Consumers as Service Providers: Relevance to ACT

8/9/2019 Consumers as Service Providers: Relevance to ACT

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Consumers as ServiceConsumers as Service

Providers: Relevance to ACTProviders: Relevance to ACT

Phyllis Solomon, Ph.D.Phyllis Solomon, Ph.D.

ProfessorProfessor

School of Social Policy & PracticeSchool of Social Policy & Practice

University of PennsylvaniaUniversity of Pennsylvania


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Outline of PresentationOutline of Presentation

IntroductionIntroduction

Definitions & Examples of Consumer Providers,Definitions & Examples of Consumer Providers,including as ACT team memberincluding as ACT team member

Theoretical & Historical baseTheoretical & Historical baseSummary of the EvidenceSummary of the Evidence

Impact of COS on consumer outcomesImpact of COS on consumer outcomes

Value of consumer providersValue of consumer providers

ChallengesChallengesStrategies for hiring consumer providersStrategies for hiring consumer providers

Consistency with RecoveryConsistency with Recovery


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IntroductionIntroduction

Currently interest in Consumer OperatedCurrently interest in Consumer Operated

Services (COS) very high internationallyServices (COS) very high internationally

US. Presidents New Freedom CommissionUS. Presidents New Freedom Commission

report in 2002 put spotlight on COSreport in 2002 put spotlight on COS

Recovery orientation internationally significantRecovery orientation internationally significant--

Canada, Scotland, England, AustraliaCanada, Scotland, England, Australia to nameto name

a fewa fewConsumer providers means to translateConsumer providers means to translate

recovery orientation into service deliveryrecovery orientation into service delivery


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What are ConsumerOperatedWhat are ConsumerOperated

Services (COS)?Services (COS)?

Services planned, operated, administered, &Services planned, operated, administered, &

evaluated by indivs. w/ mental illnessevaluated by indivs. w/ mental illness

Indivs. ID as consumersIndivs. ID as consumers

Administration & primary activities independentAdministration & primary activities independent

of mh provider orgs.of mh provider orgs.

Consumers control Board of Directors, staff, &Consumers control Board of Directors, staff, &

budgetbudget

Self contained programsSelf contained programs


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Example of COSExample of COS -- BRIDGESBRIDGES

BRIDGES of Tenn (Building Recovery of IndividualBRIDGES of Tenn (Building Recovery of IndividualDreams and Goals through Education and Support)Dreams and Goals through Education and Support)

Decade oldDecade old

Started by a federal grantStarted by a federal grantEducation program to help otherpeers establish &Education program to help otherpeers establish &maintain wellness & recoverymaintain wellness & recovery

Involves education about illness, role modeling,Involves education about illness, role modeling,using personal experiences & standard manual forusing personal experiences & standard manual for

imparting educational materialimparting educational material 15 week course15 week course --2hr2hrclassclass

Replicated in other states & CanadaReplicated in other states & Canada


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What are ConsumerWhat are Consumer

Partnerships?Partnerships?

Services provided by consumersServices provided by consumers

Self contained programsSelf contained programsConsumers self identify as having mentalConsumers self identify as having mental

illnessillness

Administration, budgeting shared by nonAdministration, budgeting shared by non--consumersconsumers

Control shared w/ nonControl shared w/ non--consumersconsumers


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Example of Peer PartnershipExample of Peer Partnership

Friends ConnectionFriends Connection

Promotes recovery from dual diagnosisPromotes recovery from dual diagnosis

Program of local MH Assoc.Program of local MH Assoc.

Started in response to closing of localStarted in response to closing of localstate hospitalstate hospital

Provides peerProvides peer--toto--peer support, sponsorspeer support, sponsors

group social activities, & alumni programgroup social activities, & alumni programClients are in intensive case managementClients are in intensive case management

& referred often by case manager& referred often by case manager


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Consumers as EmployeesConsumers as Employees

Individuals who self identify as consumerIndividuals who self identify as consumer& hired in designated consumer position or& hired in designated consumer position ortraditional MH positiontraditional MH position

Designated consumer positionsDesignated consumer positions peerpeerspecialists, case manager aids, peerspecialists, case manager aids, peer

advocates, peer companions, etc.advocates, peer companions, etc.

