Peer Support in Behavioral Health and Its Emerging Practice Standards

1. Steve Harrington Peer Support in Behavioral Health and Its Emerging Practice Standards Joe Powell Denise Camp, ALWF, CPSST Implementing Recovery-Oriented Practices August 1, 2013

2. Peer Support in Behavioral Health and Its Emerging Practice Standards August 1, 2013 Steve Harrington Executive Director, InterNational Association of Peer Specialists (iNAPS) Joe Powell Executive Director, Association of Persons Affected by Addiction Denise Camp, ALWF, CPSST WRAP® Project Coordinator/Training Specialist, On Our Own of Maryland Moderated by Larry Davidson, Ph.D. Project Director, Recovery to Practice Development Services Group, Inc.

3. Peer Support in Behavioral Health and Its Emerging Practice Standards If you cannot hear the Webinar … To access the audio portion of this Webinar, please dial the conference service directly and enter the participant access code: Audio Call-In Number: +1 (415) 655-0063 Access Code: 961-839-614 Closed captioning is now available! www.streamtext.net/text.aspx?event=DSG

4. Peer Support in Behavioral Health and Its Emerging Practice Standards 3–3:05 p.m. Welcome Steven Fry, SAMHSA/CMHS 3:05–3:10 p.m. Introductions and Overview Larry Davidson, Ph.D. 3:10–3:25 p.m. Peer Support and Practice StandardsSteve Harrington 3:25–3:40 p.m. Peer Recovery Standards and Core Competencies Joe Powell 3:40–4:00 p.m. How Peer Support Changed My LifeDenise Camp, ALWF, CPSST 4:00–4:30 p.m. Discussion Presenters and Participants

5. Peer Support in Behavioral Health and Its Emerging Practice Standards Process for Questions, Answers, and Downloading Slides Type your question in the chat window during or after the presentation. We will answer your question in the order in which it is received. The Webinar recording and PowerPoint presentation will be available at http://www.samhsa.gov/recoverytopractice/Webinars.aspx shortly after the session. A direct link to the Webinar materials will be emailed to all participants.

6. Peer Support and Practice Standards Steve Harrington Steve Harrington Executive Director, InterNational Association of Peer Specialists (iNAPS)

7. Purpose of Presentation • Review role of peer support in the mental health field • Provide an update on the curriculum for peer supporters and need for practice standards • Share the process of developing practice guidelines for behavioral health • Discuss the implications of peer support standards within the ACA

8. Role of Peer Support in the Mental Health Field Peer support has been shown to be cost-effective in engaging people in recovery, reducing inpatient hospital stays, and helping people live meaningful, satisfying lives in the community.

9. Update: RTP Curriculum for Peer Supporters and Need for Practice Standards • RTP curriculum pilots • Modifications based on lessons learned • Webinar series • Implementation phase • Need for peer support practice standards flowed from RTP project Image: Group of people engaged in discussion

10. What Are Practice Standards? There are three components of practice standards: • Practice guidelines • Identification and description of core competencies • Code of ethics Image: Notebook of guidelines superimposed on building

11. Why Are Practice Standards Needed? Image: Series of question marks

12. Practice Guidelines Development Important issues • The process must be inclusive. • Guidelines must be general enough to apply to many work settings. • Guidelines must be sufficiently specific to have meaning. • Guidelines must be applicable to a range of peer support.

13. Advisory Group Input • The Advisory Group consisted of representatives from about 15 national “stakeholder” organizations. (Dec. 2012) • Advisors represented mental health, addictions, and family members, with representatives from some cultural minority organizations. Note: The Advisory Group was convened by SAMHSA—an important part of the process.

14. The Challenges • Define “peer support.” • Develop a “solid” draft within 5 months. • Be as inclusive as possible. • Fill the need for practice guidelines. • Do everything without public funding. Image: Person fights to hold on to rope

15. Defining ‘Peer Support’ Draft definitions were distributed, and input from the field resulted in the following definition: A peer supporter is someone who has experienced the healing process of recovery from psychiatric, traumatic, and/or substance abuse challenges and, as a result, can offer assistance and support to promote another peer’s own personal recovery journey. The peer support volunteers to share portions of his or her recovery experience in an appropriate and effective manner.

16. Value-Based Guidelines Peer supporters have specific values. Our first task was to obtain consensus on what those values are. We used surveys, focus groups, and email and newsletter solicitations to obtain input on values. Image: Survey with check boxes

17. Ninety-Eight Percent of 1,000+ Peer Supporters Agreed with These Values: • Peer support is voluntary. • Peer supporters are hopeful. • Peer supports are open-minded. • Peer supporters are empathetic. • Peer supports are respectful. • Peer supporters facilitate change. Image: Three people support another as he walks across bridge

18. Peer Support Values (cont.) • Peer supporters are honest and direct. • Peer support is mutual and reciprocal. • Peer support is equally shared power. • Peer support is strengths focused. • Peer support is transparent. • Peer support is person driven.

