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Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 1 Provider Express – Provider Portal Our provider.

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Presentation on theme: "Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 1 Provider Express – Provider Portal Our provider."— Presentation transcript:

1 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 1 Provider Express – Provider Portal Our provider website is an excellent first-line resource to: –Check eligibility & benefits –Review clinical guidelines –Submit claims –Update practice information –Register for Clinical Learning programs –Find staff contacts –The general information section does not require you to log on with a user ID –To obtain a user ID go to providerexpress.com, click on the first-time user link at the top of the page, then use the live chat feature to contact an Optum representative to request a user ID 1

2 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2 Peer Support – Resources Optum’s Recovery & Resiliency Toolkit for Providers can be found on our Provider Portal Provider Express.com The Recovery & Resiliancy Toolkit includes valuable resources including information from the: Specific Resources from SAMHSA, and Depression and Bipolar Support Alliance The Recovery & Resiliency Toolkit can be found at using the following URL:

3 Peter Ashenden, Director of Consumer and Family Affairs Optum Behavioral Services January 30, 2015

4 Recovery Coaches and Their Roles

5 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 5 Example of Peer Coach Job Description  The recovery coach is an individual whose role is to support others in recovery from a substance use disorder.  The recovery coach will serve as a role model, mentor, advocate and motivator to recovering individuals in order to help prevent relapse and promote long term recovery.  Personal recovery experiences and authentic peer-to-peer relationship building is essential. TASKS 1.Ability to engage and establish rapport 2.Recognize the signs and symptoms of addiction 3.Assist the individual to identify and prioritize strengths and needs 4.Assist in the development and enhancement of the recovery plan 5.Identify emergency or crisis situations and facilitate access to appropriate community resources

6 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6 Peer Coach Job Description (Cont’d) KNOWLEDGE and AWARENESS –Active listening –Culture of addiction and recovery –Personal strengths and limitations and/or challenges –Basic cultures, environments, terminology and beliefs –Techniques that engage individuals to self-disclose –Process of recovery including different pathways –Recovery planning process –Local community resources –Recovery capital

7 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 7 Peer Coach Job Description (Cont’d) SKILLS –Compassion, empathy, respect, flexibility, hope, acceptance –Identifying signs and symptoms of intoxication, tolerance and withdrawal –Identifying common behaviors that can interfere with recovery process –Recognizing cultural differences with regard to addiction recovery –Demonstrate patience, persistence and optimism to help establish and maintain the individual’s motivation –Assist in development of recovery plan –Identifying and ability to navigate the resources and systems needed to advance the recovery plan and help overcome barriers –Writing and clearly communicating using person centered language –Identify crisis and emergency situations

8 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 8 Subcontract Statement of Work Goals and Purpose The purpose of this proposed contract is to provide Peer Coach and Support services to referred adult members who are interested in receiving support from a peer. The Contractor will provide Peer Coach services in a comfortable, supportive, culturally competent approach to referred members in the following manner: –Contact the referred member prior to discharge from the identified facility if possible –or within 24 hours of discharge –or within 24 hours of referral  They then begin to establish a personal relationship with the member, emphasizing the development of trust, mutual respect, encouragement and emotional support.  They develop a support plan to ensure engagement in community treatment and support programs and minimize non emergent use of hospital emergency room services. Support to the referred member in the recovery process, includes the following:  Understand the concerns and needs of the member and offer support, encouragement and hope based on the mutuality of the lived experience.  Help the member state their recovery goals in terms that make sense to the member and reflect the values and motivations of the member in the members own works. Then assist the member to identify what actions they believe they need to take to achieve these goals.  Encourage and support the member to take the actions they have identified as important to achieve their own recovery goals.

9 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 9 Statement of Work -continued  Offer the member a range of engagement and activation tools such as WRAP, Symptom tracking, journaling, creation of advance directives etc. that the member can use to manage symptoms, build wellness, manage anxiety, cope with escalating symptoms, plan for crisis, increase communication with family, friends and providers, build support networks and maintain wellness.  Support the individual’s agreement to treatment through the creation of tips and strategies that the consumer decides works for them.  Support the member in moving forward in the following seven domains through the use of self-care tools and strategies. Measurement of movement will occur through the use of the MARS-12 tool at 1, 3 and six months. Domains include: 1.Increase self-awareness of strengths 2.Increased planning and implementation skills 3.Management of negative self-talk 4.Increased self-confidence 5.Ability to share their story 6.Increased hope 7.Increased sense of empowerment and self-responsibility

10 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 10 Statement of Work -continued  Work with the member before each psychiatrist and therapy appointment to help the member consider what they wish and need to communicate in order to maximize their time with their providers.  Based on the members own recovery goals and their identification of things they need to do to move forward, the peer will assist the members relearn and build confidence in everyday living tasks –for example: riding a bus, grocery shopping, going to a Laundromat, etc.  The peer will orient the member to community resources, such as support groups, drop in centers, food banks, clothing closets.  The peer will introduce places the member can volunteer to build back their confidence, job placement and supported employment resources.  The peer will identify housing resources, ways to access transportation, programs to help the member pay for utilities and access to available services.

