Session #C1a
October 17, 2014
Trail Blazers: Peer Support in Integrated Health Care:
The T&T Experience (Tennessee and Texas)
Rick Ybarra, M.A., Program Officer
Hogg Foundation for Mental Health
Stephany J. Bryan, Program Officer and Consumer & Family Liaison
Hogg Foundation for Mental Health
Suzanne Bailey, Psy.D.
Clinical Psychologist and Behavioral Health Consultant
Cherokee Health Systems
Collaborative Family Healthcare Association 16th Annual Conference
October 16-18, 2014
Washington, DC U.S.A.
Faculty Disclosure
I/We have not had any relevant
financial relationships during the
past 12 months.
Learning Objectives
At the conclusion of this session, the participant will be able to:
• Identify at least three examples of the role of peer support
specialists in health care delivery systems.
• Define at least three challenges and strategies to address
challenges.
• Identify at least three policy opportunities to advance peer
support in primary care settings.
• List three resources to help organizations plan and implement
peer support in their settings.
Bibliography / References
1. Yale School of Medicine, Recovery Self-Assessment (click on Provider version).
http://www.yale.edu/PRCH/tools/rec_selfassessment.html
2. Chinman, M., George, P., Dougherty, R.H., Daniels, A.S., Ghose, S.S., Swift, A., and
Delphin-Rittmon, M.E. (2014). Peer support services for individuals with serious mental
illness: Assessing the evidence. Psychiatric Services 2014; doi:
10.1176/appi.ps.201300244. Retrieved at
http://ps.psychiatryonline.org/article.aspx?articleID=1832833
3. Gillard, S. and Holley, J. Peer workers in mental health services: literature overview.
Advances in psychiatric treatment (2014), vol. 20, 286–292.
4. Kaufman, L., Brooks, W., Bellinger, J., Steinley-Bumgarner, M., and Stevens-Manser,
S. 2014. Peer Specialist Training and Certification Programs: A National Overview.
Texas Institute for Excellence in Mental Health, School of Social Work, University of
Texas at Austin.
5. U.S. Department of Health and Human Services, Substance Abuse and Mental
Health Services Division. (2012). With peer support, recovery is possible. SAMHSA
News, Vol. 20, No. 3. Retrieved at
http://www.samhsa.gove/samhsanewsletter/Volume_20_Number_3/peer_support.aspx
Learning Assessment
• A learning assessment is required for CE
credit.
• A question and answer period will be
conducted at the end of this presentation.
Overview – Peer Support
• Definition
– Peer support services are delivered to a person with a mental
health condition or co-occurring mental and substance use
disorders by a person in recovery. Peers draw upon their lived
experiences to share ‘been there’ empathy, insights, and skills . . .
serve as role models, inculcate hope, engage patients in
treatment, and help patients access supports in the community.
• Role of peers in health care
• National movement
• The T&T Experience
Map of Peer Specialist Training and
Certification Programs by State
Source: Texas Institute for Excellence in Mental Health, School of Social Work, University of Texas at Austin.
Peer Support has been found to help:
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Reduce readmissions by 42%
Reduce days in hospital by 48%
Improve relationships with providers
Increase engagement with care
Decrease substance abuse
Decrease depression
Increase hopefulness
Increase activation and self care
Increase sense of well-being
Source: L. Davidson: Chinman et al (2014)
The Tennessee Experience
Cherokee Health Systems:
Integrated Medical & Behavioral Health
57 Clinical Locations in 14 East Tennessee Counties
63,291 unduplicated patients
15,325 new patients
484,494 patient services
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The Tennessee Experience:
Peer Utilization
Certified Peer Recovery Specialists
Primary Care & Behavioral Health
Warm Handoffs
Individual Coaching & Workshops
Multidisciplinary Team
Coordination of Care
Extending the Continuum of Care
The Tennessee Experience:
Peer Support Targets
• Chronic Disease Self-Management
• Diabetes Self-Management
• Wellness
• Tobacco Cessation
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The Tennessee Experience:
Benefits of Peer Support
Empowers patients
Increases health literacy
“Instills hope”
Significantly improved adherence
Significant decrease in BMI
The Tennessee Experience:
Challenges
• Patient engagement
• Population-based needs
• Integrated model
The Tennessee Experience:
Addressing Challenges
• Let the patients be your guide.
• Ready, fire, aim.
• Primary Care inclusion
The Tennessee Experience:
Peer Support Integration
The TEXAS experience
The Purpose
• To develop a skilled workforce of consumers
who will help others in their recovery
• To provide an added piece to a recovery
oriented continuum
• To demonstrate that individuals with lived
mental health challenges can and do
recover
The TEXAS experience
Implementation sites
• East Texas Coalition for
Mental Health Recovery
• Serves as a collaborative
Recovery–Oriented Learning
Community
• Began 2010
• 11 LMHA’s
• 1 State Hospital
The TEXAS experience
Role of peers/how peers being utilized
• “Offering and receiving help, based on shared
understanding, respect and mutual empowerment
between people in similar situations” (Mead et al., 2001)
• Identifying and setting recovery-oriented goals
• Planning specific action steps to achieve goals
• Promoting exercise and good nutrition
• Assisting in daily management tasks and problem-solving
• Providing social and emotional support and feedback in
individual and group settings
• Recovery education classes to consumers and staff to
raise awareness, dispel myths, enhance competencies
The TEXAS experience
Benefits and value added to having peers
• Change agents
• Can take away the “you do not know what it’s like” excuse
• Experience of moving from hopelessness to hope
• Increase engagement, HOPE and SUPPORT
• Improve trust and communication between patients and
health care providers
• Increase confidence, self-esteem and skills
• Improve self-responsibility, self-care and self-determination
• Improve quality of life
• Medicaid reimbursable in some states
The TEXAS experience
Challenges for peers in work setting
• Reluctance to change practice patterns
• Negative attitudes about persons with mental health and
substance use problems
• Shortage of leaders committed to and capable of
managing the organizational change process required to
achieve integration
• Lack of a clear job description
• Being required to perform tasks that have little to do with
providing peer support
• Lack of supervision, or supervision that does not match
their role
• Low—or no—pay and a lack of career advancement
The Texas experience
Policy solutions and strategies to
address challenges
• Develop clear guidelines and best practice
recommendations for peer recovery support services in
integrated health programs
• Create resources that assist States and authorities to
develop, monitor, and finance peer support/recovery
coaching services
• Create mechanisms for mental health authorities to
dialogue about supporting the implementation of peers
in the workforce
Resources Peer Support in Integrated Health Care
Certified Peer Specialists
•Copeland Center for Wellness and Recovery: http://copelandcenter.com/
•Georgia Certified Peer Specialist Project: http://www.gacps.org/
•Institute for Recovery and Community Integration:
http://www.mhrecovery.org/services/peer.php
•Via Hope – Texas Mental Health Resource: http://www.viahope.org/
•Pillars of Peer Support: http://www.pillarsofpeersupport.org/
Recovery and Wellness
•National Empowerment Center: http://www.power2u.org/
•National Council on Alcoholism and Drug Dependence, Inc.:
http://www.ncadd.org/index.php/recovery-support/overview
•Recovery Innovations: http://www.recoveryinnovations.org/index.html
•SAMHSA:
http://www.samhsa.gov/newsroom/advisories/1112223420.aspx
Learning Assessment
Discussion / Q&A
Session Evaluation
Please complete and return the
evaluation form to the classroom monitor
before leaving this session.
Thank you!