the role of the peer specialist
DESCRIPTION
CITI 2011 Conference Presentation by Scranton Area CITTRANSCRIPT
http://www.youtube.com/watch?v=Wjy3ueOtGls&feature=related
The Role of the Peer The Role of the Peer SpecialistSpecialist
Completing the CIT PictureCompleting the CIT Picture
SCRANTON AREA CITSCRANTON AREA CIT Location: Northeastern PennsylvaniaLocation: Northeastern Pennsylvania 125 miles north of Philadelphia125 miles north of Philadelphia Population: 76,089Population: 76,089 Area: 26 square milesArea: 26 square miles
Scranton CITScranton CITBorn of a TragedyBorn of a Tragedy
May 28, 2009 – May 28, 2009 –
Scranton Woman Shot and Killed by Scranton Woman Shot and Killed by Police: “Routine Mental Health Call Police: “Routine Mental Health Call Goes Bad”Goes Bad”
Public OutragePublic Outrage
Task Force CreatedTask Force Created
Final Report and RecommendationsFinal Report and Recommendations
Task Force RecommendationsTask Force Recommendations
Adopt CITAdopt CIT
Establish Response ProtocolEstablish Response Protocol
Create Culture of CooperationCreate Culture of Cooperation
Educational ProgramsEducational Programs
Establish Advisory BoardEstablish Advisory Board
Scranton Police DepartmentScranton Police Department
Total Sworn ComplementTotal Sworn Complement
January 1, 2011 – 150 OfficersJanuary 1, 2011 – 150 Officers
CIT ClassesCIT Classes
Since Inception – 2 CIT Classes Have Since Inception – 2 CIT Classes Have Been ConductedBeen Conducted
CIT OfficersCIT Officers
21 Trained Officers21 Trained Officers
18 male18 male
3 female3 female
14 of 21 – less than 10 years of 14 of 21 – less than 10 years of serviceservice
CIT Officer DeploymentCIT Officer Deployment
Day ShiftDay Shift 4 Officers – (3 SRO)4 Officers – (3 SRO)
AfternoonAfternoon 9 Officers9 Officers
MidnightMidnight 7 Officers7 Officers
Drug UnitDrug Unit 1 Officer1 Officer
TotalTotal 21 Officers21 Officers
Many Cracks to Fall Through Many Cracks to Fall Through OROR
Many Opportunities for DiversionMany Opportunities for Diversion
FamilyFamilyFriendsFriendsCommunityCommunity NeighborsNeighbors ChurchChurch SchoolSchool BusinessesBusinesses
ServicesServices PhysiciansPhysicians Mental health treatment providersMental health treatment providers 11stst Responders Responders
The Scope of the Problem…Why Divert?
8 percent of annual jail bookings have current symptoms of serious mental illness
Costly and time consuming for law enforcement officers and local jails.
Courts become backlogged
Cycle in and out of the mental health, substance abuse, and criminal justice systems
Many become homeless, engaging in survival activities Many become homeless, engaging in survival activities
The Scope of the Problem…The Scope of the Problem…Why Divert? Why Divert?
More likely to:More likely to: be poor and uninsured be poor and uninsured be detained because they cannot post even very low bailbe detained because they cannot post even very low bail be charged with more serious crimes and have stiffer penaltiesbe charged with more serious crimes and have stiffer penalties to spend two to five times longer in jailto spend two to five times longer in jail to be involved in more fights, infractions, and sanctionsto be involved in more fights, infractions, and sanctions to return to jail on a probation violationto return to jail on a probation violation
Frequently, Frequently, people who are caught in the “revolving door” of people who are caught in the “revolving door” of corrections, mental health treatment, and homelessnesscorrections, mental health treatment, and homelessness are are thought of as “bad clients” or “treatment resistant,” when in reality, thought of as “bad clients” or “treatment resistant,” when in reality, they are casualties of they are casualties of “client resistant services”“client resistant services” (H. J. Steadman, (H. J. Steadman, personal conversation, March 6, 2006).personal conversation, March 6, 2006).
Simply put:Simply put: Diversion is the Right Thing To DoDiversion is the Right Thing To Do
The Scope of the Problem…The Scope of the Problem…Why Divert?Why Divert?
