1. University of Cincinnati School of Social Work Mental Health Policy October 23, 2012 Recovery & Peer Supported Services Reneé Kopache ~ Mental Health & Recovery Services Board

2. 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

3. Overview of Recovery

4. 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.

5. EDUCATION Pets Family Friends Work Education Sexuality Health Spirituality Hopes & Dreams Values & Beliefs Illness / Disability Person Hobbies Community Recovery: What It Looks Like Person prior to mental illness

6. EDUCATION Pets Family Friends Work Education Sexuality Health Spirituality Hopes & Dreams Values & Beliefs Mentally Ill Hobbies Community Person with mental illness

7. EDUCATION Mental Illness Family Friends Work Education Sexuality Health Spiritualit y Hopes & Dreams Values & Beliefs Person Hobbies Community Recovery Process

8. 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.

9. 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 Process Factors important to recovery:

10. Recovery: The Process Guiding 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.

11. Recovery: The Result

12. Overview of Peer Support

13. 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)

14. 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

15. 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

16. Matching Support to Stages of Recovery

17. Stages of Recovery Dependent/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

18. 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

19. 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

20. 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.

21. 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!

23. 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.

24. 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!

25. 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.

26. 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

27. Role of Peer Staff Foster hope and self-determination Mentor/role model Engage Teach Support Advocate/Combat stigma Serve on boards/committees Research

28. 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

29. Challenges Dual roles (role confusion) Loss of own support system Illness/symptoms Inadequate training Boundaries Rural (one agency) communities Job titles

30. 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

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

32. Peer services in Hamilton County Recovery Center Mighty Vine Wellness Club Warmline Within treatment agencies (GCB, Core, Central Clinic, IKRON)

33. 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 30 th – National Standards being developed – National Credentialing being considered

34. 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

35. Renee Kopache, reneek@hamilton.mhrsb.state.oh.us Q&A and Contact Info.