Peer Support in Behavioral Health and Its Emerging Practice Standards

Steve Harrington Denise Camp, ALWF, CPSST

August 1, 2013Implementing Recovery-Oriented Practices

Joe Powell

Peer Support in Behavioral Health and Its Emerging Practice StandardsAugust 1, 2013

Steve Harrington Executive Director, InterNational Association of Peer Specialists (iNAPS)

Joe Powell Executive Director, Association of Persons Affected by Addiction

Denise Camp, ALWF, CPSST WRAP® Project Coordinator/Training Specialist, On Our Own of Maryland

Moderated by

Larry Davidson, Ph.D.Project Director, Recovery to PracticeDevelopment Services Group, Inc.

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Peer Support in Behavioral Health and Its Emerging Practice Standards

3–3:05 p.m. Welcome Steven Fry, SAMHSA/CMHS

3:05–3:10 p.m. Introductions and Overview Larry Davidson, Ph.D.

3:10–3:25 p.m. Peer Support and Practice Standards Steve Harrington

3:25–3:40 p.m. Peer Recovery Standards and Core Competencies Joe Powell

3:40–4:00 p.m. How Peer Support Changed My Life Denise Camp, ALWF, CPSST

4:00–4:30 p.m. Discussion Presenters and Participants

Peer Support in Behavioral Health and Its Emerging Practice Standards

Process for Questions, Answers, and Downloading SlidesType your question in the chat window during or after the presentation. We will answer your question in the order in which it is received.

The Webinar recording and PowerPoint presentation will be available at http://www.samhsa.gov/recoverytopractice/Webinars.aspx shortly after the session. A direct link to the Webinar materials will be emailed to all participants.

Peer Support in Behavioral Health and Its Emerging Practice Standards

Peer Support and Practice Standards

Steve Harrington Executive Director, InterNational Association of Peer Specialists (iNAPS)

Steve Harrington

Purpose of Presentation

Review role of peer support in the mental health field Provide an update on the curriculum for peer supporters and need for

practice standards Share the process of developing practice guidelines for behavioral health Discuss the implications of peer support standards within the ACA

Role of Peer Support in the Mental Health Field

Peer support has been shown to be cost-effective in engaging people in recovery, reducing inpatient hospital stays, and helping people live meaningful, satisfying lives in the community.

Update: RTP Curriculum for Peer Supporters and Need for Practice Standards

Image: Group of people engaged in discussion

RTP curriculum pilots Modifications based on lessons learned Webinar series Implementation phase Need for peer support practice standards flowed from RTP project

There are three components of practice standards:1) Practice guidelines2) Identification and description of core competencies3) Code of ethics

What Are Practice Standards?

Image: Notebook of guidelines superimposed on building

Why Are Practice Standards Needed?

Image: Series of question marks

Practice Guidelines Development

Important issues The process must be inclusive. Guidelines must be general enough to apply to many work settings. Guidelines must be sufficiently specific to have meaning. Guidelines must be applicable to a range of peer support.

Advisory Group Input

The Advisory Group consisted of representatives from about 15 national “stakeholder” organizations. (Dec. 2012)

Advisors represented mental health, addictions, and family members, with representatives from some cultural minority organizations.

Note: The Advisory Group was convened by SAMHSA—an important part of the process.

The Challenges

Define “peer support.” Develop a “solid” draft within 5 months. Be as inclusive as possible. Fill the need for practice guidelines. Do everything without public funding.

Image: Person fights to hold on to rope

Defining ‘Peer Support’

Draft definitions were distributed, and input from the field resulted in the following definition:

A peer supporter is someone who has experienced the healing process of recovery from psychiatric, traumatic, and/or substance abuse challenges and, as a result, can offer assistance and support to promote another peer’s own personal recovery journey. The peer support volunteers to share portions of his or her recovery experience in an appropriate and effective manner.

Value-Based Guidelines

Peer supporters have specific values. Our first task was to obtain consensus on what those values are.

We used surveys, focus groups, and email and newsletter solicitations to obtain input on values.

Image: Survey with check boxes

Ninety-Eight Percent of 1,000+ Peer Supporters Agreed with These Values:

Peer support is voluntary. Peer supporters are hopeful. Peer supports are open-minded. Peer supporters are empathetic. Peer supports are respectful. Peer supporters facilitate change.

