with integration and the establishment of healthy community connections Provide advocacy and supportive counseling Facilitate individual and group-based educational, recovery, and skill-building opportunities including wellness selfmanagement and Wellness Recovery Action Planning

9 DON S STORY

10 INTENTIONAL PEER SUPPORT IPS is a process of experimentation and co-creation, and assumes we play off each other to create ever more interesting and complex ways of understanding. Does not start with the assumption of a problem Promotes a trauma-informed way of relating The focus is on learning versus helping From individual to relationship Moving from fear to hope

11 IPS PHILOSOPHY Connection World View Shared Experience Mutuality Moving Toward

12 CRISIS BED RESPITE CENTER Three Short Term Crisis Beds, Typical Length of Stay: days. Overseen by the Office of Mental Health as part of Medicaid Redesign. Peer Recovery Specialist staffing 24/7 Connection or re-connection to other mental health services. Support services in conjunction with behavioral health professionals.

13 TARGET POPULATION Method used to assist individuals who are experiencing increased apprehension about returning to the community from a psychiatric hospitalization. Individuals already in the community who are experiencing a behavioral health crisis and could be diverted from incurring admission or readmission to inpatient care.

14 REFERRAL SOURCES Hospital inpatient units Emergency departments Health homes Outpatient clinics Apartment treatment housing providers Supported Housing providers

15 PROVISION OF SERVICES Includes: Self-advocacy education Self-help training and skill development Coordination and consultation with existing mental health treatment providers Medication coordination, monitoring, training and advocacy Room and Board Homelike Setting Transportation Wellness & Self-Management (creative writing, yoga, etc.) Assessment Supportive Counseling

16 RICK S STORY Rick came to the Crisis Beds experiencing a major depressive episode and urges to drink alcohol. Upon arrival, he refused to make eye contact, appearing very depressed. Peer staff discussed with him to develop small goals to see improvement, rather than long term goals. They also engaged with him in his hobbies, in order to build rapport. Peers worked with him establishing tasks within his natural ecology (i.e. going to work on his classic car). Creating a daily action plan also helped Richard focus on what he needed to do for the immediate future. Rick was discharged in twelve days. He left a note for the staff, stating: Thank you guys for everything you have done for me. You helped me get through some tough times. At least I can hold my head up a little more. Thanks Again. Rick

17 DOH HEALTH HOME SUPPORTIVE HOUSING PILOT PROGRAM Services are intended to be a means to provide affordable and stable housing and services, to thereby improve access to health services and the health status of Health Home members who are high-cost, high utilizers of Medicaid services. Supportive housing services to homeless or unstably housed Medicaid members enrolled in New York s Health Home program. Funds used to provide rental subsidies and/or on-site or community based services.

18 DOH HEALTH HOME SUPPORTIVE HOUSING PILOT PROGRAM 26 beds distributed across Madison, Onondaga and Cayuga Counties Eligibility: Health Home eligible Individuals who are homeless or unstably housed. Program Supervisor 1 Housing Counselor 4 Peer Specialists in each county Emergency and short-term rental subsidies Utility assistance Housing placement Peer-based health promotion services Crisis diversion/24-hour peer support

19 GARY S STORY Gary came to us from Crossroads--Syracuse Rescue Mission. He had been there for 11 years, plagued by chronic medical issues and limited physical ability and unable to get along with most people except one individual he met at Crossroads that he eventually began to room with there. Staff were able to find a 2 bedroom apartment for him and the roommate from Crossroads. Peer staff helped teach necessary daily living skills such as grocery shopping, setting up a checking account, paying rent in a timely while obtaining assistance from the Office of Aging to provide an individual who cleans his apartment as he is physically limited. After being enrolled in the program for 1 year, they are now turn-keying the apartment into their own names and will sign the new lease on July 1 st.

20 PEERS IN EMERGENCY ROOMS OASAS initiative in response to the commitment of combatting prescription drug use and heroin Funding allows for Peer Advocates to be embedded within ER s to work with individuals/families impacted by substance abuse disorders LRI recently awarded to operate a team in Monroe County (Strong and Unity Health System) Onondaga, Cortland & Madison will have a team of 1 FTE and 2 PTE s serving in the regional hospitals

21 OUTCOME/DATA MEASURES

22 PERCEPTION OF CARE SURVEY I am satisfied with Strongly Agree Agree Neither Agree Nor Disagree Disagree Strongl y Disagre e N/A Doesn t Apply 1) The space for me and my belongings. 2) The overall condition of the center. 3) The furnishings in the center 4) My input on my care plan. 5) The help I receive from peers with my care plan. 6) The effectiveness of my WRAP plan. 7) How peers encourages me and allows me to make decisions for myself. 8) The relationship I formed with the peers. 9) Peers availability when I have a concern. 10) Peers response when I express a need. 11) Peers explanations of center s services. 12) Peers respect for my confidentiality. 13) Amount of privacy I have in the center. 14) Peers respect my rights as an individual. 15) The center, overall.

23 CRISIS RESPITE PERFORMANCE OUTCOMES Successful & Sustained Transition: Average length of stay for guests is 11.8 days 82% of our guests have successfully transitioned from the program back to permanent housing within 30 days 20% of our guests were diverted successfully from the ER/hospitalization (one was diverted five times!)

24 MRT PILOT PROGRAM OUTCOMES Objective #1: At least 75% of individuals served will improve life functioning and stability in terms of chronic medical conditions. We surpassed this target with a cumulative score of 87% achievement as evidenced by: 61% of individuals are active in one monthly wellness activity. 73% of individuals are using a monthly wellness budget. 97% of individuals did not have an unnecessary medical emergency room visit. 92% of individuals did not require a medical hospitalization. 97% of individuals have a primary care provider. 98% of individuals are attending 100% of scheduled appointments.

25 PROGRAM OUTCOMES Objective #2: 85% of individuals served will stabilize the behavioral health issues which contributed to their homelessness and will be engaged in treatment. We surpassed this target with a cumulative score of 95% achievement as evidenced by: 100% of individuals served have not had an unnecessary emergency room visit for psychiatric and/ or substance use related crisis. 99% of individuals served have not required hospitalization for psychiatric and/or substance use. 90% of individuals experiencing a non-life threatening psychiatric and/ or substance use situation are using the 24 hour peer run support line. 86% of individuals are engaged in mental health and/ or substance abuse treatment. 98% of individuals report improved medication compliance. 96% of individuals report an increase in relapse prevention skills utilization.

26 OPPORTUNITIES FOR EXPANDED PEER INITIATIVES Home and Community Based Services (HCBS Waiver)/HARP Peer Empowerment Services available DSRIP: Project 3aii---Crisis Stabilization Mobile Crisis Teams with embedded Peer Staff Peer Crisis Respite Center Creation/Expansion 24-hour Warm Lines

27 CONTACT INFORMATION Marta Durkin, VP of Behavioral Health Phone: (315) , ext Melissa Jillson, Director Phone: (315) , ext. 114

28 Thank You!