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The role of the peer specialist


CITI 2011 Conference Presentation by Scranton Area CIT

CITI 2011 Conference Presentation by Scranton Area CIT

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  • 1. The Role of the Peer Specialist Completing the CIT Picture
  • 2. Presenters/Contact Info
    • Deborah Doyle Belknap
      • [email_address]
    • Ray Hayes
      • [email_address]
    • Carl Mosier
      • [email_address]
    • Marie Onukiavagae
      • [email_address]
  • 3.
      • Location: Northeastern Pennsylvania
      • 125 miles north of Philadelphia
      • Population: 76,089
      • Area: 26 square miles
  • 4. Scranton CIT Born of a Tragedy
    • May 28, 2009 –
    • Scranton Woman Shot and Killed by Police: “Routine Mental Health Call Goes Bad”
    • Public Outrage
    • Task Force Created
    • Final Report and Recommendations
  • 5.  
  • 6. Task Force Recommendations
    • Adopt CIT
    • Establish Response Protocol
    • Create Culture of Cooperation
    • Educational Programs
    • Establish Advisory Board
  • 7. Scranton Police Department
    • Total Sworn Complement
    • January 1, 2011 – 150 Officers
  • 8. CIT Classes
    • Since Inception – 2 CIT Classes Have Been Conducted
  • 9. CIT Officers
    • 21 Trained Officers
    • 18 male
    • 3 female
    • 14 of 21 – less than 10 years of service
  • 10. CIT Officer Deployment
    • Day Shift 4 Officers – (3 SRO)
    • Afternoon 9 Officers
    • Midnight 7 Officers
    • Drug Unit 1 Officer
    • Total 21 Officers
  • 11. Many Cracks to Fall Through OR Many Opportunities for Diversion
    • Family
    • Friends
    • Community
      • Neighbors
      • Church
      • School
      • Businesses
    • Services
      • Physicians
      • Mental health treatment providers
      • 1 st Responders
  • 12. 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
  • 13. The Scope of the Problem… Why Divert?
    • More likely to:
      • be poor and uninsured
      • be detained because they cannot post even very low bail
      • be charged with more serious crimes and have stiffer penalties
      • to spend two to five times longer in jail
      • to be involved in more fights, infractions, and sanctions
      • to return to jail on a probation violation
    • Frequently, people who are caught in the “revolving door” of corrections, mental health treatment, and homelessness are thought of as “bad clients” or “treatment resistant,” when in reality, they are casualties of “client resistant services” (H. J. Steadman, personal conversation, March 6, 2006).
    • Simply put:
    • Diversion is the Right Thing To Do
  • 14. The Scope of the Problem… Why Divert?
    • What Jail Diversion Has to Offer
    • A viable and humane solution
    • positive outcomes for people with mental illness, systems, and communities
    • In particular, jail diversion:
      • Reduces time spent in jail
      • Links people to community-based services
      • Results in lower criminal justice costs
      • Does not increase public safety risk
    • Jail diversion programs
      • Develop and build on broad-based community consensus and collaboration
      • Integrate services and systems and bridge the gap in fragmented systems
      • Break the cycle of recidivism, revolving door
      • 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.
    • * Practical Advice on Jail Diversion: Ten Years of Learnings on Jail Diversion from the CMHS National GAINS Center (2007)
    • http://www.gainscenter.samhsa.gov
  • 15. Sequential Intercepts Munetz & Griffin Psychiatric Services 57: 544–549, 2006 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
  • 16. How are Certified Peer Specialists currently being used in CIT programs?
    • Training: role play & critique the officers actions in the role playing
    • CIT planning committees, help arrange visits to consumer sites or arrange consumer/family panels as part of the curriculum 
    • IOOV for the consumer perspective and also have consumers represented on planning committee
    • community resource panel and the site visits had Peer Specialists on the panel
    • post-booking jail diversion programs like mental health courts
    • 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 needed basis
      • (based on informal survey of NAMI Executive Directors nationwide)
  • 17. The Mission of the Certified Peer Specialist
    • Education and Training
    • Empowerment
    • Hope
    • Promote Recovery
  • 18. Scranton Area CIT Peer Specialist Pilot Program
  • 19. Rationale/Research Support
    • 1999 Surgeon General’s Report on Mental Health