ProsumerProsumer consumer & MH professionalconsumer & MH professional


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Consumers as EmployeesConsumers as Employees

Existing jobs such as case managersExisting jobs such as case managers

Adjunctive jobs like case manager aidsAdjunctive jobs like case manager aids

Hired as ACT team membersHired as ACT team membersA number of community mental healthA number of community mental health

agencies hire consumersagencies hire consumers


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Consumers as ACT TeamConsumers as ACT Team

MembersMembersLogical context for consumerLogical context for consumer--professionalprofessionalcollaborationcollaboration Multidisciplinary teamMultidisciplinary team

Strong outreach componentStrong outreach componentProgram standards for ACT teams in OntarioProgram standards for ACT teams in OntarioCanada require minimum 1 FTE paid staff asCanada require minimum 1 FTE paid staff aspeer support workerpeer support worker

Must be paid commensurate with other staffMust be paid commensurate with other staffPeers with experience can be hired in otherPeers with experience can be hired in otherteam positions & paid at professional rateteam positions & paid at professional rate


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MembersMembersPeers provide experience not replicated byPeers provide experience not replicated byprofessional trainingprofessional training

Fully integrated in team & generalist roleFully integrated in team & generalist role

Individualized services & promote selfIndividualized services & promote selfdetermination & decisiondetermination & decision--makingmaking

Expertise & consultation to team toExpertise & consultation to team to

promote culture clients point of view &promote culture clients point of view &preferences recognized, understood, &preferences recognized, understood, &respectedrespected (Ontario Ministry of Health, 2005)(Ontario Ministry of Health, 2005)


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MembersMembersPeer Support Services serve toPeer Support Services serve to

promote active participation of client inpromote active participation of client in

service planningservice planning

validate clients experiencesvalidate clients experiences

Guide & encourage clients to takeGuide & encourage clients to take

responsibility for & participate in own recoveryresponsibility for & participate in own recovery

Help to combat stigma & discriminationHelp to combat stigma & discrimination Help to develop strategies to reduce selfHelp to develop strategies to reduce self--

imposed stigmaimposed stigma (Ontario Ministry of Health, 2005)(Ontario Ministry of Health, 2005)


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MembersMembersPeer Support Services include:Peer Support Services include:

judicious selfjudicious self--disclosure & sharing lifedisclosure & sharing lifeexperiences to serve as mentor & role modelexperiences to serve as mentor & role model

Assist clients to recognize & develop copingAssist clients to recognize & develop copingmechanisms to deal with symptoms & socialmechanisms to deal with symptoms & socialstigmastigma

Educate team regarding consumerEducate team regarding consumer

perspective on mental health system & toperspective on mental health system & tomaintain clientmaintain client--centered approach maximizingcentered approach maximizingclient participation & empowermentclient participation & empowerment


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MembersMembers-- advocating for development ofadvocating for development of

consumer initiatives in community &consumer initiatives in community &

identifying opportunities for clientidentifying opportunities for client

empowermentempowerment

-- introducing & referring clients tointroducing & referring clients to

consumer selfconsumer self--help programs &help programs &

advocacy organizations that promoteadvocacy organizations that promoterecoveryrecovery (Ontario Ministry of Health, 2005)(Ontario Ministry of Health, 2005)


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MembersMembersConsumers powerful effect on nonConsumers powerful effect on non--

consumer providersconsumer providers changing nature ofchanging nature of

team meetings & serving to humanizeteam meetings & serving to humanize

team by introducing their perspectiveteam by introducing their perspective(Solomon & Draine, 1998; Salyers & Tsembris, 2007)(Solomon & Draine, 1998; Salyers & Tsembris, 2007)

Inclusion of consumer providers on ACTInclusion of consumer providers on ACT

natural way to enhance recoverynatural way to enhance recovery--orientationorientation


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Survey of ACT Providers in OntarioSurvey of ACT Providers in Ontario

Key findingsKey findings

personal experience most important qualificationpersonal experience most important qualification

Constraints not being accepted by hospital staff, notConstraints not being accepted by hospital staff, notbeing seen as credible by staff outside teambeing seen as credible by staff outside team

Some variation in roles & degree of integration ofSome variation in roles & degree of integration ofconsumers, consumer generally well incorporated intoconsumers, consumer generally well incorporated intoteam with equal or better job satisfaction compared toteam with equal or better job satisfaction compared to

other staffother staff

(Whie, Whelan, Barnes & Baskerville, 2003)(Whie, Whelan, Barnes & Baskerville, 2003)