11 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 11 Statement of Work -continued RESPONSIBILITIES ▪Complete at least four (4) contacts per month with the referred member ▪Assist with accessing clinical and community services and supports. Specific areas to be addressed include: –Housing –Transportation –Social network –Crisis support –Personal advocacy (self-help) –Self improvement –Education / employment –System advocacy  Provide referrals, if desired by the member, to organizations and support groups. Accompanying the member at least once if requested.

12 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 12 What are the Hiring Practices for Peer Coaches?  Many Human Resources Departments are uncomfortable asking if some one has the “lived experience of addiction recovery.” –The “lived experience” is critical to doing the job –The Peer can not do the job without the lived experience –It IS a mandatory qualification for any peer job –You MUST ask the question! –Interviewing Suggestions: The person must have the ability to tell their recovery story effectively with an individual working toward treatment, it is a critically important skill for the position; Say: Please share with me 2-3 minutes of your recovery story. This is a peer position; Say: Please tell me your sobriety and/or Wellbrity date.  An important component of a peer position is their understanding of local resources and their ability to help a peer find the right support. –Ideas for asking: Tell me about some of your favorite local groups you recommend to others? When a friend asks you about your suggestions for remaining sober/clean what do you recommend?

13 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 13 Hiring Practices for Peer Coaches -continued  Some of the skills Peer coaches need can be difficult to evaluate; consider using situational questions during interview: –Tell me about a time you needed to offer support and help, what did you do? What was the outcome? Please be specific about a single time. –Tell me about a time you helped a peer to increase their self-awareness of strengths, what did you do? What was the outcome? Please be specific about a single time. –Tell me about a time when someone told you that your support had given them more hope, what did you do? What was the outcome? Please be specific about a single time.

14 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 14 After the Peer has been hired…  Use them for peer work, not as mini clerical staff or mini therapists.  Have the peer go through the same orientation any staff goes through.  Ensure the peer have the same access to record, the same access to codes anyone else working at a coordinator or a manager role-  Peers have the same ethics training anyone else has and a code of conduct.  Ensure the peer can use the same bathrooms as other staff.  Ensure the peer has the same key privileges as others have!

15 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 15 Supervision of Peer Coaches  Structured supervision and ongoing training should be used to maintain integrity or fidelity of recovery coaching program.  Supervision can continually help Peer Coaches develop their own job skills. Elements to consider: –Forum for learning and team building –Integrate principles of the recovery coach program –Development of learning plans –Review documentation (if needed) –Feedback from participants in the program  There are several online and face to face training programs to help supervisors gain insights into supervising a Peer Coach.  Many believe having a Peer supervise another Peer is an optimal model.  CMS mandates that Peers take ongoing continuing education.

16 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 16 Measuring Effectiveness of Coaching INDIVIDUAL COACHING OUTCOME MEASURES Days of abstinence per month (Of the member being served) Length of continuous abstinence Recovery reengagement following any episodes of drug or alcohol use Meeting of basic needs Stable housing Stable employment Educational achievement Lack of criminal activity and involvement with criminal justice systems Family reunification (when appropriate) Access to health and social services Quality of life index Sense of purpose and meaning in life Community connection and social inclusion Responsible citizenship Successful scheduled recovery checkups MARS-12 scoring improved

17 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 17 MARS-12 Assessment Drapalski, Amy L., et al. "Assessing recovery of people with serious mental illness: Development of a new scale." Psychiatric Services 63.1 (2012): The MARS was modified with permission of the developers. Unpublished psychometric analysis of the short form MARS -12 was conducted by Deborah Medoff, Ph.D. Psychiatry Department, University of Maryland School of Medicine is available upon request. 1/17/2014

18 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 18 Resources Provider Live and Work The College for Behavioral Health Leadership – Peer Services TOOLKIT Find the ACHMA

19 Image by Stuart Miles

20 Thank You for your time today! Kelly Champ Peter Ashenden Recovery means a full life in the community where our illness does not get in the way of achieving our hopes and dreams. How will you help us get there?


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