Sponsored by: Magellan Health Services Presented by Gayle Bluebird, RN Peer Services Director, Delaware Psychiatric Center

Paving New Ground: Peers Working in Inpatient Settings

July 31st, 2013 2013 Webinar Series

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Confidential Information

This presentation may include material non-public information about Magellan Health Services, Inc. (“Magellan” or the “Company”). By receipt of this presentation each recipient acknowledges that it is aware that the United States securities laws prohibit any person or entity in possession of material non-public information about a company or its affiliates from purchasing or selling securities of such company or from the communication of such information to any other person under circumstance in which it is reasonably foreseeable that such person may purchase or sell such securities with the benefit of such information. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential. The attached material shall not be photocopied, reproduced, distributed to or disclosed to others at any time without the prior written consent of the Company.

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Disclosures

Gayle Bluebird has no relevant financial relationship commercial interest that could be reasonably construed as a conflict of interest.

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About the Presenter: • Gayle Bluebird, RN, has been active in the consumer/survivor movement since 1974.

She has worked in many different capacities. In the 1990s she developed an Office of Consumer Affairs in Broward County, Florida and later worked as an advocate for the Florida Disability Network. From 2004-2006 she served as the coordinator of the Office of Technical Assistance (OTA) for Peer Networking, for the National Association of State Mental Health Program Directors (NASMHPD).

• Currently she is Director of Peer Services at the Delaware Psychiatric Center in New Castle, Delaware, where she coordinates a team of peer support specialists who work in the hospital and community. She has produced and edited the technical report/guidebook Paving New Ground: Peers Working in Inpatient Settings and the accompanying DVD, A Dialogue with Peers and Family members. In addition, Ms. Bluebird often speaks at national conferences on subjects of peer roles in inpatient settings, on the healing value of touching and comfort, and on recovery through the arts.

• In 2010 she was recognized with a national SAMHSA VOICE Award at Paramount Studios in Los Angeles for her contributions as a consumer advocate and activist. She is a coordinator of a national network of artists, writers and performers Altered States of the Arts and helps to maintain the website featuring their works www.alteredstatesofthearts.com.

1. Discuss the rationale for peer support in inpatient settings. 2. Define typical duties of peer supporters working in inpatient settings. 3. Describe the benefits of peer support for individuals being treated as

well as benefits for staff. 4. Identify creative strategies that can be used as alternative methods of

healing.

Learning Objectives

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Gayle Bluebird

July 2013

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Helpful Definitions:

• Consumer: Current or former patient diagnosed with a mental illness

• Peer: A person who has equal standing with another or others, and has had similar experiences as another

• Peer Specialist:

Most common term used for self-disclosed consumers who deliver recovery-oriented services. Most often they have specialized training and sometimes a certification

(Bluebird, 2004)

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Definition of Peer Support:

Peer Support is not like clinical support, nor is it just about being friends. Peer support helps people to understand each other because they’ve been there, shared similar experiences, and can model for each other a willingness to learn and grow

(Mead & MacNeil, 2003)

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Rationales for Peer Involvement in Mental Health Settings

Providing Empathy:

One of the key benefits of peer support as opposed to other forms of mental health services is the greater perceived empathy that Peer Specialists have for the people they support

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Rationales Cont’d:

• Peers can serve as role models, communicators, mediators, advocates, teachers and legal protectors

• Peers provide support from a perspective of experiential rather than professional authority

• First hand experiences provide unique insights and interpretations of situations

• Peers, hired as staff at all levels, promote movement towards an organizational culture shift

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Typical Peer Specialist Duties:

• Participate in Recovery (treatment) team meetings at

request of client • Facilitate peer support groups and recovery groups • Provide individual peer support • Address minor complaints and grievances • Help develop hospital policies with language that is

sensitive to recovery

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Inpatient Peer Support Role:

• Assisting and orienting people who are being admitted – Create admissions comfort bag – Screen for safety of items – Larger goodie bags for persons being discharged

• Addressing minor complaints and grievances

• Helping people advocate for themselves

• Documentation on records

• Discharge Planning

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Example of Peer Roles in Support and Recovery:

One core function of Peer Specialists is facilitating Wellness Recovery Action Planning (WRAP®) a personal monitoring program in which an individual develops techniques and strategies for reducing symptoms, as well as ongoing management and prevention of symptoms.

