Peer Support & WRAP as a Tool for Successful Implementation Presenter: Matthew R. Federici, M.S., C.P.R.P Executive Director Department of Veterans Affairs Peer Support Teleconference February 25 th

Mission Statement: The Copeland Center promotes personal, organizational, and community wellness and empowerment through education, training, and research. 2

Copeland Center History: The Copeland Center for Wellness and Recovery is named in honor of, and dedicated to, the memory of Kathryn Strouse Copeland ( ) The Copeland Center for Wellness and Recovery is named in honor of, and dedicated to, the memory of Kathryn Strouse Copeland ( ) Recognizing her own need to talk with others, she began gathering patients together in small groups to share their experiences. The hospital administration became uncomfortable with these meeting (the first peer support) and Kate was discharged at the age of 45. Kate went on from there to get a highly coveted job as nutritionist in an inner city high school. 3

Embedding Professional Peer Supporters in the VA System: Survey of 110 administrators at three large VA clinics in Southern California: Survey of 110 administrators at three large VA clinics in Southern California: 1. Attitudes towards working with Peer Providers 2. Barriers to future implementation 3. If Peers could improve the system (Chinman, Young, Hassell, Davidson, 2006) 4

Embedding Professional Peer Supporters in the VA System: The concerns: The concerns: Discomfort with Peers having direct 1:1 contact with patients away from traditional provider oversight Discomfort with Peers having direct 1:1 contact with patients away from traditional provider oversight May overly rely on their own experience versus formal training May overly rely on their own experience versus formal training Not many veterans would apply Not many veterans would apply Require too much supervisory time, attention and intervention Require too much supervisory time, attention and intervention Too much stress from the job for peers Too much stress from the job for peers How do we to recruit based on mental illness How do we to recruit based on mental illness Finding stable consumers for the role Finding stable consumers for the role (Chinman, Lucksted,Gresen,Davis, Losonczy, Sussner and Martone, 2008) 5

Experiences of Peers working in the VA System Four Focus groups, 59 Peers and 34 supervisors: Four Focus groups, 59 Peers and 34 supervisors: Traditional- minded staff had ongoing difficulty accepting the Peer Supporter on staff Traditional- minded staff had ongoing difficulty accepting the Peer Supporter on staff Peer reported role and expectation was ambiguous for them, their colleagues, human resources and those they were to support Peer reported role and expectation was ambiguous for them, their colleagues, human resources and those they were to support Paternalism and insensitivity from co- workers Paternalism and insensitivity from co- workers 6

We Are Not Alone! Barriers in implementing Peer Supporters as a valued Professional perspective in the broader community behavioral health system have been the exactly the same. Barriers in implementing Peer Supporters as a valued Professional perspective in the broader community behavioral health system have been the exactly the same. 7

All levels of the Workplace need attention: All levels of the Workplace need attention: Service recipients Service recipients Peer Employees Peer Employees Other mental health professionals Other mental health professionals Management Management -Consumers as Providers in Psychiatric Rehabilitation (1997), International Association of Psychosocial Rehabilitation Services PEER SUPPORT SPECIALIST WORKPLACE CHALLENGES 8

Service Recipients Service Recipients Peer may reflect the societies'/systems stigma and feels that only regular qualified mental health professionals can help them not people like them Peer may reflect the societies'/systems stigma and feels that only regular qualified mental health professionals can help them not people like them Peers may view us differently once in a paid roles Peers may view us differently once in a paid roles Peers may have former relationships with us that confuse the boundaries Peers may have former relationships with us that confuse the boundaries - Consumers as Providers in Psychiatric Rehabilitation (1997), International Association of Psychosocial Rehabilitation Services PEER SUPPORTERS WORKPLACE CHALLENGES 9

Peer Employee: Peer Employee: Multiple level role strain Multiple level role strain Fear of losing benefits Fear of losing benefits Unclear expectations or job description Unclear expectations or job description Self disclosure Self disclosure Values conflict with co-workers Values conflict with co-workers Being view through pathology Being view through pathology -Consumers as Providers in Psychiatric Rehabilitation (1997), International Association of Psychosocial Rehabilitation Services PEER SUPPORTERS WORKPLACE CHALLENGES 10