What Jail Diversion Has to OfferWhat Jail Diversion Has to Offer
A A viable and humaneviable and humane solution solution
positive outcomespositive outcomes for people with mental illness, systems, and communities for people with mental illness, systems, and communities
In particular, jail diversion:In particular, jail diversion: ReducesReduces time spent in jail time spent in jail LinksLinks people to community-based services people to community-based services Results in Results in lowerlower criminal justice costs criminal justice costs Does not increase Does not increase public safetypublic safety risk risk
Jail diversion programs Jail diversion programs Develop and build on Develop and build on broad-based community consensus and collaborationbroad-based community consensus and collaboration IntegrateIntegrate services and systems and services and systems and bridge the gapbridge the gap in fragmented systems in fragmented systems Break the cycleBreak the cycle of recidivism, revolving door of recidivism, revolving door Reflect a holistic, systemic approach to mental health service delivery that will allow most people with mental disorders Reflect a holistic, systemic approach to mental health service delivery that will allow most people with mental disorders
to live, work, learn, and participate fully and safely in their communities. to live, work, learn, and participate fully and safely in their communities.
* Practical Advice on Jail Diversion: Ten Years of Learnings on Jail Diversion from the CMHS National GAINS Center (2007)* Practical Advice on Jail Diversion: Ten Years of Learnings on Jail Diversion from the CMHS National GAINS Center (2007)
http://www.gainscenter.samhsa.govhttp://www.gainscenter.samhsa.gov
I. Law Enforcement/Emergency Services
II. Post-Arrest: Initial Detention/Initial Hearings
III. Post-Initial Hearings: Jail/Prison, Courts, Forensic Evaluations & Commitments
IV. Re-Entry from Jails, State Prisons, & Forensic Hospitalization
V. Community Corrections
& Community Support
Munetz & GriffinPsychiatric Services 57: 544–549, 2006
15
Sequential InterceptsSequential Intercepts
How are Certified Peer Specialists How are Certified Peer Specialists currently being used in CIT programs?currently being used in CIT programs?Training: role play & critique the officers actions in the role playingTraining: role play & critique the officers actions in the role playing
CIT planning committees, help arrange visits to consumer sites or arrange CIT planning committees, help arrange visits to consumer sites or arrange consumer/family panels as part of the curriculum consumer/family panels as part of the curriculum
IOOV for the consumer perspective and also have consumers represented on IOOV for the consumer perspective and also have consumers represented on planning committeeplanning committee
community resource panel and the site visits had Peer Specialists on the panelcommunity resource panel and the site visits had Peer Specialists on the panel
post-booking jail diversion programs like mental health courtspost-booking jail diversion programs like mental health courts
once the person is linked to their local mental health service provider, Peer once the person is linked to their local mental health service provider, Peer Specialists who work with those providers can become involved on an as Specialists who work with those providers can become involved on an as needed basis needed basis
(based on informal survey of NAMI Executive Directors nationwide)(based on informal survey of NAMI Executive Directors nationwide)
The Mission of the CertifiedThe Mission of the CertifiedPeer SpecialistPeer Specialist
Education and TrainingEducation and Training
EmpowermentEmpowerment
HopeHope
Promote RecoveryPromote Recovery
Scranton Area CIT Peer Specialist Scranton Area CIT Peer Specialist Pilot ProgramPilot Program
Rationale/Research SupportRationale/Research Support1999 Surgeon General’s Report on Mental Health 1999 Surgeon General’s Report on Mental Health
recognized the value of peer support in recoveryrecognized the value of peer support in recovery encouraged states and communities to incorporate peer servicesencouraged states and communities to incorporate peer services
Research suggests:Research suggests:
Peer providers are often able to more readily forge favorable Peer providers are often able to more readily forge favorable relationships with clients because of shared perspectives and relationships with clients because of shared perspectives and experiencesexperiences
Early use of peer support can:Early use of peer support can:engage those most alienated (“treatment resistant”)engage those most alienated (“treatment resistant”)help people feel empowered in their recovery planshelp people feel empowered in their recovery planskeep people engaged in traditional treatment and community self-helpkeep people engaged in traditional treatment and community self-helpresult in fewer police calls and arrests result in fewer police calls and arrests
those engaged in treatment are less likely to experience mental health crises or those engaged in treatment are less likely to experience mental health crises or require police intervention if they dorequire police intervention if they do
if police intervention does occur, those who have peer specialist services are if police intervention does occur, those who have peer specialist services are more likely to have developed recovery tools.more likely to have developed recovery tools.
