Harvey Rosenthal, NYAPRS Ellen M. Healion, Hands Across Long Island, Inc. Steve Miccio, PEOPLe, Inc.

Transcription

1 Harvey Rosenthal, NYAPRS Ellen M. Healion, Hands Across Long Island, Inc. Steve Miccio, PEOPLe, Inc. 1

2 Clinic Technical Assistance Center Webinar June 5, 2013 Harvey Rosenthal, NYAPRS

3 A peer is a person who has lived experience of recovery and wishes to provide support and/or services to others. Peer support is the process of giving and receiving encouragement and assistance to achieve long-term recovery. Peers offer emotional support, share knowledge, teach skills, provide practical assistance, and connect people with resources, opportunities, communities of support, and other people (Mead, 2003; Solomon, 2004).

4 Peer support services are described as nonclinical and recovery-focused (White, 2006). Non-clinical refers to the fact that peers do not offer professional services, assessments, dispense expert opinions, and that there is not a power differential in the relationship.

5 What Peer Support Is and Is Not Is/Does Is Not/Does Not Shares lived experience A role model See the person as a whole person in the context of the person s roles, family, community A professional Gives professional advise An authority See the person as a case or diagnosis. Motivate through hope and inspiration An advocate for the person in recovery both within the program and outside of the program Teach the person how to accomplish daily task Teach how to acquire needed resources, including money Help the person find basic necessities Help the person find professional services from: lawyers, doctors, psychologists, financial advisers Share local knowledge of resources Encourage, support, praise Help person set goals A role model for positive recovery behaviors Provide peer support services Motivate through fear of negative consequences Represent perspective of the program Do tasks for the person Give resources and money to the person Provide basic necessities, like a place to live Provide professional services Provide case management services Diagnose, assess, treat Mandate tasks and behaviors Tell person how to lead his/her life in recovery Do whatever the program insists that he/she do C. Gagne, 2012, BRSS TACS policy paper Equipping Behavioral Health Systems And Authorities To Promote Peer Specialst/Peer Recovery Coaching Services

6 Focus Purpose/Goal Role of person using services Role of person providing services Motivation for change Intervention approach Wellness-Oriented Peer Approach Multi-dimensional - physical, mentalemotional, intellectual, financial, occupational, social, environmental, and spiritual dimensions (Re)-establish valued roles and pursuit of health and wellness goals Empowered to assume personal responsibility for health and lifestyle Offers education, guidance and support so the individual can selfmonitor health behaviors and increase activity in the dimension where the individual perceives an imbalance Better health and personal control Emphasis on personal responsibility, personal strengths, and natural resources Medical Model Narrowly focused on illness, symptoms, deficiencies and incapacity Symptom Reduction and rapid stabilization Expected to adhere to the advice of professionals Acts as expert and prescribes (dictates) what they believe is in the best interest of the person Fear of continued or worsening illness Emphasis on medication or other treatments to eliminate the cause of the illness, reduce symptoms, and/or discomfort Swar brick, M. (2013). Introduction to Wellness Coaching. Fr eehod, NJ: Collaborative Support Programs of New Jersey, Institute for Wellness and Recovery Initiatives.

7 Outreach and Engagement are keys to the success of an effective health home service plan. Peer wellness coaches are uniquely skilled and effective in forming important, positive personal relationships with health home beneficiaries. They have the unique capacity to appreciate the challenges health home members face and the persistence, passion, empathy and respect to successfully engage hard to find, hard to engage individuals. They share their recovery in authentic ways that help inspire hope and trust. They start where the people they serve are, responding to their stated needs and goals rather than imposing external goals.

8 Feet on the Street : By definition, many health home beneficiaries struggle with managing their complex medical, mental health and addiction related conditions and tend to miss scheduled appointments, often due to health and housing economic instability, trauma, disorganization and poverty. Peer wellness coaches engage and meet beneficiaries in the communities in which they live, bringing personalized information, assistance and support to beneficiaries using a personal, patient and persistent approach that takes the time to listen to each individual s needs and to match them up with the appropriate information and response from the health home s provider network.

