PPathways athways PPeer eer WWellness ellness PProject: “The roject: “The thing with being a peer is: We’ve been thing with being a peer is: We’ve been

there and done that” there and done that”

Ana Stefancic, MAAna Stefancic, MAColumbia University & Pathways to HousingColumbia University & Pathways to Housing

Sam Tsemberis, PhDSam Tsemberis, PhDPathways to Housing & Columbia University Medical CenterPathways to Housing & Columbia University Medical Center

www.pathwaystohousing.org

Neil Harbus, LCSW,CPRPNeil Harbus, LCSW,CPRPCUNY & Pathways to HousingCUNY & Pathways to Housing

Peer Wellness: Program Peer Wellness: Program OverviewOverview

Funded by Substance Abuse Mental Health Services Funded by Substance Abuse Mental Health Services Administration (SAMHSA)Administration (SAMHSA)

Grant expectations: 570 individuals will receive Peer Grant expectations: 570 individuals will receive Peer Wellness services over 5 years (now in year 2)Wellness services over 5 years (now in year 2)

11 Peer Wellness Specialists hired as part-time 11 Peer Wellness Specialists hired as part-time employees (approx 5.5 FTE)employees (approx 5.5 FTE)

All Pathways consumers are eligible. Participants are All Pathways consumers are eligible. Participants are referred by support teams, peers specialists or through referred by support teams, peers specialists or through self-referralsself-referrals

Who Are Our Target Who Are Our Target Populations?Populations?

Individuals in the process of transitioning off of Individuals in the process of transitioning off of Pathways’ ACT TeamsPathways’ ACT Teams

Individuals who are looking for assistance in Individuals who are looking for assistance in planning the next step in their Recovery process. planning the next step in their Recovery process.

Individuals who are new to Pathways, and could Individuals who are new to Pathways, and could benefit from peer support during this time.benefit from peer support during this time.

Individuals who have become disengaged from Individuals who have become disengaged from their Team. their Team.

Who are the peer Who are the peer specialists?specialists?

““A A peerpeer is someone who’s been where you is someone who’s been where you been and a been and a specialistspecialist means they got training means they got training to help you better.” to help you better.”

Mental healthMental health Substance useSubstance use HomelessnessHomelessness Criminal JusticeCriminal Justice ……

Wellness ServicesWellness Services Providing “consumers with information, skills and Providing “consumers with information, skills and

strategies to self manage mental health challenges and strategies to self manage mental health challenges and to engage in recovery supporting actions”to engage in recovery supporting actions”**

Tools/EBPs:Tools/EBPs: Wellness Self-Management (WSM, IMR-derived)Wellness Self-Management (WSM, IMR-derived) Wellness Recovery Action Plan (WRAP)Wellness Recovery Action Plan (WRAP) Relapse Prevention PlanRelapse Prevention Plan Supported EmploymentSupported Employment Program Specific: Balanced Life, Healing from Within, Program Specific: Balanced Life, Healing from Within,

etc.etc.

*Center for Practice Innovations, Columbia Psychiatry*Center for Practice Innovations, Columbia Psychiatry

Training, Supervision, Training, Supervision, DocumentationDocumentation

TrainingTraining 3 day orientation: Program Overview, Wellness and Recovery 3 day orientation: Program Overview, Wellness and Recovery

principles, Intentional Peer Support, Trauma Informed Care, Crisis principles, Intentional Peer Support, Trauma Informed Care, Crisis Response, Safety, Documentation, Engagement Techniques, Response, Safety, Documentation, Engagement Techniques, WRAP, WSM and other Recovery CurriculaWRAP, WSM and other Recovery Curricula

Ad hoc trainings: Stages of Change, Motivational Interviewing, Ad hoc trainings: Stages of Change, Motivational Interviewing, CBTCBT

SupervisionSupervision Bi-weekly group supervision: clinical & administrative Bi-weekly group supervision: clinical & administrative

issues/questions + successesissues/questions + successes In-vivo Field supervision & SupportIn-vivo Field supervision & Support Ongoing review of progress notes and editsOngoing review of progress notes and edits

Documentation:Documentation: Peers complete progress notes in electronic record on same day Peers complete progress notes in electronic record on same day

of service (agency standard)of service (agency standard)

Flexible Service DeliveryFlexible Service Delivery

Location of Services:Location of Services: Consumer’s apartment, in the Consumer’s apartment, in the community, in their team office, at the Resource Centercommunity, in their team office, at the Resource Center

Format:Format: One to one or group format. Whatever works best for One to one or group format. Whatever works best for the individualthe individual

Specialties & Caseloads:Specialties & Caseloads: Apart from general Wellness, many peers have a specialty: Apart from general Wellness, many peers have a specialty:

Employment, Education, FinancesEmployment, Education, Finances Peers have caseloads but can refer consumers to others Peers have caseloads but can refer consumers to others

for specialty servicesfor specialty services Two Structural Modalities:Two Structural Modalities:

Peer Specialists Embedded on Assertive Community Peer Specialists Embedded on Assertive Community Treatment (ACT) or ICM TeamTreatment (ACT) or ICM Team

Peer Specialists at Resource CenterPeer Specialists at Resource Center

Flexible Service DeliveryFlexible Service Delivery Primary Base: ACT Team (4)Primary Base: ACT Team (4)

Work alongside clinicians, Work alongside clinicians, etc.etc.

