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Recovery & Peer Supported ServicesReneé Kopache ~ Mental Health & Recovery Services Board

Agenda

• Overview of recovery

• Overview of peer support

• Matching services & peer support to stages of recovery

• Integrating peer support with traditional services

• Peer services in Hamilton County

• Statewide Activities of importance

Overview of Recovery

Recovery: What It Is• “A deeply personal, unique process of changing one’s

attitudes, values, feelings, goals, skills and/or roles …recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness."

Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990’s. Psychosocial Rehabilitation Journal, 16(4), 11-23.

• In 1999, the Ohio Department of Mental Health defined recovery as…“the process of overcoming the negative impact of a psychiatric disability despite its continued presence.”

• In 2012, SAMHSA defines Recovery for both mental health and alcohol and substance abuse as “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” SAMHSA (2012). Working Definition of Recovery.

EDUCATIONP

ets

Fam

ily

Friends

Work

EducationSexuality

Hea

lth

Spir

itual

ityHopes & Dreams

Values & Beliefs

Illness / Disability

Person

Hobbies

Com

munity

Recovery: What It Looks Like

Person prior to mental illness

EDUCATIONP

ets

Family

Friends

Work

Education

SexualityHea

lth

Spir

itual

ityHopes & Dreams

Values & Beliefs Mentally Ill

Hobbies

Com

munity

Person with mental illness

EDUCATIONM

ental Illn

ess

Fam

ily

Friends

Work

Education

SexualityHea

lth

Spir

itual

ity

Hopes & Dreams

Values & Beliefs Person

Hobbies

Com

munity

Recovery Process

Recovery: The Process

Four Major Dimensions that Support a Life in Recovery:

Home: a stable and safe place to live;

Health: overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing.

Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and

Community: relationships and social networks that provide support, friendship, love, and hope.

SAMHSA (2012). Working Definition of Recovery.

• Clinical care• Hope• Support• Work/meaningful activity• Empowerment• Community involvement• Access to resources• Education/knowledge• Self-esteem• Self-help• Spirituality• Physical health• Self-responsibility

• Self-directed• Individualized and

person-centered• Holistic• Strengths based• Growth oriented

Recovery: The ProcessFactors important to recovery:

Recovery: The ProcessGuiding Principles of Recovery:

•Recovery emerges from hope•Recovery is person-driven•Recovery occurs via many pathways•Recovery is holistic•Recovery is supported by peers and allies•Recovery is supported through relationship and social networks•Recovery is culturally-based and influenced•Recovery is supported by addressing trauma•Recovery involves individual, family, and community strengths and responsibility•Recovery is based on respect

SAMHSA (2012). Working Definition of Recovery.

Recovery: The Result

Overview of Peer Support

What is Peer Support

• Grew out of early advocacy efforts (history)

• “Relationships built and nurtured through shared experiences. People who have liked experiences can better relate and can consequently offer more empathy and validation.” (Sherry Mead)

Purpose of Peer Support

• Advocacy

• To utilize shared experiences as a means to connect with and foster the recovery of other individuals with a mental illness

• To engage consumers who otherwise may not be willing to receive services

• To provide a more relaxed relationship

• To compliment clinical services

Evidence: Effectiveness of Support

• Peer support and peer provided services are considered “promising practices”

• Peers do as well as non-peers on most outcomes (no significant differences)

• ACT teams with peer specialists have experienced better outcomes

• Working as a consumer provider fosters empowerment, self-esteem, and a shift in meaning and purpose

Matching Support to Stages of Recovery

Stages of RecoveryDependent/Unaware

(Hope)

Consumer relies on others and is not aware of his/her own status or needs.

Dependent/Aware

(Empowerment)

Consumer relies on others but is aware of his/her status and needs.

Independent/Aware

(Self-Responsibility)

Consumer relies on self and is aware of his/her status and needs.

Interdependent/Aware

(Meaningful Role)

Consumer relies on self and others in a mutual exchange of beneficial support, services and resources.

ODMH (1999) Emerging Best Practices in Mental Health Recovery. Stages in parenthesis are from the Village Integrated Services, Inc.; Long Beach. CA

Hope

Peer Support:

• Peer support is informal• Interactions typically occur in treatment settings

• The result of being at the same place at the same time)

• Focus is often on mental illness rather than recovery

• Clinical and family support is often as important as peer support at this stage

Empowerment

Provider Services:

• Case management• Medical somatic• EBPs• Day/Psychosocial programs

• Skills development (basic)• IMR• Peer support• 12-step programs

Focus on stability and helping consumers gain independence (do “with” instead of “for”).

