azpa carefree conference 2015 - empowering people for recovery

Empowering People for Recovery

DAVID COVINGTON, LPC, MBA—RECOVERY INNOVATIONS, INC.

http://davidwcovington.com

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In mental health, it all starts with peer voice & inclusion in system design and leadership

Key to Person-Centered Care

Polling Question #1Which of the following best characterizes your agency approach to patients (peers)?

Stage 1 - We do services to peopleStage 2 - We do services for peopleStage 3 - We do services with peopleStage 4 – In addition to clinical/medical staff, we have a few peer leaders and/or ancillary peer supports servicesStage 5 - We have a peer driven system of care, where peers represent more than 25% of staff

What Have We Learned

A Mind That Found Itself1908

Clifford Beers

Galvanized the mental hygiene reform movement and founded the organization that would later become Mental Health America, which led to systematic reforms and continuous advocacy presence

The First Support Groups1935

Alcoholics Anonymous

The 12-Step program of substance recovery founded in the early ‘30s provided a demonstration of the power of self-help and support from a “peer” although the “peer” was called a “sponsor.” There is evidence Native Americans were doing something of the same as early as 1772.

First Clubhouse Model1973

John Beard (Fountain House) in New York revolutionized the old “day treatment” programs to a new approach where those served were “members” and not “patients,” and given meaningful roles in the clubhouse and community.

“On Our Own” Published1978

Judi Chamberlin

“There are real indignities and real problems when all

facets of life are controlled—when to get up, to eat, to

shower—and chemicals are put inside our bodies against

our will”

Judi Chamberlin

From Privileges to Rights2000

Judi Chamberlin

National Council on Disabilities Report“Patient privileges, such as the ability to wear their own clothes, leave the confines of psychiatric facility, or receive visitors, should instead be regarded as basic rights”

Center for Psychiatric Rehab

1979

William Anthony & Boston University

“There is a revolution brewing in the field of severe mental illness… It is a revolution in vision – in what is believed to be possible… It will be up to consumers and family members to lead this [recovery].”In 1973, 13 leaders formed Psychiatric Rehabilitation Association (PRA)

WRAP1997

Mary Ellen Copeland

First structured tool for self-help for individuals with mental health challenges. The key concepts of WRAP (hope, personal responsibility, education, self-advocacy, and support) laid the foundation for self-help recovery.

Polling Question #2The Americans with Disabilities Act gives civil rights protections and guarantees equal opportunity in public accommodations, employment, transportation, government services, and telecommunications. The ADA also applies to Mental Health.

A. TrueB. False

Olmstead Decision1999

On June 22, 1999, the US Supreme Court held that unjustified segregation of persons with disabilities constitutes discrimination in violation of the Americans with Disabilities Act and stated that people with psychiatric disabilities are legally entitled to live in communities of their choosing

Lois Curtis

1997

Cemetery Projects

Peer Support as Science1999

Surgeon General’s Report on Mental HealthIntroduced “self-help groups” and peer supports as an emerging evidence based practice and chronicled the history of the recovery movement

Medicaid-billable Service1999-2001

Georgia’s Wendy Tiegreen & Larry Fricks

Georgia was the first state to have peer supports approved by CMS (Arizona followed the next year) and laid the ground work for a national sea change with more than 20 states following suit. Recovery Innovations began using the phrase “Peer Support Specialist” in 1999.

CMS Guidelines2007

2008

Don BerwickWhat ‘Patient-Centered’ Should Mean: Confessions Of An Extremist

Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

WELL & WHAM2012

In 2001, Recovery Innovations married peer support with education by creating WELL (Wellness and Empowerment in Life and Living) as a new self-help approach to the former case management approach of compliance and monitoring of “activities of daily living.”

In 2012, the Center for Integrated Health Solutions (SAMHSA/HRSA) created WHAM (Whole Health Action Management)

2-day, in person peer support training

Set whole health and resiliency goals

10 Health and Resiliency Factors

2001

Suicide Attempt Survivors2013

Policy decisions related to the suicide prevention field have historically been made by three groups: researchers, clinicians and family members of those who died by suicide.

There have been hundreds of support groups nationally for those bereaved by suicide but few examples of similar peer opportunities for those struggling with suicide.

In 2014, a National Action Alliance for Suicide Prevention Task Force will publish “Activating Hope” (provisional title) that will challenge these norms.Eduardo Vega &

John Draper

The Gift of Peer Support

Polling Question #3Which of the following best characterizes research surrounding peer services?

A. Peer supports found less effective than non-peer professional counterparts

B. Equally effectiveC. More effectiveD. There have not been credible studies

Focus of Research

ABIL’s Phil Pangrazio

“[In our movement] we don’t have a token seat at the table. We lead the table.”

Phil Pangrazio

“Revolutions begin when people who are defined as

problems achieve the power to redefine the problem”

John McKnight

Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

The Gift of Peer Support

There is a sense of gratitude that is manifested in compassion and

commitment.

The Gift of Peer Support

There is insight into the experience of internalized stigma.

Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

The Gift of Peer Support

Peer specialists take away the “you do not know what it’s like” excuse.

Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

The Gift of Peer Support

They have had the experience of moving from hopelessness to hope.

Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

The Gift of Peer Support

They are in a unique position to develop a relationship of trust with

their peers.

Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

The Gift of Peer Support

The gift is circular and fosters recovery by affirming the ability of peers to play meaningfully roles in

other people's live and society.

