The Changing Role Of Peer Support Services - A Look To The Future The 2017 OPEN MINDS Strategy & Innovation Institute Tuesday, June 6, 2017 | 2:30pm – 3:45pm Ken Carr, Senior Associate, OPEN MINDS

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163 York Street, Gettysburg, Pennsylvania 17325 Phone: 717-334-1329 - Email: [email protected] © 2017. All Rights Reserved.

Agenda

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I.

Harvey Rosenthal, Executive Director, New York Association of Psychiatric Rehabilitation Services

II.

Sue Ann Atkerson, MA, LPC, Chief Operations Officer, RI International

III.

Briana Gilmore, Director of Planning & Recovery Practice, Community Access

IV.

Questions & Discussion

© 2017. All Rights Reserved.

Peer support models

Key Discussion Issues

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© 2017. All Rights Reserved.

Training and certification Integration and care coordination Evidence and outcomes Reimbursement models

New York Association of Psychiatric Rehabilitation Services Harvey Rosenthal, Executive Director, New York Association of Psychiatric Rehabilitation Services

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The Changing Role Of Peer Support Services - A Look To The Future Harvey Rosenthal, NYAPRS OPEN MINDS Strategy & Innovation Institute June 6, 2017

NYAPRS • A 35 year old statewide coalition that has brought

together New Yorkers with psychiatric disabilities and community recovery providers to advance policies and programs that advance recovery, rehabilitation, rights, community inclusion for all: • State and national advocacy • Training and technical assistance programs • Creating models of peer support www.nyaprs.org [email protected]

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The power of peer support is in the quality and power of our relationships

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The Basis of our Relationships • Fostering Hope • Trusted, Safe Relationships • Empathy, identification and example • Respect and reliability • Trauma informed: what happened vs.

what’s wrong

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Key Values • Person driven and directed; in the

passenger seat • Honesty and Shared Accountability • Dignity of Risk and Responsibility • Power, Choice, Rights, Freedom

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Key Practices • We start where people are….forging an

alliance that offers encouragement for people to define and move towards the goals and the life they seek • We try to see the world through the eyes of the people we support, rather than viewing them through an illness, diagnosis and deficit based lens.

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The Peer Bridger is not… • a case manager • ‘cheap staff who get people to take their

medicine and go to appointments’ • a member of the treatment team without permission of the person served • a substitute for formal crisis services • about assessing, prescribing, predicting or controlling or fixing

The Power of Peer Support Models • Respite centers • Recovery centers • Crisis warm lines • Peer run supported housing and

employment services • Peer bridger services

Peer Specialist Work in a Variety of Settings • Hospitals • Emergency Rooms • Clinics • Homeless Shelters • Prisons and Jails • Crisis Centers • Medicaid Health Homes • Peers partnering with primary care

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Training and Certifications • Intentional Peer Support (Mead) • Trained facilitators in Wellness Recovery Action

Program (Copeland) • Whole Health Action Management (Fricks) • Rutgers or CUNY credentialing program on Peer Wellness coaching; 8 Dimensions of Wellness (Swarbrick) • NYAPRS Peer Bridger Training (Stevens) • OASAS certified Addiction Recovery Coaches

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THE EVIDENCE

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NYAPRS State Hospital Peer Bridger Project Data • Approximately 136 of 190 individuals (72%) were not

re-hospitalized in the state psychiatric centers (NYAPRS 2012 Program Evaluation Data) “She talked to me. She talked straight at me. She’s the only one. She’s got a knack for going on the underlying thing and really getting at it. And I’ve never had anyone look me straight in the eye, and actually relate to somebody. And I love her for it.” “The Bridgers seem to know exactly what to say and when to push and when to hold back, because they know that. They know exactly where you are hurting…” (2003 Qualitative Assessment, MacNeil)

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NYAPRS Wellness Coaching Impact: One Person’s Outcomes • 40 year old man with long standing

addiction, mental health and medical issues • 2009-prior to enrollment: 7 detox stays (4 different facilities) $52,282 BH Medicaid • Peer coach services: transitional and follow up support, re-engagement in AA, wellness coaching, relapse prevention aid • 2010-1 detox, 1 rehab (referred by the CIDP team) $20,650 Abstinent for 1 year

