PEER SUPPORT

Tammera V. Nauts, LCSW, LACtnauts@mtpca.org

AMDD Definition MENTAL HEALTH SERVICES BUREAU DPHHS SDMI HCBS 730

Peer Support Services are provided by a Certified Peer Support Specialist to promote empowerment, self-determination, and positive coping skills through mentoring and other activities that assist a person with severe disabling mental illness to achieve their goals for personal wellness and recovery.

Individual who has lived experience with forms of adversity like poverty, homelessness, mental health challenges, substance use disorders, incarcerations, and/or forms of trauma.Peer Support Workers provide peer-to-peer services.

Examples: Veterans working with veterans, those in recovery from SUD working with those grappling with addiction.

WHAT IS A PEER?

You have probably already hired peers without even knowing it!

Peers brings life experience that cannot be taught or trained

People in recovery “know what it’s like” in a way that can’t be understood without lived experience.

Act as a liaison to other services clients would never consider without peer support.

For the peer, working in a peer support role can strengthen their own recovery process.

THE VALUE OF PEERS

Peer support workers engage in a wide range of activities. These include:

Advocating for people in recovery

Sharing resources and building skills

Building community and relationships

Leading recovery groups

Mentoring and setting goals

PEER SUPPORT ROLE

Peer support roles may also extend to the following:

Providing services and/or training

Supervising other peer workers

Developing resources

Administering programs or agencies

Educating the public and policymakers

PEER SUPPORT ROLE

RECOVERY-ORIENTED: Peer workers hold out hope to those they serve, partnering with them to envision and achieve a meaningful and purposeful life. Peer workers help those they serve identify and build on strengths and empower them to choose for themselves, recognizing that there are multiple pathways to recovery.

PEER CORE COMPETENCIES

PEER CORE COMPETENCIES Cont.

PERSON-CENTERED: Peer recovery support services are always directed by the person participating in services. Peer recovery support is personalized to align with the specific hopes, goals, and preferences of the individual served and to respond to specific needs the individuals has identified to the peer worker.

VOLUNTARY: Peer workers are partners or consultants to those they serve. They do not dictate the types of services provided or the elements of recovery plans that will guide their work with peers. Participation in peer recovery support services is always contingent on peer choice.

PEER CORE COMPETENCIES Cont.

RELATIONSHIP-FOCUSED: The relationship between the peer worker and the peer is the foundation on which peer recovery support services and support are provided. The relationship between the peer worker and peer is respectful, trusting, empathetic, collaborative, and mutual.

PEER CORE COMPETENCIES Cont.

TRAUMA-INFORMED: Peer recovery support utilizes a strengths-based framework that emphasizes physical, psychological, and emotional safety and creates opportunities for survivors to rebuild a sense of control and empowerment.

PEER CORE COMPETENCIES Cont.

• Effective use of lived experience to support an individual’s recovery journey• Listening skills and cultural competence• HIPAA, Confidentiality and mandatory reporting• Effective written and verbal communication skills• Mentoring individuals who are in recovery• Planning for crises prevention and recovery, including assistance with WRAP plans• Development and use of natural supports• Advocacy across/within systems

(education, health, public benefits, behavioral Health, etc.)• Documentation, evaluation, and achieving outcomes• Knowledge and practice of ethical boundaries, and• Strong networking skills

AMDD DEFINED SKILL SETS

RECOVERY DEFINED - SAMHSA

What Is Recovery?Through its engagement with key stakeholders, SAMHSA developed the following working definition of recovery:

Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.

This definition does not describe recovery as an end state, but rather as a process.

Complete symptom remission is neither a prerequisite of recovery nor a necessary outcome of the process.

Recovery can have many pathways that may include: professional clinical treatment;

• use of medications; • support from families and in schools; • faith-based approaches; • peer support; and • other approaches.

RECOVERY DEFINED - SAMHSA

FOUR MAJOR DIMENSIONS SUPPORTING A LIFE IN RECOVERY:

Health: Learning to overcome, manage, or more successfully live with symptoms and making healthy choices that support one’s physical and emotional wellbeing

Home: A stable and safe place to live

Purpose: Meaningful daily activities, such as a job, school, volunteer work, or creative endeavors; increased ability to lead a self-directed life; and meaningful engagement in society

Community: Relationships and social networks that provide support, friendship, love, and hope

Do you have an environment where it’s safe to talked about lived experience?

Have all staff members received training to be trauma-informed and person-centered with each other and people seeking services?

Are employees who don’t identify as peers ready and able to be respectful and welcoming with their co-workers who do?

IS YOUR ORGANIZATION READY?

Do you have written P/P related to recruiting, hiring, and supervising peers?

Hire multiple peers wherever possible – avoid creating ‘a cohort of one’

When peers need to build skills to fulfill responsibilities, is your organization prepared to spend the time/money to help build these skills?

IS YOUR ORGANIZATION READY?

