The Role of Peer-to-Peer Services: Facilitating Personal Growth

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The Role of Peer-to-Peer Services Facilitating
Personal GrowthAdvancing Recovery
Reneé Kopache Hamilton County Mental Health and
Recovery Services Board Angela
Ostholthoff Recovery Center of Hamilton
County March 28, 2008
Cincinnati VA Medical Center and Northern
Kentucky University
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Agenda

• Overview of peer support
• Matching services peer support to stages of
  recovery
• Integrating peer support
• The lived experience

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What is Peer Support

• 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)
• Grew out of early advocacy efforts (history)

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Purpose of Peer Support

• Strengthen advocacy
• To utilize shared experiences as a means to
  foster the recovery of other individuals with a
  mental illness
• Engage consumers who otherwise may not be willing
  to receive services
• To provide a more relaxed relationship
• Advance recovery

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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

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

• Provider Agency
• Acute, intense clinical services
• Case management
• Medical somatic
• Focus on increasing the consumers level of
  awareness regarding illness, health, basic needs,
  and medications. Connect to/provide services to
  address basic needs.

• Consumer Agency/ Community Supports
• When appropriate, involve family in treatment.

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Empowerment

• Clinical services emphasizing stability
• 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).

• Consumer Agency/ Community Supports
• Continue family involvement
• Introduce peer support

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Self Responsibility

• Clinical services emphasizing growth
• 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

• Consumer Agency/ Community Supports
• Add social/community support to family support
• Peer support shifts to consumer-operated agencies
  
• Recovery groups
• Self-help/peer support groups
• Education (formal/informal)
• Advanced Skill Development (computer training,
  resume writing, serving on committees/ boards,
  etc.)
• May work as peer supporter in agency or in a job
  in the community
• May advance formal education

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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.

• Consumer Agency/ Community Supports
• Employed as peer supporters and/or transition
  from peer support at consumer agency to natural
  supports in the community
• Fulfilling a meaningful role in community
  (employment, volunteer, neighbor, friend, clubs,
  etc).

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Matching Peer Support to Stages of Recovery
What Helps When and How?
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Hope

• Peer support is informal
• Interactions 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

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Empowerment

• 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

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Self Responsibility

• Peer Support takes on an equal, if not more
  important role than clinical and/or family
  support.
• Peer support is more likely to occur outside the
  formal treatment environment
• People in recovery begin to give back.they
  become volunteer or paid staff.
• Peer support begins to occur in the community
  rather than the mental health system.

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Meaningful Role

• Peer support occurs in the natural environment.
• At this point, some individuals graduate from
  the system and seek support though non-consumer
  relationships.
• If remaining a part of the consumer culture,
  individuals at this stage are the givers of
  supportthey receive their support elsewhere.
• Providing support becomes a meaningful role!

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Support that Hinders Recovery

• Support that doesnt 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 doesnt encourage and facilitate
  growththat doesnt 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.

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Support that Hinders Recovery

• Support that doesnt 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, theres a
  problem
• Support that is stigmatizing
• We cant criticize mental health professionals
  and the community for stigmatizing those with a
  mental illness if we also do it!

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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.
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Environments with Peer Support

• Consumer-operated agencies
• Peer-run agencies/programs
• Psychosocial and other programs/services at
  agencies
• ACT teams
• Hospitals, crisis centers and emergency rooms
• Jails

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Role of Consumer Staff

• Foster hope and self-determination
• Mentor/role model
• Engage
• Teach
• Support
• Research
• Combat stigma

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Training for Peer Providers

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

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Challenges

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

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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

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The Lived Experience

• Coe
• Susan
• Angela

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Resources

• Pathways to Recovery
• BRIDGES
• WRAP
• Wellness, Management Recovery
• 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

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QA and Contact Info.

• Renee Kopache
• reneek_at_hamilton.mhrsb.state.oh.us
• www.mhrecovery.com
• Angela Ostholthoff
• aostholthoff_at_gcbhs.com
• www.recoverycenterhc.org
• This presentation will be available online
• http//mhrecovery.com/presentations.htm