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1© 2017. All Rights Reserved.
www.openminds.com163 York Street, Gettysburg, Pennsylvania 17325Phone: 717-334-1329 - Email: [email protected]
The 2017 OPEN MINDS Strategy & Innovation Institute Tuesday, June 6, 2017 | 2:30pm – 3:45pm
Ken Carr, Senior Associate, OPEN MINDS
The Changing Role Of Peer Support Services - A Look To The Future
2© 2017. All Rights Reserved.
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
Agenda
3© 2017. All Rights Reserved.
KeyDiscussion
Issues
Peer support models
Training and certification
Integration and care coordination
Evidence and outcomes
Reimbursement models
New York Association of Psychiatric Rehabilitation ServicesHarvey Rosenthal, Executive Director, New York Association of Psychiatric Rehabilitation Services
The Changing Role Of Peer Support Services - A Look To The Future
Harvey Rosenthal, NYAPRS OPEN MINDS Strategy & Innovation InstituteJune 6, 2017
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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
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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•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 Values
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
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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 13
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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• 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
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NYAPRS Wellness Coaching Impact: One Person’s Outcomes
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Summary of Preliminary Utilization & Cost FindingsNYAPRS/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)
Health First Peer Bridger ProjectMember 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 ProjectMember 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 IslandMobile 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 UseForensic 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
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Independent Living Peer Services2016
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
Protecting the Integrity of Peer Support
• Peers frequently work for subcontracted peerrun agencies and are supervised by peers
• Peers who are embedded in traditionalsettings without peer supervision are at risk forco-optation.http://www.mhepinc.org/partners/the-coalition-to-protect-the-integrity-of-peer-services/peer-
run-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)
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8 Dimensions of Wellness
CompensationFrom 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 SpecialistsDaniels, A.S., Ashenden, P., Goodale, L., Stevens, T.
. The College for Behavioral Health LeadershipJanuary, 2016
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RI International
Sue Ann Atkerson, MA, LPC, Chief Operations Officer, RI International
Click to Add PPT Title
Sue Ann Atkerson, LPCChief Operations Officer
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History and Background
Early 1990’s: Pioneer in the peer and recovery space Hiring persons with lived experience
Development of Peer Training
Consulting with other companies, states, and countries
1996: Opened first crisis unit in Peoria, AZ.
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RI’s Crisis Services have expanded to14 locations nationally
Current Markets30
Four Business Units31
Crisis Services
RI Provides a Wide Range of Crisis Services
23 hour observation Evaluation and treatment
centers Subacute crisis stabilization Acute inpatient Crisis Residential Crisis respite 24/7 outpatient lobby Peer Warm Line Electronic Bed board
RI Launched Electronic Bed Board Software @NATCON 17
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Visit www.crisistech360.comto learn more.
RI’s Crisis Units Focus on Home-like Environments
RI’s Newest Crisis Unit in Riverside, CA
RI’s Flagship Peoria, AZ Facility’s “Living Room”
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Recovery Services
14 Wellness and Recovery centers
Individual and group Peer Support, Family support
Whole Health Action Management (WHAM)
Permanent Supportive Housing and Supported Employment
WRAP classes
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RI’s Wellness City Staff (Durham, NC)
Health Services
Compressive Assessment
Illness Management Recovery Programs
Substance abuse services
Co-occurring disorder treatment
Individual and group counseling
Care Transition Teams
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RI International's Outpatient Health Center Team (Phoenix, AZ)
Consulting
Certified Peer Support Specialist Training
Leading and Managing a Peer Workforce
Building Recovery-Oriented Systems of Care
Zero Suicide in Healthcare
Crisis Now www.crisisnow.com
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Zero-Suicide Academy, RI International
Model of Peer Support
Integration of Peers at all Levels
Over 60% of workforce is comprised of persons with lived experience
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From Token to Core
Which of the following best characterizes your agency’s approach to peers?
a. Level I: We do services TO peopleb. Level II: We do services FOR peoplec. Level III: We do services WITH peopled. In additional to clinical/medical staff, we have a few peer leaders and/or ancillary per support servicese. We have a peer-driven system of care, where peers represent 25% or more of the workforce
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Level I
Level 2
Level 3
Level 4
Level 5
TO FOR WITH CLINICAL& PEER
PEER DRIVEN
Marriage of Clinical/Medical and Recovery Practices
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Peer Employment Training
72-hour structured training
Trauma and integrated care
16 states
Recognized training for the VA
Advanced Peer Practices
Supervisor training
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Recovery Coaching Model
Preparing Engaging Planning Summarizing
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Benefits of Peer Supports
Able to establish trust through shared experiences
Offer hope, “I am the evidence”
Increased customer satisfaction
Increased engagement and retention
Better outcomes
Extend behavioral health workforce
Reduced costs
Increased access
System navigation
Increased efficiency and timeliness
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Consumer Benefits
Provider Benefits
System Benefits
What’s Next for Peer Supports?
National Trends: Integrated care
Value based purchasing
Research on social connectedness
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Implications for Peer Support: Medical, not just BH
Medicare and commercial payors
National standard with credential
Visit valuerecovery.org to learn more.
Thank you! Questions?
Email:[email protected]
Website: riinternational.com
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 GilmoreDirector of Planning and Recovery Practice, Community Access
Open Minds InstituteJune 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, open-door 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 person-centeredness 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 peer-driven, 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
fb.com/communityaccess
@ca_nyc
communityaccess.org/linkedin
communityaccess.org
61© 2017. All Rights Reserved.
Discussion Questions
What is the first step provider organization executives should take to link to or develop effective peer support services?
How can provider organizations best support peers to fulfill their unique roles?
What are the challenges and benefits that you see as reimbursement for peer support services becomes more prevalent?
How does certification of peers change their role?
How can peer support services be included in a more integrated care model that aligns mental health care with primary care?
Do provider organizations get reimbursed for peer support services now? And, if so, by what payers?
How do you evaluate the "ROI" of peer support? In terms of total cost, utilization, ER use, readmissions, outcomes, consumer satisfaction, etc.?
Is that ROI different in FFS vs. value-based reimbursement arrangements for peer support?
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