Peer Support · • Center for Substance Abuse Treatment. (2009). What are peer recovery support services? HHS Publication No. (SMA) 09-4454. Rockville, MD: Substance Abuse and Mental

Peer Support: A Critical Component in

Supported Housing

Tom Hill

Lyn Legere

Disclaimer Slide

This webinar was developed [in part]

under contract number

HHSS283201200021I/HHS28342003T from

the Substance Abuse and Mental Health

Services Administration (SAMHSA), U.S.

Department of Health and Human

Services (HHS). The views, policies and

opinions expressed are those of the

authors and do not necessarily reflect

those of SAMHSA or HHS.3

Supported

Housing Treatment Related/$$

• SUD and MH

• Agency & Community Based

• PSH model

• Transitional Housing

Recovery Oriented

• SUD Sober Homes

• MH Recovery

Combat

Homelessness

A Tale of Two Systems

25% Homeless

Mental Health Challenges

38% Homeless Substance Use

High percentage of

co-occurring

disorders.

Systems create

artificial division

between SUD and

MH.

Permanent Supportive Housing

”Study after study has shown that supportive

housing not only resolves homelessness and

increases housing stability, but also improves

health and lowers public costs by reducing the use

of publicly-funded crisis services, including

shelters, hospitals, psychiatric centers, jails, and

prisons.”

• “Note: Intensive

services include help

finding housing, working

with the landlord,

physical and behavioral

health care, assistance

finding employment and

others.”

• Regardless of model,

housing that has the

“supportive” element

is effective &

efficient.

Tenant Support

Services

Service Planning &

Case Management

Counseling &

Psychosocial

Assessment

Crisis Intervention

Peer Mentoring

& Peer Support

Recreational &

Socialization

Support

01

02

03

04

05

06

Potential ServicesPermanent Supportive Housing Toolkit

PEERsame Similar

Match

equal

Comparablealike

homologou

s

equivalent

parallel

Relationshi

p

reciprocal

Commonality

shared

likeness

Partnership

Allianc

e

affinity

connection

kindred

akinsimilitude

Peer Support

Case Management

The Basics…

Peer Support/Case

Management

PS & CM May Share Tasks

Examples

Give a Ride

Connect to Resources

Engage Family

Purpose & Approach different

…and I’m not

there now !

Been there,

done that,

got this

t-shirt…

Complementary,

NOT

Duplicative

Peer Support

Salzer, 2002

Can I do what I

need to do to

make a change?

Self-Efficacy

Do I believe

the outcome

will be

positive?

Belief in Outcome

Do I have an

internal or external

need to make a

change?

Need

Do I WANT

to make a

change in my

life?

Desire

Do I have the info

I need to make a

good choice?

Information

Engagement

*Vocational Peer Support, c. 2011 Boston University Center for Psychiatric Rehabilitation

Tenants Say…

“Specifically, participants reported preferring to do

activities and feeling safer with other individuals who

also experience mental health challenges. They also

reported appreciating the higher level of transparency

available when working with peers compared to

traditional staff, as well as the general support and

investment provided.”

Read more at CISRO (Housing) Portland

http://www.scra27.org/publications/tcp/tcp-past-

issues/tcpwinter2017/self-help-interest-group/#7rd8ZEUJPKcYfgDi.99

Tenants Say…

The personal approach, nonjudgemental

approach, just made you feel like a human

being, you know? [beneficiary 1]

In comparison to someone who hasn’t been

there trying to understand, because the

experience that they have helps, and it makes

you feel that you’re not the only one. [beneficiary 2]

Does Peer Support Make A Difference?

Emerging research shows that peer support is

effective for supporting recovery from behavioral

health conditions.

Increased sense of

control and ability

to bring about

changes in their

lives

Increased self-

esteem and

confidence Increased sense

that treatment is

responsive and

inclusive of

needs

Raised

empowerment

scores

BRSS TACS, (2012) Equipping Behavioral Health Systems & Authorities to Promote Peer Specialist/Peer Recovery

Coaching Services, SAMHSA Bringing Recovery Supports to Scale.

Does Peer Support Make A Difference? cont.

Increased

empathy and

acceptance

(camaraderie)

Increased

sense of

hope and

inspiration

Increased

social

support and

social

functioning

Increased

engagement

in self-care

and

wellness



Does Peer Support Make A Difference? cont.

