Integrating Peer Support onto Alberta Health Services Clinical Teams Presented by Pamela Spurvey, Peer Support Worker, AHS Sheri Schmidt, Peer Support Worker, AHS

Participant Takeaways Moving from hopelessness to hope (Personal stories). What does peer support look like in AHS? Referral process. A flow chart of how Peer Support began and is administered within Alberta Health Services. Challenges and outcomes. Successes. Quotes from staff. Resources. participants group discussion.

Empathy

TEMPLATE DESIGN © PEERS FOR RECOVERY Sheri Schmidt, Jennevieve O’Hare, Pamela Spurvey, and Keith Lang Peer Support – what is it? The clear distinction between Peer Support and other roles is the explicit requirement to draw upon and share their own experiences of emotional distress and/or of using mental health services/addictions in order to inform, inspire and support others in similar situations. Professor Geoff Shepherd, The National Council The Mental Health Commission of Canada defines peer support as any organized support provided by and for people with mental health problems/addictions. Peer support is sometimes known as self- help, mutual aid, co-counseling or mutual support. Ongoing Successes Initial ChallengesEarly Successes Interventions to Overcome Challenges Contact information Key Learnings Health Quality Domain of Focus The addition of peer support has enhanced Addiction & Mental Health Service’s ability to provide services that are relevant to client needs and based on evidence based practices. Opportunity for Improvement The Assertive Community Treatment and Inner City Support teams are the first clinical teams in Alberta to embed formal Peer Support Workers as AHS staff onto their teams. Although there is evidence and experience of embedded peer support workers onto clinical teams elsewhere, this was an opportunity to pilot this model with ACT and ICS clients. Integrating Peer Support Workers on Clinical AHS Teams Situation Without a doubt, health care professionals and paraprofessionals play an important role in client recovery. Previous to the addition of peer support workers, our vision for client recovery was limited. For example, we had never expected one of our clients to leave their home for reasons other than health appointments. After a few sessions with our peer support worker, the client is touring the city sights and discovering their own recreational interests! Expected Outcomes Clients: Enhance client recovery/engagement, improve social skills, restore hope for the future, gain insight into illness/addictions, familiarity with community resources, enhance self worth, increase independence and ownership of health. Clinicians: Expand horizon of expected client recovery, increased self awareness and reflection of own practice, increased insight into impact of care provided, develop greater overall sensitivity and skills through exposure to PSW experiential knowledge and treatment insight. Peer Support Workers: Reflection on personal struggles with illness, addictions, empowerment, gain valuable leadership experience, increased self-esteem, development of work skills & possible career choices. Challenges from the Team Perspective:  Uncertainty about what the Peer Support Worker’s (PSW) role would and should be.  Examples of questions posed by team members: - How will this impact our practice? - Do we include PSW in our case conferences? - What if we know the PSW from working inpatient at AHE? What if we cared for them in hospital? - Will working with our clients impede the PSW’s own wellness and recovery? - What if the PSW has a history of addiction, will our clients trigger them? Challenges from the PSW Perspective:  Also uncertainty around what the PSW role would be on the team.  Previous negative experiences with health care system.  Apprehension about visiting clients in the home.  Unsure if we were equipped with the skills needed to recognize a client was in danger.  Fearful that role would not be helpful or accepted to the team and the clients.  What if I see a client who is seeing a psychiatrist that I have seen before?  Past Partnership with Schizophrenia Society of Alberta to provide and employ the PSW. The SSA provided extensive training and continues to offer support to the PSW (debrief sessions etc)  Early introduction of team members into Schizophrenia Society led training sessions for PSW: Team delivered education around intro to ACT model, CTO’s, safety while working in the community etc.  Sharing of experiences from other provinces: Connected with other ACT teams outside of AB who have embedded peer support. Manager shared learning with team.  Consistently messaged to team that PSW are members of our team.  Initially, PSW accompanied team members to meet clients. This helped to gain trust and rapport for all three – client, clinician & PSW. ClientsCliniciansPSW  Increased understanding of illness.  Family feels that client is being supported and understood.  Explore interests & possibilities in life.  Increased integration with community.  Clients have hope and are able to make future goals around health & life.  Expanded vision for client recovery.  Enhanced case conferencing value with PSW participation.  Increased understanding of medication effects and illness.  Acceptance and integration into team along with support/ advocacy for PSW role.  Empowered as a result of being able to assist others experiencing mental illness/addictions.  Increased insight into own illness/addictions.  Encourages self to keep on top of own mental health.  Reminder of how far I have come and how important own mental health is. Our Goals Peer Support Workers will be embedded into all clinical services and recognized as an essential provider in Addiction and Mental Health services throughout Alberta. Peer Run Services: Normally provided relatively independent of the locally funded health services in the non-governmental organization (NGO) sector. Services provided are often a mixture of both formal and informal options that are available to interested participants. Formal Peer Support: Formal peer support services are found as an integrated part of health services and involve employment after training/education, contractual agreements addressing expectations, job descriptions, management support, clinical supervision and potential career progression. Informal Peer Support: Informal peer support is when individuals are receiving natural support from friends, volunteers, and co-participants. Informal peer support has a very long history and can be very effective. These key relationships allow individuals experiencing addiction and mental health concerns to feel understood and to break down a sense of isolation.  Consistent client visits by PSW gains trust and builds rapport.  Clearer understanding of role and integration of it into teams/services.  It was valuable to have SSA provide support and training to the PSW; AHS Mental Health and Addictions needs to further develop and provide related education.  Embedding peer support onto a clinical team has had its challenges but they have been slowly overcome with early involvement of clinicians in training and meeting PSW. Also, it is valuable to use principles of change management - early staff involvement and communication, identification of early adopters and allowing the actual experience to create a culture shift  built a burning platform for additional peer support resources.  PSW reported they gained benefits from the role such as knowledge, skills, self confidence, self insight, and self worth.  Advocacy for the PSW role in and out of the teams does not end now that we have integrated the PSWs. There is an on going need to cross educate and develop not just the clients experience and understanding of PSW but the organization of AHS’s understanding as well. Other Ideas for Improvement:  Start PSW groups – peers embedded onto other teams then ICS and ACT Edmonton Zone teams within Alberta and throughout Canada with networking and meeting within Peer Support community.  Continuing Education for PSW  Value PSW for what they are worth – increased pay!  Develop definitions, scope of practice, and standards through processes such as accreditation.  Out of the successful collaboration/partnership with the SSA, AHS hired it’s first PSW for the ICS and shortly after successfully transitioned and hired the PSWs from SSA to ACT.  Increased cohesion with perspective teams and the initiation of developing enhanced services in teams.  Offering PSW Service to Community Partners and Agencies via PSWs on ACT/ICS teams.  Early phases of developing Peer Support practice council and networking.  Increased development of client engagement and service provider relationships.  Most days we are having fun and learning and receive the occasional award. Keith Lang– Care Manager ACT, ICS, CTO Pamela Spurvey Sheri Schmidt Jennevieve O’Hare A robust and growing research evidence base shows peer support is associated with:  Reductions in hospitalizations for mental health/addictions problems  Reductions in ‘symptom’ distress  Improvements in social support  Improvements in people’s quality of life  Evidence based Practice Why Peer Support? Types of Peer Support Peer Support