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(www.mentalhealthrecovery.com/vtrecovery.html)

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Crisis Intervention:

• First level De-escalation

• Debriefing

• Personal safety plans

• Focus on Trauma

• Intensive work with individuals

• Cultural differences considered

• Comfort Rooms

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Comfort Room Examples:

Western State Hospital Tacoma, WA

Zen Room, Ft. Lauderdale Hospital, FL

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Peer Roles in Mental Health Settings: Individual Benefits

• Empathy and support

• Sharing what works/Strategies for recovery

• Empowerment

• Holistic/non-medical approach

• Knowing their rights

• Easier to relate to someone who “has been there”

(Campbell and Leaver, 2003; Clay, 2005)

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Peer Roles in Mental Health Settings: Staff Benefits

• Potential to be a force for positive change

• Education for mental health professionals about living with a mental illness and potential for recovery

• Vital and valued on treatment teams

• Staff attitudes toward clients become more positive

• Reduced workload (Campbell and Leaver, 2003; Clay, 2005)

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Challenges to Success:

• Staff not trained adequately

• Using Peers as tokens

• Peer filling traditional role- not recovery role

• Staff afraid that peer will become ill

• Peer overworks

• Boundary Issues 19

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Specialized Peer Positions:

• Inpatient Drop In Center

• Debriefer

• Peer-Bridger

• Emergency Rooms

• Crisis Alternatives

• Trauma Peer Specialist

• Admissions/Discharge Specialist

• Forensic Peer Specialist

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Qualifications Desired:

• Self -Disclosed current or past recipient of mental health services

• Stable in recovery for over a year

• Bachelors Degree preferred

• Excellent communication and writing skills

• Previous work history

• Successful completion of Peer Specialist training and certification when possible*

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Peer Hiring Process:

• Stage One – Develop Job Requirements – Application Submission and Review

• Cover Letter • Resume • Standardized Application • Peer Related Narrative Questions

• Stage Two – Informal first contact – Optional second informal contact

• Stage Three – Formal Interview: 3 different interviewers with minimum of 1 supervisor

• Stage Four – Reference Checks – Background Check

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Creative Strategies: Arts, Humor and Alternative Healing:

• Introduce journaling (purchase individual journals at Dollar Store)

• Recovery Videos (Mary Ellen Copeland and others) • Reading materials—consumer written books plus

others • Painting pillow cases or tee shirts for art exhibits • Pet Therapy • Horticulture Programs • Talent Shows • Display of client’s artwork for enhancing environment

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Lessons Learned:

• Preparation of staff is critical

• Staff need to understand the principles of recovery

• Job descriptions developed prior to hiring

• Allowances should be made for flexibility and later revisions of position

• Positions should be placed at appropriate levels of supervision; whenever possible supervisors should be peers

• Support Groups available

• More than one Peer Specialist should be hired for any given setting

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From a Peer Drop-In Center Director in Florida:

“For as long as I’ve been here, since 2002, there have been no safety incidents. We have 100-150 people come every day who claim it as their favorite place. They play pool, watch TV, hang out with their peers and have choices about what they want to do”

(Ilisa Smukler, Director, Forest Park DIC and Patient Advocate, GEO Care, Inc. /South Florida State Hospital, in Bluebird, 2008)

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A Mental Health Provider Perspective: “Peers have helped us transform our organization making

it recovery oriented in design and in service delivery. Our peer employees have helped us achieve and maintain a new way of being with people that does not require seclusion and restraint interventions.”

(Lori Ashcraft, Director Recovery Education Center, Recovery Innovations, Phoenix, Arizona)

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From an Administrator in MA:

“What is most important is that the person hired is a ‘good fit’. ‘Good fit’ is the capacity that any employee has to navigate a work environment in order to maximize their effectiveness.”

(Tony Riccetelli, CEO,Worcester State Hospital, Worcester, MA)

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Paving New Ground: Peers Working in Inpatient Settings Guide Book (2006) Paving New Ground: A Dialogue With Peers & Family Members a DVD (2006)

This DVD and Guidebook were made possible by SAMHSA’s Center for Mental Health Services through its contract with the National Technical Assistance Center (NTAC) located

at the National Association of State Mental Health Program Directors (NASMHPD) Please Contact Ashley Welton at

(302)255-2745 for a copy of either resource free of charge.

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Resources/Bibliography

Comfort Rooms • Bluebird, G. (Summer/Fall 2002). Comfort and communication help minimize conflicts,

Networks, p.18. Alexandria, VA: National Technical Assistance Center, National Association of State Mental Health Program Directors

• Bluebird, G. (Spring 2005) Comfort Rooms: reducing the need for seclusion and restraint, Residential Group Home Quarterly Vol. 5 No.4, p5

• Champagne, T., & Stromberg, N. (2004) Sensory Approaches in Inpatient Psychiatric Settings: Innovative Alternatives to Seclusion and Restraint. Journal of Psychosocial Nursing 42, (9) pp 35-44

Consumer Roles in Mental Health Settings • Bluebird, G. (2004). Redefining Consumer Roles: Changing culture and practice in mental

health settings. Journal of Psychosocial Nursing and Mental Health Services, 42(9), 46-53

