Oregon Supported Employment Center for Excellence OSECE Conference Health

Oregon Supported Employment Center for Excellence(OSECE) Conference Health Systems Division (HSD) Peer Delivered Services(PDS) October 5, 2016

Presenters Shawn Clark Oregon Health Authority (OHA) Health Systems Division (HSD) Peer Delivered Services Coordinator Shawn. Clark@state. or. us (503) 945 -9720 Ally Linfoot Clackamas County Behavioral Health Division Peer Services & Recovery Coordinator ALinfoot@co. clackamas. or. us Office: 503. 742. 5951 | Cell: 503. 260. 3386 2

Peer Delivered Services : Who, What, Where, When and How • • 3 People will understand current Peer Delivered Services(PDS) in Oregon and help identify the Vision People will hear about hope, resilience and recovery People will understand the scope of practice for Peer Support and Peer Wellness Specialists(PSS/PWS) People will know what PDS can do to support people getting and keeping work People will learn about the Office of Consumer Activities( OCA) and be able to access Technical Assistance People will understand a disciple that is a uniquely an option for people with lived experience People will learn about specific Peer Run Programs and the outcomes of those programs

Ally Linfoot Peer Support & Recovery Coordinator Clackamas County Behavioral Health Division alinfoot@Clackamas. us Office: 503 -742 -5951 Cell: 503 -260 -3386

Logic Model - Values • Cultural diversity • Persistence • Inclusive and welcoming of underrepresented communities • • Whole Health Recovery Self-direction, empowerment, and choice • Prevention, Education, Outreach and Peer In-reach Participatory process • • • • Community inclusion Leadership development Reduction of isolation and discrimination Wellness and resilience Community building • • Peer support providers and organizations as equal partners Collaboration/partnership between systems, addictions, corrections, families, CSX, young adults in transition, across the lifespan Creation of a trauma informed system Cultural Responsiveness

Elements of Peer Support Services - Roles ADULT Recovery Coach (defined by William White) • Anyone interested in promoting addiction recovery • Serves as a personal guide & mentor • Removes barriers • Links newly recovering persons to the recovery community Peer Support Specialist (defined by Pillars of Peer Support) • An individual in mental health recovery • Is a valued member of an individuals planning team • Provides support, information, and navigation • Assists in times of transition Forensic Peer Specialist (GAINES) • Individuals with history of mental illness and incarceration • Serves as community guide, coach, advocate for those in early stages of re-entry • Willing to share their experience • Model skills • Helping relinquish learned survival mechanisms & attitudes in criminal justice settings YOUTH / YOUNG ADULT/ ADULT Young Adult Peer Mentors (defined by TRACSTransition Resources & Community Supports); Peer Coach • Individuals that offer first hand experience of living with & overcoming mental health issues to support & assist young adults • Demonstrate by their presence that recovery is real & possible • Provide more intensive, community-based outreach & support • 1: 1 mentoring for approx 6 mo. , 1 -2 hrs/wk • Young adult sets goals to be addressed in weekly meetings with mentor • Focus is on developing natural, sustainable resources • At the end of the mentorship the young adult no longer should need a mentor • Mentors are encouraged to be open about their illness & recovery experiences, but to share only when the young adult is interested & the information will be to their benefit PARENT/CAREGIVER Family Support Specialist (defined by FFCMH) • A person who is parenting or has parented a child experiencing mental, emotional or behavioral health disorders • Strengths based • Establishes relationship on mutual learning from common lived experience • Empowers parents & caregivers to advocate for their child/youth’s needs • Promotes wellness, trust & hope • Reduces isolation of family members experience & stigma • Can articulate the understanding of their experience with another parent/caregiver • Identification & understanding of cultural & linguistic diversity

Measures and Outcomes services 1. Reduce recidivism to higher 14. Community and civic levels of care, corrections, 6. Seamless referrals to peer engagement juvenile justice, Oregon support programs from 15. Cost savings Youth Authority traditional mental health and 16. A more informed public 2. Reduce utilization of addiction services (elimination of traditional mental health and 7. MHO screening activities will discrimination) addiction services show a % of referrals to peer 17. Community inclusion 3. Help increase the support programs 18. Support network for peer effectiveness of traditional 8. Improved quality of life specialists mental health and addiction 9. Increased participation in 19. Continuing education for servcies formal education peer specialists 4. Satisfaction surveys will 10. Increase in overall wellness 20. Training and education for indicate care is self-directed (whole health) system professionals on the and individuals and families role of peer supports feel heard, honored 11. Increase in natural supports 12. Increased alternative health 21. Reduction/elimination of and respected misdiagnosis due to cultural practices 5. Peer Support Programs barriers and become an alternative to 13. Increased involvement in misunderstanding system advocacy activities traditional mental health