Small group of CIT officers selected at Small group of CIT officers selected at random to participaterandom to participate
Peer specialist services described to officersPeer specialist services described to officers
Instructions given on how to describe peer Instructions given on how to describe peer specialist services specialist services
(“someone who has been in the same kind of situation”)(“someone who has been in the same kind of situation”)
Officers offer peer services after CIT crisis call Officers offer peer services after CIT crisis call is resolved on sceneis resolved on scene
Not if arrest occursNot if arrest occurs
Not if person is transported to the hospital Not if person is transported to the hospital Phase IIPhase II
ProcedureProcedureOfficer asks if person would like to receive Officer asks if person would like to receive a call from a peer specialista call from a peer specialist If no, card/brochure left with person or familyIf no, card/brochure left with person or family If yes, officer calls peer specialist coordinatorIf yes, officer calls peer specialist coordinator
Coordinator assigns peer specialist to the caseCoordinator assigns peer specialist to the case
Peer specialist makes call w/i 12-24 hours of crisisPeer specialist makes call w/i 12-24 hours of crisis
Describes peer support services, treatment Describes peer support services, treatment options, community programs, etc.; offers peer options, community programs, etc.; offers peer support services if appropriatesupport services if appropriate
CIT Call
ArrestCrisis resolved
on scene
Transport to hospital
{Phase II}
Peer specialist described; permission requested to refer to peer specialist for outreach call
Permission refused; peer specialist
card given
Permission granted; officer contacts
peer specialist coordinator
Peer specialist makes outreach call within12-24 hours of crisis
(describes services, treatment options, community programs)
Peer services accepted
Peer services rejected
Data collection:Date of call
1, 3 & 6 months later
Data collectionDate of call
1, 3 & 6 months later
Data CollectionData Collection
Peer specialist gathers data (during call, Peer specialist gathers data (during call, two weeks later, one month later, three two weeks later, one month later, three months later, six months later)months later, six months later) services being usedservices being used community involvementcommunity involvement engagement in treatmentengagement in treatment satisfaction with treatmentsatisfaction with treatment
Police records reviewed (three months & Police records reviewed (three months & six months later -- crisis calls/arrests)six months later -- crisis calls/arrests)
Post-Pilot StrategyPost-Pilot Strategy
Use of pilot results to:Use of pilot results to:
Demonstrate effectiveness of early peer services to Demonstrate effectiveness of early peer services to divert people from criminal justice system, reduce divert people from criminal justice system, reduce repeat police calls, engage people in treatmentrepeat police calls, engage people in treatment
Support funding requests and grant proposals to Support funding requests and grant proposals to incorporate peer specialist services in all appropriate incorporate peer specialist services in all appropriate CIT callsCIT calls
Support other CIT programs in seeking funding Support other CIT programs in seeking funding sources to incorporate peer specialist servicessources to incorporate peer specialist services
Total Sworn ComplimentTotal Sworn Compliment
January 1, 2011 – 150 OfficersJanuary 1, 2011 – 150 Officers
August 31, 2011 – 134 OfficersAugust 31, 2011 – 134 Officers
Obstacles to ImplementationObstacles to Implementation
PolicePolice Lay Offs – Loss of CIT OfficersLay Offs – Loss of CIT Officers Data collection problemsData collection problems
ObstaclesObstacles
Paying for CPS services Paying for CPS services State regulations:State regulations:
Medical necessity for CPS ServicesMedical necessity for CPS ServicesAgreement of the individual to receive servicesAgreement of the individual to receive servicesStrict provider qualifications for MA compensable Strict provider qualifications for MA compensable Peer Support Services providersPeer Support Services providers
Hospital & provider buy-inHospital & provider buy-in Resistance to change from medical model to Resistance to change from medical model to
