1. THE EXPANDING AND EVOLVING ROLE OF PEERS AND PEER SUPPORT SERVICES LaVerne D. Miller lmiller@prainc.com 1

2. OUR COLLECTIVE CHALLENGE Regain our momentum Directly combat tendency to retreat in the face of media reporting of violent incidents View challenges as opportunities 2

3. WHO IS A PEER? 3

4. KEY VALUES AND PRINCIPLES OF PEER SUPPORT Mutuality Choice Self-determination Strength based Peers support services are not clinical but can complement clinical interventions 4

5. SNAPSHOT OF PEER SUPPORT SERVICES Navigation Discharge Planning Education Employment Housing Whole Health and Wellness Advocacy Community Integration Crisis Services 5

6. ROLES OF PEER STAFF Peer Specialists Recovery Coaches Bridgers Whole Health Counselors Navigators Warmline Operators 6

7. SETTINGS Community Homes In Patient Outpatient Prisons/Jails Courts 7

8. DELIVERY SYSTEMS FOR PEER SUPPORT SERVICES Provided directly by peer operated programs(independent peer organizations) Provided by peers in provider agencies Peer operated programs contract with provider agencies Self-Employment 8

9. NEW INNOVATIONS IN EVIDENCE BASED PRACTICES SAMHSA funded Mental Health Transformation Projects Supported Employment- Colorado, New Jersey, Oregon Supportive Housing- Washington State, Connecticut Critical Time Intervention- Idaho Supported Education-Colorado, Michigan Trauma Informed Care- Oklahoma, Michigan 9

10. WHAT WE ARE SEEING Improved recovery outcomes Improved engagement Increased satisfaction with services Fidelity to EBP 10

11. KEYS TO SUCCESSFUL IMPLEMENTATION Strong and visionary leadership Meaningful involvement of peers Training Supervision Mentoring 11

12. EVIDENCE BASE FOR PEER RECOVERY SERVICES 12

13. COSP MULTI-SITE RESEARCH INITIATIVE 1998-2006 Largest and most rigorous study of COSPs to date Studied several models of peer-operated services around the country Jean Campbell, principal investigator 13

14. DO COSPS REALLY HELP? WHAT IS THE EVIDENCE? Findings: Greater levels of independence, empowerment, and self- esteem  Improved sense that consumers could make their own decisions, solve problems, and help others  Quality of life improved  Increases in social support, employment skills, education 14

15. EVIDENCE IN SUPPORT OF PEER SERVICES 15 Services provided by consumer staff can be as effective or more effective than non-peer provided staff (Davidson, et al., Deegan, 2003; Clarke et al. 1995; Felton et al, 1995; Chinman, Rosenbheck, Lam, &Davidson et al. 2000). Services provided by consumer staff can be as effective or more effective than non-peer provided staff (Davidson, et al., Deegan, 2003; Clarke et al. 1995; Felton et al, 1995; Chinman, Rosenbheck, Lam, &Davidson et al. 2000). Fewer hospitalizations, use fewer crisis services, reduce substance abuse, and experience improved employment outcomes, social functioning and quality of life (Armstrong et al. 1995; Besio & Mahler, 1993). Fewer hospitalizations, use fewer crisis services, reduce substance abuse, and experience improved employment outcomes, social functioning and quality of life (Armstrong et al. 1995; Besio & Mahler, 1993). Consumer staff benefit from their helping roles (Anthony, 2000; Mowbray, 1997, Shiff, 2004, Solomon, 2004) Consumer staff benefit from their helping roles (Anthony, 2000; Mowbray, 1997, Shiff, 2004, Solomon, 2004) Consumers benefit from self-sufficiency due to increased income and sense of self-efficacy and purpose to life that work brings (Akabas & Kurzman, 2005) Consumers benefit from self-sufficiency due to increased income and sense of self-efficacy and purpose to life that work brings (Akabas & Kurzman, 2005)

16. NEW DEVELOPMENTS National competencies and standards Increase in number of certified training programs Medicaid Reimbursement Private Insurance 16

17. ONGOING CHALLENGES Disparities in access (training and services) Organizational culture Stigma and discrimination against peer staff Policies and practices consistent with American with Disabilities Act Career advancement (“Prozac Ceiling”) Compensation Collateral consequences of any involvement with the criminal justice system Understanding the impact that movement to state certification with emphasis on testing will have upon specific populations or communities 17