1. Innovative Ways to Utilize Consumer/Peer-Run Organizations in SOAR Webinar Please stay on the line. The webinar will begin shortly. AUDIO: Toll Free Number: 1-855-749-4750 Access code: 661 493 144 Contact lguerin@prainc.com if you experience technical difficultieslguerin@prainc.com

2. Innovative Ways to Utilize Consumer/Peer-Run Organizations in SOAR PRESENTED BY: SAMHSA SOAR TECHNICAL ASSISTANCE CENTER POLICY RESEARCH ASSOCIATES, INC. UNDER CONTRACT TO: SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

3. Welcome! PAMELA FISCHER, PH.D., SOCIAL SCIENCE ANALYST SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION CENTER FOR MENTAL HEALTH SERVICES HOMELESS SERVICES BRANCH

4. Webinar Instructions  Muting  Recording availability  Downloading documents  Evaluation  Question instructions

5. Agenda Peers/Consumer-Run Organizations: An Overview  Matt Canuteson, MA, Project Associate at the SAMHSA SOAR Technical Assistance Center, Policy Research Associates, Inc. in Delmar, New York SOAR Provider Presentations: Peer Support Models and Perspectives  Brian Smith, MA, Housing Program Administrator, PATH State Contact and SOAR State Lead at Vermont Department of Mental Health in Montpelier, Vermont  Joshua Black, PATH Program Manager at Capital Recovery Center in Olympia, Washington  Cara Coleman, MA-LPC, Homeless Grant Coordinator/Supervisor at Allegan County Community Mental Health in Allegan, Michigan

6. Agenda  John Mills, CPSS, Homeless Outreach & Services Specialist with Allegan County Mental Health in Allegan, Michigan  Ben Busfield, CPSS, Housing and Mental Health Court Peer Support Specialist with Allegan County Mental Health, in Allegan, Michigan  William Doub, MAUP, Supervision, Community Housing, Genesee Health System in Flint, Michigan  Joann McCann, CPSS, Certified Peer Support Specialist, Genesee Health System in Flint, Michigan  Questions & Answers, SOAR Technical Assistance Center

7. Poll Question #1 To what extent are peers involved in your SOAR process? a. Our agency/program currently uses peers as a part of our SOAR process b. Our agency currently uses peers but not as a part of our SOAR process b. Our program does not currently use peers but we would like to hire or partner with a program that has peers - inviting them to participate in SOAR in our community d. We are not at a place where we are considering hiring peers but would like more information about how to make that possible

8. Peers and SOAR: How People with Lived Experience Can Make Your Program SOAR Higher! MATT CANUTESON, MA, PROJECT ASSOCIATE SAMHSA SOAR TECHNICAL ASSISTANCE CENTER POLICY RESEARCH ASSOCIATES, INC.

9. What Are Peer Services? Peer services are provided by people in recovery from mental health and or substance use disorders. They provide an opportunity for consumers to assist others in their recovery journeys by supplementing existing treatment/service options by: Modeling/promoting recovery and hope; Teaching skills; Supporting empowerment; Aiding in system navigation.

10. Where Are Peer Services Used?  Outpatient settings  Bridger Programs  Crisis residences  Inpatient hospitals  Forensic settings  Criminal justice programs  Street outreach programs  In SOAR Programs!

11. Where Are We?  In 2007 CMS in its letter to states indicated that “Peer support services are an evidence-based mental health model of care which consists of a qualified peer support provider who assists individuals with their recovery from mental illness and substance use disorders. CMS recognizes that the experiences of peer support providers, as consumers of mental health and substance use services, can be an important component in a State’s delivery of effective treatment.”  SAMHSA identifies peer support/consumer operated services as evidence based practices.  The Institute of Medicine emphasized the importance of peer support and peer delivered services in its landmark report, Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series.

12. Why are peer services important? Peers can be effective in engaging people who are earlier in their recovery and/or who may be hesitant to use traditional services. Research suggests that the deployment of peer staff may be most crucial in the earliest phases of engaging people into care, including people who have substance use disorders and/or a history of criminal justice involvement. Peers are especially useful when working with special populations such as veterans and young adults.

