Angel Prater Tom Lane

Community Counseling Magellan

Solutions Health Care

2015

Creating and Operating

Peer Warmlines

Peer Alternatives:Warm Lines

What is a warm line anyway?• Telephonic peer support alternative

• Operators have lived experience

• Virtual resource accessible broadly

Warm line values• Choice – use is voluntary, self-determined

• Anonymity is honored

• Non-judgmental

Peer Alternatives:Warm Lines

Over 100 peer-operated warm lines in the U.S.• 30+ states have at least 1 peer-operated warm

line

• Approximately 12 national warm lines

Models vary• De-centralized or hub?

• Embedded or “free standing”?

• Inbound, Inbound/Outbound, Outbound

Peer Alternatives:Warm Lines

Hours vary• Few hours a week, limited days

• 24/7/365

Staffing Varies• Volunteers

• Paid

• Combination

Telephone Recovery Support

Connecticut Community for Addictions Recovery (CCAR)• Innovative outbound model focused on

supporting others living with addictions

• www.ccar.us

Features• Volunteer (peer) operators

• Simple “consent” form

• Virtual recovery community

Peer Alternatives:Warm Lines

Are there differences?• Condition-focused: e.g. – Autism

• Experience-focused: e.g. – Vet 2 Vet

• Role-focused: e.g. – family, parent

• Life spectrum-focused: e.g. – teen, youth

Making it work

• Ideas into Action!

Community Counseling Solutions

David Romprey Oregon Warmline

In the beginning

• In November of 2007, CCS hired a

professional consultant and trained

Warmline operators to provide

Warmline services.

• Workshop leaders reviewed the

differences between a Warmline call

and a crisis call, and discussed under

what circumstances it is appropriate for

Warmline peers to contact crisis

professionals.

Pilot Start up Funds

• CCS was awarded $25,000 through the

Block Grant of the State of Oregon to

pilot the Warmline.

• This funding and combined funding of

CCS and the pilot began.

Funding History

• Began with 5 hours per week as a Pilot.

• Marketed to all Community Mental Health Providers (CMHP) in Oregon to generate interest to add hours for a small annual “buy in” of $5000.00.

• Each “buy in” brought a location to the CMHP area for operators in their local community to be trained, obtain part time employment, and build a beginning foundation of peer support in local community. Win-Win for everyone!

Funding History cont.

• 7 CMHP’s “bought in” for one year.

• Bringing the hours of Operation from 5

hrs/wk to 35 hrs/wk.

• After 1 year data collection

demonstrated that the usage was

consistent and working.

• While also giving 1 full year to

determine “true costs” of operation.

Continued

• “Buy in” now for anyone who wanted a location set up in their area is $21,900/yr.

• Currently operates 70 hrs/week

• 50% of operation hours have at least 2 operators working at the same time.

• Year 3: Awarded $190,000 a year by the state of Oregon to sustain the program for an additional 2 years.

• Jan 2012: Given an additional $250,000 from Clackamas county to increase the hours by 78 hours a week. They operate their location 7 days a week.

Continued

• 2013 Clackamas County was hit with a $2.2

million dollar budget cut and were forced to

cut the location site to 50%.

• 2014 awarded MHBG of $200,000 by the state

of Oregon AMH for base funding.

• 2014-2016 New contract with Oregon Health

Authority Addictions and Mental Health

awarded permanent funding annually of

$480,000.

Current Funding structure

• Oregon Health Authority (OHA) annual

$480,000 (Permanent)

• Greater Oregon Behavior Health Inc.

(GOBHI) $75,000 (ongoing)

• Total current annual budget: $555,000

Training

• All Warmline Operators are trained in Intentional Peer Support (IPS) a SheryMead Curriculum.

• A 6th Module was added with permission from Shery Mead to meet Oregon’s Peer Delivered Service requirements to include HIPAA, Confidentiality, Charting, Ethics/Boundaries, Abuse reporting.

• Training is 40 hours and Certified PSS by Oregon Health Authority.