Management Issues Management Issues Employment practices (i.e. recruitment, hiring, pay scales…) Employment practices (i.e. recruitment, hiring, pay scales…) Conflict management Conflict management Outdated policies Outdated policies Lack of information on role definition Lack of information on role definition Conflicting systems messages (i.e. Medical necessity and licensing requirements and push for recovery orientation) Conflicting systems messages (i.e. Medical necessity and licensing requirements and push for recovery orientation) PEER SUPPORT SPECIALIST WORKPLACE CHALLENGES - Consumers as Providers in Psychiatric Rehabilitation (1997), International Association of Psychosocial Rehabilitation Services 11

Essential Ingredients To Implementation 1. Systems Orientation and Engagement: National Speakers; analysis of local barriers and identifying action steps which includes all systems stakeholders 2. Forming local Planning Teams: developing ownership of change process which includes your key service recipients 3. Facilitating Peer Resource Sharing: between planning teams. i.e. macro level peer support 4. Orientation & Continued Education: Supervisors, administrators and human resources personnel 12

WRAP As A Tool for Systems Transformation WRAP provides an orientation for all stakeholders on key concepts of recovery from research with people who were struggling with metal health challenges. WRAP provides an orientation for all stakeholders on key concepts of recovery from research with people who were struggling with metal health challenges. Provides a structure that can be used for an individuals recovery and groups looking to transform their system. Provides a structure that can be used for an individuals recovery and groups looking to transform their system. WRAP can be used by anyone regardless of a diagnosis and therefore creates a culture of peer support for everyone. WRAP can be used by anyone regardless of a diagnosis and therefore creates a culture of peer support for everyone. Provides a tool for people in recovery to stay well in peer support roles as well as non-peer provider roles to stay well despite work place stress. Provides a tool for people in recovery to stay well in peer support roles as well as non-peer provider roles to stay well despite work place stress. 13

WRAP Facilitators Course Copeland Center Advance Level Facilitators offer a five day course for VA Peer Counselors and other supporters to facilitate Wellness Recovery Action Planning for those the VA serves. Copeland Center Advance Level Facilitators offer a five day course for VA Peer Counselors and other supporters to facilitate Wellness Recovery Action Planning for those the VA serves. Participants of this are grounded in core values and ethics that will foster relationships and environments that promote recovery and peer support: Participants of this are grounded in core values and ethics that will foster relationships and environments that promote recovery and peer support: Counters stigma Counters stigma Strengthens the value of peer support and its role in service delivery. Strengthens the value of peer support and its role in service delivery. 14

15 Utilizing WRAP to Strengthen Peer Support Groups Five day course: 1.Develop individual Wellness Recovery Action Plans 2.Develop and WRAP for your peer support group 3.Define your groups mission

Organizational WRAP Copeland Center Advance Level Facilitators who are also systems leaders can work with your VISN or VA group to develop an organizational WRAP to guide your services and team toward its wellness goals. Copeland Center Advance Level Facilitators who are also systems leaders can work with your VISN or VA group to develop an organizational WRAP to guide your services and team toward its wellness goals. Developing and organizational WRAP also parallels a familiar process and language for working through challenges that translate directly to the individual recovery experience. Developing and organizational WRAP also parallels a familiar process and language for working through challenges that translate directly to the individual recovery experience. 16

ADVANCE LEVEL FACILITATORS TRAINING Once the VA has trained WRAP Facilitators who have experience facilitating the development of WRAP for others they may be able to become Advance Level Facilitators Once the VA has trained WRAP Facilitators who have experience facilitating the development of WRAP for others they may be able to become Advance Level Facilitators Advance Level Facilitators become key stakeholders of the Copeland Center who are empowered to mentor others in the core values and ethics in order to have more facilitators for WRAP. Advance Level Facilitators become key stakeholders of the Copeland Center who are empowered to mentor others in the core values and ethics in order to have more facilitators for WRAP. With VA Employees who are Advance Level Facilitators we can partner in ways that are cost effective and yield long tern resources to offer WRAP to Veterans With VA Employees who are Advance Level Facilitators we can partner in ways that are cost effective and yield long tern resources to offer WRAP to Veterans 17