Image: Three people support another as he walks across bridge

Peer Support Values (cont.)

Peer supporters are honest and direct. Peer support is mutual and reciprocal. Peer support is equally shared power. Peer support is strengths focused. Peer support is transparent. Peer support is person driven.

Practice Guidelines Draft and Review Process

With input from the Advisory Group, a set of practice guidelines was drafted and reviewed several times.

The draft was then sent to 1,000+ peer supporters for review and comments. (May 2013)

More than 200 peer supporters responded with comments. Comments were organized, analyzed, and incorporated into a new draft

and distributed. (June 2013) The new draft with field input was reviewed by the Advisory Group. Additional suggestions were incorporated. A new draft was reviewed and approved by the Advisory Group and

distributed. (July 2013)

Practice Guidelines Example

The full set of guidelines is on the iNAPS Web site at http://inaops.org/national-standards. Here is one example of a core value:

Peer supporters are respectful.Each person is valued and seen as having something important and unique to contribute to the world. Peer supporters treat people with kindness, warmth, and dignity. Peer supporters accept and are open to differences, encouraging people to share the gifts and strengths that come from human diversity. Peer supporters honor and make room for everyone’s ideas and opinions and believe every person is equally capable of contributing to the whole.

Practice Guidelines Example

Practice: Be curious and embrace diversity.

1. Peer supporters embrace diversity of culture and thought as a means of personal growth for those they support and themselves.

2. Peer supporters encourage others to explore how differences can contribute to their lives and the lives of those around them.

3. Peer supporters practice patience, kindness, warmth, and dignity with everyone they interact with in their work.

4. Peer supporters treat each person they encounter with dignity and see them as worthy of all basic human rights.

5. Peer supporters embrace the full range of cultural experiences, strengths, and approaches to recovery for those they support and themselves.

As you can see, a single value can lead to many practice guidelines. From the 12 values, there are 54 guidelines.

Image: Four people set off in different directions

Twelve Values, 54 Guidelines

So What?

We will hear from Joe and Denise about how the guidelines can be applied to practice and the identification and description of core competencies and a code of ethics.

How are these guidelines relevant?

Image: Notebook of guidelines superimposed on building

How Did We Deal with the Challenges?

Develop “solid” draft in 5 months Focused on action Used a “shotgun” approach to obtain input Collaborated with other stakeholder organizations Kept communication going in many directions

Image: Spaceship moves toward the stars

Used social and electronic media Used SurveyMonkey Built on collaborations Outreach Listen! Listen! Listen!

Image: Group holds hands in a circle

Being as Inclusive as Possible

Reminded Advisory Group of the need for balance Reminded everyone of the goal of the project Gave meaning to all input

Fulfilling the Need

Image: Balance scale

Private donor provided $17,000 to cover costs related to communication, organizing information, analyzing data, literature search, review, etc.

Image: Man pushes over dollar sign

Doing Without Public Funds

Responses

“Much needed.” “Great job under the ‘gun.’” “This project is a great example of inclusive leadership.” “Glad someone stepped up to do this!” “Thanks for really listening to what we had to say.”

Image: Check mark

Criticisms

“This project should be ongoing.” “Too much work fell on too few shoulders.” “If so many felt this project was so important, why was there inadequate

funding?” “These guidelines were too long in coming.” “We need a good set of ethical guidelines now!” “Do we really want to be considered ‘professionals?’”

Unexpected Benefits

New collaborations New communication strategies Sense of accomplishment Increased respect for the profession New conversations about profession and

organizational development Recognition of the value and practical

application of an inclusive process

Image: Arrow hits bulls eye on target

More Unexpected Benefits

Influx of memberships for the International Association of Peer Supporters

International initiative to create peer support practice standards involving the United States, Australia, United Kingdom, Canada, Japan, New Zealand, Spain, Portugal, etc.