Ongoing Support/Training

• Operators are invited to attend the IPS again and again as they are offered.

• Team Leaders hold ongoing support groups using the IPS manual as a guide for further practice.

• Coordinators meet with teams ongoing to support the process and team building activities

• Coordinators meet with each individual to learn with operator and support them in their goals while working for CCS (ie: skill building, computers etc.)

• Each operator/team leader receives 40 hours of continuing education per year as required by OHA

Day to Day Operations

• There are 13 locations in Oregon that have Warmline Operators working from each site.

• Each location has a Team Leader Support.

• Team sizes vary.

• Each location is designated 5 hours per week of operation, these hours are shared rotation for each operator.

• Except for Clackamas County they operate 78 hours per week (7 days per week) Ending June 30th 2015.

Douglas County Behavior

Health

EmployeesCountyAgency

Douglas County

Douglas

Fowler House

Team leader (open)

Judy, Denny

Open Open

Clackamas County

EmployeesCountyAgency

Clackamas Community

Health

Clackamas

Happy Valley

Team Leaders Katie, David, Heather, Joel

Steve,Trinity, Gwen, Chris,

Heather

Clackamas Wilsonville

Sheryl, Terry Joe, Joe, Ruth

and Karen

Continued

• An 800 number that allows anyone to call the Warmline.

• As an operator comes on shift they log in to have phone calls forwarded to their location.

• Each operator collects information at the end of each call to collect specific data.

• The operator asks the caller at the end of each call if they would be willing to answer some questions in order for us to seek ongoing funding.

• A series of questions are asked at the end of each call to collect this data.

Warmline 1-800-698-2392

800

Clackamas

Douglas

Wheeler

Clatsop

Deschutes

Malheur

Crook

Grant

Benton

Columbia

Lincoln

Jefferson

Multiple Sites “ON” at once

Saturday

• Grant Co: 5pm-10pm

Saturday “find me” #1

• Clackamas: 4pm-9pm

Saturday “find me” #2 • OPEN

Saturday “find me” #3

Data and Warm Lines

Limited research, lots of action• Empirical studies; where are they?

• What are we looking for?

• How do you measure what you can’t measure?

So…what is good data?• How do you measure what’s hard to measure?

• Challenges and opportunities

• Progress, Success and Innovation: The David Romprey warm line story!

Data Collection

• Initials of operator (used to help identify who may need support while collecting stats, or if there is a crisis referral we know who to talk with to learn more of the nature of the call)

• Date/Time in/Time out

• Caller’s name (this is not used for reporting purposes, only to remember the caller’s name during the call)

• Gender of caller

• Type of call ie: Did they call/Voicemail/Hang up/Call back

Data collection

• Reason for call (Just to talk/ thank you/

suicide/ family matters/ AD/DV etc.)

• Vet? Y or N

• County/state calling from

• Insurance type: OHP/Medicare/private

(this allows billing for services through

PEO for state provided insurance and

CMHP to contribute funding to

Warmline.

Data Collection

• How did you hear about the Warmline(i.e.: Crisis line/flier/provider/friend etc.)

• Was the call helpful?

• If no Warmline/access other costly services (i.e. 911/hospital/crisis line/case manager etc)? This data is used to identify a cost difference, analysis to show savings around the state.

• Was the caller referred to 911 or Crisis support?

• Out reach program? Name/Phone?

Was the Call Helpful?

Analysis of “Was the call helpful?”

• A total of 77% of the callers indicated the call was helpful, 3% indicated it was not helpful, and 20% were unknown. It is not known if "Unknown" means the caller could not determine the answer, or if the Warmline staff did not ask the question.