13. Peers in SOAR: The ADDED Value!  Aid in engagement  Show people that recovery is real and POSSIBLE!  Peer providers have their recoveries strengthened!  Provide a non-clinical view about a person’s strength’s and challenges  Provide an agency with added passion and dedication because they have “been there”  Have a hand on the pulse of the local cultural groupings

14. Cost Effective? Using peers instead of traditional treatment in 2006, the GA Department of Behavioral Health & Developmental Disabilities compared consumers using certified peer specialists vs. consumers who received the normal services in day treatment (the control group). Consumers using the services of certified peer specialists showed improvement as compared to the control group in each of these areas:  Reduction of current symptoms/behaviors  Increase in skills/abilities  Ability to access resources/meet their own needs In comparing the cost of services, those using the certified peer specialists cost the state, on average, $997 versus the average cost of $6491 in day treatment. Average cost savings of $5494 per person!

15. Cost Effective? Peer Bridgers help ‘bridge’ people from hospitals and criminal justice settings back into the community. In New York, the New York Association of Psychiatric Rehabilitation Services’ program was evaluated by Stephen Beller Ph.D. (National Health Data Systems) who found that while in the program, people had a significantly lower hospitalization rate. During the 2-year baseline period ‘Matches’ were hospitalized an average of 60% of the time. While enrolled in the program they were re-hospitalized only 19% of the time. That's an improvement of 41%!!

16. Strategies for Implementation

17.  Find your “champion” to address issues that arise on a systemic level and to keep the development of peer services a priority for the agency.  Prepare a clear job description that is fully endorsed by key stakeholders. It should include all relevant competencies and a clear policy for evaluating job performance.  Involve non-consumer staff and organizational leaders early and throughout the process of creating and filling peer positions.  Ensure that peer staff reflect the cultural, linguistic, and social diversity of consumers you will be serving. One approach to identifying and recruiting staff that will help ensure a good match is to form collaborative relationships with community-based organizations representing diverse client populations.

18. Strategies for Implementation  Identify and value the unique contributions that peers can make to your program. The optimal benefits of hiring peers will not be realized if they are only trained and expected to carry out traditional case-management tasks.  Start with at least two peer staff to facilitate their transition to this new role. This gives them the opportunity to share job experiences and provide support to each other. Additionally, connect them with other sources of professional support specifically designed for peer workers (see resources section at the end of this PPT).

19. Strategies for Implementation  Provide training for peer staff that covers the specific skills and tasks required in their roles, such as using their recovery story to the benefit of the people they work with, listening effectively, creating positive relationships, addressing emergent situations, fulfilling documentation requirements, adhering to ethics and confidentiality rules, setting boundaries, and resolving conflicts in the workplace.  Provide supervision for peer staff that concentrates on job skills, performance, and support, rather than on the person's clinical status. This establishes expectations of peer staff that are equivalent to the agency's expectations of other employees.

20. Strategies for Implementation  Provide training and education for non-peer staff that covers the Americans with Disabilities Act and its implications for hiring and the provision of reasonable accommodations, expectations of peer staff, ethics, boundaries, adopting person-first language and a respectful attitude toward all coworkers.  Make benefits specialists who are knowledgeable about the various work incentive programs and ways employment may affect a person’s benefits available.  Disseminate success stories that inspire hope and persistence in all parties!