Reduced hospital

admission rates and

longer community

tenure

Decreased

psychotic

symptoms

Decreased

substance

use and

depression



Tenants Say…

“I just feel that with the support worker, because

they’ve had their own issues and mental health

issues, I feel they have a better understanding of

where you’re coming from. …. I really think the

sharing bit, and I think that helped to build up trust

as well. It made me feel like a person rather than

some sort of patient.”[beneficiary 1]

“When I saw that other

people recovered, it gave

me hope that I could too.”Corinna





When

PEER support

is implemented

&

supported

BRSS TACS, (2012) Equipping Behavioral Health Systems & Authorities to Promote Peer

Specialist/Peer Recovery Coaching Services, SAMHSA Bringing Recovery Supports to Scale.

Peer Bridging

• Peer Bridger Project

71% decrease in hospitalization

• PeerLink Tennessee/Optum study73% decrease in hospital days

• PeerLink Wisconsin Optum study44% decrease in hospital days

Hendry, P., Hill, T., Rosenthal, H. Peer Services Toolkit: A Guide to Advancing and Implementing Peer-run Behavioral Health Services.

ACMHA: The College for Behavioral Health Leadership and Optum, 2014

Examples

• PeerNET, PA: mobile peer teams supporting people to acquire and maintain housing;

• Central City Concern, Portland Oregon

• Peer AHEAD (Access to Housing through peer-delivered Engagement, Assistance, and Direction), PA: Homeless outreach and housing support

• Shelter Plus Care – Promise Resource Network, Charlotte, NC

• ReStart – Recovery Innovations, AZ Temporary housing, peer run

• Sober Recovery Homes

Using Peer Support/Recovery Coaches in

Housing Models: Getting Started

• What treatment agencies in your area are

currently using peer support workers?

• What recovery supports and services are

currently available in your community?

• Why reinvent the wheel when there are potential

collaboration opportunities?• Use of peer support workers in housing models

• Shared peer programs on- and off-site

• Training and evaluation tools

The peer specialist can help reduce the consumer’s

ambivalence because the peer specialist’s lived

experience brings a level of credibility. By modeling

behaviors and showing that doing “X” will bring a

particular benefit, they have legitimacy. The

consumers that do well as peer support specialists

are the stellar clients, the ones who have made

enormous transformations in their own lives.

Steacy, A. (2011). Tips for peer support specialist programs. Rockville, MD: Substance Abuse and

Mental Health Services Administration. Retrieved from http://homeless.samhsa.gov/resource/tips-for-

peer-support-specialist-programs-50689.aspx

“Wraparound services—and especially those

delivered by peer recovery specialists—are

key to helping the newly housed person

adjust, building a new community, and

understanding how to live housed.” Steve Samra

References – Peer Specialists

• Bellamy, C. D., Rowe, M., Benedict, P., & Davidson, L. (2012). Giving back and getting

something back: The role of mutual- aid groups for individuals in recovery from

incarceration, addiction, and mental illness. Journal of Groups in Addiction &

Recovery, 7, 223-236.

• Bologna, M. J., & Pulice, R. T. (2011). Evaluation of a peer-run hospital diversion

program: A descriptive study. American Journal of Psychiatric Rehabilitation, 14,

272-286.

• Chinman, M., Oberman, R. S., Hanusa, B. H., Cohen, A. N., Salyers, M. P., Twamley, E. W.,

& Young, A. S. (2015). A cluster randomized trial of adding peer specialists to intensive case

management teams in the Veterans Health Administration. Journal of Behavioral Health

Services Research, 42, 109-121.

• Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., &

Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental

illnesses: Assessing the evidence. Psychiatric Services, 65, 429-441.

• Coatsworth-Puspoky, R., Forchuk, C., & Ward-Griffin, C. (2006). Peer support relationships:

An unexplored interpersonal process in mental health. Journal of Psychiatric & Mental Health

Nursing, 13(5), 490–497.


• Cook, J. A., Copeland, M. E., Corey, L., Buffington, E., Jonikas, J. A., Curtis, L. C., &

Nichols, W. H. (2010). Developing the evidence base for peer-led services: Changes among

participants following Wellness Recovery Action Planning (WRAP) education in two statewide

initiatives. Psychiatric Rehabilitation Journal, 34, 113-120.

• Corrigan, P. W., & Sokol, K. A. (2013). The impact of self- stigma and mutual help programs

on the quality of life of people with serious mental illnesses. Community Mental Health Journal,

49, 1-6.

• Davidson, L., Bellamy, C., Guy, K., & Miller, R. (2012). Peer support among persons with

severe mental illnesses: A review of evidence and experience. World Psychiatry, 11, 123-128.

Druss, B. G., Zhao, L., von Esenwein, S. A., Bona, J. R., Fricks, L., Jenkins-Tucker, S,

Sterling, E., Diclemente, R., & Lorig, K. (2010). The Health and Recovery Peer (HARP)

Program: A peer-led intervention to improve medical self-management for persons with serious

mental illness. Schizophrenia Research, 118, 264-270.

