A Peer Supprt Mdel fr Outpatient Prblem Gambling Treatment Sctt Nelsn, LCSW & Stephen Mats, RSS
Peers
The Cnnectin, Inc. (TCI) Lcated in Middletwn, CT with ffices and services prvided thrugh the state Established mre than 40 years ag. Three service areas: Family Supprt Services, Behaviral Health Services and Cmmunity Justice Services Prvides services fr ver 6,000 individuals yearly acrss all service areas Maintains its wn Institute fr Innvative Practice and IRB
The Bettr Chice Prgram Netwrk f Prblem Gambling treatment prviders in the State f CT Funding prvided by State f CT Prblem Gambling Services The Cnnectin prvides services in suth central area f the state Currently 95 active clients receiving utpatient services within The Bettr Chice prgram at TCI
PG treatment structure in CT DMHAS Cmmissiner Statewide Services Prblem Gambling Services Preventin Services Clinical Services RACs & CCPG Statewide Awareness Case Finding/ Outreach B/C Prgrams Helpline (CCPG) The Cnnectin Wheeler MCCA UCFS
Objectives fr presentatin 1. Identify imprtance f persns-in-recvery as part f the helping prcess 2. Explain and discuss the Peer supprt/case management mdel at The Cnnectin 3. Identify the impact peers have had n thse in recvery frm gambling addictin in the Bettr Chice Prgram at TCI 4. Understand challenges unique t thse in recvery as recvery supprts 5. Discuss educatin and training f peer supprt prviders
Thse in Recvery wrking in Recvery Studies have prduced several statistics n percentages f substance use disrder treatment prviders being in recvery. A review f the literature fund that mst were in the range f 35%-50% with the highest number identified being 57%. (Knudsen, Ducharme & Rman, 2006)
Recvery status has been fund t play an imprtant rle in the level cmmitment t wrk amng SUD cunselrs. (Curtis and Eby, 2010) Recvery status helps in attachment t the rganizatin that emplys them. Agency missin = Persnal Experience
Thse in recvery wh are invlved in client care have an ability t expse their clients/patients t 12-step and ther selfhelp supprts in ways that thse nt in recvery are unable t d. 12-step affiliatin is shwn t be imprtant in substance addictin recvery and a predictr f life satisfactin (Laudet, et al., 2006) Many peple hld the belief that thse withut shared experience cannt help them/understand them.
What is a peer supprt? Smene with lived experience that is able t share that perspective with thers A peer is smene that is able t be with a client and guide nt lead Prvides a link between clinical services and utside supprts Fsters trust in a healthcare system that has ften disenfranchised many f thse whm it serves A peer supprt is a persn in recvery but a persn in recvery is nt necessarily a peer supprt.
Health vs. Illness Peers ften better equipped t fcus n lng-term recvery vs. Stabilizatin/Remissin Fcus is mre n heath and wellness vs. client illness
Wh defines? Peer Supprt/Recvery Supprt/Peer Cunselr NIDA SAMHSA Internatinal Assciatin f Peer Supprters (inaps) Publish natinal/internatinal practice guidelines fr peers. Lcal Recvery Supprt Prgrams and Training Services Agencies Peers
Need fr peer supprts in disrdered gambling treatment Issues with Self Help access GA/GamAnn Public supprt and knwledge is different Islating nature f gambling addictin disclsure Financial issues/pressure-relief
Bettr Chice Case Manager/Peer Jb Descriptin The Cnnectin, Inc. POSITION TITLE: CASE MANAGER/PEER SERVICE AREA: POSITION CATEGORY: CASE MANAGER/Peer (Full-time) PROGRAM: Bettr Chice is a Gambling-specific treatment prgram ffering utpatient clinical and peer supprt cunseling services fr bth gamblers and their family members. The prgram ffers a variety f utpatient services including: individual, grup, and family cunseling, psychiatric evaluatins, budget management, and an array f supprtive interventins. POSITION SUMMARY: The Case Manager/Peer prvides client engagement, supprtbased individual and family sessins, grup psych-educatinal grups and/r psychscial interventins, in rder t imprve clients' quality f life. The Case Manager III respnds effectively t the needs f clients, staff, cmmunity members and funding agents. EMPLOYEE NAME: SUPERVISOR: Respnsibilities f the Psitin All agency psitins are cmpsed f the fllwing three areas: 1. CONSTITUENCY BUILDING-CIVIC ENGAGEMENT 2. PLANNING AND DEVELOPMENT 3. OPERATIONS While the level f activity required in each f these three areas varies frm psitin t psitin, every emplyee is expected t prvide high-quality service in each area in rder t fulfill the respnsibilities f their psitin. I. CONSTITUENCY BUILDING Key respnsibilities: Under supervisin f Prgram Directr, respnds t the needs f lcal, state, reginal and federal fficials and the cmmunities the Agency serves. Ensures that the prgram acts as a gd neighbr within its cmmunity.
