1. Peer Services Enhancing the Continuum of Care Doug Smith, M.D., DFAPA Medical Director and Forensic Psychiatrist Summit County ADM Board Director of Community Psychiatry, NEOMED DougSmith@admboard.org

2. Development of Consumer-Operated Service Programs (COSPs) By the turn of the 21st century, the push for recovery and the use of peer support services has accelerated across the United States as COSPs matured, diversified, and increased in numbers. http://www.promoteacceptance.samhsa.gov/ 2

3. Primary COSP Models Today, a wide range of peer support services are available through six primary COSP service delivery models: –Self-help groups –Drop-in centers –Specialized peer services (crisis, unemployment, homelessness) –Multi-service agencies –Peer educator and advocacy programs –Peer phone services (warmlines) http://www.promoteacceptance.samhsa.gov/ 3

4. COSP Study Results Analysis of more than 1,800 participants in the randomized, controlled trial revealed that those offered consumer-operated services as an adjunct to their traditional mental health services showed significant gains in well-being— hope, self-efficacy, empowerment, goal attainment, and meaning of life —in comparison to those who were offered traditional mental health services only. http://www.promoteacceptance.samhsa.gov/ 4

5. 5 Change in Well-being Over Time *COSP = Consumer-Operated Service Programs TMHS = Traditional Mental Health Services

6. COSP Study Results The greatest gains in well-being were found for the participants who used the peer support services the most. So, Peer Support Services are EBPs. Variations in well-being effects across sites were unrelated to formal COSP models of peer support service delivery. Most important, analyses of COSP common ingredients and outcome results established evidence of a strong relationship between key peer practices that support inclusion, peer beliefs, self-expression, and an increase in well-being outcomes. http://www.promoteacceptance.samhsa.gov/ 6

7. What does “Peer Support” Mean? Peer support services: “Programs, discussions, events, groups, etc. within the mental health system that are led by people in recovery and based on the philosophy of peer support. They take place within the structure of an agency or organization and are provided as a service by a trained peer specialist.” Appalachian Consulting Group, 2011

8. Building a Continuum

9. Practical Considerations 1.Environment that welcomes peer supporters 2.Staff Selection 3.Supervision 4.Roles of Peer Service individuals

10. Challenges Peer delivered services are still seen as relatively new concepts in some formal systems of mental health care. Subsequently, concern has been voiced about: Dual relationships Professional ethics and boundaries Peers being viewed as a “friend” rather than as a provider

11. Why Challenges? Because staff may still look at PS as a “client” and clients may see PS as “staff”. They both may do this without understanding that the PS did or still does receive mental health services. They don’t fully understand the model and its value.

12. Summit County Continuum Public Arena So Far Private sector likely in Near future

13. Our Local need for Services Surgeon General Report (2008)U.S %Local# US Adults with Mental Illness22%93,885 US Adults with Addictive Disorder9%40,207 US Adults with Both3%12,802 US Adults with “Serious Mental Illness”5.4%23,044 US Adults with Severe and Persistent MI2.6%11,095 US Youth Mental DO w/ at least mild impairment20%25,494 US Youth 9-17 with “Serious Emotional Disturbance”5-9%6373- 11472 US Youth with Addictive Disorder2%2549

14. Continuum of Care: An integrated system of care that guides patients over time through a array of health services and levels of care. A typical continuum of care spans the following categories: Due to the chronic nature of many mental illnesses and addictions, a client may go back and forth between levels of care. Peer Services may be value-added at all points.

15. 1.Adult AoD 2.Adult Mental Health 3.Youth AoD 4.Youth Mental Health, and; 5.Prevention Services Five Service Continuums

16. Adult AoD PROVIDERAssessmentStabilization/ Crisis TreatmentMaintain/ Support UMADAOPXOP/IOP CHCXOP/IOP/ResMAT/Housing Edwin ShawXOP/IOP Mature Services XOP/IOP OrianaXXOP/IOP/ResSHARP/ Diversion Sr. IgnatiaX Public HealthXOP/IOP

17. Youth AoD PROVIDERAssessmentStabilization/ Crisis TreatmentMaintain/ Support Public HealthXOP CHCXOP/IOP Edwin ShawXOP/IOP New Directions Res

18. Adult MH PROVIDERAssessmentStabilization/ Crisis TreatmentMaintain/ Support CSSXOP/PHP/CPST/ Res Vocational/ Primary care PORTAGE PATHXXOP/ PHP Local Hospitals (AGMC/Summa) XOP/IOP Tarry HouseRes BlickCPST/ PHP/ Res Summit PsychXJail Services/ OP ChoicesOP/IOPEducation/ Social MHAEducation

19. Youth MH PROVIDERAssessmentStabilization/ Crisis TreatmentMaintain/ Support CG& FSXOP/CPST/ Home- Based/ Residential* Akron Children’s Hospital XXOP/IOP MHAEducation *Subcontracted to residential provider

