Tanya Stevens, Peer Services Division Director tanyas@nyaprs.org Elizabeth R. Stone, MA, CASAC elizabeths@nyaprs.org

1. This is Our Time! Taking Peer Wellness Coaching to New Groups and New Partners Tanya Stevens, Peer Services Division Director tanyas@nyaprs.org Elizabeth R. Stone, MA, CASAC elizabeths@nyaprs.org Coleen Mimnagh, Certified Peer Wellness Coach coleenm@nyaprs.org NYAPRS 2010 Annual Conference www.nyaprs.org

2. Shery Mead 2004 • “In peer support we come together with the intention of changing our patterns, getting out of “stuck” places, building relationships that are respectful, mutually responsible and potentially mutually transforming. • We validate each other for our ‘personhood’ rather than our ‘patienthood’…[we] see each other’s behavior through the lens of personal experience rather than through the lens of illness.”

3. Key Elements of Peer Support • Sharing, validating and normalizing similar experiences • Building empathy, sharing opportunities for connection and knowledge • Building honest mutually responsible relationships • Based on the intention to change patterns and get unstuck • Full respect for each of our unique processes of change • Willingness to challenge each other

4. Peer Support Models: Helping People and Systems to Get Unstuck Peer Bridging: Alternatives to Long term or ‘Revolving Door’ Use of Inpatient Care Peer Health Care Coaching: Support for Improved Self-managed Health and Recovery Peer Crisis Support and Respite: Alternatives to Chronic Use of Emergency/Inpatient Care Peer Brokered Self Direction: Alternatives to Chronic Community Institutionalization Restoring Lives, Redirecting and Saving $

5. NYAPRS Peer Bridger ProjectBackground Funded by: New York State Office of Mental Health New York’s Community Reinvestment Act of 1993 Combining Two Top Criteria: Reducing State Hospital Census Promoting Peer Support Development Team: Dr. Edward Knight Dr. Cheryl MacNeil Harvey Rosenthal Chacku Mathai Shery Mead

6. The Peer Bridger Lens “We support each other to get out of the hospital, stay out of the hospital and get the hospital out of us.”

7. NYAPRS Peer Bridger ModelBasic Elements • Involvement in Mutual Support Meetings in the Hospital and in the Community • Developing a Mutually Responsible Peer Relationship • Strengthening/Modeling Community Adjustment, Wellness Self-Management and Relapse Prevention/Crisis Management Skills • Connecting with Natural and Service-Based Supports and Community Resources • Infusing Recovery And Cultural Competence In Hospital And Community Service Settings

8. NYAPRS Peer SupportCore Values • Honest, direct communication • Power sharing and mutuality • Building hope and faith • Empathy and mutuality • Personal responsibility and accountability • Valuing and creating community • Not using “symptoms” or “illness” as a reason to not meet each other’s needs • Learning to work through conflict • Being accountable to the relationship • Understanding trauma is central

9. NYAPRS Peer Bridger Project Services • Skill teaching • Social and emotional support • Recreation and companionship • Development of self-advocacy • Mutual peer support • Participation at weekly peer support meetings • Development of wellness self-management WRAP plans • Discovering community (community guides)

10. NYAPRS Peer Bridger Project Reframing Crisis • WRAP and Wellness Self-Management Tools • Forming Communities of Support • Dealing with “Big Feelings” • Keeping Your Power When Things Break Down

11. NYAPRS Peer Bridger Project 2009 Data Numbers of MatchesTotal # of people referred to the project 368 # of people in matches 339 # of people referred from the hospitals 129 # of people who self-referred 239 # of new matches since 1/1/09 312

12. Additional Data for 2009 Number of TransitionsTotal # of people released from state psychiatric centers 205 # of people who left psych centers who have not returned for three months or more 199 # of people who transitioned from on-grounds residences 138 # of people who transitioned from inpatient to on-grounds residences or independent living 186 Total # of people who were discharged 320 # of people who were assessed to be discharge ready and who were waiting for community housing 123

13. Reducing Re-Hospitalization In 2008, the Peer Bridger Project worked with 251 individuals and 190 of those consented to the release of their hospitalization data. After a preliminary review of this data, approximately 136 of these individuals were not re-hospitalized in the state psychiatric centers in 2008. That means that approximately 72% percent of the people we worked with were able to stay out of the hospital for the following year.