Attend morning meetingAttend morning meeting Visit clients in the Visit clients in the

communitycommunity Enhance quality of Enhance quality of

services, not replace services, not replace existing servicesexisting services

One-on-one or group One-on-one or group sessionssessions

Primary Base: Resource Primary Base: Resource Center (7)Center (7) All services are peer-ledAll services are peer-led Facilitate classes and Facilitate classes and

groupsgroups One-on-one counseling One-on-one counseling

sessionssessions Visit clients in the Visit clients in the

communitycommunity Develop program Develop program

curriculacurricula

All 11 peer specialists are “linked” to one of 9 teams All 11 peer specialists are “linked” to one of 9 teams (spread over 6 geographically dispersed areas) (spread over 6 geographically dispersed areas)

to facilitate referral, service delivery, and communicationto facilitate referral, service delivery, and communication

Pathways Resource CenterPathways Resource CenterOpen 6 days a week, the Resource Center offers upwards of 25 Open 6 days a week, the Resource Center offers upwards of 25

Peer-led Recovery Classes a week including:Peer-led Recovery Classes a week including:

Nutrition Class including cooking Nutrition Class including cooking and gardeningand gardening

WSM and WSM plusWSM and WSM plus Healing from WithinHealing from Within PhotographyPhotography ArtArt Financial WellnessFinancial Wellness Life BalanceLife Balance Filling a Man’s ShoesFilling a Man’s Shoes Going Broke for a SmokeGoing Broke for a Smoke Parenting Support GroupParenting Support Group

Harm ReductionHarm Reduction JournalingJournaling 2 Computer Classes2 Computer Classes 2 Continuing Ed/College Prep 2 Continuing Ed/College Prep

ClassesClasses My Neighborhood, My WorldMy Neighborhood, My World Women’s IssuesWomen’s Issues Work NowWork Now WRAP GroupWRAP Group Science Science HistoryHistory JournalingJournaling Harm ReductionHarm Reduction Moving On GroupMoving On Group

* A number of these groups are also * A number of these groups are also offered at other Pathways’ sites*offered at other Pathways’ sites*

Peers Enhancing Peers Enhancing ServicesServices

Average contact is close to an hourAverage contact is close to an hour Spend quality time with individuals focusing on wellness Spend quality time with individuals focusing on wellness

and minimizing “case management” functionsand minimizing “case management” functions Increasing monthly contact with consumers:Increasing monthly contact with consumers:

Served over 170 individuals since start-up (varying levels of service Served over 170 individuals since start-up (varying levels of service intensity)intensity)

Averaging 240 contacts a monthAveraging 240 contacts a month Increasing community contacts with a variety of services being Increasing community contacts with a variety of services being

offeredoffered Contributing to the overall stability of individuals, which Contributing to the overall stability of individuals, which

leaves the Team with more time to focus on immediate leaves the Team with more time to focus on immediate crisescrises

Reengaging and reestablishing working relationships with Reengaging and reestablishing working relationships with individuals on behalf of the Teamsindividuals on behalf of the Teams

Targeted Wellness Targeted Wellness DomainsDomains

Environment:Environment: Housing, SafetyHousing, Safety Social: Social: Family Reconnection, Family Reconnection,

Friends/Partners, LossFriends/Partners, Loss Intellectual:Intellectual: GED/College PrepGED/College Prep Financial:Financial: Entitlements, Financial Entitlements, Financial

EmpowermentEmpowerment Occupational: Occupational: Leisure pursuits, employment Leisure pursuits, employment

activities, Job training activities, Job training

Physical: Physical: Checkups/ScreeningsCheckups/Screenings

Managing Chronic Illness Managing Chronic Illness Nutrition & ExerciseNutrition & Exercise Emotional/MentalEmotional/Mental

Stress ReductionStress ReductionSymptom ManagementSymptom ManagementMedicationMedicationSubstance useSubstance use

Spiritual: Spiritual: Meaning and PurposeMeaning and PurposeValues, Code of ConductValues, Code of Conduct

Process & Outcomes Process & Outcomes EvaluationEvaluation

Consumer Outcomes:Consumer Outcomes: Interviews with participants at Interviews with participants at intake and every 6-months thereafter intake and every 6-months thereafter Quantitative: Functioning, Social Activities, Quantitative: Functioning, Social Activities,

