Pathways Peer Wellness Project: “The
thing with being a peer is: We’ve been
there and done that”
Neil Harbus, LCSW,CPRP
CUNY & Pathways to Housing
Ana Stefancic, MA
Columbia University & Pathways to Housing
Sam Tsemberis, PhD
Pathways to Housing & Columbia University Medical Center
www.pathwaystohousing.org
Peer Wellness: Program Overview
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Funded by Substance Abuse Mental Health Services
Administration (SAMHSA)
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Grant expectations: 570 individuals will receive Peer
Wellness services over 5 years (now in year 2)
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11 Peer Wellness Specialists hired as part-time
employees (approx 5.5 FTE)
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All Pathways consumers are eligible. Participants are
referred by support teams, peers specialists or through
self-referrals
Who Are Our Target
Populations?
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Individuals in the process of transitioning off of
Pathways’ ACT Teams
Individuals who are looking for assistance in
planning the next step in their Recovery process.
Individuals who are new to Pathways, and could
benefit from peer support during this time.
Individuals who have become disengaged from
their Team.
Who are the peer specialists?
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“A peer is someone who’s been where you
been and a specialist means they got training
to help you better.”
 Mental
health
 Substance use
 Homelessness
 Criminal Justice
…
Wellness Services
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Providing “consumers with information, skills and
strategies to self manage mental health challenges and
to engage in recovery supporting actions”*
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Tools/EBPs:
 Wellness Self-Management (WSM, IMR-derived)
 Wellness Recovery Action Plan (WRAP)
 Relapse Prevention Plan
 Supported Employment
 Program Specific: Balanced Life, Healing from Within,
etc.
*Center for Practice Innovations, Columbia Psychiatry
Training, Supervision, Documentation
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Training
 3 day orientation: Program Overview, Wellness and Recovery
principles, Intentional Peer Support, Trauma Informed Care, Crisis
Response, Safety, Documentation, Engagement Techniques,
WRAP, WSM and other Recovery Curricula
 Ad hoc trainings: Stages of Change, Motivational Interviewing,
CBT
Supervision
 Bi-weekly group supervision: clinical & administrative
issues/questions + successes
 In-vivo Field supervision & Support
 Ongoing review of progress notes and edits
Documentation:
 Peers complete progress notes in electronic record on same day
of service (agency standard)
Flexible Service Delivery
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Location of Services: Consumer’s apartment, in the
community, in their team office, at the Resource Center
Format: One to one or group format. Whatever works best for
the individual
Specialties & Caseloads:
 Apart from general Wellness, many peers have a specialty:
Employment, Education, Finances
 Peers have caseloads but can refer consumers to others
for specialty services
Two Structural Modalities:
 Peer Specialists Embedded on Assertive Community
Treatment (ACT) or ICM Team
 Peer Specialists at Resource Center
Flexible Service Delivery

Primary Base: ACT Team (4)
 Work alongside clinicians,
etc.
 Attend morning meeting
 Visit clients in the
community
 Enhance quality of
services, not replace
existing services
 One-on-one or group
sessions

Primary Base: Resource
Center (7)
 All services are peer-led
 Facilitate classes and
groups
 One-on-one counseling
sessions
 Visit clients in the
community
 Develop program
curricula
All 11 peer specialists are “linked” to one of 9 teams
(spread over 6 geographically dispersed areas)
to facilitate referral, service delivery, and communication
Pathways Resource Center
Open 6 days a week, the Resource Center offers upwards of 25
Peer-led Recovery Classes a week including:
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Nutrition Class including cooking
and gardening
WSM and WSM plus
Healing from Within
Photography
Art
Financial Wellness
Life Balance
Filling a Man’s Shoes
Going Broke for a Smoke
Parenting Support Group
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Harm Reduction
Journaling
2 Computer Classes
2 Continuing Ed/College Prep
Classes
My Neighborhood, My World
Women’s Issues
Work Now
WRAP Group
Science
History
Journaling
Harm Reduction
Moving On Group
* A number of these groups are also
offered at other Pathways’ sites*
Peers Enhancing Services
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Average contact is close to an hour
Spend quality time with individuals focusing on wellness
and minimizing “case management” functions
Increasing monthly contact with consumers:
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Served over 170 individuals since start-up (varying levels of service
intensity)
Averaging 240 contacts a month
Increasing community contacts with a variety of services being
offered
Contributing to the overall stability of individuals, which
leaves the Team with more time to focus on immediate
crises
Reengaging and reestablishing working relationships with
individuals on behalf of the Teams
Targeted Wellness Domains
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Environment:
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Housing, Safety
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Checkups/Screenings
Managing Chronic Illness
Nutrition & Exercise
Social:
Family Reconnection,
Friends/Partners, Loss
Intellectual:
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Financial:
Entitlements, Financial
Empowerment
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Occupational:
Leisure pursuits, employment
activities, Job training
Emotional/Mental
Stress Reduction
Symptom Management
Medication
Substance use
GED/College Prep
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Physical:
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Spiritual:
Meaning and Purpose
Values, Code of Conduct
Process & Outcomes Evaluation
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Consumer Outcomes: Interviews with participants at
intake and every 6-months thereafter
 Quantitative: Functioning, Social Activities,
Employment, Recovery
 Qualitative: Goals, next steps, what’s helped and
what hasn’t
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Process Evaluation: Peer specialist interviews
 Qualitative: Peer role, challenges, successes…
Sample Outcomes
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Client Perception of Functioning: improved 24% over baseline
Employment: improved 11% over baseline. This includes a
dozen people securing either competitive or transitional
employment positions.