      • recognized the value of peer support in recovery
      • encouraged states and communities to incorporate peer services
    • Research suggests:
      • Peer providers are often able to more readily forge favorable relationships with clients because of shared perspectives and experiences
      • Early use of peer support can:
        • engage those most alienated (“treatment resistant”)
        • help people feel empowered in their recovery plans
        • keep people engaged in traditional treatment and community self-help
        • result in fewer police calls and arrests
          • those engaged in treatment are less likely to experience mental health crises or require police intervention if they do
          • if police intervention does occur, those who have peer specialist services are more likely to have developed recovery tools.
  • 20.
      • Small group of CIT officers selected at random to participate
        • Peer specialist services described to officers
        • Instructions given on how to describe peer specialist services
          • (“someone who has been in the same kind of situation”)
      • Officers offer peer services after CIT crisis call is resolved on scene
        • Not if arrest occurs
        • Not if person is transported to the hospital
          • Phase II
  • 21. Procedure
    • Officer asks if person would like to receive a call from a peer specialist
      • If no, card/brochure left with person or family
      • If yes, officer calls peer specialist coordinator
        • Coordinator assigns peer specialist to the case
        • Peer specialist makes call w/i 12-24 hours of crisis
        • Describes peer support services, treatment options, community programs, etc.; offers peer support services if appropriate
  • 22. CIT Call Arrest Crisis 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 within 12-24 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 collection Date of call 1, 3 & 6 months later
  • 23. Data Collection
    • Peer specialist gathers data (during call, two weeks later, one month later, three months later, six months later)
      • services being used
      • community involvement
      • engagement in treatment
      • satisfaction with treatment
    • Police records reviewed (three months & six months later -- crisis calls/arrests)
  • 24. Post-Pilot Strategy
    • Use of pilot results to:
      • Demonstrate effectiveness of early peer services to divert people from criminal justice system, reduce repeat police calls, engage people in treatment
      • Support funding requests and grant proposals to incorporate peer specialist services in all appropriate CIT calls
      • Support other CIT programs in seeking funding sources to incorporate peer specialist services
  • 25. Total Sworn Compliment
    • January 1, 2011 – 150 Officers
    • August 31, 2011 – 134 Officers
  • 26. Obstacles to Implementation
    • Police
      • Lay Offs – Loss of CIT Officers
      • Data collection problems
  • 27. Obstacles
    • Paying for CPS services
      • State regulations:
        • Medical necessity for CPS Services
        • Agreement of the individual to receive services
        • Strict provider qualifications for MA compensable Peer Support Services providers
    • Hospital & provider buy-in
      • Resistance to change from medical model to recovery-oriented model
  • 28. References
    • 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 programs vs. usual care. Mental Health Services Research . Retrieved from http://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 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 management teams: impact on client outcomes. Psychiatric Services, 46 , 1037-1044.
    • Lucksted, A., McNulty, K., Lorener, B., Forbes, C. (2009). Initial evaluation of the peer-to-peer program. Psychiatric Services, 60 , 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 program. Community Mental Health Journal, 32(1) , 33-__.
    • 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.pdf
    • Meehan, T., Bergen, H., Coveney, C., & Thornton, R. (2002). Development and evaluation of a training program in peer support for former consumers. International Joural of Mental Health Nursing, 11 , 34-39.
    • Munetz & 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 severe mental illness. Psychiatric Services , 59(11) , 1322-1327.
    • 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. Psychiatric Services . 57(8) , 1179-1184.
    • U.S. Department of Health and Human Services (1999). Mental Health: A Report of the Surgeon General—Executive Summary . Rockville, MD: 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.