Why a case manager? Organizatinal buy-in Changing ecnmics fr nt-fr-prfit rganizatins State and natinal fcuses n cntrlling Medicaid csts. It is the case management functin that is mst imprtant when it cmes t cntrlling Medicaid csts (Stid and Shah, 2012) Higher utilizatin f mental health treatment is assciated with recreatinal gambling fr thse with depressin and/r alchl use issues (Desai and Ptenza, 2009)
Medicaid Rehab Optin
Bettr Chice Mdel Recgnizes bth the necessity and limitatin f the medical mdel f care Allws clinical services t be within the medical mdel (e.g. clinical diagnsis, treatment f symptms thrugh EBPs, dcumentatin f medical necessity, etc.) while recgnizing the limitatins f this mdel Peer cunselrs prmte and create a cmmunity atmsphere within the medical service were clients are able t transitin easily between clinical and nn-clinical care Recgnizes the imprtance f lng-term supprt and wellness in recvery while recgnizing the limitatins f medical mdel and self-help cmmunity t prvide these services t thse with gambling addictins Accepts that stigma, as it relates t gambling addictin, is real and views attachment t the Bettr Chice prgram as a psitive.
Areas f fcus Full Integratin int Prgram Prvide cmfrt and rientatin t a new envirnment/culture (client engagement and retentin Be the face f hpe / face f recvery Advcacy Prgram Develpment Direct care invlvement Different set f eyes
Invlvement in every area Staff Meetings Clinical Meetings/Runds With clients frm Beginning t End Hld wn case lads Agency cmmittees Teach/train staff frm ther prgrams Aid clients in giving back (step 12) Trauma Infrmed Care/Citizenship 5 R s Relatinships, Rles, Resurces, Respnsibilities and Rights (Michael Rwe, PhD)
Specific activities Grups Scial Sundays Family grups Individual cunseling Financial cunseling Phne Cntact (including afterhurs) Meet clients in the cmmunity Present/Teach/Train Integrate 12-step principles int the prgram Vice f thse in recvery regarding prgrammatic decisins/changes Prvide a cnnectin t Recvery Cmmunity Supprt with negtiatin f Criminal Justice System Supprt t family members f thse with PG issues
Fellwship Place, New Haven, CT
Fellwship Place inspired by the uplifting and therapeutic benefits f dance and creative expressin we are a full-service psych-scial center, pen 365 days a year, prviding a brad range f husing, supprt, rehabilitatin and emplyment services t help adults with chrnic mental illness lead mre meaningful, fulfilling, and healthy lives. Missin Statement T help adults wh have a mental illness lead mre meaningful, fulfilling and healthy lives by ffering resurces, educatin and pprtunity.
Breakut activity #1 Break int small Grups
Bettr Chice Prgram Bettr Chice client census currently is 95. Of these, 22 have a peer cunselr listed as Primary cunselr. Mre than 2/3 are engaged with peers.
Brief prgram utcme study 5/1/14-4/30/15 -- 33 clients are discharged frm prgram services. Of thse, 24 discharges are cnsidered successful discharges Peer cunselrs have regular invlvement (mnthly r mre ften) with 18 f these 24 clients. Average length f engagement in services fr these clients is 607.5 days. Average length f engagement in services fr thse withut regular peer invlvement is 402 days. (thugh 1 client skews this number significantly, average f ther 5 clients is 160 days.
Impact n unsuccessful treatment episdes 9 unsuccessful treatment engagements. 2 clients with regular engagement with peers Other 7 discharges have a average length service engagement f 86.5 days.
Impact n thse seeking help Peer supprt invlvement Mre client engagement in services, mre willingness t stay beynd the ending f the crisis Increased understanding f recvery and sustainability (Better Outcmes)
Disrdered gambling and peer supprts Why d thse with gambling addictin respnd well t peer supprts? Islating nature f the addictin Lack f prevalent self-help ptins Lack f inpatient/intensive ut-patient ptins Dealing with issues f hpe Gambling is nrmalized in ur culture Trust and dignity
Case examples I prbably wuld nt have made it withut [peer cunselr]. Client f Bettr Chice prgram, May 2015.
