An Overview of the An Overview of the Enhanced Curriculum to Enhanced Curriculum to

expand Peer Support expand Peer Support Services to Service Services to Service

Members, Veterans & Members, Veterans & Their FamiliesTheir Families

Liz WoodleyGina Noel-Brown

Where to begin…Where to begin…Demonstrating the power of Peer support:•What is my role in supporting a Veteran - Service connected person?•What impact do I want to make on a Veteran – Service connected persons’ recovery journey?•What challenges do I anticipate in making a connection?

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Peer Support Principles Peer Support Principles • Voluntary• Non-Judgmental • Empathetic• Respectful• Honest and direct communication• Mutual responsibility• Reciprocal

(Shery Mead, Darby Penny and Laura Prescott)3

Peer Support ActivitiesPeer Support Activities

What can you think of?

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Veteran Peer SupportVeteran Peer Support• An important strategy in supporting the

behavioral health needs of service members, Veterans, and their families

• A bridge to services and help ease transitions • Peers with military experience and experience

with recovery offer valuable knowledge and skills to assist others

• Improves the overall quality of life for those being served

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Why, Veteran Peer Support Services? Why, Veteran Peer Support Services?

PA’s Veterans population: •PA has approximately 1 million Veterans. It is the fourth largest Veterans population in the country •70% of PA’s Vets are over the age of 55•PA has about 19,000 men and women serving in the National Guard, and the National Guard has deployed over 35,000 individuals during the Iraq and Afghanistan conflicts•PA has the 2nd highest suicide rate for Veterans in the country•Approximately 10% of all adults in U.S. jails and prisons are Veterans

Source: U.S. Dept. of Veterans Affairs

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Certified Peer Specialist – Veterans: Certified Peer Specialist – Veterans: RolesRoles

• Provide information • Act as a referral source to clinicians and other

mental health professionals • Provide support and understanding to Veterans

they serve• Partner with Veterans in problem-solving,

decision-making, and setting goals • Identify resources in the community • Assist Veterans with attaining full integration

into the community.7

Responsibilities: General Guidelines Responsibilities: General Guidelines The CPS who supports Veterans and Military personnel also:• Maintains confidentiality

• Demonstrates appropriate and respectful language

• Maintains appropriate boundaries

• Demonstrates appropriate personal appearance and dress code in the workplace

• Works in the interest of supporting those served

• Able to ask for help and receive feedback

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MILITARY CULTURE : WHY IT MATTERS MILITARY CULTURE : WHY IT MATTERS

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In this section we will…In this section we will…

• Describe military structure and processes• Review the demographics of today’s military• Identify stresses by mission and conflict• Discuss ways for CPSs to support

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Military Operational OrganizationMilitary Operational Organization• Status: – Active Duty – National Guard – Reserve

• Doctrine and Regulations– Doctrines can change with leadership – Regulations are federal therefore the same

for Active, Reserve and GuardAir Force

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Today’s Military DemographicsToday’s Military Demographics• Specifics vary by

service• All volunteer force for

since 1974• 2.2 M total serving in

uniform today compared to 15 M in WWII

• Desegregation in 1948– 39% ethnic diversity– 15% are women

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Today’s Military DemographicsToday’s Military Demographicsin Comparison to the Draft Population

• Average age is older• Educational backgrounds higher—

percent college graduates, high school/GED requirement, ASVAB scores

• Marital status higher than civilian • Heritage: “military brat”

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The ServicesThe ServicesCommonalities• Recruiting• Testing• Training• Core Values• Fitness• Joint Service• Some Language• Rank is Great Equalizer

Differences

• The Mission• Individual Service

Cultures• Uniforms • Rank Insignias• Language and Acronyms

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Values Values • Army:– Loyalty, duty, respect, selfless service, honor, integrity

and personal courage• Navy and Marine Corps:– Honor, courage and commitment

• Air Force:– Integrity first, service before self, excellence in all we

do• Coast Guard: – Honor, respect , devotion to duty

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MissionsMissions• Army – fight and win our nation’s wars with sustained

land dominance across full range of military operations• Navy – power projections, strategic deliverance and

tactical delivery of combat power• Air Force – to provide strategic air lift and tactical air

combat support• Marines – rapid deployment force; seizure of or

defense of advanced naval bases for land operations• Coast Guard - safeguarded our Nation's maritime

interests and environment around the world

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Considerations, Challenges and Considerations, Challenges and Implications Implications

• Access to services• Effects (physical, psychological) of life in a war

zone• Military rank and authority• Help-seeking and peer-to-peer support• Family well-being and reintegration• Civilian reintegration• Impact on Veterans returning from Iraq & Afghanistan

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Peer Support in Action: Peer Support in Action: Making the ConnectionMaking the Connection

• How to use military values and history to drive the peer process?– Loyalty– Respect– Selfless service– Honor and integrity– Excellence and commitment– Personal courage– Devotion to duty

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WHEN CULTURES MEET

~ Civilian/Corporate ~ Military ~ Mental Health ~Criminal Justice

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Service SystemsService SystemsMilitary Mental Health Criminal Justice

Strength, resilience, courage, personal sacrificeElitism, superiorityMental toughnessCollectivism, group identifyInner strength, self-reliance

Illness, clinical, deficiency-orientedInjury, problems, disordersEmotional vulnerabilityIndividualized, one-on-one Seek help from others

Crime, criminal, victim, conditions Law enforcement Prosecution Judiciary Corrections (probation and parole - community corrections)