Summary of Preliminary Utilization & Cost Findings NYAPRS/Optum Managed Care Peer Bridger Project •

6 months pre-post, members who enroll in the program show: • Significant Decreases in % who use inpatient services • NY: 47.9% decrease (from 92.6% to 48.2%) • Significant Decreases in # of inpatient days • NY: 62.5% decrease (from 11.2 days to 4.2) • Significant Increases in # of outpatient visits • NY: 28.0% increase (from 8.5 visits to 11.8) • Significant Decreases in total BH costs • NY:47.1% decrease (from $9,998.69 to $5,291.59) 18

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Health First Peer Bridger Project Member Outcomes • Stable housing and supports • Secured identification; cleared legal issues • Employment and/or access to Medicaid/VA/SS

benefits • Increased access to transportation • Is better connected to community resources (food pantry, library et al) • Is connected to and/or has reconnected and is more involved with friends, family and community • Can be accessed by cell phone, e-mail or snail mail

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Health First Peer Bridger Project Member Outcomes • More engaged with medical, mental health and/or

SUD practitioners and treatment • Getting prescriptions filled • Uses peer support • Has self-defined wellness, relapse prevention, crisis plans • Has filed a psychiatric advance directive • Has greater access to food and is engaged in a program of improved diet and nutrition • Demonstrates improved personal hygiene • Has enrolled in a smoking cessation program

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Hands Across Long Island • • •

• • •

Mobile Shower Unit Served 278 Individuals since November 2016 Led to 92% Returned; 73% Requested Assistance; 42% Followed Up with Appointment Results: Decreased Police Involvement, Hospitalization, Illness and Drug/Alcohol Use Forensic Peer Bridger Served 198 Individuals Since January 2016 Led to 89% Continued Engagement Post Release, 95% Requested Assistance, 90% Followed Up with Appointment Results: Decreased Police Involvement, Hospitalization, Illness and Drug/Alcohol Use • Wellness & Recovery Center

• Served 523 Individuals since February 2016 • Results: Decreased ER visits, Police Involvement, Homelessness,

Diabetes, Weight

Independent Living Peer Services 2016 Peer Hospital Diversion Crisis Intervention Service • 189 individuals served – referrals from Hospital

Emergency Departments (ORMC & Bon Secours), Mobile Crisis and CIT Newburgh Police Department • 567 services (engagements) provided (avg. 3 engagements/ individual over 30 days) • 177 out of 189 individuals served did not return to the hospital within 30 days during Peer Hospital Diversion Crisis Intervention services = 94% success rate *1999 - 2014 AHA Annual Survey, Copyright 2015 by Health Forum, LLC, an affiliate of the American Hospital Association

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Protecting the Integrity of Peer Support • Peers frequently work for subcontracted peer

run agencies and are supervised by peers • Peers who are embedded in traditional settings without peer supervision are at risk for co-optation. http://www.mhepinc.org/partners/the-coalitionto-protect-the-integrity-of-peer-services/peerrun-services-fact-sheet

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What Lies Ahead Peers will comprise over 25% of the behavioral health workforce (Manderscheid) Peer wellness coaches will work in complementary relationships with medical practices (integrated but separate)

8 Dimensions of Wellness

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Compensation From Entry Level Jobs to Careers • Consumer/Peer Run Organizations: $15.51 • Community Behavioral Health Organizations:

$15.33 • Psychiatric Inpatient Facilities: $25.14 • Health plan/ Managed Care Organizations: $18.66 • NYAPRS: $19.23 National Survey of Compensation Among Peer Support Specialists Daniels, A.S., Ashenden, P., Goodale, L., Stevens, T. . The College for Behavioral Health Leadership January, 2016

RI International Sue Ann Atkerson, MA, LPC, Chief Operations Officer, RI International

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Click to Add PPT Title

Sue Ann Atkerson, LPC Chief Operations Officer

History and Background 

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RI’s Crisis Services have expanded to14 locations nationally

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Early 1990’s: Pioneer in the peer and recovery space 

Hiring persons with lived experience

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Development of Peer Training

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Consulting with other companies, states, and countries

1996: Opened first crisis unit in Peoria, AZ.