• Felton, C., Stastny, P., Shern, D., Blanch, A., Donahue, S., Knight, E., & Brown, C. (1995).

Consumers as peer specialists on intensive case management teams: Impact on client

outcomes. Psychiatric Services, 46, 1037-1044


• Mead, S., & MacNeil, C. (2006). Peer support: What makes it unique? International Journal of

Psychosocial Rehabilitation, 10, 29-37.

• Min, S-Y., Whitecraft, J., Rothbard, A. B., & Salzer, M. S. (2007). Peer support for persons

with co-occurring disorders and community tenure: A survival analysis. Psychiatric

Rehabilitation Journal, 30, 207-213.

• Short, R., Woods-Nyc, K., Cross. S. L., Hurst, M., Gordish, L., & Raia, J. (2012). The impact

of forensic peer support specialists on risk reduction and discharge readiness in a psychiatric

facility a five-year perspective. International Journal of Psychosocial Rehabilitation, 16, 3-10.

Sledge, W. H., Lawless, M., Sells, D., Wieland, M., O’Connell, M. J., & Davidson, L. (2011).

Effectiveness of peer support in reducing readmissions of persons with multiple psychiatric

hospitalizations. Psychiatric Services, 62, 541-544.

• Trachtenberg T, Parsonage M, Shepherd G, Boardman J. (2013) Peer Support in mental

health: Is it good value for money? London: Centre for Mental Health

• Walker, G., & Bryant, W. (2013). Peer support in adult mental health services: A

metasynthesis of qualitative findings. Psychiatric Rehabilitation Journal, 36, 28

References – Recovery Coaching

• Bassuk, E. L., Hanson, J., Greene, R. N., Richard, M., & Laudet, A. (2016). Peer-

delivered recovery support services for addictions in the United States: A systematic review.

Journal of Substance Abuse Treatment, 63, 1–9. doi: 10.1016/j.jsat.2016.01.003

• Best, D., & Laudet, A. (2010). The potential of recovery capital. London: RSA Projects.

Retrieved from https://www.thersa.org/discover/publications-and-articles/reports/ the-potential-

of-recovery-capital

• Center for Substance Abuse Treatment. (2009). What are peer recovery support services?

HHS Publication No. (SMA) 09-4454. Rockville, MD: Substance Abuse and Mental Health

Services Administration, U.S. Department of Health and Human Services.

• Cloud, W., & Granfield, R. (2008). Conceptualizing recovery capital: Expansion of a theoretical

construct. Substance Use & Misuse, 43(12–13), 1971–1986. doi: 10.1080/10826080802289762

• Reif, S., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Delphin

Rittmon, M. E. (2014). . Peer recovery support for individuals with substance use disorders:

Assessing the evidence. Psychiatric Services, 65(7), 853–861. doi: 10.1176/

appi.ps.201400047

• White, W. (2009). Peer-based addiction recovery support: History, theory, practice, and

scientific evaluation. Chicago, IL: Great Lakes Addiction Technology Transfer Center and

Philadelphia Department of Behavioral H

References – Peer Bridging

• http://www.nyaprs.org/peer-

services/peer-bridger/

• Hendry, P., Hill, T., Rosenthal, H. Peer

Services Toolkit: A Guide to Advancing

and Implementing Peer-run Behavioral

Health Services. ACMHA: The College

for Behavioral Health Leadership and

Optum, 2014

Toolkit References

• Adler, D., Bergeson, S., (2012) The Next Step to Sustainability: Guide for Family

and Consumer Run Organizations Seeking to Expand Their Funding by Becoming a

Part of a Managed Care Network, Optum Health, Public Sector,

• BRSS TACS, (2012) Equipping Behavioral Health Systems & Authorities to Promote

Peer Specialist/Peer Recovery Coaching Services, SAMHSA Bringing Recovery

Supports to Scale.

• Dickerson, G., Integrating Peer-support Services with Healthcare Reform, Homeless

Resource Center. SAMHSA. (2014)

http://homeless.samhsa.gov/resource/integrating-peer-supportservices-with-

health-care-reform-56161.aspx

• Hendry, P., Hill, T., Rosenthal, H. Peer Services Toolkit: A Guide to Advancing

and Implementing Peer-run Behavioral Health Services. ACMHA: The College for

Behavioral Health Leadership and Optum, 2014

http://homeless.samhsa.gov/resource/integrating-peer-supportservices-with-health-care-reform-56161.aspx

Documents

Peer Support · • Center for Substance Abuse Treatment. (2009). What are peer recovery support services? HHS Publication No. (SMA) 09-4454. Rockville, MD: Substance Abuse and Mental