University of Cincinnati School of Social Work Mental Health Policy October 23, 2012

1. University of CincinnatiSchool of Social Work Mental Health PolicyOctober 23, 2012 Recovery & Peer Supported Services Reneé Kopache ~ Mental Health & Recovery Services Board

2. Agenda • Overview of recovery • Overview of peer support • Matching services & peer support to stages of recovery • Integrating peer support with traditional services • Peer services in Hamilton County • Statewide Activities of importance

3. Overview of Recovery

4. Recovery: What It Is • “A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles …recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness." Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990’s. Psychosocial Rehabilitation Journal, 16(4), 11-23. • In 1999, the Ohio Department of Mental Health defined recovery as…“the process of overcoming the negative impact of a psychiatric disability despite its continued presence.” • In 2012, SAMHSA defines Recovery for both mental health and alcohol and substance abuse as “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” SAMHSA (2012). Working Definition of Recovery.

5. Recovery: What It Looks Like Person prior to mental illness Pets Family Community Friends Hobbies Illness / Disability Person EDUCATION Values & Beliefs Work Education Hopes & Dreams Sexuality Spirituality Health

6. Person with mental illness Pets Family Community Hobbies Friends Work Mentally Ill Values & Beliefs EDUCATION Education Hopes & Dreams Health Sexuality Spirituality

7. Recovery Process Family Mental Illness Community Hobbies Friends Work Person Values & Beliefs EDUCATION Education Hopes & Dreams Spirituality Health Sexuality

8. Recovery: The Process Four Major Dimensions that Support a Life in Recovery: Home:a stable and safe place to live; Health: overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing. Purpose:meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and Community: relationships and social networks that provide support, friendship, love, and hope. SAMHSA (2012). Working Definition of Recovery.

9. Recovery: The Process Factors important to recovery: • Self-directed • Individualized and person-centered • Holistic • Strengths based • Growth oriented • Clinical care • Hope • Support • Work/meaningful activity • Empowerment • Community involvement • Access to resources • Education/knowledge • Self-esteem • Self-help • Spirituality • Physical health • Self-responsibility

10. Recovery: The Process • Guiding Principles of Recovery: • Recovery emerges from hope • Recovery is person-driven • Recovery occurs via many pathways • Recovery is holistic • Recovery is supported by peers and allies • Recovery is supported through relationship and social networks • Recovery is culturally-based and influenced • Recovery is supported by addressing trauma • Recovery involves individual, family, and community strengths and responsibility • Recovery is based on respect • SAMHSA (2012). Working Definition of Recovery.

11. Recovery: The Result

12. Overview of Peer Support

13. What is Peer Support • Grew out of early advocacy efforts (history) • “Relationships built and nurtured through shared experiences. People who have liked experiences can better relate and can consequently offer more empathy and validation.” (Sherry Mead)

14. Purpose of Peer Support • Advocacy • To utilize shared experiences as a means to connect with and foster the recovery of other individuals with a mental illness • To engage consumers who otherwise may not be willing to receive services • To provide a more relaxed relationship • To compliment clinical services

15. Evidence: Effectiveness of Support • Peer support and peer provided services are considered “promising practices” • Peers do as well as non-peers on most outcomes (no significant differences) • ACT teams with peer specialists have experienced better outcomes • Working as a consumer provider fosters empowerment, self-esteem, and a shift in meaning and purpose

16. Matching Support to Stages of Recovery

17. Stages of Recovery ODMH (1999) Emerging Best Practices in Mental Health Recovery. Stages in parenthesis are from the Village Integrated Services, Inc.; Long Beach. CA

18. Peer Support: Peer support is informal Interactions typically occur in treatment settings The result of being at the same place at the same time) Focus is often on mental illness rather than recovery Clinical and family support is often as important as peer support at this stage Hope

19. Provider Services: Case management Medical somatic EBPs Day/Psychosocial programs Skills development (basic) IMR Peer support 12-step programs Focus on stability and helping consumers gain independence (do “with” instead of “for”). Peer Support: Becomes more formal Often occurs at agencies/hospitals day programs, groups, peer-to-peer classes Focus begins to shift from mental illness to advocacy and recovery While clinical support is still critical in this stage, peer support takes on increasing importance Empowerment