Peer Language added to Medicaid Statutes:(q) services of behavioral health peer support specialists certified under Title 37, chapter 38, PROVIDED 4 TO ADULTS 18 YEARS OF AGE AND OLDER WITH A DIAGNOSIS OF A MENTAL DISORDER, AS DEFINED IN 53-21-102;• DPHHS has verbally said they will also reimburse for SUD peer support

specialists due to the co-occurring nature of mental health/SUD.• DPHHS will need to file a state plan amendment with CMS to start the

reimbursement so hopefully by January 1, 2020.• The bill actually says effective date is July 1, 2019. Given that DPHHS has to

amend the state plan amendment, it may be retroactive…• The funding included in HB 2 (State budget) is technically one-time-only for

this biennium. For the next session, peer support services will be included in the Medicaid case load in the state’s budget and should not need additional appropriation.

• Now we wait and see……..

Certification of Peer Supporters

• Behavioral Health Peer Support Specialist (BHPSS)• Effective October 1, 2017• Requirements:

• Complete standardized training• Regular Clinical Supervision by a licensed professional• Fingerprint and background check• Continuing Education

Certification of Peer Supporters

SB 62 Section 4: A person may apply for certification as a Behavioral Health Peer Support Specialist (BHPSS) if the person has attested to the fact that the person:- Has been diagnosed by a mental health professional as having a

behavioral health disorder- Has received treatment- Is in recovery

Montana’s Peer Network

• 501C3 non profit founded in 2011

• Statewide Recovery Organization

• Mission - to lead the expansion and development of recovery oriented behavioral health services in Montana

• More than 800+ members in Montana

Focus Areas

Training

• Peer Support 101

• Clinical Supervision

• Provider/Employer

• Continuing Education

Consultation • Certification• Recruiting and hiring of

peer staff• Policy and Procedure• Programming• Cultural shift

Contact Montana Peer Support Network

Jim Hajny

406-551-1058 eMail: jim@mtpeernetwork.org

www.mtpeernetwork.org

Harm Reduction

Tammera V. Nauts, LCSW, LACtnauts@mtpca.org

Harm Reduction Model – Harm Reduction Coalition

• Accepts that, for better and/or worse, drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.

• Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.

• Establishes quality of individual and community life and well-being–not necessarily cessation of all drug use–as the criteria for successful interventions and policies.

Harm Reduction Model – Cont.

• Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.

• Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.

• Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.

Harm Reduction Model – Cont.• Recognizes that the realities of poverty, class, racism, social

isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.

• Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.

PUNISHMENT IS NOT A PUBLIC HEALTH MANAGEMENT STRATEGY!

Harm Reduction—not a new concept in health care:

- Diabetes- Asthma

- Hypertension- Medication compliance

- Relapsing behaviors (SUD/MH)- Use while in SUD treatment

Harm Reduction – SUD Specific

• The best should never be allowed to be the enemy of the good!

• Approach is person-centered, meet people where they are.

• Reduce harms of SUDs to individuals and communities

• Improved health and functioning of the individual is primary goal or outcome

• Harm reduction interventions should be integrated into the continuum of SUD prevention and treatment, which occurs in many venues

TREATMENT GOALS

• Variable based on degree of ambivalence• Stage of change not the same for each identified problem• A harm reduction approach will apply to some problems and a

comprehensive therapeutic approach to others• Engagement long term develops trust and an opportunity to

facilitate change e.g., resolve ambivalence and facilitate determination

TREATMENT GOALS—a Continuum

MINIMIZATION OF HARM SUSTAINED

RECOVERY

MINIMIZATION OF HARM

• Accept less engagement

• Accept less compliance

• Accept less adherence

• Accept the use of other substances

• Define the minimum, realizing the challenge for team buy-in

SUSTAINED RECOVERY• More engagement and broadening of social supports

• Compliant/committed/motivated/self actualizing

• Abstinence

• Growth and stability across multiple domains and determinants of health

• Lapses/relapses are the results of mistakes, not failures, and create learning opportunities and potential enhanced recovery

What can you and your team tolerate ???

• Think about the care provided other chronic diseases, like diabetes and the continuum of harm minimization to comprehensive care management

• What happens in AA? “Keep coming back”--regardless of abstinence—harm reduction through continued engagement

• What constitutes abandonment especially when relapse can be LETHAL?

• UDS: are positive results deal breakers? Therapeutic opportunity or punitive action?

• Functional status, is always the benchmark for potential intervention, especially with co-occurring patients

Harm Prevention Strategy Examples for Overdose Prevention

• Overdose prevention

• Naloxone rescue kits

• Low-threshold treatment models

• Educate patients about handling syringes and needles

• Educate patients about safer injection techniques

• Some people may see this as enabling, or contradictory to the goal of addiction medicine or addiction treatment,” ….. “But this is a false dichotomy. It is not a choice between treatment or reducing the harm of drug use; these can and should be complementary.”

• “Ultimately, we want to keep people safe, and improve the quality of their life and health. Our goal is for people to get into treatment and get into recovery, but we need keep them alive and well until they get there.”

Presented to ASAM by Dr. Wakeman, Medical Director for Substance Use Disorders at Massachusetts General Hospital, Center for Community Health Improvement.

In the Realm of Hungry GhostsClose Encounters with Addiction

• Much as I want to accept them, at least in principle, some days I find myself full of disapproval and judgment, rejecting them and wanting them to be other than who they are. That contradiction originations with me, not with my patients. It’s my problem –except that, given the obvious power imbalance between us, it’s all too easy for me to make it their problem.”

~Gabor Mate, MD