Current Markets

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Four Business Units

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Crisis Services RI Provides a Wide Range of Crisis Services 

23 hour observation

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Evaluation and treatment centers

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Subacute crisis stabilization

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Acute inpatient

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Crisis Residential

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Crisis respite

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24/7 outpatient lobby

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Peer Warm Line

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Electronic Bed board

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RI Launched Electronic Bed Board Software @NATCON 17

Visit www.crisistech360.com to learn more.

RI’s Crisis Units Focus on Home-like Environments

RI’s Newest Crisis Unit in Riverside, CA

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RI’s Flagship Peoria, AZ Facility’s “Living Room”

Recovery Services

RI’s Wellness City Staff (Durham, NC)

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14 Wellness and Recovery centers

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Individual and group Peer Support, Family support

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Whole Health Action Management (WHAM)

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Permanent Supportive Housing and Supported Employment

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WRAP classes

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Health Services

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RI International's Outpatient Health Center Team (Phoenix, AZ) 

Compressive Assessment

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Illness Management Recovery Programs

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Substance abuse services

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Co-occurring disorder treatment

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Individual and group counseling

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Care Transition Teams

Consulting

Zero-Suicide Academy, RI International 

Certified Peer Support Specialist Training

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Leading and Managing a Peer Workforce

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Building Recovery-Oriented Systems of Care

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Zero Suicide in Healthcare

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Crisis Now www.crisisnow.com

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Model of Peer Support

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Integration of Peers at all Levels

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Over 60% of workforce is comprised of persons with lived experience

From Token to Core

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Which of the following best characterizes your agency’s approach to peers?

TO

FOR

WITH

CLINICAL & PEER

PEER DRIVEN

a. Level I: We do services TO people b. Level II: We do services FOR people

Level I

Level 2

Level 3

Level 4

Level 5

c. Level III: We do services WITH people d. In additional to clinical/medical staff, we have a few peer leaders and/or ancillary per support services e. We have a peer-driven system of care, where peers represent 25% or more of the workforce

Marriage of Clinical/Medical and Recovery Practices

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Peer Employment Training 

72-hour structured training

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Trauma and integrated care

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16 states

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Recognized training for the VA

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Advanced Peer Practices

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Supervisor training

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Recovery Coaching Model

Preparing

Engaging

Planning

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Summarizing

Benefits of Peer Supports

Consumer Benefits

Provider Benefits

System Benefits

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Able to establish trust through shared experiences

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Offer hope, “I am the evidence”

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Increased customer satisfaction

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Increased engagement and retention

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Better outcomes

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Extend behavioral health workforce

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Reduced costs

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Increased access

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System navigation

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Increased efficiency and timeliness

What’s Next for Peer Supports?

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Visit valuerecovery.org to learn more. 

National Trends:

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Implications for Peer Support:

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Integrated care

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Medical, not just BH

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Value based purchasing

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Research on social connectedness

Medicare and commercial payors

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National standard with credential

Thank you! Questions?

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Email:

[email protected] 

Website: riinternational.com

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Social Media: Like us on Facebook Follow us on Twitter: @riinternationa

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Community Access Briana Gilmore, Director of Planning & Recovery Practice, Community Access

Beyond Inclusion: Peer Specialist Culture in Healthcare Systems Briana Gilmore Director of Planning and Recovery Practice, Community Access Open Minds Institute June 6, 2017

Community Access Hiring of People with Lived Experience • Values rely on: Human Rights; Peer Expertise; Self-determination; Harm reduction; Healing and recovery • CA has included people with experience of systems involvement at all operational levels since founding in 1974; aiming for 51% representation, now across over 400 staff

Community Access Peer-run Models • Howie the Harp: 21-year old, 8-month peer specialist training and internship with focus on intersectional experiences, wellness management, career obtainment • Blueprint Supported Education: Objective adjustment of educational processes with focus on individualized MH supports • Crisis Respite: 7-day hospital diversion for adults, with individual rooms, WRAP planning, opendoor and harm reduction policy • Advocacy Department: Grassroots organizing and systems-level policy change

Peer Support, and, Jobs for Peers • No ‘peer specialist’ roles on CA staff.