Similarities t clinical staff Bund by ethical guidelines and agency and prgram expectatins fr prfessinal behavir Supprt client change and meet clients where they are at Can utilize clinical techniques such as mindfulness Schedule appintments and meet with clients bth in individual and grup settings Respnsible fr maintaining relatinship bundaries Timely and cmplete dcumentatin Mtivated t help thers Can be idealized by thse whm they serve Clinical Training
Share mre f ne s self Differences Persnal experience is the primary qualificatin Sessins can be cnversatins and nt clinical interventins Pwer/rle differential is nt as great Take treatment prcess beynd ffice walls (allw client mre emtinal and physical access) Teach by ding vs. telling Services nt determined by medical necessity
But isn t this what spnsrs are fr? Answer: Yes and N Spnsrs d engage their Spnsees in many f the same areas. It culd be viewed that Peer Supprts/Cunselrs act as spnsrs in a clinical setting. HOWEVER, while there is sme activity that is the same, cmprmise and challenges ften exists fr peers that d nt exist fr spnsrs in the same way. Such as
What t share?
When t share?
Challenges I felt like I was in Kindergarten again. -- Stephen Mats, 2015.
Challenges Training cmes secnd /Availability f Certified peer supprts/cunselrs that have gambling addictin Insurance Cverage and need fr clinical diagnsis at initial treatment visit. C-ccurring MH/SA issues and hw t address withut lived experience Maintaining nn-clinical bundaries Harm Reductin Cntrlled gambling vs. abstinence frm gambling
Hw lng in recvery? Stability vs. length f Time Natinal Institute f Drug Abuse (NIDA) recmmends minimum f 5 years in recvery Is it apprpriate t ask abut recvery in jb interviews and part f supervisin prcess?
Ethics/Bundaries This is a large challenge as relates t Peer Supprt Services Bundaries nt as clearly defined as with clinical persnnel Agencies ften d nt accunt fr differences in rles when crafting internal ethical/bundary expectatins fr direct service care. Ethics (mrals/values) and Bundaries (prfessinal relatinship guidelines) are ften seen as equivalent. Bundary differences d nt necessarily indicate ethical differences. N peer equivalent f the NASW Cde f Ethics
Breakut activity #2 Return t same (r different) small grups
Educatin f Peers Statewide advcacy rganizatins prvide certificatins fr peer supprts Advcacy Unlimited Recvery University Recvery Supprt Specialist Certificatin is recgnized by State f CT Cnnecticut Cmmunity fr Addictin Recvery (CCAR) Recvery Cach Academy
Educatin Recvery University 80hr. training curse (2 days per week fr tw mnths) Nthing Abut Us Withut Us Training prgram Addressed: Rle Definitin Mental Health issues Hw t tell yur stry Trauma Cultural Cmpetency Many Pathways Advcacy
Educatin Recvery Cach Academy 35hr. Training (7 hurs per day fr ne week) Educatin Invlved: Learning hw t talk t clients Mtivatinal Interviewing Recvery Pathways Cmmunity Resurces **Nte that this educatin and training is in additin/as cmplement t inservice and cmmunity direct service/clinical training activities.
Increasing the pathways t recvery Peer Supprts as Natural Supprts?
Integratin f 12-step materials 12-step is ne f the primary pathways fr addictin recvery. Fundatins f Recvery Grup is a 12-step based grup that has fcused integrating 12-steps with therapeutic techniques such as mindfulness Prgress thrugh the steps ne-by-ne as part f a structured grup prcess GA literature is ffered and available t clients, and is utilized in grup prcess. Spirituality is discussed with clients Infrmatin and discussin n 12-step meetings Wrk n assciating client belief system with 12-steps principles Trust Gd Cleaning Huse Help Others
Treatment planning that includes peer supprt In ut-patient treatment, TX plans dictate medical necessity (they must be clinically fcused) Yu Can: Integrate nn-clinical services int a clinical treatment plan Invlve peers in treatment planning Ensure that peers are aware f gals that clients are wrking n and are able t prvide supprt tward these gals as well as input n gal prgress t the treatment team As part f treatment planning discuss with client the divisin f duties and respnsibilities
Breakut activity #3 In pairs r small grups Cme up with an example f a client-centered treatment plan that wuld include a rle fr peer supprt invlvement.
Self-care Where d Peers g fr supprt? C-wrkers (including ther peers) 12-step meetings Therapy Gym (health and wellness activities) Church Family/Friends Start slwly and use supervisin Imprtant fr thse wrking as Peers nt t frget what was helpful in getting them t where they are.
Questins? Sctt Nelsn, LCSW snelsn@thecnnectininc.rg; (860) 262-6610 Stephen Mats, RSS smats@thecnnectininc.rg; (860) 262-5985 Thank Yu fr Listening