21. Resources!  Intentional Peer Support www.intentionalpeersupport.org  The InterNational Association of Peer Supporters (iNaps) www.inaops.org  Your State’s Office of Consumer Affairs  Statewide Consumer Networks  Matt Canuteson at the SOAR TA Center mcanuteson@prainc.com

22. Contact Information Matt Canuteson, Project Associate SAMHSA SOAR Technical Assistance Center Policy Research Associates, Inc. 345 Delaware Ave. Delmar, New York Phone: (518)439-7415, ext. 5243 Fax: (518) 439-7612 Email: mcanuteson@prainc.com

23. Peer Support Specialists Lead SOAR Efforts in Vermont BRIAN SMITH, MA, HOUSING PROGRAM ADMINISTRATOR, PATH STATE CONTACT AND SOAR STATE TEAM LEAD AT VERMONT DEPARTMENT OF MENTAL HEALTH MONTPELIER, VERMONT

24. Focused Peer Effort from Beginning  First SOAR Forum, June 2012  SOAR implementation plan: Vermont’s 7 PATH programs, beginning with Pathways Vermont in Burlington  SOAR State Lead recommended Peer Support Specialists within Pathways Vermont to hold positions of SOAR Trainer and later, SOAR Local Lead.  Both SOAR Stepping Stones Trainings were attended by Peers from various consumer-run organizations, e.g.) Brattleboro Drop-in Center, Wellness Co-op, Vermont Psychiatric Survivors

25. Pathways Vermont  Since 2009 has been providing “Housing First” support services in communities across the state of Vermont  Pathways Vermont transforms the lives of people experiencing mental health and other life challenges by supporting self directed roads to recovery and wellness in an atmosphere of dignity, respect, choice and hope  Advocates for the rights of people to live without stigma and discrimination and promote civil rights, community integration, health care, affordable housing and employment for all

26. Pathways Vermont  In 2012, Pathways created it's second program, The Wellness Co-op, funded by SAMHSA  Created to provide Chittenden County residents with a safe space in which alternatives to traditional mental health services would be offered  Supported 2 Peers to attend SAMHSA’s SOAR Train-the-Trainer programs and later, SAMHSA’s SOAR Leadership Academy  Facilitated 2 statewide SOAR Trainings which were heavily attended by Peer/Consumer-run organizations, e.g.) Brattleboro Drop-in Center  Peer Support Specialists secured and maintained SSI/SSDI benefits via SOAR program

27. What Vermont Knows is Possible  Individual and system of care benefits at the same time, e.g.) SOAR Applicant, Clinicians, adds value to program resources  Significant meaning to Peers recovery journey, e.g.) educating others, expanding knowledge, giving back, having career, hope and promise of recovery  Strengths based delivery system created “for” and “by” us  Best engagement opportunity has been by having persons with lived experience open the conversation and deliver a successful application

28. Contact Information Brian Smith, MA, Housing Program Administrator PATH State Contact and SOAR State Team Lead Vermont Department of Mental Health Montpelier, Vermont Phone: 802-828-3844 Email: Brian.Smith@state.vt.us

29. PEER Support and SOAR (People with Lived Experience and Expertise in Recovery) JOSHUA BLACK, CPC PROGRAM MANAGER – PROJECTS FOR ASSISTANCE IN TRANSITION FROM HOMELESSNESS (PATH) CAPITAL RECOVERY CENTER – OLYMPIA, WA

30. Capital Recovery Center  Located in Olympia, WA  Consumer/PEER run licensed Community Mental Health Agency  Consists of 3 distinct programs:  PEER Support Program  PATH Program  Olympia Downtown Ambassador Program  Each program includes Certified PEER Counselors  Began providing services in 1988 as Capital Clubhouse

31. PEER Support and SOAR  PEER Support Specialists (PSS) assist throughout the entire application process  PSS build trust and provide a level of empathy based on their own lived experiences. They are nonjudgmental advocates for the applicant  PSS provide assistance with the application, but also emotional support  PSS create a welcoming/comfortable environment on site, but are also able to meet at other locations if more comfortable for the applicant  PSS work with Disability Determination Service Specialists and SSA Representatives on behalf of the applicant, or can be present during conversations  CRC has individuals on site who have successfully applied for SSI/SSDI benefits

32. Challenges and Moving Forward  Staff turnover has led to fewer SOAR trained PSS  Fewer SOAR trained PSS leads to decreased capacity to serve and increased demand on available SOAR trained PSS  CRC is pursuing more funding to increase the number of SOAR trained PSS available  CRC aims to have SOAR trained individuals in all 3 programs (PEER Support, PATH and DAP)  PEER Support + SOAR WORKS! But it takes time/commitment