14. Number of Meetings and Staff Trainings on Peer Support in 2007 2007 Data on Peer Support Meetings and Staff Trainings Peer Support Meetings held in State PCs 33 Peer Support Meetings held in the community 31 Average # of people attending each meeting 13 Total # of people served in meetings 1,300 Plus: 148 hospital and community trainings conducted by the Peer Support Specialists

15. wellness matters • On average, individuals with a psychiatric diagnosis die 25 years earlier than people in the general population. • Sixty percent of premature deaths can be attributed to medical conditions that are frequently caused by or worsened by controllable lifestyle factors such as: • poor diet and nutrition • smoking • substance abuse • limited physical activity • difficulty accessing consistent medical care • Morbidity and Mortality in People with Serious Mental Illness NASMHPD October 2006

16. Wellness is . . . an individual’s personal perception of reaching his or her full potential by achieving a better quality of life in conjunction with mind, body and spirit

17. National Health Care Reform Focus:More Integrated Coordinated Effective Care • Focus on ‘moving further upstream’ with prevention & early intervention services to prevent ‘complex medical and behavioral health conditions’ from becoming chronic costly health conditions; • Emphasis on wellness & person centered care • Improved coordination of care and use of evidence-informed approaches • Decreased overuse and underuse of services • Dramatically improve the management of chronic health conditions for the 45% of Americans with one or more such conditions whose treatment = 75% of total medical costs

18. The NYS Challenge: Improving Care, Reducing Costs for People with ‘Chronic Illnesses’ • “20% of NYS Medicaid beneficiaries account for a significant amount (75%) of the program’s expenditures.” • “These beneficiaries have multiple co-morbidities, are medically complicated and require services across multiple provider agencies.” • “Due to their multiple and intensive needs, their care can often be fragmented, uncoordinated and ..duplicative.” • Included in these special populations are recipients with chronic conditions, mental illness, chemical dependency, HIV/AIDS, developmental disabilities and mental retardation, and individuals requiring long term care.” NYS Department of Health CDIP Request for Proposals 2008

19. The Promise of Peer Health Care Coaching:NYAPRS Proposal to OptumHealth CDIP • Most healthcare systems don’t appreciate the crucial importance of relationship, of fostering hope for change, of being available before and during crises: they often passively wait in vain for people whose struggles, whose lack of financial and transportation resources and whose lack of hope and connection make them appear to be ‘non compliant no shows.’ • We know…we are those ‘high cost high needs’ people with medical and behavioral health conditions. • Building on our Peer Bridger experience, NYAPRS Peer Wellness Coaches can help bring hope and proactive, personalized, mobile ‘real time’ relationship-based help.

20. The Promise of Peer Health Care Coaching:NYAPRS Proposal to OptumHealth CDIP UMDNJ or CUNY Trained and Certified Peer Wellness Coaches are uniquely skilled at: • Active outreach and engagement • Reinforcing accurate information about medical conditions and self management care approaches • Providing ongoing support and reinforcement, including cues, reminders and prompts to follow up on medicine, health appointments, exercise, use of the nicotine patch, etc. • Conveying the power of relationship and personal support

21. A Peer Wellness Coach is Someone Who Shares experiences and hope Uses communication skills Uses motivational questions Assists with challenging perceptions Assists with inner strength building Assists with problem solving Asks permission before giving a suggestion Assists with goal setting Assists with strategic planning

22. Peer Support in OptumHealth’sChronic Illness Demonstration Project in NY Peer Support in OptumHealth’s Chronic Illness Demonstration Project in NY NYAPRS Peer Health Care Coaching • Assist With Locating And Enrolling Consumers • Provide Individual Health Coaching and Support • Provide Health Focused Peer Support Groups • Link Individuals With Local Mental Health Supports • Assist With Relapse Prevention Activities, • Actively Participate In Enrollee Treatment Planning PEOPLe, Inc • Peer And Staff Training On Recovery And Relapse Prevention • Possible Establishment Of Crisis Respite Residence

23. CIDP Peer Wellness Coaching Activities • Using provided contact information, seek out identified Medicaid recipients to explain program, encourage them to enroll in program, and complete initial enrollment forms • Engage enrolled individuals to form trust-based relationships that foster hope for positive change and personal empowerment • Examine lifestyle factors that impact health and wellness with enrolled individuals • Utilize tools with enrolled individuals to discuss and plan for changing to behaviors that will lead to improved health self-management • Help enrolled individuals identify and engage with a range of community-based supports • Serve on Project Management Subcommittees

24. Peer Wellness Coaching Basics Motivational Dialogues toward Healthy Living • Asking helpful questions • Building self-confidence • Connecting with personal goals • Focusing on what’s important Realistic Possibilities • People may not be ready for change • It may take numerous attempts to change a lifestyle behavior • Lack of personal motivation hinders someone’s willingness to change • Minimal patience “Wanting what you want, when you want it”

25. LIFE WHEEL BALANCE DIMENSIONS Physical Emotional/Mental Financial Social Spiritual Environmental Occupational Intellectual HOW IT IS VS. HOW I WANT IT TO BE

26. Explaining Illnesses (Explanatory Models of Illness) • People from different cultures and backgrounds have • different ways of explaining • what caused their illness, • what it is called, • the course it takes and • what can help them.