recovery-oriented modelrecovery-oriented model
ReferencesReferencesClarke, G., Herinckx, H., Kinney, R., Paulson, R., Cutler, D., Lewis, K., & Oxman, E. (2000). Psychiatric hospitalizations, arrests, emergency Clarke, G., Herinckx, H., Kinney, R., Paulson, R., Cutler, D., Lewis, K., & Oxman, E. (2000). Psychiatric hospitalizations, arrests, emergency
room visits, and homelessness of clients with serious and persistent mental illness: findings from a randomized trial of two ACT room visits, and homelessness of clients with serious and persistent mental illness: findings from a randomized trial of two ACT programs vs. usual care. programs vs. usual care. Mental Health ServicesMental Health Services Research Research. Retrieved from . Retrieved from http://springerlink.metapress.com/openurl.asp?genre=article&id=doi:10.1023/A:1010141826867http://springerlink.metapress.com/openurl.asp?genre=article&id=doi:10.1023/A:1010141826867
CMHS National Gains Center. (2007). Practical Advice on Jail Diversion: Ten Years of Learnings on Jail DiversionCMHS National Gains Center. (2007). Practical Advice on Jail Diversion: Ten Years of Learnings on Jail Diversion
Felton, C.J., Stastny, P., Shern, D.L., Blanch, A., Donahue, S.A., Knight, E., Brown, C. (1995). Consumers as peer specialists on intensive case Felton, C.J., Stastny, P., Shern, D.L., Blanch, A., Donahue, S.A., Knight, E., Brown, C. (1995). Consumers as peer specialists on intensive case management teams: impact on client outcomes. management teams: impact on client outcomes. Psychiatric Services, 46Psychiatric Services, 46, 1037-1044., 1037-1044.
Lucksted, A., McNulty, K., Lorener, B., Forbes, C. (2009). Initial evaluation of the peer-to-peer program. Lucksted, A., McNulty, K., Lorener, B., Forbes, C. (2009). Initial evaluation of the peer-to-peer program. Psychiatric Services, 60Psychiatric Services, 60, 250-253., 250-253.
Lyons, J.S., Cook, J.A., Amity, R.R., Karver, M., Slagg, N.B. (1996). Service delivery using consumer staff in a mobile crisis assessment Lyons, J.S., Cook, J.A., Amity, R.R., Karver, M., Slagg, N.B. (1996). Service delivery using consumer staff in a mobile crisis assessment program. program. Community Mental Health Journal, 32(1)Community Mental Health Journal, 32(1), 33-__. , 33-__.
Mayor’s Task Force on Law Enforcement and Mental Health (2010). Final Report. Scranton, PA. Mayor’s Task Force on Law Enforcement and Mental Health (2010). Final Report. Scranton, PA. http://www.scrantonpa.gov/images/Final%20Report%20and%20Recommendations%20of%20the%20Mayor's%20Task%20Force.pdfhttp://www.scrantonpa.gov/images/Final%20Report%20and%20Recommendations%20of%20the%20Mayor's%20Task%20Force.pdf
Meehan, T., Bergen, H., Coveney, C., & Thornton, R. (2002). Development and evaluation of a training program in peer support for former Meehan, T., Bergen, H., Coveney, C., & Thornton, R. (2002). Development and evaluation of a training program in peer support for former consumers. consumers. International Joural of Mental Health Nursing, 11International Joural of Mental Health Nursing, 11, 34-39., 34-39.
Munetz & Griffin, Psychiatric Services 57: 544–549, 2006Munetz & Griffin, Psychiatric Services 57: 544–549, 2006
Sells, E., Black, R., Davidson, L., Rowe, M. (2008). Beyond generic support: Incidence and impact of invalidation in peer services for clients with Sells, E., Black, R., Davidson, L., Rowe, M. (2008). Beyond generic support: Incidence and impact of invalidation in peer services for clients with severe mental illness. severe mental illness. Psychiatric ServicesPsychiatric Services, , 59(11)59(11), 1322-1327., 1322-1327.
Sells, D, Davidson, L., Jewell, C., Falzer, P., Rowe, M. (2006). The treatment relationship in peer-based and regular case management for Sells, D, Davidson, L., Jewell, C., Falzer, P., Rowe, M. (2006). The treatment relationship in peer-based and regular case management for clients with severe mental illness. clients with severe mental illness. Psychiatric ServicesPsychiatric Services. . 57(8)57(8), 1179-1184., 1179-1184.
U.S. Department of Health and Human Services (1999). U.S. Department of Health and Human Services (1999). Mental Health: A Report of the Surgeon General—Executive SummaryMental Health: A Report of the Surgeon General—Executive Summary. Rockville, MD: . Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.Health Services, National Institutes of Health, National Institute of Mental Health.