second annual recovery summit september 20 and 22 2011 north york ontario
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Second Annual Recovery Summit September 20 and 22, 2011 North York, Ontario. Year 1and 2 Evaluation Outcomes. What is PREFER?. PREFER is an innovative education program designed to build personal and system capacity for employment and to promote a recovery-supporting workforce.

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second annual recovery summit september 20 and 22 2011 north york ontario
Second AnnualRecovery SummitSeptember 20 and 22, 2011North York, Ontario
  • Year 1and 2 Evaluation Outcomes

what is prefer
What is PREFER?

PREFER is an innovative education program designed to build personal and system capacity for employment and to promote a recovery-supporting workforce.

A commitment to mental health recovery underpins the program.

PREFER is funded by the Ontario Trillium Foundation

the objectives for prefer are
The objectives for PREFER are:
  • To establish a personal foundation of recovery for participants
  • To nurture a critical perspective regarding personal and systemic factors that support recovery
  • To develop skills and capacities to deliver wellness and recovery programs in the workforce
  • To create recovery-supporting workplaces
  • To facilitate a supportive network of peers

program components
Program Components

the key points for evaluation were
The key points for evaluation were:

How has the program affected your personal recovery?

How has the program affected your sense of comfort and confidence in work or education and employment status.

What programs have you completed in our program?

How much have you implemented certifications?

who are the prefer participants
Who are the PREFER Participants?

This report covers 2 groups of PREFER Participants:

Those entering in 2010 and those entering in 2011.

Of the group who entered in 2010, 60+% have graduated.

For the 2010 group 70+% are currently working in peer support while less than 15% of the 2011 group are working in peer support.

The 2010 group is actively using WRAP facilitation. 27% are facilitating WRAP groups and almost 150 peers have completed WRAP programs facilitated by this group !


41% report they are not working now

  • 71% of participants currently volunteer; there is a 10% increase for the 2010 group
  • There is evidence to support increased employment for both groups in terms of more part time work and more hours worked.
  • For the 2010 group, 27% have become involved in formal education on a PT (23%) or FT (4%) basis; For the 2011 group 18% have become involved in formal education on a PT basis.

why evaluate prefer
Why evaluate PREFER?
  • Funders require it….
  • Identifies areas for improvement…..
  • Supports a growing body of evidence regarding the impact of peer support and recovery education for participants…
  • Therefore, these kinds of initiatives ought to be funded – building the peer workforce.


To compare this program with other funded programs, we needed to say that we were working with the same people, experiencing the same barriers.

  • To do this, we needed to ask questions we weren’t happy with – and for that we did, and continue to apologize. It wasn’t an easy decision – we hope you will see why today.

conventional understanding about barriers to employment
“Conventional” understanding about Barriers to Employment
  • The literature identifies 4 kinds of barriers to employment for people with “mental illness”:
  • In the workplace: ex. Stigma; unwillingness/limited workplace accommodation; lack of supported employment or training
  • Characteristics of the person: lack of “readiness” or skill; personal organization/reliability; social skill; confidence

conventional barriers continued
Conventional Barriers (continued)

3. Impact of the illness/disorder

  • Intrusive clinical symptoms; Treatment/care demands
  • Episodic nature of the disorders - Disrupted education – lack of skills/qualifications; Disrupted employment; absenteeism,
  • Impaired judgment and problem-solving
  • Effects of medication – fatigue; impaired dexterity etc
  • Concurrent substance abuse

4. Social Factors

  • Discrimination; Low income/poverty; financial disincentives
  • Housing insecurity

the key barriers to work that participants report are
The key barriers to work that participants report are:
  • Confidence
  • Financial issues (fees for training/tuition, transportation, & time off)
  • Mental Health problems (next slide)
  • Time Pressures/Responsibilities (work, family, self)
  • Systemic issues (discrimination; lack of jobs)
  • “Gaps”


At least 85% of the participants who completed the benchmark survey experience intrusion due to MH/SA problems.