9 Person Centered Care: Peer wellness coaches can help ensure that health home service plans and services are truly person centered and self-directed. They can serve as a trusted liaison between the beneficiary and the network who helps translate the needs and concerns of each entity to the other. Peer wellness coaches are skilled at helping beneficiaries to develop: personal Wellness Recovery Action Plans ( that identify their needs and patterns to inform and direct both their health home service plan and their Advance Directive, a legal document that indicates what kinds of care and support beneficiaries want and need during times of crisis (National Resource Center on Psychiatric Advance Directives

10 There is increasing evidence that individuals who feel empowered and exhibit more self-advocacy have fewer symptoms and are more willing to engage in services. (Jonikas, Copeland, Cook et al, Improving Propensity for Patient Self-Advocacy nts/improvingpropensityforpatientself-advocacy.pdf

11 Increasing Health Literacy and Self-Management: Peer wellness coaches help share/teach/learn encourage wellness practices, using tools like: The 8 Dimensions of Wellness: Emotional, Physical, Financial, Occupational, Social, Spiritual, Intellectual and Environmental Whole Health Action Management (WHAM): a training program and peer support group model that encourage increased resiliency, wellness, and self-management of health and behavioral health conditions via 8-week WHAM groups where they support each other to work toward, achieve, and maintain whole health goals. With the help of their coach, a beneficiary can learn to track their own blood pressure, blood sugar and cholesterol and make lifestyle changes that support wellness.

12 Advocate, Inform and Help Transform the System: Peer wellness coaches can educate health home team members about a recovery frame work and the recovery process; they can share information about the beneficiaries needs and circumstances that are not recognized by the team and to advocate for their preferences in ways that boost team success with previously unresponsive beneficiaries. Peer coaches can focus service plans on the critical importance of addressing the social determinants of health by asking about basic elements such as income, housing, stress, early childhood experiences, social exclusion, occupation, education level, sanitation, social support, discrimination (eg, racism), and lack of access to resources.

13 Relapse Prevention and Crisis Management Support: Peer wellness coaches can support effective relapse prevention and crisis management approaches that provide alternatives to avoidable ER and inpatient readmission. They often serve as the supporter of first/last resort.

14 Introduce/Encourage Participation in EHR, Technology: Peer wellness coaches can encourage beneficiaries ownership in the health home service plan by ensuring they have access to their electronic health record, to use peer run crisis warm lines and respite centers and to use website and applications that promote self-care, e.g. OptumHealth Whole Health Tracker and apps like What s My Mood, 12 Step Companion, 24 Hours

15 Individualized Budgets: redirect service dollars based on wellness/service plans in order to purchase services and supports as beneficiaries pursue recovery and wellness. Beneficiaries are typically assisted by peer brokers in the financial management of the budget. Peer supported models that feature such selfdirected budgeting are demonstrating impressive results in Texas and Pennsylvania managed care initiatives.

16 2010 study: 90% of PEOPLe Inc s Rose House crisis respite guests did not return to hospital in the following two years NYAPRS Peer Bridger programs helped support a: 72% drop in NY state psychiatric hospital and a 50% drop in numbers of people hospitalized in local Medicaid psychiatric inpatient units and total hospital days when admitted 2010 Optum Health Peer Link reduced hospital days by 71% in Wisconsin, by 41% in Tennessee 2010: Mental Health Peer Connection s Life Coaches helped 53% of individuals with employment goals to successfully return to work 2011: Housing Options Made Easy helped 70% of residents to successfully stay out of hospital in the following year 16

17 Services in Support of Participant Direction: Information and Assistance in Support of Participant Direction and Financial Management Services Crisis: Crisis Respite Support Services: Community Transition, Family Support, Advocacy/ Support and Training and Counseling for Unpaid Caregivers Empowerment Services: Peer Supports Service Coordination Rehabilitation: Pre-vocational, Transitional Employment, Assisted Competitive, Employment, Supported Employment, Supported Education, Onsite Rehabilitation, Respite and Habilitation

18 Participation In Employment; Enrollment In Vocational Rehab Services And Education/Training; Housing Status; Community Tenure; Criminal Justice Involvement; Peer Service Use And Improving Functional Status

19 June 5, 2013 New York Association Psychiatric Rehabilitation Services CTAC Ellen M. Healion, MA Executive Director Hands Across Long Island, Inc

20 Recipient Speaks at Hospital Job Fair 75 People Sign Up For SELF-HELP GROUPS 13 Groups started in State Run Clinics across County Identify People s Needs to Survive in the Community 1989 Open Drop In Center on Saturdays Run by Peers $15, 000 grant passed through Clinic Point System people attend