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Peer SpecialistsPeer Specialists

Peer SpecialistsPeer Specialists current or formercurrent or former

recipients of mh services who provide directrecipients of mh services who provide direct

services to consumers in emergency, outpt,services to consumers in emergency, outpt,

inpt settings. Perform a range of tasksinpt settings. Perform a range of tasksdesigned to assist consumers in regainingdesigned to assist consumers in regaining

control over own lives & control over theircontrol over own lives & control over their

recovery processes. Model competence &recovery processes. Model competence &

possibility of recovery. Assist consumer inpossibility of recovery. Assist consumer indeveloping perspective & skills that facilitatedeveloping perspective & skills that facilitate

recovery. Have taken training & certifiedrecovery. Have taken training & certified


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Peer SpecialistsPeer Specialists

Requirements of Peer SpecialistRequirements of Peer Specialist

High school degree or equivalentHigh school degree or equivalent

Current or former recipient of servicesCurrent or former recipient of services

Experience, e.g., 1 year advocacy exp.,Experience, e.g., 1 year advocacy exp.,demonstrate effort at selfdemonstrate effort at self--directed recoverydirected recovery

Skills & knowledgeSkills & knowledge-- verbal & written skills, goodverbal & written skills, good

interpersonal skills, good problem solving skills,interpersonal skills, good problem solving skills,

basic knowledge of community supports, state &basic knowledge of community supports, state &federal benefitsfederal benefits


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Peer Specialist TrainingPeer Specialist Training

Georgia trainingGeorgia training -- 8 days8 days Training to assist consumer in skill building, goalTraining to assist consumer in skill building, goal

setting, problem solving, conducting Recoverysetting, problem solving, conducting RecoveryDialogue, setting up & sustaining mutual self helpDialogue, setting up & sustaining mutual self help

groups, assist consumersgroups, assist consumers Medicaid reimbursableMedicaid reimbursable

Depression & Bipolar Support AllianceDepression & Bipolar Support Alliance provide 5provide 5--day trning nationallyday trning nationally

Topics include: role ofpeer support in recovery,Topics include: role ofpeer support in recovery,problem solving; effective listening & art ofproblem solving; effective listening & art ofasking questions; combating negative self talk;asking questions; combating negative self talk;power, conflict & integrity in workplacepower, conflict & integrity in workplace


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Peer Specialist TrainingPeer Specialist Training

Number of Peer Specialist TrainingNumber of Peer Specialist TrainingPrograms in existencePrograms in existence

META Arizona (now Recovery Innovations,META Arizona (now Recovery Innovations,

Inc) does national trainingInc) does national training Philadelphia recently started trningPhiladelphia recently started trning

National org.National org. Peer Specialists Alliance ofPeer Specialists Alliance ofAmericaAmerica formed as National Associationformed as National Associationof Peer Specialist in 2006of Peer Specialist in 2006


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Self HelpSelf Help-- Mutual Support GroupsMutual Support Groups

Self help groups different from COSSelf help groups different from COS Peer support services not same peer involved servicesPeer support services not same peer involved services

Voluntary small group structures for mutual aid formedVoluntary small group structures for mutual aid formedby peers to satisfy common need, overcoming commonby peers to satisfy common need, overcoming common

handicap or disrupting problem, or bring about desiredhandicap or disrupting problem, or bring about desired&/or personal change&/or personal change FaceFace--toto--FaceFace

Internet Support ServicesInternet Support Services

Offer hope, information, & opportunity to help each otherOffer hope, information, & opportunity to help each other

Share some features in common as Peer SupportShare some features in common as Peer SupportServicesServices


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Theoretical Basis for ConsumerTheoretical Basis for Consumer

ProvidersProviders

Emotional supportEmotional support demonstrating &demonstrating &

communicating acceptance & approvalcommunicating acceptance & approval

Experiential learning or reciprocal learningExperiential learning or reciprocal learningprocessprocess provided specialized informationprovided specialized information

& perspective& perspective

Social learning theorySocial learning theory competent rolecompetent role

modelsmodels-- learning through active exampleslearning through active examples


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Theoretical Basis For ConsumerTheoretical Basis For Consumer

ProvidersProviders

Social comparison theorySocial comparison theory UpwardUpward

comparisoncomparison hope & incentive;hope & incentive;