20. Sequential Intercept Model

21. Other ways to Conceptualize Stages of Change-Prochaska & DiClemente (1992) – Precontemplation – Contemplation – Preparation – Action – Maintenance Addiction Recovery Stages (Connecticut Community for Addiction Recovery – CCAR) –Stabilization (~ year 1) –Deepening (~year 2) –Connectedness (~years 3-5) –Integration (~years 6-10)

22. Peer Services Currently in SC PS in Youth AOD and Youth MH –Still in their infancy !

23. Peer Services in SC-Adult MH Community Support Services Recovery Specialists 10 FTEs, divided across up to 20 slots Every CPST Team Supported Employment Services Homeless Outreach Commons at Madaline Park Housing SC Jail Customer Service in CSS Main Lobby

24. Peer Services in SC-Adult MH Northcoast Behavioral Healthcare –4 Peer Support Specialists 1 FT, 3 PT –None in CSN so far.

25. Peer Services in SC-Adult AOD Oriana House, Inc. –Detox –Drop-In –Pre-Treatment Groups –Residential Waitlist Groups –CBCF – Leonard Mayo

26. Peer Services in SC-Adult AOD ADM + Collaborators have trained ~150 individuals in Peer Services Sober Houses Last 2 weeks of Residential at IBH/RAMAR Churches Prison Reentry – “Bondage Breakers” Bridges out of Poverty – “Getting Ahead”

27. It costs a candle nothing to light another candle http://www.promoteacceptance.samhsa.gov/ 27

28. Additional Resources “Certified Peer Specialist Roles and Activities: Results From a National Survey.” http://psychservices.psychiatryonline.org/cgi/content/abstract/61/5/520. http://psychservices.psychiatryonline.org/cgi/content/abstract/61/5/520 “Certified Peer Specialist Training Program Descriptions.” http://www.upennrrtc.org/var/tool/file/33-Certified%20Peer%20Specialist%20Training%20- %20PDF.pdf. http://www.upennrrtc.org/var/tool/file/33-Certified%20Peer%20Specialist%20Training%20- %20PDF.pdf Chamberlin, J. (1979). On our Own: Patient-Controlled Alternatives to the Mental Health System. New York: McGraw-Hill. “Consumer-Delivered Services as a Best Practice in Mental Health Care Delivery and The Development of Practice Guidelines.” http://www.informaworld.com/smpp/content~db=all~content=a789766707. http://www.informaworld.com/smpp/content~db=all~content=a789766707 Daniels, A., Grant, E., Filson, B., Powell, I., Fricks, L., and Goodale, L. (eds). Pillars of peer support: Transforming mental health systems of care through peer support services. January 2010, http://www.pillarsofpeersupport.org.http://www.pillarsofpeersupport.org Key Assistance Report on Certified Peer Specialists. http://www.mhselfhelp.org/pubs/view.php?publication_id=195. http://www.mhselfhelp.org/pubs/view.php?publication_id=195 http://www.promoteacceptance.samhsa.gov/ 28

29. Additional Resources Mead, S., and Copeland, M. E. (2004). WRAP and peer support: Personal, program and group development. Peach Press: Dummerston, VT. Fisher, D. and Chamberlain, J. Recovery Through Peer Support Cirriculum. http://www.power2u.org/mm5/merchant.mvc?Screen=PROD&Store_Code=NEC&Product_Code= PACE-RecoveryPeerSupportCurriculum&Category_Code=pace http://www.power2u.org/mm5/merchant.mvc?Screen=PROD&Store_Code=NEC&Product_Code= PACE-RecoveryPeerSupportCurriculum&Category_Code=pace Fisher, D. and Long, A. Recovery Through Peer Providers http://www.power2u.org/mm5/merchant.mvc?Screen=PROD&Store_Code=NEC&Product_Code= PACE-RecoveryPeerProviders&Category_Code=pace http://www.power2u.org/mm5/merchant.mvc?Screen=PROD&Store_Code=NEC&Product_Code= PACE-RecoveryPeerProviders&Category_Code=pace Salzer, M. S. and Mental Health Association of Southeastern Pennsylvania Best Practices Team, etal. (2002). Consumer-delivered services as a best practice in mental health care delivery and the development of practice guidelines. Psychiatric Rehabilitation Skills, 6, 355-382. Solomon, P. (2004). Peer Support, Peer Provided Services Underlying Process, Benefits, and Critical Ingredients. Psychiatric Rehabilitation Journal, (27) 4, 392-401. http://www.promoteacceptance.samhsa.gov/ 29

30. For more information check out: www.admboard.orgwww.admboard.org or call 330.762.3500 Find us on Facebook : SummitADMBoard