1. An Overview of the Enhanced Curriculum to expand Peer Support Services to Service Members, Veterans & Their Families Liz Woodley Gina Noel-Brown

2. Where to begin… Demonstrating the power of Peer support: What is my role in supporting a Veteran - Service connected person? What impact do I want to make on a Veteran – Service connected persons’ recovery journey? What challenges do I anticipate in making a connection? 2

3. Peer Support Principles Voluntary Non-Judgmental Empathetic Respectful Honest and direct communication Mutual responsibility Reciprocal (Shery Mead, Darby Penny and Laura Prescott) 3

4. Peer Support Activities What can you think of? 4

5. Veteran Peer Support An important strategy in supporting the behavioral health needs of service members, Veterans, and their families A bridge to services and help ease transitions Peers with military experience and experience with recovery offer valuable knowledge and skills to assist others Improves the overall quality of life for those being served 5

6. Why, Veteran Peer Support Services? PA’s Veterans population: PA has approximately 1 million Veterans. It is the fourth largest Veterans population in the country 70% of PA’s Vets are over the age of 55 PA has about 19,000 men and women serving in the National Guard, and the National Guard has deployed over 35,000 individuals during the Iraq and Afghanistan conflicts PA has the 2nd highest suicide rate for Veterans in the country Approximately 10% of all adults in U.S. jails and prisons are Veterans Source: U.S. Dept. of Veterans Affairs 6

7. Certified Peer Specialist – Veterans: Roles Provide information Act as a referral source to clinicians and other mental health professionals Provide support and understanding to Veterans they serve Partner with Veterans in problem-solving, decision-making, and setting goals Identify resources in the community Assist Veterans with attaining full integration into the community. 7

8. Responsibilities: General Guidelines The CPS who supports Veterans and Military personnel also: Maintains confidentiality Demonstrates appropriate and respectful language Maintains appropriate boundaries Demonstrates appropriate personal appearance and dress code in the workplace Works in the interest of supporting those served Able to ask for help and receive feedback 8

9. MILITARY CULTURE : WHY IT MATTERS 9

10. In this section we will… Describe military structure and processes Review the demographics of today’s military Identify stresses by mission and conflict Discuss ways for CPSs to support 10

11. Military Operational Organization Status: – Active Duty – National Guard – Reserve Doctrine and Regulations – Doctrines can change with leadership – Regulations are federal therefore the same for Active, Reserve and Guard Air Force 11

12. Today’s Military Demographics Specifics vary by service All volunteer force for since 1974 2.2 M total serving in uniform today compared to 15 M in WWII Desegregation in 1948 – 39% ethnic diversity – 15% are women 12

13. Today’s Military Demographics Today’s Military Demographics in Comparison to the Draft Population Average age is older Educational backgrounds higher— percent college graduates, high school/GED requirement, ASVAB scores Marital status higher than civilian Heritage: “military brat” 13

14. The Services Commonalities Recruiting Testing Training Core Values Fitness Joint Service Some Language Rank is Great Equalizer Differences The Mission Individual Service Cultures Uniforms Rank Insignias Language and Acronyms 14

15. Values Army: – Loyalty, duty, respect, selfless service, honor, integrity and personal courage Navy and Marine Corps: – Honor, courage and commitment Air Force: – Integrity first, service before self, excellence in all we do Coast Guard: – Honor, respect, devotion to duty 15

16. Missions Army – fight and win our nation’s wars with sustained land dominance across full range of military operations Navy – power projections, strategic deliverance and tactical delivery of combat power Air Force – to provide strategic air lift and tactical air combat support Marines – rapid deployment force; seizure of or defense of advanced naval bases for land operations Coast Guard - safeguarded our Nation's maritime interests and environment around the world 16

17. Considerations, Challenges and Implications Access to services Effects (physical, psychological) of life in a war zone Military rank and authority Help-seeking and peer-to-peer support Family well-being and reintegration Civilian reintegration Impact on Veterans returning from Iraq & Afghanistan 17

18. Peer Support in Action: Making the Connection How to use military values and history to drive the peer process? – Loyalty – Respect – Selfless service – Honor and integrity – Excellence and commitment – Personal courage – Devotion to duty 18

19. WHEN CULTURES MEET ~ Civilian/Corporate ~ Military ~ Mental Health ~Criminal Justice 19

20. Service Systems MilitaryMental HealthCriminal Justice Strength, resilience, courage, personal sacrifice Elitism, superiority Mental toughness Collectivism, group identify Inner strength, self- reliance Illness, clinical, deficiency-oriented Injury, problems, disorders Emotional vulnerability Individualized, one- on-one Seek help from others Crime, criminal, victim, conditions Law enforcement Prosecution Judiciary Corrections (probation and parole - community corrections) 20