Social Connectedness: improved 11% over baseline
Skills Enhancement:
 27 Individuals worked on developing positive strategies to
reduce the harmfulness of behaviors that interfere with
their wellness, including substance use.
 15 individuals were observed to have enhanced their
computer skills.
 15 individuals worked on enhancing their understanding of
healthy cooking and nutrition.
Outcomes
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Clinical:
 3 individuals were assisted in transitioning from ACT
services to a less intensive level of care,
 25 individuals reported enhanced social relationships
and family reconnection.
 30 individuals reported improved medication
adherence.
Case Examples
12 psychiatric admissions/ER visits in 14 months before
working with peer wellness program
No contact with daughter for over 20 years
Case Examples
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From 12 psychiatric admissions/ER visits
in 14 months to 0 admissions/ER visits in
12 months+ post-enrollment
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From no contact with daughter in 20+
years to… Peer helped him open an e-mail
account, open a Facebook account and
found her on Facebook. She lives overseas
& they’re arranging a meeting in the U.S.
Sample Note
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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
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 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. 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 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 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, 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. 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 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 him. B. stated okay. Peer will follow-up
on…
Consumer Interviews
What’s Changed Since Being In
the Program?
What’s Helpful about The
Program?
“ I want to become a Peer
Specialist”
“ I got an apartment, I have
more privacy, I’m more
alert, I have better
concentration”
“I’m Focusing on School”
“I got a job”
“It Helped Me Bridge The Gap
Between Who I Was And
Who I Was Becoming”
“They brought me Hope!”
“I’m learning and exploring
new things”
“They helped me with my
medical problems”
“ I grew a lot, I became a
better person”
What Did People Most Report
Was Missing From Their Lives?
A
Partner
 A Job
 Visitation with their Children
or having their Children
returned to them
*We will soon be starting a parenting initiative*
Peer Specialist Perspective:
Bumps In The Road
Selling a New Program is always a Challenge:
“There are some individuals who have been so knocked
down and beaten up, decades and decades and decades,
that they don’t trust anybody. And a lot of them…they
been so beaten down that they don’t think- they don’t feel
that they’re worth even talking to to see what is goin’ on
with them.”
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Gaining Full Acceptance from “Professional” staff:
“And there are people from counselors on up to the clinicians
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
their jobs, or they think we’re tryin’ to be them.”
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Bumps in the Road
Gaining Full Acceptance from Pathways’
participants:
“I’ve had- one or two people who uh, didn’t want to
accept my, my services, or me, solely because I was a
peer, and not a professional.”
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Managing one’s own wellness
“Sometimes I have to drop appointments and- and I’mI’m only one person, and my wellness comes first
and foremost.”
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Peer Specialist Perspective: Successes
Making a Difference
“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. So, that makes me feel like, you know, I’m
playing a part, and it’s not just the Seroquel.”
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Advocacy/Mediation
“My job is to advocate for the consumer. That’s my job first
and foremost. There for employment, to make sure these
guys are afforded their rights. And if Pathways is
supposed to be doing something for them? It’s my job to
make enough noise so that it’s done.”
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Sense of Community
“The camaraderie with the co-workers, the consumers, the
environment…walking here is like walking home.”
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Thank You!
If you are interested in bringing
Peer Wellness Services to your agency contact:
Neil Harbus
nharbus@pathwaystohousing.org
Also, Presentations at
Housing First Partners Conference
New Orleans, March 21-23, 2012