project magic of peer voice 2013 10
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October 2013 presentation on Magic of Peer Supports (YouTube) - http://bit.ly/PeerDrivenSystems In 2012, Magellan was directed by the Arizona Department of Health Services to reinvest $27 million in enhanced services for individuals with serious mental illness but who lacked Medicaid (AHCCCS). In partnership with the state and community, hundreds of peer and family roles were hired to work alongside case managers, clinicians and medical staff to create something truly different. The decade of recovery in the 1990s must now yield recovery and peer supports being adopted by systems.TRANSCRIPT
The Magic of Peer Voice: From Token to Core System
DAVID COVINGTON, LPC, MBA—CRISIS ACCESS, LLC
crisisaccess.com
It All Starts With Peer Voice
Acknowledgements: Larry Fricks Gene Johnson & Lori Ashcraft Eduardo Vega
Polling Question #1Which of the following best characterizes your agency approach to peers?
Level 1 - We do services to peopleLevel 2 - We do services for peopleLevel 3 - We do services with peopleLevel 4 - We have peer-driven care & leadersLevel 5 - We have a peer driven system of care
What Have We Learned
A Mind That Found Itself
1908
Clifford Beers
Galvanized the mental hygiene reform movement and founded the organization that would later become Mental Health America, which led to systematic reforms and continuous advocacy presence
The First Support Groups
1935
Alcoholics Anonymous
The 12-Step program of substance recovery founded in the early ‘30s provided a demonstration of the power of self-help and support from a “peer” although the “peer” was called a “sponsor.” There is evidence Native Americans were doing something of the same as early as 1772.
First Clubhouse Model
1973
John Beard (Fountain House) in New York revolutionized the old “day treatment” programs to a new approach where those served were “members” and not “patients,” and given meaningful roles in the clubhouse and community.
“On Our Own” Published
1978
Judi Chamberlin
“There are real indignities and real problems when all
facets of life are controlled—when to get up, to eat, to
shower—and chemicals are put inside our bodies against
our will”
Judi Chamberlin
From Privileges to Rights
2000
Judi Chamberlin
National Council on Disabilities Report“Patient privileges, such as the ability to wear their own clothes, leave the confines of psychiatric facility, or receive visitors, should instead be regarded as basic rights”
Center for Psychiatric Rehab
1979
William Anthony & Boston University
“There is a revolution brewing in the field of severe mental illness… It is a revolution in vision – in what is believed to be possible… It will be up to consumers and family members to lead this [recovery].”In 1973, 13 leaders formed Psychiatric Rehabilitation Association (PRA)
WRAP
1997
Mary Ellen Copeland
First structured tool for self-help for individuals with mental health challenges. The key concepts of WRAP (hope, personal responsibility, education, self-advocacy, and support) laid the foundation for self-help recovery.
Polling Question #2The Americans with Disabilities Act gives civil rights protections and guarantees equal opportunity in public accommodations, employment, transportation, government services, and telecommunications. The ADA also applies to Mental Health.
A. TrueB. False
Olmstead Decision
1999
On June 22, 1999, the US Supreme Court held that unjustified segregation of persons with disabilities constitutes discrimination in violation of the Americans with Disabilities Act and stated that people with psychiatric disabilities are legally entitled to live in communities of their choosing
Lois Curtis
1997
Cemetery Projects
Peer Support as Science
1999
Surgeon General’s Report on Mental HealthIntroduced “self-help groups” and peer supports as an emerging evidence based practice and chronicled the history of the recovery movement
Medicaid-billable Service
1999-2001
Georgia’s Wendy Tiegreen & Larry Fricks
Georgia was the first state to have peer supports approved by CMS (Arizona followed the next year) and laid the ground work for a national sea change with more than 20 states following suit. Recovery Innovations began using the phrase “Peer Support Specialist” in 1999.
CMS Guidelines
2007
2008
Don BerwickWhat ‘Patient-Centered’ Should Mean: Confessions Of An Extremist
Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks
WELL & WHAM
2012
In 2001, Recovery Innovations married peer support with education by creating WELL (Wellness and Empowerment in Life and Living) as a new self-help approach to the former case management approach of compliance and monitoring of “activities of daily living.”