Peer Support in action Support Benefit Accessing social and recreational activities: Swimming Bookstores Coffee shops Play card games Accessing Programs ex; WOW, Pathways, Prosper Place, and CMHA Sweats and aboriginal groups Recovery groups (12 Step groups) Self- help groups Libraries Cooking classes Zoo, Muttart, and Fort Edmonton Park Take clients for walks Art classes Grocery shopping Help clients access free clothing Accessing the food bank Access resources in there community Help clients access and obtain a leisure pass Physical activities Independence Engagement Autonomy Problem solving skills Belonging Education Self-esteem Social inclusion Lifelong learning Self-determination Respect Trust Acceptance Role model Creativity Positive interpersonal interaction Empowerment Stress management Hope

Peer Support in action cont’d… Practical Support Benefit Facilitate and support clients and teams with emerging needs Accompany clients to appointments ex; medical, dental, psychiatrist, probation, court, and hair cuts Goal setting PSW’s are an advocate Budgeting Get I.D. Help with filling out forms Support self-care Encourage medication management Facilitate and support clients and teams with emerging needs Accompany clients to appointments ex; medical, dental, psychiatrist, probation, court, and hair cuts Goal setting PSW’s are an advocate Budgeting Get I.D. Help with filling out forms Support self-care Encourage medication management

Referral Process Example Peer Support Referral Referring Therapist: Peer Support Worker Referred to: Anticipated Frequency of Visits: Preferred Meeting Place: Transportation Needs: Gets around independently Requires assistance on bus Has DATS Other (explain) Brief History: Relevant Risks/Precautions: Strengths and Interests: Purpose of Visits:

Contracted Positions; BRIDGES; Footsteps Contracted Positions; WOW WRAP Contracted Positions; Wellness Network (Peer Navigators) AHS contracted 3 part-time Peer Support workers from The Schizophrenia Society of Alberta in 2012/2013 to work on the ACT team First full-time Peer support worker was hired with AHS Feb 2015 to work with the ICS team. In April 2015 the 3 contracted ACT Peer Support Workers where hired by AHS. These positions are permanent status. Flow Chart

Continuing to Grow AHS Diversity Housing hired 2 Peer Support Workers 2016 ARCH hired Peer Support Worker 2016 Where do we see us next? Emergency waiting rooms, Cross Cancer Centers and Psychiatric Units, correctional Facilities Future

Social Determinants of Health client Physical health Trauma and internal stigma Cultural background Addiction and mental health Family dynamics Homelessness and lack of income

Hiring PSWs Challenge Outcome Uncertainty regarding the peer support worker’s role caused apprehension about the peers joining our team Clearly defined PSW’s role Presentation to AHS on “What is lived experience.” Collaborating in care of client PSW’s same clinic as team Education and training are key