21 1991 INCORPORATED Open Alternative Housing Project Peer Run Sunday Drop In 1994 FIRST COUNTY GRANTS Psychosocial & Advocacy Peers Driving State Vehicles 1994 FIRST STATE GRANT FOR HOUSING 1999 PURCHASED PROGRAM/OFFICE BLDG

22 EXPAND PROGRAMS JAIL DIVERSION SING SING PRISON PROGRAM COUNTY JAIL PROGRAMS 2007 OPENED FIRST PEER RUN MENTAL HEALTH CLINIC IN UNITED STATES 2009 RE ENTRY HOUSING PILOT PROJECT 2010 EXPAND HOUSING EXPAND SERVICES TO NASSAU CNTY OPENED 2 ND PEER RUN CLINIC! QUEENS

23 PEOPLE IN RECOVERY WORK EVERYWHERE THEIR LIVED EXPERIENCE IS ONLY SHARED AS THEY WANT IT TO BE THE DESIRE TO WORK WITHIN A SYSTEM THAT THEY MAY HAVE RECEIVED SERVICES FROM IS NOTHING SHORT OF HEROIC THEY DO NOT HAVE THE CHOICE IN WHO TO SHARE THEIR LIVED EXPERIENCE WITH IT S THE TITLE OF THEIR JOB!!!!

24 PEERS HAVE BEEN DEVELOPING THEIR ROLE IN THE MENTAL HEALTH FIELDS FOR YEARS. REMEMBER HOW DIFFICULT IT WAS FOR STAFF TO ALLOW A CONSUMER TO RUN A GROUP DRIVE A VAN WORK IN THE CLERICAL DEPARTMENT WORK IN THE KITCHEN WORK IN THE MAINTENANCE DEPARTMENT

25 PEERS CONTINUE TO PROVE AND DEMONSTRATE THEIR CAPABILITY, THEIR SKILLS, THEIR PROFESSIONALISM AND THEIR ABILITY TO SERVE THOSE INDIVIDUALS WHO SHARE THEIR JOURNEY OF RECOVERY. BUT HOW????????

26 AT THE TOP!

27 ANSWER HONESTLY

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29 What about letting peers read files? What about Team Meetings? What about Clinical Meetings? What kind of roles are we talking about here? What happens if the peer decompensates? Will we have the person s Psychiatrist information available?

30 Where do we get the money to pay for them?

31 IF WE BELIEVE PEOPLE CAN RECOVER; CAN WE BELIEVE PEOPLE IN RECOVERY CAN WORK WITH OTHER WORKERS IN THE MENTAL HEALTH SYSTEM SIDE BY SIDE?

32 BEYOND CREDENTIALS EXPERIENCE AS A PEER ABILITY TO EXPRESS PERSONAL EXPERIENCE IN SMALL AMOUNTS AS APPROPRIATE EMPATHY, NOT SYMPATHY LEAD BY EXAMPLE CHEER PEOPLE ON TO BE THE BEST THEY CAN BE. COLLABORATION

33 APPROPRIATE AND TRUSTWORTHY SUPERVISION OF CLINICAL STAFF GUIDANCE TO STAY TRUE TO THE AGENCY MISSION SUPPORT IN THEIR OWN GROWTH AND DEVELOPMENT BEHAVIOR THAT REFLECTS BEHAVIOR EXPECTED TOWARD PARTICIPANTS LEADING BY EXAMPLE

34 WILL NOT HAPPEN THE FIRST TIME OUT BE PREPARED TO CONTINUALLY RE- STRUCTURE THE TEAM. UNDERSTAND THAT EVEN THOUGH SOME WILL TALK THE TALK AT AN INTERVIEW THEY CAN T WALK THE WALK EVEN IF THEY ARE PEERS! UNDERSTAND THE HUMAN CONDITION SOME ARE UNABLE TO WORK AS A TEAM!

35 LISTEN A LOT ATTEND EVERY CLINICAL MEETING ENSURE MISSION IS BEING CARRIED OUT AND THAT PEOPLE DON T BECOME CO-OPTED. REMIND FOLKS THAT WE RE CREATING A NEW THAT IT WON T BE PERFECT EVER! BUT WE HAVE TO KEEP WORKING OUT THE KINKS! TEACH RESPECT, MUTUALITY, TRUST AND KINDNESS-AMIST CONTROVERSY.