In 2012, the Center for Integrated Health Solutions (SAMHSA/HRSA) created WHAM (Whole Health Action Management)
2-day, in person peer support training
Set whole health and resiliency goals
10 Health and Resiliency Factors
2001
Suicide Attempt Survivors
2013
Policy decisions related to the suicide prevention field have historically been made by three groups: researchers, clinicians and family members of those who died by suicide.
There have been hundreds of support groups nationally for those bereaved by suicide but few examples of similar peer opportunities for those struggling with suicide.
In 2014, a National Action Alliance for Suicide Prevention Task Force will publish “Activating Hope” (provisional title) that will challenge these norms.Eduardo Vega &
John Draper
The Gift of Peer Support
Polling Question #3Which of the following best characterizes research surrounding peer services?
A. Peer supports found less effective than non-peer professional counterparts
B. Equally effectiveC. More effectiveD. There have not been credible studies
Focus of Research
ABIL’s Phil Pangrazio
“[In our movement] we don’t have a token seat at the table. We lead the table.”
Phil Pangrazio
“Revolutions begin when people who are defined as
problems achieve the power to redefine the problem”
John McKnight
Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks
The Gift of Peer Support
There is a sense of gratitude that is manifested in compassion and
commitment.
The Gift of Peer Support
There is insight into the experience of internalized stigma.
Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks
The Gift of Peer Support
Peer specialists take away the “you do not know what it’s like” excuse.
Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks
The Gift of Peer Support
They have had the experience of moving from hopelessness to hope.
Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks
The Gift of Peer Support
They are in a unique position to develop a relationship of trust with
their peers.
Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks
The Gift of Peer Support
The gift is circular and fosters recovery by affirming the ability of peers to play meaningfully roles in
other people's live and society.
Courtesy of Eduardo Vega (MHA of San Francisco)
Peer Driven Systems by Next Tuesday
Peer-Driven System
Recovery Empowerment Continuum Characteristics Perspective Level 1 Level 2 Level 3 Level 4 Level 5
Traditional Psychosocial Rehabilitation
Philosophy/ContinuumPeer-Driven
CarePeer-Driven
SystemMotto Done to Done for Done with Done by
Characteristics
Clinical team identifies goals and develops service plans.
Compliance with directives is focal point activities.
Strong dependence on
system & artificial (paid)
supports with no individual risk
taking or family engagement.
Genuine voice and
participation with some support for
individual risk taking &
engagement in natural
supports.
Self-directed care is a core value
with peers holding some
leadership and advocacy
positions within the system.
Many roles in the system are filled by peers,
including workforce,
governance, etc. Not a token
gesture.
Core Value
Clinically sound professional services & stability
Safety and security with a goal of stability
Personal recovery through
collaboration
Personal recovery through self-directed care
Culture change through peer leaders and
staffing
Person(s) Compliant DependentRespected
(Voice)Leader Empowered
Subservient Institutionalized Involved Advocate LeadersStaff Member
Prescriptive Caretaker Partner Consultant PeersDirective Protector Guide Support Advocate
Organization
Clinically driven Protective Collaborative Recovery driven Peer-driven Provider is expert Risk Averse Engaging Person is expert Peer-staffed
Risk Taking
Discouraged Blocked Supported Encouraged Expected
1950
Compliance/Directive
1980
Dependent/Care Taker
2010Voice & Participation
PresentAction & Leadership
FuturePeer-Driven
System
Polling Question #4Which of the following are reasons a CBHC peer staff member should be terminated?
A. Sleeping with a clientB. Not showing up to work the first dayC. Stealing from the organizationD. Being re-hospitalized for mental
healthE. Reporting hearing active
hallucinatory voices
Recovery Innovations’ Education Center
Lori Ashcraft
1. Organizational commitment2. Quality training prior to
employment3. Recovery training for all staff
Supervisor and leadership training
4. Job-specific peer support roles
5. “Tipping point” with critical mass of peer support workers
Courtesy of Recovery Innovations & Gene Johnson
Recovery Innovations’ Education Center
Gene Johnson
6. Develop career ladder to the peer support discipline
7. Parity for peer support workers; supervision and support, performance expectations, pay, promotion, ethics
8. Remember, it’s real work, not sheltered work or therapyCourtesy of Recovery Innovations & Gene Johnson
Peers Make a Difference. If she can do it, then so can I!
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