DownwardDownward things could be worsethings could be worse

HelperHelper--therapy principletherapy principle helping others,helping others,

helps oneselfhelps oneself


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Historical Roots of ConsumerHistorical Roots of Consumer

ProvidersProviders

Early 20Early 20thth Century Clifford Beers promotedCentury Clifford Beers promotedconsumer advocacy voiceconsumer advocacy voice started MHstarted MHAssociationAssociation

1940s1940s self help group of dischargedself help group of dischargedpsychiatric patient started Fountain Housepsychiatric patient started Fountain House psychosocial rehab centerpsychosocial rehab center

Otherpsychosocial rehab centers promotedOtherpsychosocial rehab centers promotedconsumer empowermentconsumer empowerment


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Historical Roots of ConsumerHistorical Roots of Consumer

ProvidersProviders

1970s expatient movement1970s expatient movement consumer developedconsumer developedalternatives like dropalternatives like drop--in centers, crash pads;in centers, crash pads;consciousness raising support groupsconsciousness raising support groups AntiAnti--psychiatry movementpsychiatry movement

Late 1970sLate 1970s Community Support Program FederalCommunity Support Program Federalprogram promoted development of COS throughprogram promoted development of COS throughgrant programgrant program

Some states supported development of COS throughSome states supported development of COS throughgrantsgrants

Currently most states dept of MH have ConsumerCurrently most states dept of MH have ConsumerAffairs directorpositionAffairs directorposition


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Anecdotal Data on COSAnecdotal Data on COS

EnvironmentsEnvironments

NonNon--threatening environmentthreatening environment

Minimal disclosure ofpersonal informationMinimal disclosure ofpersonal information

Accept services at own paceAccept services at own pace

Engender feelings of safetyEngender feelings of safety

Greater ability to engage consumersGreater ability to engage consumers difficult & resistant to txdifficult & resistant to tx


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Critical Ingredients ofCritical Ingredients of

ConsumerConsumer--Operated Services (COS)Operated Services (COS)

National study of experts using modifiedNational study of experts using modifiedDelphi methodDelphi method

StructureStructure Emphasizing value of consumerismEmphasizing value of consumerism

Consumer involvement in operation & decisionConsumer involvement in operation & decision--makingmaking

ProcessProcess Belief SystemsBelief SystemsEmphasizing recovery & empowermentEmphasizing recovery & empowerment

ProcessProcess Social SupportSocial SupportEmphasizing sense of belonging, friendship,Emphasizing sense of belonging, friendship,giving receivinggiving receiving helperprinciplehelperprinciple

(Holter, et al., 2004(Holter, et al., 2004))


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Summary of the EvidenceSummary of the Evidence

Early studies demonstrated consumerEarly studies demonstrated consumercapabilitycapability

No detrimental effects from consumerNo detrimental effects from consumer

providing serviceproviding serviceNo detrimental effects to consumersNo detrimental effects to consumersproviding servicesproviding services

Limited researchLimited research most descriptive studies,most descriptive studies,

few RCTsfew RCTsSometimes difficult to distinguish COS fromSometimes difficult to distinguish COS fromConsumer PartnershipConsumer Partnership


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COS/Consumer Partnership Marginally moreCOS/Consumer Partnership Marginally moreeffectiveeffective

Generally as effective as nonGenerally as effective as non--consumer inconsumer inproviding conventional servicesproviding conventional services

Consumer on team generally equivalentConsumer on team generally equivalentoutcomes for clients served as nonoutcomes for clients served as non--consumerconsumer

Some studies found more positive outcomes forSome studies found more positive outcomes forclientsclients -- fewer hospitalization, increasedfewer hospitalization, increased

empowerment, self efficacy, growth, & improvedempowerment, self efficacy, growth, & improvedquality of lifequality of life


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Some studies positive outcomes forSome studies positive outcomes for

systemssystems-- reducing costs, improvedreducing costs, improved

outreach & engagement, improvedoutreach & engagement, improved

provider attitudesprovider attitudes

Continue to show NO detrimental effectsContinue to show NO detrimental effects

Shows promiseShows promise Presidents NewPresidents New

Freedom Commission considers COSFreedom Commission considers COS

Emerging Best PracticeEmerging Best Practice


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Importance ofEvidence BasedImportance ofEvidence Based