Employment, RecoveryEmployment, Recovery Qualitative: Goals, next steps, what’s helped and Qualitative: Goals, next steps, what’s helped and

what hasn’twhat hasn’t

Process Evaluation:Process Evaluation: Peer specialist interviews Peer specialist interviews Qualitative: Peer role, challenges, successes…Qualitative: Peer role, challenges, successes…

Sample OutcomesSample Outcomes

Client Perception of Functioning:Client Perception of Functioning: improved 24% over baseline improved 24% over baseline Employment:Employment: improved 11% over baseline. This includes a improved 11% over baseline. This includes a

dozen people securing either competitive or transitional dozen people securing either competitive or transitional employment positions. employment positions.

Social Connectedness:Social Connectedness: improved 11% over baseline improved 11% over baseline Skills Enhancement:Skills Enhancement:

27 Individuals worked on developing positive strategies to 27 Individuals worked on developing positive strategies to reduce the harmfulness of behaviors that interfere with reduce the harmfulness of behaviors that interfere with their wellness, including substance use. their wellness, including substance use.

15 individuals were observed to have enhanced their 15 individuals were observed to have enhanced their computer skills. computer skills.

15 individuals worked on enhancing their understanding of 15 individuals worked on enhancing their understanding of healthy cooking and nutrition.healthy cooking and nutrition.

OutcomesOutcomes Clinical:Clinical:

3 individuals were assisted in transitioning from ACT 3 individuals were assisted in transitioning from ACT services to a less intensive level of care, services to a less intensive level of care,

25 individuals reported enhanced social relationships 25 individuals reported enhanced social relationships and family reconnection.and family reconnection.

30 individuals reported improved medication 30 individuals reported improved medication adherence. adherence.

Case ExamplesCase Examples 12 psychiatric admissions/ER visits in 14 months before 12 psychiatric admissions/ER visits in 14 months before

working with peer wellness programworking with peer wellness program

No contact with daughter for over 20 yearsNo contact with daughter for over 20 years

Case ExamplesCase Examples

From 12 psychiatric admissions/ER visits From 12 psychiatric admissions/ER visits in 14 months to 0 admissions/ER visits in in 14 months to 0 admissions/ER visits in 12 months+ post-enrollment12 months+ post-enrollment

From no contact with daughter in 20+ From no contact with daughter in 20+ years to… Peer helped him open an e-mail years to… Peer helped him open an e-mail account, open a Facebook account and account, open a Facebook account and found her on Facebook. She lives overseas found her on Facebook. She lives overseas & they’re arranging a meeting in the U.S.& they’re arranging a meeting in the U.S.

Sample NoteSample Note This was the first time that I spoke with B. Peer introduced index cards to This was the first time that I spoke with B. Peer introduced index cards to

B. in order to find out what goals he wanted to work on. B. decided that B. in order to find out what goals he wanted to work on. B. decided that he wanted to stay out of the hospital, go back to school, and get his own he wanted to stay out of the hospital, go back to school, and get his own apartment. B. talked about how he was depressed. Peer asked why was he apartment. B. talked about how he was depressed. Peer asked why was he depressed. B. stated that he felt hurt and pain, and it consumed his whole depressed. B. stated that he felt hurt and pain, and it consumed his whole body. B.’s mother stated that he was heart broken over different women. body. B.’s mother stated that he was heart broken over different women. B. then showed me pictures of different women, and talked about how B. then showed me pictures of different women, and talked about how they hurt him. Peer suggested to B. that maybe at this time he can focus they hurt him. Peer suggested to B. that maybe at this time he can focus on his goals and not concentrate so much on different women that may on his goals and not concentrate so much on different women that may hurt him. B. then agreed and said this is true. Peer talked about the Wrap hurt him. B. then agreed and said this is true. Peer talked about the Wrap Plan and suggested different ways B. can cope with stress and depression. Plan and suggested different ways B. can cope with stress and depression. Peer suggested that B. could use Wrap Plan techniques like listen to music, Peer suggested that B. could use Wrap Plan techniques like listen to music, or meditate, or take walks. B. stated that he was depressed and didn't feel or meditate, or take walks. B. stated that he was depressed and didn't feel like doing anything. Peer encouraged B. to try and use some techniques. B. like doing anything. Peer encouraged B. to try and use some techniques. B. stated that he will try. Peer stated to B. that we will be working with the stated that he will try. Peer stated to B. that we will be working with the WSM Workbook and doing different Lessons. B. stated ok, he just wants WSM Workbook and doing different Lessons. B. stated ok, he just wants someone to work with him and understand him. Peer assured B. that I will someone to work with him and understand him. Peer assured B. that I will work with him and help him to better understand what’s going on with work with him and help him to better understand what’s going on with him. B. stated okay. Peer will follow-up on…him. B. stated okay. Peer will follow-up on…

Consumer InterviewsConsumer Interviews

What’s Changed Since Being In What’s Changed Since Being In the Program?the Program?