Becoming part of a team Challenge Outcome How could the team change their practice to include PSW’s? PSW’s using electronic medical record Provide the introduction to clients Have PSW as key in engaging clients in their care plan Client centered care is imperative

Team Player Challenge Outcome What is the PSW’s role in case conferences about our clients? Advocate for clients as a peer going through the health care system In a helpful way, challenge the ineffectiveness of “we have always done things this way” PSW’s challenge the stigmas of addiction and mental health Assist team members to be empathetic towards clients needs (trauma informed care) PSW’s have a hopeful outlook Cultural Safety/Competencies

Collaboration Challenge Outcome What if the staff member treated the peer support worker ? Team member would be expected to treat PSW with respect Have a conversation to help PSW feel supported Be non-judgmental Follow AHS confidentiality policy

Self Care Challenge Outcome Will working with our clients negatively impact the peer’s own recovery? PSW’s need to be aware of warning signs and know triggers Practice self-care Know who/where to ask for help The wellness of the PSW is essential to the functioning of the role Healthy Boundaries

Engagement Challenges Outcomes How and why do PSW’s engage in community? Know the resources available in our community Networking with multiple agencies Engaging with other peer driven agencies Strengthens and increases knowledge around PSWs role Knowledge gathering and sharing To build cultural competence

Referrals Challenges Outcomes Referrals from team for PSW’s was low, how do we increase referrals? Shadowing Colleagues to understand their role and vice versa Teach and mentor the team on the value of Peer Support Assertive collaboration in case conference PSW’s take an active role in requesting referrals

Challenges and Solutions Challenge Outcome Who will cover transportation and community engagement costs for PSW’s? Manager and PSWs advocated to the city and received access to Rec. Centers when with clients Provided Tim Horton’s cards for coffee Mileage and parking covered Bus passes covered

Key Learnings/Successes Clinicians view on recovery has expanded therefore patient care has changed PSW’s have had a lot of autonomy and their ideas have been respected and encouraged PSW’s won an award and received acclaim through the 2015 Partner In Health Award Spoke with the Grant MacEwan Mental Health Nursing program

Key Learnings/Successes Built key relationships with other PSW’s within Edmonton and area Peer mentorship Certification from Prairies to Peaks Our full time PSW is in the process of completing her PSACC certification Speaking to and working with staff, administration, management at all levels PSW’s have become a voice within the system to create change

Key Learnings/Success A practice council has now been established; Peer Support Council; provides an opportunity for all individuals involved in various peer roles to meet and discuss commonalities, share resources and participate in learning opportunities relevant to the peer role Partnerships with community agencies Provincial PSW Community of Practice Awareness around PSWs being a valuable & essential part of the team

Quotes from Staff “ I am often very protective of my clients but it is great having someone I know I can trust to come along side them and show them that change and progress can be a reality” “The PSW is always using a non-judgmental approach and I know she has been a great example to several clients but also clinicians so working w her is a great reminder of how to interact w clients in the genuine and honest manner that best fosters therapeutic growth for the client.”

Quotes from Staff “In summary, your approach in your work has changed my perspective in a positive manner by broadening my understanding of your role and seeing what a valuable asset it is in our multidisciplinary team.” “The PSW is essential to the therapeutic process and helps bridge the gap between clinician and client. The PSW has a gift for navigating health systems and community resources with remarkable aptitude for liaison work.” “that's why you guys are so valuable- you bring perspective and think of questions I would never think to ask! You speak from experience."

Resources (Supporting Behaviour and Social Participation) (Elementary Mental Health Kit) (Ways to Wellness Toolkit) (The Wellness Dimensions Quiz)

Resources (Pamela’s Story United Way) care.ca/files/YouTube_Videos2_Revised_December_2013.pdf care.ca/files/YouTube_Videos2_Revised_December_2013.pdf (Child & Youth Mental Health Toolkits Electronic/Online Resources- Videos) (The Gratitude Experiment) (AHS: Ways to Wellness)

Resources (Wellness Recovery Action Plan) (Mental Health Peer Work Development and Promotion) (Actions for happiness) yGuidelines yGuidelines (Guidelines for Recovery-Oriented Practice)

Resources (resilience quiz for kids) ces_for_teachers_and_schools/Pages/resources_for_teachers_and_s chools.aspx ces_for_teachers_and_schools/Pages/resources_for_teachers_and_s chools.aspx (Resources for teachers and schools) (strengths-based conversation-building tools)

Resources ent/Peer_Support_Guidelines.pdf ent/Peer_Support_Guidelines.pdf (Peer support guidelines) ent/MHCC_Peer_Support_Webinar_Slides_March_19_2014.pdf ent/MHCC_Peer_Support_Webinar_Slides_March_19_2014.pdf (The Road to Recovery: The Value of MHCC’s Peer Support Guidelines in Strengthening Your Organization’s Policies, Programs and Practices )

Support