Use of guidelines by accreditation organizations Support for integration of addictions and mental health fields

Next Steps

Guidelines to be used, in part, to identify and describe core competencies by Bringing Recovery Supports to Scale Technical Assistance Center (BRSS TACS)

Identify who will develop a code of ethics and how Publication and dissemination of practice guidelines

and other practice standard components

Image: Footsteps follow path

Contact Information

Steve Harrington Executive Director, InterNational Association of Peer Specialists (iNAPS)

steve@recoverresources.com

http://inaops.org

Peer Recovery Standards and Core Competencies

Joe Powell Executive Director, Association of Persons Affected by Addiction

Joe Powell

Association of Persons Affected by Addiction

The Association of Persons Affected by Addiction (APAA) is a leading peer-driven recovery community support program that encourages and supports personal recovery by offering peer-to-peer assistance finding services/resources that support recovery, reduce relapse, and promote high-level wellness in individuals, their families, and the community. This program was created by and for the recovery community.

Peer Recovery Community Organization

Connecting with and

Mobilizing the Community

Building Relationships and Linkages with Others

1. Recovery First2. Inclusion3. Authenticity4. Participatory

Process5. Strength Based

Building a Recovery

Community Organization

Supporting Recovery/Being

of Service

RCSP to RCO — Structure(5) Guiding Principles(12) Quality IndicatorsAccreditation Standards

Peer Practice Guidelines

ROSC

ROSC

National Practice Guidelines for Peer Supporters

Peer Providers of Support and Services

Peer Coaches and Navigators—In long-term recovery with lived experience; trained to assist others in initiating and sustaining recovery, enhancing the quality of life for individuals and their families. Peer recovery support services are inherently designed, developed, delivered, evaluated, and supervised by peers in long-term recovery. 

Practice—Peer recovery supporters operate in a capacity that is distinct and separate from clinical roles, regardless of the setting in which the work is performed, including standards and core competencies.

Performance—Evaluated for medical and behavioral health wellness outcomes.

Principles—Peer recovery supporters operate from a strength-based perspective and acknowledge the strengths, informed choices, and decisions of peers as a foundation for recovery.

Practice-based evidence standards are employed in any role or setting

Contribution to recovery communities—integrity

Complements recovery principles and core values

Is the thread in recovery-oriented systems of care

Target prevention activities for children with family histories of addiction

Standards that provide early intervention strategies aimed at preventing/shortening addiction careers

Image: Group of people at work sharing folders

How Will Practice Standards Benefit Peers Working in Addiction Recovery?

The qualities/standards that make an effective peer supporter are best defined by the individual receiving support, rather than by an organization or care provider. Matching peer supporters with peers often encompasses shared cultural standards and characteristics, gender, ethnicity, language, sexual orientation, co-occurring challenges, lived experience in recovery, time in the military or exposure to the criminal justice system, or other identity-shaping life experiences that increase common language and provide hope, mutual understanding, trust, confidence, and safety. Image: Pair of penguins

Shared Standards of Service

The peer support workforce faces exciting and challenging opportunities. The profession is emerging as one that has the potential to play a central and facilitative role as part of the interdisciplinary teams that will provide the majority of health care to an increasing number of Americans over the next decade. What do some of those roles look like in practice today, and what might they look like in the future?

Image: Group of people dancing

Peer Standards Go Where No Man Has Gone Before

Guiding Principles Recovery Advocacy Supports and Services Universal Core Competencies

and Standards Welcoming Peer Climate Performance Measures Recovery Coaching Peer Navigators Traveling Companion

Community Engagement Treatment Center Recovery Trainings Honor All Roads of Recovery Resource Connectors Psychiatric and Primary Care Recovery at the Movies: “The Anonymous People” Recovery Planning Formerly Incarcerated or

Incarcerated

Association of Persons Affected by Addiction

Community contribution to ROSC—Educate communities BRSS TACS—Expand standards and core competencies National, state, and local recovery advocacy Recovery coach trainings, peer specialists, peer navigator roles Bring peer provider value to recovery movement Eliminate discrimination associated with addiction recovery and

mental health challenges

Image: Community inside another community

What Do Some of Those Roles Look Like with Practice Standards Today?