Intrusive experiences include:

  • Disrupted sleep/fatigue 47% ; Nightmares 22%
  • Reduced focus and concentration 41%; Confusion/problems with memory 26%
  • Extreme sadness/ depression 53%; Suicidal thoughts 20%
  • Extreme worry/anxiety 40%
  • Social discomfort and isolation 45%
  • Panic 19% ; Flashbacks 20%
  • Side effects of medication 31%
  • Problems with personal organization 43%
  • Hearing voices 7%

what are the core programs and their completion rates
What are the core programs and their completion rates?
  • Introduction to WRAP 85 participants
  • WRAP Facilitator Certification 69 participants
  • Pathways to Recovery Facilitator Training 55 participants
  • Like Minds: Peer Support Education 78 participants
  • Gaining Autonomy with Medication 61 participants
  • Crisis Intervention / Suicide Prevention 70 participants

year two employment profiles n 59
Year Two Employment Profiles (n=59):
  • 41% of participants are not working now
  • 19% who were not working when they started the program are now working part time and 2% are working full time
  • 17% who were working when they started are now working more hours; 9% are working less hours
  • 12% who were working when they started the program are now not working

  • There is evidence of a net increase in employment for people who are participants of the program.
  • 23% have become part time (21%) and full time (2%) students in a formal education program.
  • Interestingly, for the group in their second year with PREFER (2010 cohort) 70+% are currently employed in Peer Support roles; less than 15% of Year 1 participants (2011 cohort) are currently employed in Peer Support roles.

71 of participants are volunteering
71% of participants are volunteering
  • According to participants: Volunteering links to employment because it provides a structure to learn and practice skills and build strengths that increase my confidence and self-esteem. It adds experience to build a resume and a personal network that can/has led to work. It gives the sense of accomplishment and fulfilment, and belonging and contributing to society which support recovery.

more year one outcomes
More Year One Outcomes:
  • 40% report an increase in comfort & confidence in applying for work
  • 32% report an increase in comfort & confidence in attending a job interview
  • 50% report an increase in comfort & confidence in searching for and applying to a formal education program
  • 12% have developed a resume since starting PREFER – 78% have updated their resume


These results suggest that PREFER is having a positive effect on employment for its participants.

does supporting participant recovery make a difference
Does supporting participant recovery make a difference?
  • 74% of participants believe there is a link between their recovery and their comfort and confidence to find/work
  • 64% report PREFER made quite a bit of difference in there recovery and 28% report it had a positive impact – stronger effect for those in the program longer
  • 45% describe themselves as a lot more hopeful now
  • 93% of participants have developed Personal Wellness Plans

prefer affects personal recovery by
PREFER affects personal recovery by:
  • …Underlined my strengths, given me a sense of empowerment, provided me with a larger community, encouraged me to share and strengthen my resources…
  • I don\'t feel as alone in the world. I don\'t think my issues are as \'unique\' (in an unsolvable kind of way). I feel more connected to the human race. I feel more integrated within myself and society….
  • …Enhanced my network of support & learning/ development; Allowed me to practice my skills; Provided an arena to validate and articulate my emerging beliefs about sustainable wellness and recovery...
  • …Created a space for like-minded people to intentionally grow and develop…

more examples
More examples…
  • …I have learned that recovery is possible; I see it in my peers
  • …monthly support groups to learn from others in the same work field & with similar issues. Workshops helped to create deeply supportive relationships with peers. WRAP & Pathways have been particularly helpful for recognizing triggers & keeping a balanced lifestyle...
  • … Trainings taught me not only how to support others, but how I can support myself…I have gained self confidence & analytical thinking skills which have benefitted me in my return to University…
  • … It widened my view on recovery issues. It gave me sense of being a part of the movement. I met like-minded peers & seeing their success & determination helps me to look forward in to future...

tackling barriers to employment
Tackling Barriers to Employment…
  • 47% report that participating in PREFER has made a substantial difference in how their “symptoms” negatively impact their work; 21% report less impact but are gaining more awareness.
  • 36%* of participants who were using conventional services are now using less
  • 28%* who were using conventional crisis services are using less
  • 38% increase in new CSI users!

*Last year we wondered if these results were an anomaly – this year the results are stronger!