Peer Support:• Becomes more formal

– Often occurs at agencies/hospitals

– day programs, groups, peer-to-peer classes

• Focus begins to shift from mental illness to advocacy and recovery

• While clinical support is still critical in this stage, peer support takes on increasing importance

Self Responsibility

Provider Services:

• Reduced medical somatic• Transition out of case

management• Therapy • Vocational services• Supported

housing/education• Transition out of

day/psychosocial programs

Focus on self-esteem and continued empowerment

Peer Support:

• Peer Support takes on an equal, if not more important role as clinical support.

• Peer support is more likely to occur outside the formal treatment environment.

• Peer support occurring in the community and is based on shared interest rather than illness.

• People in recovery begin to “give back”….they become volunteer or paid staff.

Meaningful Role

Provider Services:– Medical somatic only

services

– Safety net for other services should the need surface

Focus on utilization of natural supports and, for some, transition from mental health services.

Peer Support:

• Peer support occurs in the natural environment.

• At this point, some individuals “graduate” from the system and gain support though non-consumer relationships.

• If remaining a part of the consumer culture, individuals at this stage are the givers of support…they receive their support elsewhere.

• Providing support becomes a meaningful role!

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Hope Empowerment Self-Responsibility Meaningful Role

Impo

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Stages of recovery

Changes in Types of Peer Support Across Stages of Recovery

non-structured contact (hospital, agency) Tx program/groupspeer to peer (classes, support groups) self-help/natural support

Support That Hinders Recovery• Support that doesn’t match the needs and desires

of the individual

– e.g. providing peer-to-peer classes to a person who has acute clinical needs is far less effective than having a peer available for that individual to talk to.

• Support that doesn’t encourage and facilitate growth…that doesn’t help an individual establish and reach his/her goals

– e.g. doing things for a person that they are capable of doing for themselves, or learning to do for themselves.

Support That Hinders Recovery• Support that doesn’t end

– Avoid the Hotel California syndrome…• when peer support is no longer necessary and/or

beneficial, the person should be encouraged to transition to something else (i.e. natural supports in the community).

• Support that is controlling

– If the relationship is hierarchical, there’s a problem

• Support that is stigmatizing

– We can’t criticize mental health professionals and the community for stigmatizing those with a mental illness if we also do it!

Integrating Peer Support

“Recovery is the mending process that reweaves Human Beings back into the fabric of our society”

And…

Peer Support is a critical ingredient of recovery.

Environments with Peer Support

• Consumer-operated agencies

• Peer-run centers/programs

• Psychosocial and other programs/services at agencies

• ACT teams

• Hospitals, crisis centers, and emergency rooms

• Jails

Role of Peer Staff

• Foster hope and self-determination• Mentor/role model• Engage• Teach• Support• Advocate/Combat stigma• Serve on boards/committees• Research

Peer Support Competencies• Encouraging independence• Beliefs supporting recovery• Interpersonal skills• Peer-based program support• Understanding how peers cope• Advocacy• Legal rights and antidiscrimination• Training for work and family life

* Campbell, Dumont, and Einspahr, 1999

Challenges

• Dual roles (role confusion)

• Loss of own support system

• Illness/symptoms

• Inadequate training

• Boundaries

• Rural (one agency) communities

• Job titles

Challenges• Perceptions of other employees that peer staff

receive favorable treatment

• ADA (accommodations), extended illness/symptoms

• Employing consumers are providers without having a culture that supports recovery-oriented services

• Ethical standards for licensed professionals

• Supervision

Training for Peer Providers• Train the trainer method/Peer support specialists• Collaboration with community colleges• Recovery Centers• Organizational certification• Consultants/technical assistance centers

Peer services in Hamilton County• Recovery Center

• Mighty Vine Wellness Club

• Warmline

• Within treatment agencies (GCB, Core, Central Clinic, IKRON)

Activities at State & National Level

• Ohio Empowerment Coalition• COS Director’s Association (OCOSA)• Medicaid billable peer services

– Medicaid elevation– Currently 29 states have Medicaid billable peer

services….Ohio is trying to become the 30th

– National Standards being developed– National Credentialing being considered

Resources• Pathways to Recovery• Wellness Recovery Action Plan (WRAP)• Wellness, Management & Recovery (WMR)• Peer Support Specialists training• Self-determination series• DBSA (dbsa.org)• www.mentalhealthpeers.com• National Association for Peer Specialist www.naops.org• The Institute for Recovery and Community Integration

www.mhrecovery.org

Renee Kopache, reneek@hamilton.mhrsb.state.oh.us

Q&A and Contact Info.