What are Peer Delivered Services? Frances Purdy, MEd JD Family Partnership Specialist frances. s. purdy@state. or. us 503 -957 -9863 cell 503 -945 -5783 desk 8

Family Support Specialists assists parents to • Identify the individual family members’ values, dreams, and vision • Communicate parental long and short term goals • Identify hope, self-help skills and natural supports • Clarify what is known to make a decision or plan • Find information for the unknown • Make decisions for short and long term goals • Participate in service plans • Practice and evaluate actions • Be an advocate for self, family, and community

Family Support Specialists • Model concepts and skills to parents for them to promote resiliency and recovery with their children: hope, personal empowerment, respect, social connections, selfresponsibility, and self-determination • Assist parents to support and teach youth/young adults to progressively increase their capability to sustain living independently

Youth Support Specialists assist Youth to • Identify values, goals and vision • Communicate long and short term employment/educational goals • Identify hope, self-help skills and natural supports • Work collaboratively within a team of teachers, case managers, etc. • Be an advocate for self, friends, family and community

• The Results – 14 Peer Support Programs Adults • Supported Housing and County Clinics (FQHC’s) • Clackamas County Jail • Peers with the Clackamas County Sheriff’s Office Behavioral Health Unit • Child Welfare • Drop-in Centers and Mobile Outreach Transition Age Youth • Youth Drop-in and 1: 1 Peer Support and Navigation • LGBTQQ drop-in and Gay Straight Alliance development in Schools Families • Family Partners with ISA Family Facilitators • Family Partners on Wraparound teams • Community Education and Support Groups Serving All • NAMI • Warm Line • Centerstone Crisis Walk-in Total Cost for Peer Support Services 2016: $2. 4 mil.

The Numbers – All Served People Served Experience of Services • • • Engagement Rate: 87% • Report improved overall wellness (whole health): 83% • Report improved quality of life: 79% • Report an increase in natural supports: 73% • Feel accepted in the community: 47% • Report they would have returned to a higher level of care if not for PDS: 61% Total Served: 5012 1: 1 Peer Services: 3601 Drop-ins: 1411 Support Groups & Workshops for individuals served: 2821 • Outreach activities to system and community partners: 219 • Staff training activities: 46 • NOTE: The above numbers do not include Warmline

The Numbers – Children & Fams People Served Experience of Services • • Children & Family Programs: • Engagement Rate: 84% • Report improved quality of life: 82% • Report an increase in natural supports: 82% 1: 1 Family Support: 438 Family Reunifications: 45 – 16 children originally had a permanency plan of adoption System Involvement • • • Child Welfare: 257 Juv Justice or OYA: 20 Adult Addiction Tx: 48 Adult Court: 143 Other: 70 Parent Programs • • Feel accepted in their community: 30% Increased wellness: 84%

Estimated cost savings to Jail: $1, 288, 710 Estimated cost savings to child welfare: $720, 400 Estimated cost savings to system based on Warm Line calls: $283, 003 Cost of Peer Services 2014: $1. 2 mil Cost Savings: Data is from FY 14 This cost savings was determined using only the data submitted by 3 of our 14 peer support programs.

Funding Mechanisms – Braid It! • Federal A&D • Sub-recipient • Mental Health Block Grant • Adult • Children • Beer and Wine Tax • County General Fund • Service Element 63 • MHS 37 16

What Was • 2007 Peer Support Specialists (PSS) • 2011 Traditional Health Workers Community Health Workers Doulas PSS/Recovery Mentors Peer Wellness Workers Personal Health Navigators 17

Certified Traditional Health Workers (THWs) • Peer Support Specialists 958 • Peer Wellness Specialists 38 • Community Health Workers 406 18

Certification • Be a peer in recovery for at least two years (Addictions) • Complete an approved training program • Apply for certification • Pass a background check • Become Certified for three years • Earn 20 continuing education hours 19

What is • 75 Peer Run Organizations • 25 OHA Approved Peer Support and Peer Wellness Training Programs • Office of Consumer Activities(OCA) – shout to Mike Hlebchuk OCA Director and Libbie Rascon OCA Coordinator Desk: (503) 947 -5009 Cell: (971) 600 -8180 Fax: (503) 947 -2341 E-mail: Libbie. D. Rascon@state. or. us 20