“ “ I want to become a Peer I want to become a Peer Specialist”Specialist”

“ “ I got an apartment, I have I got an apartment, I have more privacy, I’m more more privacy, I’m more alert, I have better alert, I have better concentration”concentration”

““I’m Focusing on School”I’m Focusing on School”““I got a job”I got a job”

What’s Helpful about The What’s Helpful about The Program?Program?““It Helped Me Bridge The Gap It Helped Me Bridge The Gap

Between Who I Was And Between Who I Was And Who I Was Becoming”Who I Was Becoming”

““They brought me Hope!”They brought me Hope!”““I’m learning and exploring I’m learning and exploring

new things”new things”““They helped me with my They helped me with my

medical problems”medical problems”“ “ I grew a lot, I became a I grew a lot, I became a

better person”better person”

What Did People Most What Did People Most Report Was Missing Report Was Missing From Their Lives?From Their Lives?

A PartnerA PartnerA JobA JobVisitation with their Children Visitation with their Children

or having their Children or having their Children returned to themreturned to them

*We will soon be starting a parenting initiative**We will soon be starting a parenting initiative*

Peer Specialist Perspective: Peer Specialist Perspective: Bumps In The RoadBumps In The Road

Selling a New Program is always a Challenge:Selling a New Program is always a Challenge:““There are some individuals who have been so knocked There are some individuals who have been so knocked

down and beaten up, decades and decades and decades, down and beaten up, decades and decades and decades, that they don’t trust anybody. And a that they don’t trust anybody. And a lot lot of them…they of them…they been so beaten down that they don’t think- they don’t feel been so beaten down that they don’t think- they don’t feel that they’re worth even talking to to that they’re worth even talking to to see see what is goin’ on what is goin’ on with them.” with them.”

Gaining Full Acceptance from “Professional” staff:Gaining Full Acceptance from “Professional” staff:““And there are people from counselors on up to the clinicians And there are people from counselors on up to the clinicians

who are not willing to accept us. Either they think we’re who are not willing to accept us. Either they think we’re tryin’ to step on their toes, they think we’re tryin’ to take tryin’ to step on their toes, they think we’re tryin’ to take their jobs, or they think we’re tryin’ to be them.”their jobs, or they think we’re tryin’ to be them.”

Bumps in the RoadBumps in the Road

Gaining Full Acceptance from Pathways’ Gaining Full Acceptance from Pathways’ participants:participants:

““I’ve had- one or two people who uh, didn’t want to I’ve had- one or two people who uh, didn’t want to accept my, my services, or me, solely because I was a accept my, my services, or me, solely because I was a peer, and not a professional.” peer, and not a professional.”

Managing one’s own wellnessManaging one’s own wellness““Sometimes I have to drop appointments and- and I’m- Sometimes I have to drop appointments and- and I’m-

I’m only one person, and my wellness comes first I’m only one person, and my wellness comes first and foremost.”and foremost.”

Peer Specialist Perspective: Peer Specialist Perspective: SuccessesSuccesses Making a DifferenceMaking a Difference

““I asked him if he just wants ‘em to increase the Seroquel and I asked him if he just wants ‘em to increase the Seroquel and that’ll do it. And he said, no, it’s the Seroquel and the program. that’ll do it. And he said, no, it’s the Seroquel and the program. So, that makes me feel like, you know, I’m playing a part, and So, that makes me feel like, you know, I’m playing a part, and it’s not just the Seroquel.” it’s not just the Seroquel.”

Advocacy/MediationAdvocacy/Mediation““My job My job isis to advocate for the consumer. That’s my job to advocate for the consumer. That’s my job first first and and

foremostforemost. There for employment, to make sure these guys are . There for employment, to make sure these guys are afforded their rights. And if Pathways is supposed to be doing afforded their rights. And if Pathways is supposed to be doing something for them? It’s my job to make enough noise so that something for them? It’s my job to make enough noise so that it’s it’s done.done.” ”

Sense of CommunitySense of Community““The camaraderie with the co-workers, the consumers, the The camaraderie with the co-workers, the consumers, the

environment…walking here is like walking home.”environment…walking here is like walking home.”

Thank You!Thank You!

If you are interested in bringing If you are interested in bringing Peer Wellness Services to your agency Peer Wellness Services to your agency

contact:contact:Neil HarbusNeil Harbus

nharbus@pathwaystohousing.org

Also, Presentations atAlso, Presentations atHousing First Partners ConferenceHousing First Partners Conference

New Orleans, March 21-23, 2012New Orleans, March 21-23, 2012