Practice for Consumer ProvidersPractice for Consumer Providers

Credibility of servicesCredibility of services

Financial resourcesFinancial resourcesOrganizational supportOrganizational support

Stability of servicesStability of services

Sustainability as part of MH serviceSustainability as part of MH servicedelivery systemdelivery system


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Impact of COS Environment onImpact of COS Environment on

ConsumerOutcomesConsumerOutcomes

Greater involvement & control in COS greater gainsGreater involvement & control in COS greater gainsin personal empowerment & social functioningin personal empowerment & social functioning (Segal

& Silverman, 2002) increase in recovery (Corrigan, 2006

Greater use of COS greater increase in wellGreater use of COS greater increase in well--beingbeing(Teague, et al., 2005)(Teague, et al., 2005)

Greaterparticipation larger social network, impr. selfGreaterparticipation larger social network, impr. selfconcept, dec. hosp.concept, dec. hosp. (Corrigan, et al, 2005)(Corrigan, et al, 2005)

Attendance assoc. w/inc.Attendance assoc. w/inc. social functioningsocial functioning (Yanos, et al,(Yanos, et al,2001)2001)


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Impact of COS Environment onImpact of COS Environment on

ConsumerOutcomesConsumerOutcomes

Opportunities to participate in decisionsOpportunities to participate in decisionsabout care result in positive outcomes (about care result in positive outcomes (Segal &Segal &Silverman, 2002)Silverman, 2002)

Quality ofparticipation (meaningful involved)Quality ofparticipation (meaningful involved)result in short term positive outcomesresult in short term positive outcomes quality of life, daily activities, & communityquality of life, daily activities, & communityintegrationintegration (Nelson & Lomotey, 2006)(Nelson & Lomotey, 2006)

Environmental acceptance result in engagement ofEnvironmental acceptance result in engagement ofconsumers who dont want or have had negativeconsumers who dont want or have had negativeexperiences w/ conventional MH servicesexperiences w/ conventional MH services


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Value of Consumer Provided ServicesValue of Consumer Provided Services

ConsumerOperated ServicesConsumerOperated Services offer realoffer realvalue to consumersvalue to consumers

Offer hope, acceptance, insight & recoveryOffer hope, acceptance, insight & recovery

orientationorientationDemonstrate to professionals, families, &Demonstrate to professionals, families, &society capability of consumerssociety capability of consumers

Help to engage individuals that may notHelp to engage individuals that may not

otherwise be engaged but need services &otherwise be engaged but need services &supportssupports

Offering an accepting environmentOffering an accepting environment


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Value of Consumer ProvidersValue of Consumer Providers

Offer consumerperspectiveOffer consumerperspective

Engage other consumers at a personalEngage other consumers at a personal

levellevelHelp other consumers withHelp other consumers with

socialization & supportsocialization & support

Knowledgeable about diversity ofKnowledgeable about diversity ofhuman services & health systemshuman services & health systems

Offer successful coping strategiesOffer successful coping strategies


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Value of Consumer ProvidersValue of Consumer Providers

Offer coping & problem solving skillOffer coping & problem solving skill

developmentdevelopment

Offer role models for other consumersOffer role models for other consumersProviders see consumers in new rolesProviders see consumers in new roles

& as capable individuals& as capable individuals

Help to change providers attitudesHelp to change providers attitudesHelp to transform systemsHelp to transform systems

Help to combat discriminationHelp to combat discrimination


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Benefits to Consumer ProvidersBenefits to Consumer Providers

Work opportunityWork opportunity

Build a work resume & career trajectoryBuild a work resume & career trajectory

Personal growthPersonal growth-- assume responsibility &assume responsibility &increase awareness of own capabilitiesincrease awareness of own capabilities

Learn time management skillsLearn time management skills

Socialization into world of workSocialization into world of work


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Challenges to Professionals ofChallenges to Professionals of

Consumer ProvidersConsumer Providers

Professional attitudesProfessional attitudes

Believing in capabilities of consumersBelieving in capabilities of consumers

Paternalistic attitudesPaternalistic attitudes fear of stressfear of stress

Easier to change heads than heartsEasier to change heads than hearts

Georgia experienceGeorgia experience

Boundary issuesBoundary issues

Concerns of violation of confidentialityConcerns of violation of confidentiality

Concerns about dual relationshipConcerns about dual relationship


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Challenges to Professionals ofChallenges to Professionals of