• Clay, S.; Schell, B.; Corrigan, P.W.; Ralph, Ruth O. (Eds.) (2005). On our own together: peer programs for people with mental illness. Vanderbilt University Press: Nashville

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• Hutchinson, D.S., Anthony, W.A.; Ashcraft, L., Johnson, E., Dunn, E.C. Lyass, A. & Rogers, E.S. (2006) The personal and vocational impact of training and employing people with psychiatric disabilities as providers, Psychiatric Rehabilitation Journal 29, (3) 20-213

• Mead, S; Hilton D. & Curtis L.; (2001) Peer Support: A theoretical perspective, Psychiatric Rehabilitation Journal, 25, 2 134-141

• Ridgway, P. (1988, December). The voice of consumers in mental health systems: A call for change. Center for Community Change through Housing and Support. National Institute of Mental Health

• Solomon, P. (2004). Peer Support/Peer Provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal, 27. 392-401

Dialogues and Communication • SAMHSA, (2000). A Participatory Dialogue Report—Consumers and Psychiatrists in

Dialogue. website: http://store.mentalhealth.org/consumersurvivor/publications.aspx (Other reports of dialogues between consumers and providers also available on this site.)

• SAMHSA, (2000). Participatory Dialogues, A guide to organizing interactive discussions on mental health issues among consumers, providers and family members, On line: http://store.mentalhealth.org/consumersurvivor/publications.aspx (SMA))-3472)

• Public Conversations Project, Fostering Dialogue across divides: A nuts and bolts guide from the public conversations project. www.cafepress.com/pcp_press

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Guidelines for Hiring Peer Specialists

• Ralph O. Ruth, (2002). The Dynamics of Disclosure: Its Impact on Recovery and Rehabilitation. Psychiatric Rehabilitation Journal, 26. 165-172

• Salzer, M.S., &Mental Health Association of Southeastern Pennsylvania Best Practices Team (2002). Consume Delivered Services as a Best Practice I Mental Health Care and the Development of Practice Guidelines. Psychiatric Rehabilitation Skills, 7, 355-382. (Available by contacting pennrrtc@mail.med.upenn.edu)

Legislation and Advocacy

• National Association of Protection and Advocacy Systems. (2003). Restraint and Seclusion: Overview of federal laws and policies (2003). Retrieved January 15, 2004, from http://www.napas.org/AbuseNeglect/Restraintoutline03.htm

• Shared Visions – New Pathways: The Joint Commission’s Redesigned Accreditation Process (Behavioral Health Care) Video Length: 52 minutes. Video clip. Http://www.jcrinc.com/media/DEP/behavioral-shared-NTSC.wmv

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Peer Support Resources • Mazelis, R. The Cutting Edge: A Newsletter for People Living with Self-Inflicted Violence.

www.sidran.org

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• Copeland, Mary Ellen, MS, MA. Wellness Recovery Action Plan. Online at: www.mentalhealthrecovery.com

• Deegan, P. (1998) Recovery as a self-directed process of healing and transformation. Online at http://intentionalcare.org/articles/_trans.pdf

Stories and Experiences

• Bassman, R., (2007). A Fight to Be: A psychologists experience from both sides of the locked door. Albany, New York, Tantamount Press

• Martinez, R., Grimm, M., & Adamson, M. (1999). From the other side of the door: Patient views of seclusion. Journal of Psychosocial Nursing, 73(3), 3-22

• National Executive Training Institute (NETI), Lane, T. (editor): Speaking Out: Personal Experiences of Seclusion and Restraint. A resource compendium toward culture change and best practice. 2005, Alexandria, Virginia

• Ray, N.K., Myers, K.J., & Rapport, M.E. (1996). Patient perspectives on restraint and seclusion experiences: A survey of former patients of New York State psychiatric facilities. Psychiatric Rehabilitation Journal 20(1), 11-18

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Contact Information

• Gayle Bluebird

Delaware Psychiatric Center

1901 North DuPont Highway

Springer Building

New Castle, DE 19720

gayle.bluebird@state.de.us

(302)255-2701

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Q&A and CE Credit Instructions

• We will take questions that have first been submitted via the Q&A pod.

• We will attempt to answer as many questions as possible during the time allocated for Questions and Answers.

• For those seeking CE credits for today’s live presentation, please use the link below to access the post-test/course evaluation. Please plan to complete the post-test/course evaluation by Friday, August 2nd, by 9 p.m. Eastern. If you have difficulties accessing the CE credit link, please contact Tom Lane at Tlane@Magellanhealth.com.

• http://www.surveymonkey.com/s/K5HX5BZ • CE credits are not offered for participants viewing the archived webinar.

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