Phone Company Report

Month JAN FEB MARCH APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC Total

2009 0 94 2160 2266 4,520

2010 0 2884 2807 2707 2242 3282 3949 3953 3705 4901 4146 5708 5241 45,525

2011 0 6170 5873 5754 5844 7637 5887 4950 4468 2839 2182 2626 3533 57,763

2012 0 3969 4086 5349 5694 6826 6809 6812 7512 7076 8410 7447 9163 79,153

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

Actual calls dialed into 800 overall

Cost Comparison

Cost savings Approximate total savings 2008-2013 = $1,263,910.00

Calculations based on:

--This information is based on average cost of services--Warmline cost approximately $10.00 per call

2012 Call Comparison

• Total Number of Calls Taken 25,962

• Total Number from Phone Company 79,153

• Total Number of calls Unanswered 53,191

• Cost Avoidance Savings reported by callers: $411,070.00

• It is not known how many of these unanswered calls were repeat calls trying to get through, but it shows the potential usage overall. If we were able to answer all calls we run less risk of someone not calling back due to being unable to get through. That being said, it could potentially decrease significantly the overall cost of utilization of higher cost services.

25,962 Callers said If no

Warmline..

0.00100,000.00200,000.00300,000.00400,000.00500,000.00

19,980.00

417,960.00

15,180.00 3,345.00 0.00134,730.00

53,730.00148,590.00 109,120.00Dollars

Service

Costly Services in Oregon

From January 1, 2012 Through December 31, 2012

For All Counties…

Service Cost of Service Warmline Savings per Call

911 $100.00 $90.00

Crisis Line $50.00 $40.00

Hospital

Emergency

Room

$700.00 $690.00

Maybe $25.00 $15.00

Other $25.00 $15.00

Primary Care

Provider

$100.00 $90.00

Provider $100.00 $90.00

Unknown $50.00 $40.00

2013 and beyond

• 2013 total calls into Warmline 800#: 158,158. • Total calls answered were 33,927• Total estimated state cost savings $500,000

• 2014 total calls into Warmline 800#: 165,642. • The total answered were 35,956• Total estimated state cost savings $500,000

• Currently transitioning to a new data collection system and are unable to give the totals of cost savings overall.

Significant Changes

• As of January 2015, the OHA is

requiring us to become a Warmline

only for Oregonians. Historically we

have a been a national/international

Warmline, with approximately 50% of

calls from outside the state of Oregon.

• Will now only serve people residing in

Oregon with Oregon phone numbers.

Some things the Warmline will

do

• Reduce the number of calls to crisis lines

• Provide Peer Support to peers around the entire state

• Reduce psychiatric hospitalizations

• Increase use of more natural supports

• Provide meaningful employment and volunteer opportunities

• Provide risk management options for local law enforcement

• Demonstrate that Oregon is a pioneer in developing innovative practices

Magellan’s Experience

• Contract with provider agency, but peer-operated

• Inbound model, shifting to include outbound

• Distributed operatorsLouisiana

• Staffed by Magellan peer recovery navigators

• Inbound/Outbound model

• Combination of hub and distributed operatorsVirginia

• Contract with peer-run organization

• Inbound/Outbound model

• Now embedded within crisis system

Maricopa County

Personal Testimonies

• “I Love this job and I'll work as many days I can get...Not JUST for money but I’m loving how I can help someone and they help me, I’m really enjoying It. There are days when it’s my time to work and I’m not having a good day week or even month, and when I get on the line I’m easily turned around. Wish I could do this every day”. ~Gina -Warmline Operator

• I have called the Warmline for over two years. I appreciate having someone to call that does not try to “fix” me. I feel very validated and respected, while also realizing that the operator is someone just like me and we can learn from each other, I can give back as well as receive. --Anonymous caller

Personal Testimonies

• “Having a Warmline location here in

our county allows us to start Peer

Delivered Services in our area without a

large budget. While also providing a

much needed service to our residents,

and creating jobs in our community.”

Agency staff

Contact Information

Community Counseling

Solutions

Angel Prater

Warmline Program Manager

PO Box 469

Heppner, Oregon 97836

503-319-6671

chooserecovery@yahoo.com

www.communitycounselingsol

utions.org

Magellan Healthcare

Thomas Lane

Senior Director

Consumer and Recovery

Services

217-384-4332

TLane@MagellanHealth.com

www.MagellanHealth.com

Thank you all!

Questions?