• Peer-designated roles include Specialists in: Harm Reduction; Career Development; Supported Education; Crisis Management; Advocacy Coordination; Health Management; Rehabilitation; Strategic Planning

• Peer support includes specific modalities of communication, grounded in philosophy of personcenteredness rather than systems orientation • Jobs and career mobility for people with systems involvement as an aspect of their experience can be grounded in a peer-philosophy and peer-modalities, but the role can be specific to expertise and job description

“Inclusivity”: Dominant Narratives in Concept and Practice • Organizational “Inclusion” of peers typically refers to the retention of a dominant philosophy and approach that is not peerdriven, with additional programs or staff roles for peer specialists or peer “programs” • Meaningful inclusion requires a reevaluation of principles and practices, with adjustments in approach across all organizational levels

Person-Centeredness in Recruitment, Hiring, and Career Development

• Recruitment: – Minimal experience requirements, compared to preference for levels of lived and educational/ professional experience; – Accommodating/ blind to typical “red flags” in a resume such as gaps between employment, brief work tenure; – Experience in unrelated fields viewed as additive to qualifications.

Person-Centeredness in Recruitment, Hiring, and Career Development • Hiring: – Multiple roles in evaluation through hiring committee, with priority on trainability; – Clearance levels at state/ city minimums, with focus on eliminating barriers where possible, including in procurement of educational/ residence documentation.

Person-Centeredness in Recruitment, Hiring, and Career Development • Career Development:

– Accommodations of time and support for health and mental health without negative impact on job retention, mobility, or development; – Focus on strengths and skills rather than job title or role in decisions related to promotions and role mobility; – Participation in agency-wide decision-making not dependent on job tenure, performance, or experience (no rewards for “good behavior” that delineate value to organization).

Shared Decision Making • PPAG: Program Participant Advisory Group; with representation from each housing site and program, elected by peers, self-organizing collaborative structure • Advocacy: Grassroots organizing and participation, including in issues directly related to workforce • Feedback sessions: Annual budget and information sessions between direct staff and senior management • Senior management: Effort to include individuals with lived experience in senior team

Dignity of Risk • Program processes co-created between staff and participants to the greatest degree possible • ‘Right to fail’ extends to human resource protocols that create risk-sharing relationship with agency

Questions to Consider when Preparing for a Peer Workforce • Do our organizational procedures reflect peer values? • Are we prepared to integrate the voices of lived experience into structural practices? • Does our board and senior management fully buy-in to the operational changes that may be necessary to make this culture change? • Are there (insurmountable) programmatic demands that jeopardize or contradict the role of a peer?

Trends in Peer Certification • Over thirty state certification processes • Some states create state-mandated testing, while others designate training locations that provide verified coursework that result in certification • Most commonly, certification includes combination of training, testing, and work requirements

NYS Certification Process • Academy of Peer Services

– Initiated by State Office of Mental Health Consumer Affairs Division, created in partnership with Rutgers University and delivered through state association – Online module-based test portal, plus experience requirement – Criticism of NYS certification include, but are not limited to:

• Tests are only online, only delivered in English, reflect memorization of training components; • No certification (yet) for peer supervisors or recognition of the relationship between peer specialist and supervisor

National Certification Process • Mental Health America introduced national certification process in 2017 • Certification comprises 125-question mutliple choice test; costs $450 and $200 every two years to renew • 3,000 experience requirement and completion of approved training • Criticisms of national certification include, but are not limited to: – – – –

Not driven by a peer-run organization (“somebody had to do it”) Resources extraction Tokenized “enhanced” trained peers Peer-turned-clinician (learn clinical practice to avoid “getting in the way”)

fb.com/communityaccess

@ca_nyc

communityaccess.org/linkedin

communityaccess.org

Discussion Questions

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What is the first step provider organization executives should take to link to or develop effective peer support services?

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How can provider organizations best support peers to fulfill their unique roles?

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What are the challenges and benefits that you see as reimbursement for peer support services becomes more prevalent?

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How does certification of peers change their role?

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How can peer support services be included in a more integrated care model that aligns mental health care with primary care?

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Do provider organizations get reimbursed for peer support services now? And, if so, by what payers?

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How do you evaluate the "ROI" of peer support? In terms of total cost, utilization, ER use, readmissions, outcomes, consumer satisfaction, etc.?

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Is that ROI different in FFS vs. value-based reimbursement arrangements for peer support?

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