21. Veterans, The Criminal Justice System and Peer Support A Challenge & Implication of ReIntegration

22. Innovation: Veterans Treatment Court Why: To divert those with mental health issues from the traditional justice system and To give them treatment and tools for rehabilitation and readjustment. The progress: – As of February, 2013, there were 168 Veterans Treatment Courts in the United States. – Currently 17 in Pennsylvania Resource: http://www.justiceforvets.orgwww.justiceforvets.org 22

23. Innovation: Veterans Justice Outreach The VJO provides direct services to justice-involved Veterans Developed by the Veterans Administration Each VA Medical Center has a designated justice outreach specialist who – functions as a link between the VA, Veterans, and the local justice system whether incarcerated or not incarcerated The VJO specialist works with the courts to – help eligible justice-involved Veterans get mental health assessment, treatment planning, and referrals to VA services – communicate with officers of the court about Veterans' compliance with VA treatment programs – may assist in training law enforcement personnel on issues such as PTSD or traumatic brain injury. For information and a list of VJO contacts, see Justice Outreach handout 23

24. PA RESPONSE Forensic Peer Support and The Sequential Intercept Approach 24

25. Forensic Peer Support for Vets Peer Support offered to Veterans and military personnel with MH or Co-occurring challenges involved in the Criminal Justice System from initial contact with law enforcement through re- entry into the community from incarceration To effectively offer support by understanding the Criminal Justice System and the resources needed for successful Community Re-entry 25

26. How? Jail Diversions – programs that divert individuals with mental illness from the criminal justice system to community based services 26

27. The Purpose of FPS for Vets To support VMPs during their involvement in the Criminal Justice System To promote recovery principles including self- advocacy To advocate for VMPs when they are unable to advocate for themselves To educate stakeholders in VA and CJ systems about mental health recovery To inspire hope Ultimately, to keep people in the community 27

28. What’s the benefit? Positive relationship development Assistance with understanding and navigating the Criminal Justice System Aids in finding and utilizing resources Educates individuals about recovery Supports completion of parole/probation requirements Reduces the time in jail/prison re: the lack of community supports, housing options and resources 28

29. An Approach The Sequential Intercept Model 29

30. The Sequential Intercept Model What is it? – A conceptual framework for communities to use when considering the interface between the criminal justice and mental health systems as they address concerns about criminalization of people with mental illness. – Use of the Sequential Intercept Model as an Approach to Decriminalization of People With Serious Mental Illness, 2006 30

31. 5 Key Points of Intercept 1. Law Enforcement and Emergency Services 2. Initial Hearings/Initial Detention 3. Jails and Courts 4. Re-entry (from Jails, Prisons, and Hospitals) 5. Community Corrections / Community Support Services 31

32. Peer Support in Action Peer Support in Action “Dialogue and Development” Coming Home: Military Veterans involved in the Criminal Justice System The Issue: "Large numbers of Iraq and Afghanistan war Veterans are returning home with serious mental and emotional problems. Possible Responses: What can peers do to support the healing of psychologically-scarred* troops? * profound stress and the challenges of adjusting to civilian life when returning home. 32

33. Objectives Discuss origins and stages of impact of mental health issues Compare and contrast “traditional” medical model and psychiatric rehabilitation approaches to understanding assessment and treatment of mental health issues Brief discussion about medication and adherence issues Identify approaches peer specialist can use when Veterans experience mental health issues 33

34. Why CPSs Need to Know This To understand the common language used in behavioral and VA healthcare settings where CPSs work To use the information as a bridge between clinical providers and Veterans receiving services 34

35. Approaches and Possibilities Treatments, Rehabilitation, Reintegration and Supports 35 SAMHSA Wellness Project: http://www.promoteacceptance.samhsa.govhttp://www.promoteacceptance.samhsa.gov

36. CPS with Veterans Suggestions Communicate a belief that the Veteran can and will recover. “I believe you can have the life you want to have, and I will support you in your journey to get there. I have hope for you.” Listen. Really listen. Do not judge, dismiss, or advise. Just listen. Engage in conversations about goals, dreams, and wishes. Ask questions like, “What would be a satisfying life for you? How can you get there?” 36

37. CPS with Veterans Suggestions Use snippets of personal recovery story to inspire. Also, encourage the Veteran to tell his/her story. Share success stories. Believe in the potential of each Veteran to recover in his/her own way. Advocate for the Veteran with VA and BHC clinical staff members and the Veteran’s family as needed and desired by the Veteran. Share resource information and refer the Veteran to needed available services. 37

38. Objective To identify some specific tools and resources to guide the CSP Veterans and Service Members process: – Personal Recovery Story; – Motivational Interviewing Skills; – Shared Decision Making; – Problem-Solving Skills; – Positive Self-Talk; 38

39. Thank You Liz Woodley CPS liz921@yahoo.com (724)331-0417 & Gina Noel-Brown CPS gmnoelbrown@gmail.com (412)277-2526 liz921@yahoo.com gmnoelbrown@gmail.com liz921@yahoo.com gmnoelbrown@gmail.com