2016 Metro. Plus Substance Use Disorder Peer Delivered Services Survey There an estimated 4, 308 addiction/co-occurring peer clients that receive Substance Use Disorder (SUD) specific peer services in Multnomah, Washington and Clackamas counties, served by 304 peers. 21

What is • • 22 Peer Run Organizations Peer Drop In Centers Peer Club Houses Community Based Organizations Community Mental Health Programs Recovery Centers Integrated Health Centers

Measures and Outcomes Tracking System (MOTS) • Informed 11, 000 • Received 3000 • Planned 1, 100 (2014 -9/2016) 23

SUDs and Criminal Justice • • Service Element #63 All but one County 320 served to date Programs still under development “We had 8 men that are now fathers and taking care of their children and living substance free. ” 24

Additional Training Oral Health Requirement • • (a) Basic dental anatomy; (b) Caries and periodontal disease process; (c) Infection and communicable disease; (d) Basic oral hygiene and disease prevention for different ages; and • (e) Healthcare system navigation, access and coverage, including Medicaid 25

Vision “Vision is the art of seeing things invisible” Jonathan Swift “Peer-based models of care can have a transforming effect on larger systems of care and on our society by enhancing long-term addiction recovery outcomes and elevating public and professional perceptions of hope for recovery. ” William White 26

What do you think about? Medicaid Recovery Oriented System of Care(ROSC) https: //www. oregon. gov/oha/OHPB/Documents/Waiver %20 Renewal%20 Submission. pdf USDOJ Oregon Performance Plan http: //www. oregon. gov/oha/bhp/Pages/USDOJAgreement. aspx SAMHSA Peer Delivered Services http: //www. samhsa. gov/section-223/carecoordination/person-family-centered 27

Oregon Performance Plan • • 28 Medicaid Management Information System (MMIS) 24% Block Grant 2015 -2016 Base line from July 2016 20% from baseline of July 2017 40% from baseline of July 2016

Advocacy Efforts • Professional Organization Oregon Consumer/Survivor Coalition • Oregon Family Support Network (OFSN) • Addiction Counselor Certification Board of Oregon (ACCBO) • Oregon Consumer Advisory Council (OCAC) • AMHPAC and CSAC • CCO Advisory Councils 29

Legislation • Naya Family Center • Oregon Community Health Worker Association (ORCHWA) • Amend 3650 • Funding for 100 positions statewide Greatest Health Inequities • Require CCO’s provide PDS 30

Vision for the Process • Difference between Licensing and Certification • Discussion “Currently, the only threat to the volunteer peer movement appears to be exclusionary credentialing requirements” 2016 Metro. Plus+ SUD PDS Survey 31

PSS and PWS part of all Teams? • Supported Employment “Vocation…would include finding out the place where the need of the world coincides with your own gifts, where that which you can give is joyfully received. ” James Carroll • Assertive Community Treatment Add a requirement they must have a PSS/PWS on the team? • Supported Housing • Peer Run Respite Care/Center 32

Specialties • Forensics • Peer Bridgers • Dual Diagnosis • ACCBO Peer Recovery Counselor Certification • Recovery House Managers • Supervision 33

Facilitation Centers Metro. Plus+ Yamhill/Polk/ Marion Coos People who are involved with the criminal justice system, are without homes, are living in rural/poor areas, people in medically assisted treatment, older adults and young adults in transition 34

Supervision Now and in the Future Clinical Mutual Other Models “Over half of peers believe an experienced peer should be the minimum qualification for SUD peer supervisors. Over half of supervisors believe a CADC should be the minimum qualification for SUD peer supervisors. ” Health Share Report on Metro. Plus 35

Including the Community • Refugee PSS Training Program Approved • Spanish Language Recovery Peer Mentors Graduated • Tribal PSS Training Program in Development 36

Links that May be Helpful Office of Equity and Inclusion (OEI) Traditional Health Workers • http: //www. oregon. gov/oha/oei/Pages/Traditional-Health-Worker -Program. aspx Addiction Counselor Certification Board of Oregon • http: //www. accbo. com/ Health Systems Division Peer Delivered Services • http: //www. oregon. gov/oha/amh/pd/Pages/index. aspx Support and Services for Young Adults in Transition • http: //www. oregon. gov/oha/amh/youth-hub/Pages/index. aspx Peer. Blast http: //drupal. llnest. com/ 37

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