27. Differing Views • Some people think their illness is hereditary • Others believe that it is caused by their environment • A few even think it may be caused by supernatural forces • Then there are those who are not sure of the origin of their illness

28. We can work with varied understandings of illnesses by . . . Asking questions (What, Why, How and Who) Educating ourselves on different beliefs and cultures Having respect and empathy

29. Wellness Assessments DIMENSIONS Overall Physical Health Nutrition Physical Activity Sleep / Rest Relaxation / Stress Management Environment Medical Care / Screenings

30. Assess Your Strengths, Needs & Barriers What are your personal strengths? What do you want to change or improve? What could / does get in the way? Assess Your Level of Satisfaction

31. The Decision Balance “helps you evaluate if the change you say you want to make is really that important to you” Dr. Rick Bothelo Weighing the PROS and CONS of your goal: Which is most influential?

32. A Decision Balance • Helps you understand why you might stay the same (resistance to change) • Helps you understand why you might want to change (motivation) • Encourages you to think more about change • Can help you put a plan into action

33. A Decision Balance • Reasons to • Stay the Same • Benefits of staying the same • Concerns about change • Reasons to • Change • Concerns about staying the same • Benefits of Change List benefits and concerns Assign a value to each Total the values See which side has a greater total List which factors have the greatest weight Discuss what would have to shift for you to be successful in making a desired change

34. What Helps And What Hinders Conversation

35. Active Listening Involves . . . • Responding to content(Stating back to the person what you heard him or her say, in your own words) • Responding to feeling (Stating the feeling you sensed from what the person described) • Responding to meaning (A combination of content and feeling; lets the person know you understand his or her experience / situation)

36. H.E. A. L. I. N. G. COMMUNICATION HEAD UP EYE CONTACT ATTENTIVE LEANING FORWARD INTERESTED NO DISTRACTIONS GENUINENESS

37. Open Ended Questions . . . invoke conversation . . . do not feel like a quiz . . . do not have a right or wrong answer . . . are used sporadically throughout the conversation

38. Blocks to Listening • Comparing • Mind Reading • Rehearsing • Filtering & Dreaming • Judging • Identifying • Advising • Derailing & Placating

39. peers helping peers • Identification • Unique personal relationship • Focus on growth and self-stabilization • Building self-esteem and confidence • Focus on the whole person – not just a diagnosis • Realization of the importance of being self-involved in one’s recovery • Providing a safe and trusting environment

40. Critical CDIP Role • Our Queens peer wellness coaches helped find, engage and enroll over 1/3 of identified beneficiaries. • They helped OptumHealth staff successfully connect with numerous community agencies that proved helpful in finding or serving this group. • Our coaches’ inclusion in OptumHealth’s weekly team case rounds “gives the team the opportunity to learn from our peer partners, and hear an additional viewpoint on how to best manage the case being presented. In addition it is a great opportunity to get additional case referrals to peer support.”

41. Peer Wellness Coaching: One Consumer’s Story FIRST CONTACT • Met him with his mother in their home • Medicaid was inactive and he lacked meds – called HRA, pharmacy & Optum staff • Shared how knowing what to do was based on personal experience • Discussed how working with a peer could help him achieve positive outcomes

42. Peer Wellness Coaching: One Person’s Story FIRST CONTACT • Talked about her own recovery story and her personal ways of maintaining mental, physical and spiritual wellness • Learned about and reflected value of his accomplishments of 14-month sobriety, leaving an unsafe residence and managing diabetes • Made a commitment to work together on personally meaningful goals he sets

43. Peer Wellness Coaching: One Person’s Story • SUCCESSES • Helped expedite reinstatement of Medicaid • Established trust and a good rapport based on shared experiences • Co-created a wellness plan with action steps and means for accountability • Encouraging him to focus on current accomplishments rather than prior relapses

44. Peer Wellness Coaching: One Person’s Story SUCCESSES • Motivating him by helping him recognize the part he plays in his own wellness • Attending 12-step meetings together to link to natural supports in the community • Continuing contact several times a week, including on Fridays to review successes with wellness plan • Evolving mutually-supportive relationship

45. Moving Forward:AmeriChoice/OptumHealth Peer Bridger Initiative • New contract to work with 200+ identified NYC/LI Medicaid Managed Care beneficiaries who have had multiple re-hospitalizations and have not engaged with outpatient services (‘high needs high cost’) • Goals are to reduce re-hospitalization rate by 40% and to improve ‘community tenure’ by 15% • Similar objectives to CDIP: increase hope, support and self care, increase connection to healthcare, reduce avoidable ER and inpatient use

46. Moving Forward:AmeriChoice/OptumHealth Peer Bridger Initiative • 6 trained NYAPRS Peer Bridgers/Wellness Coaches with TRAC phones and cars, poised for prompt engagement and outreach efforts and active, ongoing support, real time crisis assistance. • Complementing individual relationships and efforts with peer support meetings in or around high use clinics.

47. This is Our Time • National and state healthcare systems are focused on improving care via greater focus on wellness and prevention, especially for ‘high needs high cost’ people with complex medical and mental health conditions. • Peer bridgers/wellness coaches provide a critical new resource: appealing, active, empathetic, engaging, mobile, community based, positive support skilled at helping people to gain the hope to get better via improved self care and improved connection to appropriate healthcare….before the next crisis.