19. Practice Guidelines Draft and Review Process • With input from the Advisory Group, a set of practice guidelines was drafted and reviewed several times. • The draft was then sent to 1,000+ peer supporters for review and comments. (May 2013) • More than 200 peer supporters responded with comments. • Comments were organized, analyzed, and incorporated into a new draft and distributed. (June 2013) • The new draft with field input was reviewed by the Advisory Group. • Additional suggestions were incorporated. • A new draft was reviewed and approved by the Advisory Group and distributed. (July 2013)

20. Practice Guidelines Example The full set of guidelines is on the iNAPS Web site at http://inaops.org/national-standards. Here is one example of a core value: Peer supporters are respectful. Each person is valued and seen as having something important and unique to contribute to the world. Peer supporters treat people with kindness, warmth, and dignity. Peer supporters accept and are open to differences, encouraging people to share the gifts and strengths that come from human diversity. Peer supporters honor and make room for everyone’s ideas and opinions and believe every person is equally capable of contributing to the whole.

21. Practice Guidelines Example Practice: Be curious and embrace diversity. 1. Peer supporters embrace diversity of culture and thought as a means of personal growth for those they support and themselves. 2. Peer supporters encourage others to explore how differences can contribute to their lives and the lives of those around them. 3. Peer supporters practice patience, kindness, warmth, and dignity with everyone they interact with in their work. 4. Peer supporters treat each person they encounter with dignity and see them as worthy of all basic human rights. 5. Peer supporters embrace the full range of cultural experiences, strengths, and approaches to recovery for those they support and themselves.

22. Twelve Values, 54 Guidelines As you can see, a single value can lead to many practice guidelines. From the 12 values, there are 54 guidelines. Image: Four people set off in different directions

23. So What? • We will hear from Joe and Denise about how the guidelines can be applied to practice and the identification and description of core competencies and a code of ethics. • How are these guidelines relevant? Image: Notebook of guidelines superimposed on building

24. How Did We Deal with the Challenges? Develop “solid” draft in 5 months • Focused on action • Used a “shotgun” approach to obtain input • Collaborated with other stakeholder organizations • Kept communication going in many directions Image: Spaceship moves toward the stars

25. Being as Inclusive as Possible • Used social and electronic media • Used SurveyMonkey • Built on collaborations • Outreach • Listen! Listen! Listen! Image: Group holds hands in a circle

26. Fulfilling the Need • Reminded Advisory Group of the need for balance • Reminded everyone of the goal of the project • Gave meaning to all input Image: Balance scale

27. Doing Without Public Funds Private donor provided $17,000 to cover costs related to communication, organizing information, analyzing data, literature search, review, etc. Image: Man pushes over dollar sign

28. Responses • “Much needed.” • “Great job under the ‘gun.’” • “This project is a great example of inclusive leadership.” • “Glad someone stepped up to do this!” • “Thanks for really listening to what we had to say.” Image: Check mark

29. Criticisms • “This project should be ongoing.” • “Too much work fell on too few shoulders.” • “If so many felt this project was so important, why was there inadequate funding?” • “These guidelines were too long in coming.” • “We need a good set of ethical guidelines now!” • “Do we really want to be considered ‘professionals?’”

30. Unexpected Benefits • New collaborations • New communication strategies • Sense of accomplishment • Increased respect for the profession • New conversations about profession and organizational development • Recognition of the value and practical application of an inclusive process Image: Arrow hits bulls eye on target

31. More Unexpected Benefits • Influx of memberships for the International Association of Peer Supporters • International initiative to create peer support practice standards involving the United States, Australia, United Kingdom, Canada, Japan, New Zealand, Spain, Portugal, etc. • Use of guidelines by accreditation organizations • Support for integration of addictions and mental health fields

32. Next Steps • Guidelines to be used, in part, to identify and describe core competencies by Bringing Recovery Supports to Scale Technical Assistance Center (BRSS TACS) • Identify who will develop a code of ethics and how • Publication and dissemination of practice guidelines and other practice standard components Image: Footsteps follow path

33. Contact Information Steve Harrington Executive Director, InterNational Association of Peer Specialists (iNAPS) steve@recoverresources.com http://inaops.org

34. Peer Recovery Standards and Core Competencies Joe Powell Joe Powell Executive Director, Association of Persons Affected by Addiction

35. Association of Persons Affected by Addiction The Association of Persons Affected by Addiction (APAA) is a leading peer-driven recovery community support program that encourages and supports personal recovery by offering peer-to-peer assistance finding services/resources that support recovery, reduce relapse, and promote high-level wellness in individuals, their families, and the community. This program was created by and for the recovery community.

36. Peer Recovery Community Organization Connecting with and Mobilizing the Community Building Relationships and Linkages with Others • Recovery First • Inclusion • Authenticity • Participatory Process • Strength Based RCSP to RCO — Structure (5) Guiding Principles (12) Quality Indicators Accreditation Standards Peer Practice Guidelines ROSC National Practice Guidelines for Peer Supporters Building a Recovery Community Organization Supporting Recovery/Being of Service ROSC

37. Peer Providers of Support and Services • Peer Coaches and Navigators—In long-term recovery with lived experience; trained to assist others in initiating and sustaining recovery, enhancing the quality of life for individuals and their families. Peer recovery support services are inherently designed, developed, delivered, evaluated, and supervised by peers in long-term recovery.  • Practice—Peer recovery supporters operate in a capacity that is distinct and separate from clinical roles, regardless of the setting in which the work is performed, including standards and core competencies. • Performance—Evaluated for medical and behavioral health wellness outcomes. • Principles—Peer recovery supporters operate from a strength-based perspective and acknowledge the strengths, informed choices, and decisions of peers as a foundation for recovery.