Consumer ProvidersConsumer Providers

Role conflictsRole conflicts

Power struggles between peer providers &Power struggles between peer providers &

professionalsprofessionals

Balancing peer status with professionalBalancing peer status with professional

identityidentity

Require special accommodationsRequire special accommodations


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Challenges to Consumers as ProvidersChallenges to Consumers as Providers

Having to cope with dual roleHaving to cope with dual role

Peers do not want to receive services fromPeers do not want to receive services from

other peersother peersSocialize consumers to professionalSocialize consumers to professional

beliefs & rolesbeliefs & roles diminishing uniquediminishing unique

perspectiveperspective


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Consumer Methods for Coping with DualConsumer Methods for Coping with Dual

RoleRole

Participating in support groupsParticipating in support groups

Following own treatment planFollowing own treatment plan

Being active in care of ones illness/selfBeing active in care of ones illness/self--monitoringmonitoring

Seeking support of supervisorSeeking support of supervisor

Attending trainingsAttending trainingsSeeking support from peers, friends,Seeking support from peers, friends,

family/using diverse support networkfamily/using diverse support network


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Challenges to Families RegardingChallenges to Families Regarding

Consumers as ProvidersConsumers as Providers

Lack of belief in capability of consumersLack of belief in capability of consumers

Paternalistic view of consumersPaternalistic view of consumers concernconcern

regarding stressregarding stressConcern that their relative receivingConcern that their relative receiving

lesser quality serviceslesser quality services

Too stressfulToo stressful


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Challenges to Hiring Peer WorkersChallenges to Hiring Peer Workers

Need to know how to involve peersNeed to know how to involve peers

How to support themHow to support them

How to resolve potential conflictsHow to resolve potential conflictsHow to weigh different perspectives ofHow to weigh different perspectives of

clinicians & peersclinicians & peers


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Workplace Strategies to Respond toWorkplace Strategies to Respond to

Problems & Promote IntegrationProblems & Promote Integration

Problem: Attitude toward RecoveryProblem: Attitude toward Recovery

Clear recovery position in mission statementClear recovery position in mission statement

Leadership commitment to recovery wellLeadership commitment to recovery well

communicatedcommunicated

Leadership to support recoveryLeadership to support recovery

Peer position viewed as essential rather thanPeer position viewed as essential rather than

an addan add--onon


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Problem: Role Conflict & ConfusionProblem: Role Conflict & Confusion

Well defined recruitment strategiesWell defined recruitment strategies

Consistent application of workplace policiesConsistent application of workplace policies

to peer & nonto peer & non--peer staffpeer staff

Written job descriptions for all staff includingWritten job descriptions for all staff including

peerspeers

Well developed qualifications, includingWell developed qualifications, includingexclusion criteria e.g., substance abuse,exclusion criteria e.g., substance abuse,

location of service receiptlocation of service receipt


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Problem: Role Conflict & ConfusionProblem: Role Conflict & Confusion

Supervision to ensure actual job expectationsSupervision to ensure actual job expectations

same as written job expectationssame as written job expectations

Training to staff & clients to provideTraining to staff & clients to provide

understanding of rolesunderstanding of roles

New employees receive formal orientationNew employees receive formal orientation


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Problem: Lack of ConfidentialityProblem: Lack of Confidentiality

Neutral job titles not disclosing peer statusNeutral job titles not disclosing peer status

Implement formal disclosure process forImplement formal disclosure process for

peerspeers

Keep previous treatment records of internallyKeep previous treatment records of internally

recruited peers in confidential filesrecruited peers in confidential files


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Problem: Lack of ConfidentialityProblem: Lack of Confidentiality

Do not allow peers to receive services in unitsDo not allow peers to receive services in units

where employedwhere employed

Training on policies & practices related toTraining on policies & practices related to

confidentialityconfidentiality

Establish formal process for sharing workEstablish formal process for sharing work--

related information between peer & nonrelated information between peer & non--peerpeerstaffstaff


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Problem: Job StructureProblem: Job Structure

Accepts experience in lieu of formalAccepts experience in lieu of formal

credentials a HR policycredentials a HR policy

Peer positions paramountPeer positions paramount

Peer positions balance professionalism &Peer positions balance professionalism &

consumer experimentalismconsumer experimentalism

Peer positions have clear path for promotionPeer positions have clear path for promotion