20. Provider Services: Reduced medical somatic Transition out of case management Therapy Vocational services Supported housing/education Transition out of day/psychosocial programs Focus on self-esteem and continued empowerment Peer Support: Peer Support takes on an equal, if not more important role as clinical support. Peer support is more likely to occur outside the formal treatment environment. Peer support occurring in the community and is based on shared interest rather than illness. People in recovery begin to “give back”….they become volunteer or paid staff. Self Responsibility

21. Provider Services: Medical somatic only services Safety net for other services should the need surface Focus on utilization of natural supports and, for some, transition from mental health services. Peer Support: Peer support occurs in the natural environment. At this point, some individuals “graduate” from the system and gain support though non-consumer relationships. If remaining a part of the consumer culture, individuals at this stage are the givers of support…they receive their support elsewhere. Providing support becomes a meaningful role! Meaningful Role

23. Support That Hinders Recovery • Support that doesn’t match the needs and desires of the individual • e.g. providing peer-to-peer classes to a person who has acute clinical needs is far less effective than having a peer available for that individual to talk to. • Support that doesn’t encourage and facilitate growth…that doesn’t help an individual establish and reach his/her goals • e.g. doing things for a person that they are capable of doing for themselves, or learning to do for themselves.

24. Support That Hinders Recovery • Support that doesn’t end • Avoid the Hotel California syndrome… • when peer support is no longer necessary and/or beneficial, the person should be encouraged to transition to something else (i.e. natural supports in the community). • Support that is controlling • If the relationship is hierarchical, there’s a problem • Support that is stigmatizing • We can’t criticize mental health professionals and the community for stigmatizing those with a mental illness if we also do it!

25. Integrating Peer Support “Recovery is the mending process that reweaves Human Beings back into the fabric of our society” And… Peer Support is a critical ingredient of recovery.

26. Environments with Peer Support • Consumer-operated agencies • Peer-run centers/programs • Psychosocial and other programs/services at agencies • ACT teams • Hospitals, crisis centers, and emergency rooms • Jails

27. Role of Peer Staff • Foster hope and self-determination • Mentor/role model • Engage • Teach • Support • Advocate/Combat stigma • Serve on boards/committees • Research

28. Peer Support Competencies • Encouraging independence • Beliefs supporting recovery • Interpersonal skills • Peer-based program support • Understanding how peers cope • Advocacy • Legal rights and antidiscrimination • Training for work and family life * Campbell, Dumont, and Einspahr, 1999

29. Challenges • Dual roles (role confusion) • Loss of own support system • Illness/symptoms • Inadequate training • Boundaries • Rural (one agency) communities • Job titles

30. Challenges • Perceptions of other employees that peer staff receive favorable treatment • ADA (accommodations), extended illness/symptoms • Employing consumers are providers without having a culture that supports recovery-oriented services • Ethical standards for licensed professionals • Supervision

31. Training for Peer Providers • Train the trainer method/Peer support specialists • Collaboration with community colleges • Recovery Centers • Organizational certification • Consultants/technical assistance centers

32. Peer services in Hamilton County • Recovery Center • Mighty Vine Wellness Club • Warmline • Within treatment agencies (GCB, Core, Central Clinic, IKRON)

33. Activities at State & National Level • Ohio Empowerment Coalition • COS Director’s Association (OCOSA) • Medicaid billable peer services • Medicaid elevation • Currently 29 states have Medicaid billable peer services….Ohio is trying to become the 30th • National Standards being developed • National Credentialing being considered

34. Resources • Pathways to Recovery • Wellness Recovery Action Plan (WRAP) • Wellness, Management & Recovery (WMR) • Peer Support Specialists training • Self-determination series • DBSA (dbsa.org) • www.mentalhealthpeers.com • National Association for Peer Specialist www.naops.org • The Institute for Recovery and Community Integration www.mhrecovery.org

35. Q&A and Contact Info. Renee Kopache, reneek@hamilton.mhrsb.state.oh.us