Courtesy of Eduardo Vega (MHA of San Francisco)

Peer Driven Systems by Next Tuesday

Peer-Driven System

Recovery Empowerment Continuum Characteristics Perspective Level 1 Level 2 Level 3 Level 4 Level 5

 Traditional Psychosocial Rehabilitation

Philosophy/ContinuumPeer-Driven

CarePeer-Driven

SystemMotto Done to Done for Done with Done by

Characteristics

Clinical team identifies goals and develops service plans.

Compliance with directives is focal point activities.

Strong dependence on

system & artificial (paid)

supports with no individual risk

taking or family engagement.

Genuine voice and

participation with some support for

individual risk taking &

engagement in natural

supports.

Self-directed care is a core value

with peers holding some

leadership and advocacy

positions within the system.

Many roles in the system are filled by peers,

including workforce,

governance, etc. Not a token

gesture.

Core ValueClinically sound

professional services & stability

Safety and security with a goal of stability

Personal recovery through

collaboration

Personal recovery through self-directed care

Culture change through peer leaders and

staffing

Person(s) Compliant Dependent Respected (Voice) Leader Empowered

Subservient Institutionalized Involved Advocate LeadersStaff Member

Prescriptive Caretaker Partner Consultant PeersDirective Protector Guide Support Advocate

Organization

Clinically driven Protective Collaborative Recovery driven Peer-driven Provider is expert Risk Averse Engaging Person is expert Peer-staffed

Risk Taking Discouraged Blocked Supported Encouraged Expected

1950

Compliance/Directive

1980Dependent/Care Taker

2010Voice & Participation

PresentAction & LeadershipFuture

Peer-Driven System

Polling Question #4Which of the following are reasons a CBHC peer staff member should be terminated?

A. Sleeping with a clientB. Not showing up to work the first dayC. Stealing from the organizationD. Being re-hospitalized for mental

healthE. Reporting hearing active

hallucinatory voices

Recovery Innovations’ Education Center1. Organizational commitment2. Quality training prior to employment3. Recovery training for all staff Supervisor

and leadership training4. Job-specific peer support roles5. “Tipping point” with critical mass of peer

support workers

Courtesy of Recovery Innovations & Gene Johnson

Recovery Innovations’ Education Center6. Develop career ladder to the peer

support discipline7. Parity for peer support workers;

supervision and support, performance expectations, pay, promotion, ethics

8. Remember, it’s real work, not sheltered work or therapy

Courtesy of Recovery Innovations & Gene Johnson

Peers Make a Difference. If she can do it, then so can I!

Three Forces

Psychiatric Inpatient Asylums

Stag

e 1

Primary Era: 1800 - 1972

Community Mental Health Centers

Stag

e 2

Primary Era: 1963 - present

Psychiatric Rehabilitation

Stag

e 3

Primary Era: 2000 - present

Symbolic Peer Leadership

Stag

e 4

Primary Era: 2010 - present

Peer Driven Systems of Care

Stag

e 5

Primary Era: Emerging Innovation

Recovery Empowerment Continuum Characteristics Perspective Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

 Traditional Psychosocial Rehabilitation

Philosophy/ContinuumPeer-Driven

CarePeer-Driven

SystemMotto Done to Done for Done with Done by

Characteristics

Clinical team identifies goals and develops service plans.

Compliance with directives is focal point activities.

Strong dependence on

system & artificial (paid)

supports with no individual risk

taking or family engagement.

Genuine voice and

participation with some support for

individual risk taking &

engagement in natural

supports.

Self-directed care is a core value

with peers holding some

leadership and advocacy

positions within the system.

Many roles in the system are filled by peers,

including workforce,

governance, etc. Not a token

gesture.

Core ValueClinically sound

professional services & stability

Safety and security with a goal of stability

Personal recovery through

collaboration

Personal recovery through self-directed care

Culture change through peer leaders and

staffing

Person(s) Compliant Dependent Respected (Voice) Leader Empowered

Subservient Institutionalized Involved Advocate LeadersStaff Member

Prescriptive Caretaker Partner Consultant PeersDirective Protector Guide Support Advocate

Organization

Clinically driven Protective Collaborative Recovery driven Peer-driven Provider is expert Risk Averse Engaging Person is expert Peer-staffed

Risk Taking Discouraged Blocked Supported Encouraged Expected

1950

Compliance/Directive

1980Dependent/Care Taker

2010Voice & Participation

Present Action & LeadershipFuture

Peer-Driven System

Peer Leadership & Workforce

Welcoming Environments

Recovery Coaching/Values1. Organizational

commitment2. Quality training pre-

employment3. Recovery training for

all staff 4. Job-specific peer

support roles6. “Tipping point” critical

mass 7. Develop career ladder 8. Parity for peer workers9. Remember, it’s real

work, not sheltered work or therapy

Traditional Language Recovery/Opportunity

Consumer Guest

Sub-acute Psych Inpatient Living Room

23 Hour Observation Retreat

24/7 Crisis Walk-in Front Lobby

Crisis Center Recovery Response Center

Crisis Opportunity

Intake Recovery Partnership

Assessment Getting to Know Each Other

Psychosocial History Telling My Story

Treatment Plan Recovery Solutions

Recovery Language

Polling Question #2The Americans with Disabilities Act gives civil rights protections and guarantees equal opportunity in public accommodations, employment, transportation, government services, and telecommunications. The ADA also applies to Mental Health.

A. TrueB. False

New Civil Rights Struggle“We stand on the doorstep to make momentous progress in

advancing the cause of this new civil rights struggle started by the work of President Kennedy

over 50 years ago.”

DEC’s Phil Pangrazio

“[In the disability empowerment movement] we don’t have a token seat at the

table. We lead the table.”

Contact Us CEO & President David.Covington@recoveryinnovations.org

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