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Problem: Job StructureProblem: Job Structure

Apply same performance standards to peersApply same performance standards to peers

& non& non--peerspeers

Compensate peers & nonCompensate peers & non--peers equally inpeers equally in

comparable positionscomparable positions

Provide benefits counseling to help informProvide benefits counseling to help inform

peers decisions on hours to workpeers decisions on hours to work


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Problem: Social SupportProblem: Social Support

Opportunities for interaction in agency lifeOpportunities for interaction in agency life(team meetings)(team meetings)

Include peer input in treatment planning &Include peer input in treatment planning &case notescase notes

Training in dressing for work, good hygiene, &Training in dressing for work, good hygiene, &regular attendance & timeliness at workregular attendance & timeliness at work

Training in emotional detachment, objectivity,Training in emotional detachment, objectivity,listening & providing support, focus onlistening & providing support, focus onproblem solvingproblem solving


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Problem: Social SupportProblem: Social Support

Offer peers training to learn language ofOffer peers training to learn language of

workplaceworkplace

Supervision & support in work placeSupervision & support in work place

Meet ADA requirements for accommodationMeet ADA requirements for accommodation

( adapted from Gates & Akabas, 2007)( adapted from Gates & Akabas, 2007)


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Vision for ConsumerOperated &Vision for ConsumerOperated &

Provided ServicesProvided Services

Hire Consumer ProvidersHire Consumer Providers Create positionsCreate positions

Help to develop ConsumerOperatedHelp to develop ConsumerOperated

Services/Consumer PartnershipsServices/Consumer Partnerships Offer technical assistance & supportOffer technical assistance & support

Offer resources & fundingOffer resources & funding

Offer acceptance & beliefOffer acceptance & belief

Define clear rolesDefine clear roles build on consumer strengthsbuild on consumer strengths Offer training forpeer specialistsOffer training forpeer specialists

Hire Consumers into existing positionsHire Consumers into existing positions


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Recovery OrientationRecovery Orientation

Hiring peer providers does not necessarilyHiring peer providers does not necessarily

equal recovery oriented servicesequal recovery oriented services

Recovery oriented services are differentRecovery oriented services are different

way of viewing & working with clientsway of viewing & working with clients

Dont assume hiring of consumersDont assume hiring of consumers

absolves providers of all sinsabsolves providers of all sins


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Consumers as Providers Consistent withConsumers as Providers Consistent with

Components of RecoveryComponents of Recovery

SelfSelf--directiondirection consumer leads & choosesconsumer leads & choosesdirectiondirection

Individualized & personIndividualized & person--centeredcentered varies byvaries by

strengths, needs, experiences & preferencesstrengths, needs, experiences & preferencesEmpowermentEmpowerment consumers authority toconsumers authority toparticipate in all decisions about their lifeparticipate in all decisions about their life

HolisticHolistic encompasses all aspects ones life,encompasses all aspects ones life,

including mind, body, & spiritincluding mind, body, & spiritNonNon--linearlinear continual growth, occasionalcontinual growth, occasionalsetbacks & learning from experiencesetbacks & learning from experience


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StrengthsStrengths--basedbased builds on personalbuilds on personalstrengths, capabilities, resiliencies,strengths, capabilities, resiliencies,talents, coping abilities & personaltalents, coping abilities & personalworthworth

Peer supportPeer support mutual support frommutual support fromother consumers essentialother consumers essential

RespectRespect community systems, &community systems, &societal acceptancesocietal acceptance


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ResponsibilityResponsibility consumers haveconsumers have

personal responsibility for ownpersonal responsibility for own

selfself--care & journey of recoverycare & journey of recoveryHope catalyst for recovery & canHope catalyst for recovery & can

be fostered by othersbe fostered by othersNational Consensus Conference on mental HealthNational Consensus Conference on mental Health

RecoveryRecovery SAMHSASAMHSA-- 20042004


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ConclusionsConclusions

Although the evidence may not be veryAlthough the evidence may not be very

strongstrong the values are strongthe values are strong

There will be challenges to developingThere will be challenges to developing

these services, but the beneficial valuesthese services, but the beneficial values

are greatare great

Believing in people & treating with respectBelieving in people & treating with respect

accomplishes a lotaccomplishes a lot these services canthese services cancommunicate these valuescommunicate these values

Consumers as Service Providers: Relevance to ACT

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