Twelve Core Values and Standards of Recovery

Recovery is contagious (White, 2010). Recovery is spread via recovery carriers (White, 2012). Prevalence of recovery carriers can be strategically increased with standards

and core competencies. Mechanisms: Alumni, volunteer, recovery coach, advocacy, education,

community service opportunities

Image: People in different roles on a path

The identification of guidelines for developing appropriate and meaningful job descriptions

Providing a foundation upon which peer support core competencies can be identified Creating a basis for peer ethical guidelines Creating a foundation for a national credential Facilitating reciprocity policies (recognized in multiple states) Providing information that could be used to examine peer supporter

training curricula

Image: Blue map of the United States

What Are the Recovery Benefits?

Such standards will enable peer workers, non-peer staff, program administrators and developers, systems administrators, funders, researchers, and policymakers to better understand peer values and the appropriate roles and tasks that can and should be carried out by peer workers in a manner that benefits all parties.

Image: Three people push pieces of pie chart together

Who Benefits from Peer Guidelines?

Core competencies can be created, which will help improve understanding about peer support, reduce workplace tensions and frustrations, and help healthcare workplaces develop effective job descriptions for peer support roles.

Image: Man and woman work together at table

Core Competencies

Guiding Principles of Recovery Pathways

Paying debts (Restitution) Saying I’m sorry (Forgiveness) Saying thank you (Gratitude) Telling the truth (Honesty) Telling one’s story (Witness) Respecting privacy (Discretion) Keeping promises (Fidelity) Laughing (Humor) Celebrating (Joy) Avoiding complications and distractions

(Simplicity) Doing one’s duty (Responsibility) Giving and helping (Service) Accepting differences (Tolerance)

Multiple paths Highways Bridges Construction Bad weather Sunny days

Image: Path through the mountains on a sunny day

Role of Recovery Community

Multiple Paths(Choice – Person Driven)

Image: Car navigates road

Contact Information

Joe Powell Executive Director, Association of Persons Affected by Addiction

3116 Martin Luther King Blvd.

Dallas, TX 75215

214-634-2722

Joep2722@aol.com

www.apaarecovery.org

“The Largest Health Resource in the U.S. Is Peers in Recovery.”

How Peer Support Changed My Life

Denise Camp, ALWF, CPSST WRAP® Project Coordinator/Training SpecialistOn Our Own of Maryland

Denise Camp, ALWF, CPSST

Before Peer Support

In a culture of “disease management,” all I could do was manage symptoms and maintain the status quo.

There was little or no focus on recovery, growing, or moving on. I had no hope or examples that things could be any different.

Image: Broken heart walking

My Peer Supporters

Inspired HOPE in the possibilities Encouraged me Listened and did not offer advice Shared their stories/experience Connected me to resources, learning, and training opportunities Educated me about the effects of TRAUMA Facilitated movement toward my goals

Image: Leaf rests on fingertips

My Peer Supporters’ Skills Included …

Ability to communicate despite cultural differences

Ability to feel and show empathy Desire to help others Ability to be nonjudgmental Ability to be a team player Ability to be an advocate and empower

me to advocate for myself

Image: People work together to climb mountain

My Peer Supporters Used These Principles

Hope Respect Person-Driven Recovery Focusing on Strengths Taking Responsibility

Image: Building blocks spell “HOPE”

And She Helped Me See I Had Those Skills Too!

Image: Two people put puzzle pieces together

I Learned …

Recovery is a journey, not a destination. To support peers in recovery to make choices about which recovery

pathway(s) will work for them, rather than urging them to adopt my path, someone else’s program, or any specific program of recovery.

The peer-to-peer relationship is highly supportive, rather than directive. The peer-to-peer relationship is intentional. Peers do not diagnose, peers do not provide therapy, peers do not give

advice. A strengths-based focus leads to a “value added” attitude and improved

self-esteem.

Now I am “Paying it Forward” By …

Sharing my story Supporting others in their recovery Building intentional relationships Effecting system transformation Busting negative attitudes Continuing personal growth and my

own recovery

Image: Ivy wrapped around heart

Contact Information

Denise Camp, ALWF, CPSST WRAP® Project Coordinator/Training Specialist, On Our Own of Maryland

denisec@onourownmd.org

www.onourownmd.org

Type your question in the chat window during or after the presentation. We will answer your question in the order in which it is received.

Larry Davidson, Ph.D.Project Director, Recovery to PracticeDevelopment Services Group, Inc.ldavidson@dsgonline.com

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