33. Contact Information Joshua Black Program Manager – PATH Program Capital Recovery Center 1000 Cherry Street SE Olympia, WA 98501 Phone: (360) 357-2582, ext. 117 Fax: (360) 357-2821 Email: josh@capitalclubhouse.org

34. Successful Peer Integration: Supervision, Training and Collaboration CARA COLEMAN, MA-LPC HOMELESS GRANT COORDINATOR/SUPERVISOR ALLEGAN COUNTY COMMUNITY MENTAL HEALTH ALLEGAN, MICHIGAN

35. Our Beginnings  Allegan CMH and SAMHSA Research Grant- Peers Employed in Evidenced Based Practices in 2010-2015  Through grant we were able to employ 2 part-time peers in the housing programs, who have 100% input into all our housing/PATH programs  Peer Training included certification, SOAR, Motivational Interviewing, Trauma- Informed Services, Housing First to name a few  Allegan CMH now employs 2 full-time Certified Peer Support Specialists:  1 FTE in PATH Grant  1 FTE split between Supportive Housing, PATH, and Mental Health Treatment Court  Medicaid Billable Services for Certified Peer Support Specialist for Case Management, Supports Coordination, and Community Living Supports

36. PEER Support and SOAR  Peers assist claimants through the entire SOAR application process, from homelessness to housed  We use a team approach using SOAR as a tool to help people obtain income supports necessary to sustain permanent housing.  Cara provides supervision with each application and reviews MSR before it goes to Policy Research Associates for TA/review  Program Data 2014:  3 Initial Applications: 2 Approvals, 1 Denial  1 Appeal (the denial above) represented by Peer at Hearing: Approved

37. Challenges and Moving Forward  Supervision is vital to support peers  Supervisors must be sensitive to peers own recovery  Weekly supervision meetings or check-ins are important  Peer salaries are usually lower than other clinical staff & there are not many grants to cover peer case management services  Be intentional with how you will use peers in SOAR process and designing your program to not only support those experiencing homelessness but for peers as well

38. Contact Information Cara Coleman, MA-LPC Homeless Grant Coordinator Allegan County Community Mental Health Services 3285 122 nd Ave Allegan, MI Phone: 269-673-6617 Email: ccoleman@accmhs.org

39. Doing it ALL! From Initials to Hearings… Best Practices from Allegan Peers, Part I BEN BUSFIELD, CPSS HOUSING AND MENTAL HEALTH COURT PEER SUPPORT SPECIALIST ALLEGAN COUNTY MENTAL HEALTH ALLEGAN, MICHIGAN

40. My First Claimant  First Initial Impression using SOAR  Gathering Medical Evidence and Reviewing  The MSR  First SOAR Claimant  Initial Application  Appeal Hearing  SOAR Claimant’s Response to Approved Decision  My response to using SOAR after first approval

41. Being A Peer  What it means to me to do this work  Doing SOAR  Housing Programs  Supervision needs for a peer  Accessibility  Open to peer input and support for Peer/Recovery Initiatives  Helpful hints for employing peers  What works well here  Things I would change with what I know now

42. Challenges and Moving Forward  Agency Culture and Staff Attitudes  Support for Peer Driven Services from the top-down  May have to challenge staff attitudes and philosophies  Employing peers, What’s next?  Funding Opportunities  Set up your program with strong supervision

43. Contact Information Ben Busfield, CPSS Allegan County Community Mental Health Services 3285 122 nd Ave Allegan, MI Phone: 269-673-6617 Email: bbusfield@accmhs.org

44. Doing it ALL! From Initials to Hearings… Best Practices from Allegan Peers, Part II JOHN MILLS, CPSS, HOMELESS OUTREACH & SERVICES SPECIALIST ALLEGAN COUNTY MENTAL HEALTH ALLEGAN, MICHIGAN