Effects on Conventional Service use Since PREFER….

  • I "use" services for my own recovery/benefit
  • I plan before I go what I want and don\'t want; I am more selective; I look for services that support my recovery
  • I ask more questions; I am more candid and questioning.
  • I am able to better switch between the language of the conventional system, recovery language, and my own language I use to describe my discovery.
  • I have learned to be more assertive; I approach services with a lot more confidence
  • I am a stronger advocate for myself.

has how has prefer affected your use of crisis service
Has/How Has PREFER affected your use of Crisis Service?
  • I act sooner
  • I have a depth of understanding about recovery
  • I have more friends; I use peer support now;
  • I understand the limits of crisis programs;
  • I have increased awareness of self/triggers
  • I am aware of and comfortable to use alternative supports/resources
  • Wider variety of coping techniques to stay well
  • I feel more stable overall
  • I have a plan.


With these results, PREFER is building the case for more peer support…

year 2 outcomes becoming a peer supporter
Year 2 Outcomes: Becoming a Peer Supporter
  • 39% of Participants report a significant increase in skill & comfort in providing peer support with a person in distress and 43% for supporting a person in an extreme state. 40% of participants report an increase in skill & comfort talking with a person who is expressing a wish to harm themselves, or is suicidal
  • These results are substantially higher than Year 1; The improved outcomes in Year 2 suggest a cumulative effect of the Program.

rolling out wrap
Rolling out WRAP
  • This year, 27% of (2010) participants are facilitating WRAP groups – a 21% increase from Year 1
  • 145+ survivors have completed WRAP that was facilitated by a PREFER participant (100% increase from Year 1)
  • 83% of participants are using the principles of WRAP in their individual or group work with peers (20% higher application in 2010 cohort – again, supporting cumulative change)

how has wrap affected your own recovery how you support the recovery of your peers
How has WRAP affected your own recovery & how you support the recovery of your peers?
  • I have Wellness routines & tools; focus on self care
  • Developing my own WRAP has given me much hope
  • More aware of myself, my triggers; more tolerance for distress; I have a crisis plan; more confidence to soothe myself ; it has given me grounding
  • I use these transferable skills in my work; I am less directive, more patient, more accepting of myself & others. I let people do more of their own stuff instead of doing for them.
  • Before WRAP…I don\'t recall anyone ever asking me what I was like when I am well. It was such an eye opener for me. I have learned to see my strengths and strengths in others…

what is the impact of prefer participation
What is the impact of PREFER Participation:
  • 53% say PREFER improved their skill & comfort in Peer Support in a substantial way; 30% more say it has had a positive impact
  • 79% describe themselves as feeling more capable as an advocate and leader.

more impact
More impact…
  • It has given me more confidence in my work… I am more committed to serving my community (my peers) and encouraging them with hope… PREFER has increased my level of hope for myself and others to live a full and satisfying life.
  • I am more willing to take risks
  • I now view my strengths, skills, talents and life experiences in a positive, proactive manner which has given me the confidence to seek work that aligns with my goals and plans rather than discounting myself
  • It has made me realize how much my peers want to be heard and validated


My goals now go far beyond survival to an approach of looking for work that will see me thrive/grow.

  • PREFER has been very helpful in modeling mutual respect; the beauty of group consensus for comfort agreements and how they ground the group; learning to actively listen and most importantly how to do small meaningful things every day that support my own wellness. So many wonderful checks and balances along the way for facilitators who make this work very authentic and filled with learning.
  • …the support network that is inherent in the PREFER program that has had a significant impact on my recovery and I love knowing that I have a group of people who I could relate to and ask for guidance in pursuing a career as a peer support worker.

so far
So far…..

Three trends are not only emerging (as we thought last year) but are being verified over time:

  • PREFER is improving employment and making a difference in employment potential for participants
  • Personal recovery is linked to employment
  • Peer Support, including the peer support of the program is effective. Increasing Peer Support is reducing use of conventional crisis and mental health services, and improving their effectiveness

Therefore – more peer support is required and PREFER appears to be a good program to support their education !