36 Outcomes to Date: 78% REDUCTION IN HOSPITALIZATION/CRISIS 36% PARTICIPANTS WENT TO SCHOOL OR WORK 29% PARTICIPANTS REDUCED PUBLIC BENEFITS BECAUSE OF EMPLOYMENT

37 THE OUTCOMES ARE A RESULT OF AN AMAZING MELDED TEAM OF PROFESSIONALS FROM ALL WORLDS REHABILITATION CLINICAL LICENSED & UNLICENSED PROFESSIONALS CERTIFIED & UNCERTIFIED PROFESSIONS OF WHICH 84% + ARE PEOPLE WITH LIVED EXPERIENCE.

38 159 Brightside Avenue Central Islip, NY JAMAICA AVE JAMAICA, NY

39 Steve Miccio PEOPLe, Inc.

40 In 2005 an agreement was made to provide peer advocacy in the clinics in Ulster County, NY. The local govt. unit embraced moving from an illness to wellness care delivery system The purpose of placing a peer in the clinic was to assist and promote develop and promote a wellness and recovery in a traditional setting.

41 Provide wellness education to staff and service users Facilitate support groups Advocate at treatment team meetings Assist people in developing WRAP plans Provide session prep and crisis support

42 Provide Information and technical assistance on additional natural support in the community that support wellness Committee representation at all local meetings Representation at local trainings and conferences Link people to peer services in the community Work collaboratively with peer diversion services to avoid unnecessary hospitalizations or ED visits

43 Stigma and fear that the peer would spy on clinicians (this was real!) Fear that the peer would decompensate from the stress of working with people in need Worry around marginalizing the medical model

44 Consistent communication and collaboration with the clinicians on what may help the people served Maintained the mission of wellness offering teaching moments to people served and clinicians Co-facilitated group therapy with clinicians to illustrate how mutuality builds trust among people served

45 Peer advocates practiced wellness and share that all had WRAP plans Discussed how a wellness plan for clinical staff would be of benefit as stress was prevalent in the clinics Developed a team culture around wellness and recovery

46 Developed an open door policy at all levels Agreed on transparency in all decision making that affects the clinic Practiced core values by creating behaviors that support them

47 The medical model was not marginalized, however it was challenged at all team meetings to discuss it s efficacy and how the wellness and medical model could be of mutual benefit Trained and reviewed person centered and strength based approaches as a team

48 As a result of having a peer in the clinic, the following outcomes were attained: Outcomes are annual averages from the past 5 years: Annual WRAP plans created 400 Co-facilitated groups held 150 groups People diverted from crisis services 30 People referred to employment services 85 Advocacy* services provided - 220

49 Advocacy services ranged in the form of the following: Clinic advocacy Entitlement/Benefits advocacy Community advocacy Systems advocacy

50 The lived experience can enhance the quality of service delivery in any traditional environment Providing a good orientation through a peer connection at the clinic can better prepare a customer in terms of expectations Shifting the paradigm to a wellness approach can be more successful with strong peer advocacy and education

51 51

52 C. Gagne, 2012, BRSS TACS policy paper Equipping Behavioral Health Systems And Authorities To Promote Peer Specialst/Peer Recovery Coaching Services Swarbrick, M. (2013). Introduction to Wellness Coaching. Freehod, NJ: Collaborative Support Programs of New Jersey, Institute for Wellness and Recovery Initiatives. ensityforpatientself-advocacy.pdf Services-/SMA Evidence-Based-Practices-EBP-KIT/SMA CD-DVD 52

53 %20Theoretical%20Perspective%20Mead.pdf : International Association of Peer Specialists (inaps; formerly National Association of Peer Specialists): Healing Neen (video): Practices-EBP-KIT/SMA Intentional Peer Support: hat%20makes%20it%20unique%20mead.pdf 3 Pillars of Peer Support: _salzer.pdf 53

54 July 17, 2013 from 12-1pm: Suicide Prevention with Aruna Jha, PhD., September and October: Substance Use For more information, please check the CTAC website at

55 Harvey Rosenthal, NYAPRS, Ellen M. Healion, MA: Executive Director Hands Across Long Island, Inc. Steve Miccio: PEOPLe, Inc.126 Innis Avenue, Poughkeepsie, NY Contact Kara, the CTAC Clinical Lunch & Learn Webinar Series Coordinator at or Justine, the CTAC Business Practices Coordinator, with any additional questions at 55