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Veterans, Veterans, The Criminal Justice System The Criminal Justice System

and and Peer Support Peer Support

A Challenge & Implication of

ReIntegration

Innovation: Veterans Treatment Innovation: Veterans Treatment CourtCourt

Why: •To divert those with mental health issues from the traditional justice system and •To give them treatment and tools for rehabilitation and readjustment. The progress: – As of February, 2013, there were 168 Veterans

Treatment Courts in the United States. – Currently 17 in Pennsylvania

Resource: http://www.justiceforvets.org 22

Innovation: Veterans Justice OutreachInnovation: Veterans Justice Outreach• The VJO provides direct services to justice-involved Veterans• Developed by the Veterans Administration • Each VA Medical Center has a designated justice outreach

specialist who– functions as a link between the VA, Veterans, and the local justice

system whether incarcerated or not incarcerated • The VJO specialist works with the courts to

– help eligible justice-involved Veterans get mental health assessment, treatment planning, and referrals to VA services

– communicate with officers of the court about Veterans' compliance with VA treatment programs

– may assist in training law enforcement personnel on issues such as PTSD or traumatic brain injury.

• For information and a list of VJO contacts, see Justice Outreach handout

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PA RESPONSEForensic Peer Support and The Sequential Intercept Approach

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Forensic Peer Support for VetsForensic Peer Support for Vets

• Peer Support offered to Veterans and military personnel with MH or Co-occurring challenges involved in the Criminal Justice System from initial contact with law enforcement through re-entry into the community from incarceration

• To effectively offer support by understanding the Criminal Justice System and the resources needed for successful Community Re-entry

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How? How?

• Jail Diversions –programs that divert individuals with

mental illness from the criminal justice system to community based services

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The Purpose of FPS for VetsThe Purpose of FPS for Vets• To support VMPs during their involvement in the

Criminal Justice System• To promote recovery principles including self-

advocacy • To advocate for VMPs when they are unable to

advocate for themselves• To educate stakeholders in VA and CJ systems

about mental health recovery• To inspire hope• Ultimately, to keep people in the community

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What’s the benefit? What’s the benefit? • Positive relationship development• Assistance with understanding and navigating

the Criminal Justice System• Aids in finding and utilizing resources• Educates individuals about recovery• Supports completion of parole/probation

requirements• Reduces the time in jail/prison re: the lack of

community supports, housing options and resources 28

An ApproachAn Approach

The Sequential Intercept Model

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The Sequential Intercept ModelThe Sequential Intercept Model• What is it?– A conceptual framework for communities to use

when considering the interface between the criminal justice and mental health systems as they address concerns about criminalization of people with mental illness.

– Use of the Sequential Intercept Model as an Approach to Decriminalization of People With Serious Mental Illness, 2006

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5 Key Points of Intercept5 Key Points of Intercept

1. Law Enforcement and Emergency Services2. Initial Hearings/Initial Detention3. Jails and Courts4. Re-entry (from Jails, Prisons, and Hospitals)5. Community Corrections / Community Support Services

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Peer Support in Action Peer Support in Action “Dialogue and Development”

Coming Home: Military Veterans involved in the Criminal Justice System

The Issue: •"Large numbers of Iraq and Afghanistan war Veterans are returning home with serious mental and emotional problems. Possible Responses: •What can peers do to support the healing of psychologically-scarred* troops?

* profound stress and the challenges of adjusting to civilian life when returning home.

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ObjectivesObjectives• Discuss origins and stages of impact of mental

health issues• Compare and contrast “traditional” medical

model and psychiatric rehabilitation approaches to understanding assessment and treatment of mental health issues

• Brief discussion about medication and adherence issues

• Identify approaches peer specialist can use when Veterans experience mental health issues

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Why CPSs Need to Know ThisWhy CPSs Need to Know This

• To understand the common language used in behavioral and VA healthcare settings where CPSs work

• To use the information as a bridge between clinical providers and Veterans receiving services

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Approaches and PossibilitiesApproaches and Possibilities

Treatments, Rehabilitation, Reintegration and Supports

35SAMHSA Wellness Project: http://www.promoteacceptance.samhsa.gov

CPS with Veterans Suggestions CPS with Veterans Suggestions • Communicate a belief that the Veteran

can and will recover. “I believe you can have the life you want to have, and I will support you in your journey to get there. I have hope for you.”

• Listen. Really listen. Do not judge, dismiss, or advise. Just listen.

• Engage in conversations about goals, dreams, and wishes.

• Ask questions like, “What would be a satisfying life for you? How can you get there?”

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CPS with Veterans SuggestionsCPS with Veterans Suggestions• Use snippets of personal recovery story to inspire. Also,

encourage the Veteran to tell his/her story. Share success stories.

• Believe in the potential of each Veteran to recover in his/her own way.

• Advocate for the Veteran with VA and BHC clinical staff members and the Veteran’s family as needed and desired by the Veteran.

• Share resource information and refer the Veteran to needed available services.

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Objective Objective • To identify some specific tools and resources to

guide the CSP Veterans and Service Members process:– Personal Recovery Story; – Motivational Interviewing Skills;– Shared Decision Making;– Problem-Solving Skills; – Positive Self-Talk;

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Thank YouThank YouLiz Woodley CPSLiz Woodley CPS

liz921@yahoo.com(724)331-0417(724)331-0417

&&Gina Noel-Brown CPSGina Noel-Brown CPS

gmnoelbrown@gmail.com(412)277-2526(412)277-2526