Trail Blazers: Peer Support in Integrated Health Care: The T&T Experience (Tennessee and Texas )

1. Session #C1a October 17, 2014 Trail Blazers: Peer Support in Integrated Health Care: The T&T Experience (Tennessee and Texas) Rick Ybarra, M.A., Program Officer Hogg Foundation for Mental Health Stephany J. Bryan, Program Officer and Consumer & Family Liaison Hogg Foundation for Mental Health Suzanne Bailey, Psy.D. Clinical Psychologist and Behavioral Health Consultant Cherokee Health Systems Collaborative Family Healthcare Association 16th Annual Conference October 16-18, 2014 Washington, DC U.S.A.

2. Faculty Disclosure I/We have not had any relevant financial relationships during the past 12 months.

3. Learning ObjectivesAt the conclusion of this session, the participant will be able to: • Identify at least three examples of the role of peer support specialists in health care delivery systems. • Define at least three challenges and strategies to address challenges. • Identify at least three policy opportunities to advance peer support in primary care settings. • List three resources to help organizations plan and implement peer support in their settings.

4. Bibliography / References 1. Yale School of Medicine, Recovery Self-Assessment (click on Provider version). http://www.yale.edu/PRCH/tools/rec_selfassessment.html 2. Chinman, M., George, P., Dougherty, R.H., Daniels, A.S., Ghose, S.S., Swift, A., and Delphin-Rittmon, M.E. (2014). Peer support services for individuals with serious mental illness: Assessing the evidence. Psychiatric Services 2014; doi: 10.1176/appi.ps.201300244. Retrieved at http://ps.psychiatryonline.org/article.aspx?articleID=1832833 3. Gillard, S. and Holley, J. Peer workers in mental health services: literature overview. Advances in psychiatric treatment (2014), vol. 20, 286–292. 4. Kaufman, L., Brooks, W., Bellinger, J., Steinley-Bumgarner, M., and Stevens-Manser, S. 2014. Peer Specialist Training and Certification Programs: A National Overview. Texas Institute for Excellence in Mental Health, School of Social Work, University of Texas at Austin. 5. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Division. (2012). With peer support, recovery is possible. SAMHSA News, Vol. 20, No. 3. Retrieved at http://www.samhsa.gove/samhsanewsletter/Volume_20_Number_3/peer_support.aspx

5. Learning Assessment • A learning assessment is required for CE credit. • A question and answer period will be conducted at the end of this presentation.

6. Overview – Peer Support • Definition • Peer support services are delivered to a person with a mental health condition or co-occurring mental and substance use disorders by a person in recovery. Peers draw upon their lived experiences to share ‘been there’ empathy, insights, and skills . . . serve as role models, inculcate hope, engage patients in treatment, and help patients access supports in the community. • Role of peers in health care • National movement • The T&T Experience

7. Map of Peer Specialist Training and Certification Programs by State Source: Texas Institute for Excellence in Mental Health, School of Social Work, University of Texas at Austin.

8. Peer Support has been found to help: • Reduce readmissions by 42% • Reduce days in hospital by 48% • Improve relationships with providers • Increase engagement with care • Decrease substance abuse • Decrease depression • Increase hopefulness • Increase activation and self care • Increase sense of well-being Source: L. Davidson: Chinman et al (2014)

9. The TennesseeExperience Cherokee Health Systems: Integrated Medical & Behavioral Health 57 Clinical Locations in 14 East Tennessee Counties 63,291 unduplicated patients 15,325 new patients 484,494 patient services

10. The Tennessee Experience: Peer Utilization • Certified Peer Recovery Specialists • Primary Care & Behavioral Health • Warm Handoffs • Individual Coaching & Workshops • Multidisciplinary Team • Coordination of Care • Extending the Continuum of Care

11. The Tennessee Experience:Peer Support Targets • Chronic Disease Self-Management • Diabetes Self-Management • Wellness • Tobacco Cessation

12. The TennesseeExperience: Benefits of Peer Support • Empowers patients • Increases health literacy • “Instills hope” • Significantly improved adherence • Significant decrease in BMI

13. The TennesseeExperience: Challenges • Patient engagement • Population-based needs • Integrated model

14. The TennesseeExperience: Addressing Challenges • Let the patients be your guide. • Ready, fire, aim. • Primary Care inclusion

15. The Tennessee Experience:Peer Support Integration

16. The TEXASexperience • The Purpose • To develop a skilled workforce of consumers who will help others in their recovery • To provide an added piece to a recovery • oriented continuum • To demonstrate that individuals with lived mental health challenges can and do recover

17. The TEXAS experience Implementation sites • East Texas Coalition for Mental Health Recovery • Serves as a collaborative Recovery–Oriented Learning Community • Began 2010 • 11 LMHA’s • 1 State Hospital

18. The TEXAS experience • Role of peers/how peers being utilized • “Offering and receiving help, based on shared understanding, respect and mutual empowerment between people in similar situations” (Mead et al., 2001) • Identifying and setting recovery-oriented goals • Planning specific action steps to achieve goals • Promoting exercise and good nutrition • Assisting in daily management tasks and problem-solving • Providing social and emotional support and feedback in individual and group settings • Recovery education classes to consumers and staff to raise awareness, dispel myths, enhance competencies

19. The TEXASexperience • Benefits and value added to having peers • Change agents • Can take away the “you do not know what it’s like” excuse • Experience of moving from hopelessness to hope • Increase engagement, HOPE and SUPPORT • Improve trust and communication between patients and health care providers • Increase confidence, self-esteem and skills • Improve self-responsibility, self-care and self-determination • Improve quality of life • Medicaid reimbursable in some states

20. The TEXAS experience • Challenges for peers in work setting • Reluctance to change practice patterns • Negative attitudes about persons with mental health and substance use problems • Shortage of leaders committed to and capable of managing the organizational change process required to achieve integration • Lack of a clear job description • Being required to perform tasks that have little to do with providing peer support • Lack of supervision, or supervision that does not match their role • Low—or no—pay and a lack of career advancement

21. The Texasexperience • Policy solutions and strategies to address challenges • Develop clear guidelines and best practice recommendations for peer recovery support services in integrated health programs • Create resources that assist States and authorities to develop, monitor, and finance peer support/recovery coaching services • Create mechanisms for mental health authorities to dialogue about supporting the implementation of peers in the workforce

22. Resources Peer Support in Integrated Health Care Certified Peer Specialists • Copeland Center for Wellness and Recovery: http://copelandcenter.com/ • Georgia Certified Peer Specialist Project: http://www.gacps.org/ • Institute for Recovery and Community Integration: http://www.mhrecovery.org/services/peer.php • Via Hope – Texas Mental Health Resource: http://www.viahope.org/ • Pillars of Peer Support: http://www.pillarsofpeersupport.org/ Recovery and Wellness • National Empowerment Center: http://www.power2u.org/ • National Council on Alcoholism and Drug Dependence, Inc.: http://www.ncadd.org/index.php/recovery-support/overview • Recovery Innovations: http://www.recoveryinnovations.org/index.html • SAMHSA: http://www.samhsa.gov/newsroom/advisories/1112223420.aspx

23. Learning Assessment Discussion / Q&A

24. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!