45. My First Claimant  First Initial Impression using SOAR  Gathering Medical Evidence and Reviewing  The MSR  First SOAR Claimant  Appeal Hearing  Awaiting Decision  Claimant Response so far  My response to using SOAR

46. Being A Peer  What it means to me to do this work  PATH  SOAR  Supervision needs for a peer  Accessibility  Open to peer input and support for Peer/Recovery Initiatives  Helpful hints for employing peers  What works well here  Things I would change with what I know now

47. Challenges and Moving Forward  Working with those with severe and persistent mental illness and co-occurring disorders who are experiencing chronic homelessness  Street Outreach  Engagement  Being willing to share your own recovery story as needed to support engagement and another’s recovery journey

48. Contact Information John Mills, CPSS Allegan County Community Mental Health Services 3285 122 nd Ave Allegan, MI Phone: 269-673-6617 Email: jmills@accmhs.org

49. How to Integrate Peer Supports Into Your SOAR Program for Successful Outcomes for All! WILLIAM DOUB, SUPERVISOR, COMMUNITY HOUSING GENESEE HEALTH SYSTEM FLINT, MICHIGAN

50.  Serves Genesee County/City of Flint, same as the Continuum of Care;  Provides Outreach Services, Consumer Engagement, Connecting prospective tenants to Housing, Benefits, and Community-Based Services;  Provides targeted supports for housing retention; and  Assists consumer with acquiring skills, income, education, and/or applying for benefits.  An important adjunct to this process is the utilization of Certified Peer Support Specialists to connect consumers with assistance and supports, including making the application process for housing and benefits both accessible and understandable. Genesee Health System Community Housing

51.  Certified Peer Support Specialist assigned full-time to Community Housing  CPSS staff are trained agency-wide and credentialed with the State of Michigan. Peer staff are cross-trained as Recovery Coaches familiar with substance use and motivational interviewing  CPSS provides peer support to consumers throughout all aspects of the housing assistance process beginning with outreach to transitioning out of program;  Builds trust by seeking to engage consumer during the housing intake and assessment process;  Provides assistance with the application for benefits, both for State and Federal Assistance;  Engages and supports consumers through the lengthy interviewing and application process Peer Support and SOAR

52.  Peer Support Specialists provide a critical service to Community Housing by using their experience to connect with consumers.  From a program management standpoint, Peer Services, especially that of assisting consumers with applying for benefits, is a Medicaid billable activity;  If the consumer currently does not have Medicaid, it becomes imperative that clinical and peer staff assist consumers with the application and record gathering process;  Peer staff assigned to Community Housing have been instrumental with getting clients approved through the State and Federal disability application process.  Having SOAR trained staff is essential to this process! Ms. Joann McCann has used her SOAR knowledge and training to make successful claims for the clients she has been assigned to provide assistance. Peer Support and SOAR

53. Contact Information William Doub, Supervisor, Community Housing Genesee Health System 420 W. 5 th Avenue, Flint, MI 48503 Phone 810.496.4851 Fax 810.257.3665 Email : wdoub@genhs.orgwdoub@genhs.org

54. The SOAR Role in Our Recovery JOANN MCCANN, CPSS (CERTIFIED PEER SUPPORT SPECIALIST) GENESEE HEALTH SYSTEM FLINT, MICHIGAN

55. Contact Information Joann McCann, CPSS (Certified Peer Support Specialist) Genesee Health System 420 W. 5 th Avenue, Flint, MI 48503 Phone 810.496.4851 Fax 810.257.3665 Email : jmccann@genhs.orgjmccann@genhs.org

56. Questions and Answers Facilitated By: SAMHSA SOAR Technical Assistance Center Policy Research Associates, Inc.  Please type your question into the Q&A panel located underneath the participant tab, or  To ask a question by phone, please raise your hand by clicking the hand icon in the participant pod. We will unmute you so you can ask your question.

57. For More Information on SOAR http://soarworks.prainc.com SAMHSA SOAR TA Center 345 Delaware Avenue Delmar, New York 12054 (518) 439 – 7415 soar@prainc.com www.facebook.com/soarworks @SOARWorks