38. How Will Practice Standards Benefit Peers Working in Addiction Recovery? • Practice-based evidence standards are employed in any role or setting • Contribution to recovery communities—integrity • Complements recovery principles and core values • Is the thread in recovery-oriented systems of care • Target prevention activities for children with family histories of addiction • Standards that provide early intervention strategies aimed at preventing/shortening addiction careers Image: Group of people at work sharing folders

39. Shared Standards of Service The qualities/standards that make an effective peer supporter are best defined by the individual receiving support, rather than by an organization or care provider. Matching peer supporters with peers often encompasses shared cultural standards and characteristics, gender, ethnicity, language, sexual orientation, co-occurring challenges, lived experience in recovery, time in the military or exposure to the criminal justice system, or other identity-shaping life experiences that increase common language and provide hope, mutual understanding, trust, confidence, and safety. Image: Pair of penguins

40. Peer Standards Go • Where No Man Has Gone Before The peer support workforce faces exciting and challenging opportunities. The profession is emerging as one that has the potential to play a central and facilitative role as part of the interdisciplinary teams that will provide the majority of health care to an increasing number of Americans over the next decade. What do some of those roles look like in practice today, and what might they look like in the future? Image: Group of people dancing

41. Association of Persons Affected by Addiction • Guiding Principles • Recovery Advocacy • Supports and Services • Universal Core Competencies and Standards • Welcoming Peer Climate • Performance Measures • Recovery Coaching • Peer Navigators • Traveling Companion • Community Engagement • Treatment Center • Recovery Trainings • Honor All Roads of Recovery • Resource Connectors • Psychiatric and Primary Care • Recovery at the Movies: • “The Anonymous People” • Recovery Planning • Formerly Incarcerated or Incarcerated

42. What Do Some of Those Roles Look • Like with Practice Standards Today? Community contribution to • ROSC—Educate communities • BRSS TACS—Expand standards and core competencies • National, state, and local recovery advocacy • Recovery coach trainings, peer specialists, peer navigator roles • Bring peer provider value to recovery movement • Eliminate discrimination associated with addiction recovery and mental health challenges Image: Community inside another community

43. Twelve Core Values and Standards of Recovery • Recovery is contagious (White, 2010). • Recovery is spread via recovery carriers (White, 2012). • Prevalence of recovery carriers can be strategically increased with standards and core competencies. • Mechanisms: Alumni, volunteer, recovery coach, advocacy, education, community service opportunities Image: People in different roles on a path

44. What Are the Recovery Benefits? • The identification of guidelines for developing appropriate and meaningful job descriptions • Providing a foundation upon which peer support core competencies can be identified • Creating a basis for peer ethical guidelines • Creating a foundation for a national credential • Facilitating reciprocity policies (recognized in multiple states) • Providing information that could be used to examine peer supporter training curricula Image: Blue map of the United States

45. Who Benefits from Peer Guidelines? Such standards will enable peer workers, non-peer staff, program administrators and developers, systems administrators, funders, researchers, and policymakers to better understand peer values and the appropriate roles and tasks that can and should be carried out by peer workers in a manner that benefits all parties. Image: Three people push pieces of pie chart together

46. Core Competencies Core competencies can be created, which will help improve understanding about peer support, reduce workplace tensions and frustrations, and help healthcare workplaces develop effective job descriptions for peer support roles. Image: Man and woman work together at table

47. Guiding Principles of Recovery Pathways • Paying debts (Restitution) • Saying I’m sorry (Forgiveness) • Saying thank you (Gratitude) • Telling the truth (Honesty) • Telling one’s story (Witness) • Respecting privacy (Discretion) • Keeping promises (Fidelity) • Laughing (Humor) • Celebrating (Joy) • Avoiding complications and distractions (Simplicity) • Doing one’s duty (Responsibility) • Giving and helping (Service) • Accepting differences (Tolerance) Image: Path through the mountains on a sunny day • Multiple paths • Highways • Bridges • Construction • Bad weather • Sunny days

48. Role of Recovery Community Multiple Paths (Choice – Person Driven) Image: Car navigates road

49. Contact Information Joe Powell Executive Director, Association of Persons Affected by Addiction 3116 Martin Luther King Blvd. Dallas, TX 75215 214-634-2722 Joep2722@aol.com www.apaarecovery.org “The Largest Health Resource in the U.S. Is Peers in Recovery.”

50. How Peer Support Changed My Life Denise Camp, ALWF, CPSST Denise Camp, ALWF, CPSST WRAP® Project Coordinator/Training Specialist On Our Own of Maryland