1. 2013
LRC Recommendations
Exploration Team
Peer Specialist in Building 5, Cottages on LRC
Grounds and Telemedicine
Tanner Mitten, Cody Manthei, Janine Fromm, Stacey Werth-
Sweeney, Sue Adams, Scott Loder, Mette Brynolf

2. System Enhancement Initiative (SEI) – LRC Recommendations
1. Peer Specialist in Building 5
2. Cottages on LRC Grounds
3. Telemedicine
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1. Peer Support in Building 5
What is Peer Support and Forensic Peer Support?
Peer Support and Forensic Peer Support is the art of giving and receiving support through lived experience based
on integrity, connection and trust. Peer Support and Forensic Peer Support represents the paradigm shift
necessary for continually creating opportunities of empowerment and recovery for individuals with mental illness
and/or co-occurring disorders who also may have criminal justice involvement. Forensic Peer Support is peer
support with a twist.
Resources:
 GAINS Center white paper on Forensic Peer Specialists contains a logic, which may help SEI members
better understand the benefits of peer support. Particularly when paired with other services and types of
support (such as psychotherapy), it can improve crisis stabilization; increase recovery rates, and reduce
re-entry rates.
http://gainscenter.samhsa.gov/peer_resources/pdfs/Davidson_Rowe_Peersupport.pdf
 Peer Bridger Project, which was created specifically to build a program that was geared to "help ease the
transition into community life for individuals being discharged from New York State Psychiatric Centers
and help to significantly decrease their need for readmission by offering an array of both intensive
individual and group peer support services”
http://www.nyaprs.org/peer-services/peer-bridger/
 Recovery Edge Peer Support, a program specifically geared for individuals who are status offenders
dealing with jails or hospitals because of a judge’s order. The Trauma Recovery and Crisis Intercept Matrix
(TRACIM) will provide the necessary support, through a phase-based progression, and will focus on a
change of intellectual processing in order to create practical, responsible and accountable actions and re-
actions.
 Phase I TRU Criminalization and De-Criminalization Matrix
 Phase II Integrated Triadic Recovery Approach
 Phase III Evolved Emancipation
http://www.recoveryedge.org/Forensic-Peer-Support.html
 The Peer Support Program at Riverview Psychiatric Center. Peer Supporters are with patients every step
of their stay at Riverview. They are present at admissions, and there is a full-time peer supporter assigned
to each of the 4 units of the hospital. There are Peer Supporters who also work on the weekends. They
have the time to build relationships with patients. They will attend treatment team meetings if that is the
wish of the patient. They will make sure that the patient needs are being met, and that the patient voices

3. are being heard. And they can share their wisdom, knowledge and empathy to patients and staff in the
hospital. Peer Supporters also provide support groups and wellness and recovery classes in the hospital.
http://www.maine.gov/dhhs/riverview/departments/peer-support.html
 Pennsylvania Mental Health and Criminal Justice System (PMHCA), a program which was created
specifically for consumers and criminal justice involvement. The similarities are noteworthy and may be
helpful for us to consider.
http://www.pmhca.org/projects/forensic.html
They also produced a recent report on their project:
www.pmhca.org/projects/PMHCATestimony5_9_13.pdf
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2. Cottages on LRC Grounds
Examples of cottages were difficult to find, but there are many examples of drop-in centers, which offer activities
that have the potential to facilitate smooth community transitions and successful discharge. Drop-in center
activities vary from place to place and are determined based upon the particular wishes and needs of the
consumers involved, but many consumers who use drop-in centers find that peer support is a powerful tool in
their recovery.
In addition to in-house support groups, many drop-in centers provide an array of activities that can provide a
gentle, non-threatening introduction to services in the community that persons can access once fully discharged,
as well as outreach to consumers in state hospitals and prisons. The following examples are not campus-based,
but we may be able to model a program on LRC campus after them.
Types of activities at Drop-in Centers/Cottages:
 Self-help group meetings (also called mutual support or rap sessions). Some drop-in centers offer formal
self-help programs such as Double Trouble in Recovery (DTR) Alcoholics Anonymous (AA) or MICA
(Mentally Ill Chemical Abusers). Others set aside meeting times for specific groups, such as a bipolar
support group or an anxiety support group. Mutual support is key to every drop-in center, and consumers
offer support to each other whether or not a meeting is in session.
 Speakers' bureaus. Many drop-in centers educate the public about mental health issues and consumer
perspectives. By organizing a speaker’s bureau, participants not only are able to present mental health
issues to an audience, but also are able to demonstrate by example that consumers can be eloquent and
capable speakers.
 Advocacy and networking. Drop-in centers use advocacy to help consumers regain a sense of power and
self-determination. Advocates might help consumers obtain help with Social Security benefits, housing,
transportation, or other government services. They might help consumers obtain access to their medical
records or write an "advance directive" dictating what treatments they will or will not accept. However,
the ultimate goal of these advocacy programs is to teach consumers the value of self-advocacy: when
consumers learn to assert their rights, they are much more successful in obtaining desirable results.
 Systems advocacy. In addition to helping consumers with their own lives, many drop-in centers teach
consumers to become advocates for systems change. Because drop-in centers serve as meeting places
and places to receive help, they can also serve as places to obtain referrals for consumers who want
them.

4.  Computers. Computers are an important part of everyday life, and for consumers to be fully empowered,
they must be familiar with computers. Many drop-in centers now offer computer access and training.
Drop-in centers have also connected many consumers to the Internet. By connecting to the Internet,
consumers can learn about mental health issues and become part of a growing electronic advocacy
network.
 Employment services. Some drop-in centers offer services such as help with résumés, practice interviews,
and assistance with job placement.
 Guest speakers/workshops. Drop-in centers offer a wide variety of educational opportunities for
consumers. Topics range from basic life skills such as sewing, cooking, and baking to alternative health
topics. Many drop-in centers across the nation offer the Boston University Recovery and Empowerment
Curricula or the BRIDGES program, a 15-week course on the topic of recovery, developed by the
Tennessee Mental Health Consumers' Association (TMHCA).
 Assistance with basic needs. In addition to providing meals to consumers, many drop-in centers collect
food or clothing donations for distribution to consumers. Housing services are also important and include
providing supports for people transitioning to independent living.
 Consumer-run businesses. Some drop-in centers have small businesses that serve several purposes. They
help raise money for the center, but more importantly they can provide vocational opportunities for
members and also can provide free or low-cost services to other consumers.
 Outreach programs. Many consumers who use drop-in centers find that peer support is a powerful tool in
their recovery. In addition to in-house support groups, many drop-in centers provide outreach to
consumers in state hospitals and prisons
http://www.bhc.state.nm.us/BHConsumers/OCADropInCenter.html
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3. Telemedicine/Telehealth
Outline of Telehealth Program from Magellan:
Background
The digital revolution is transforming the way providers, patients, and payers engage in healthcare delivery. With
over 273 million Internet users in the United States today, more people are accessing health related information
and services online than ever before. Magellan recognizes the importance of meeting members “where they are”
to provide optimal support, and “when they’re available” at the right time for happier, healthier living. Through
our state of the art technologies we provide choice, flexibility, and accommodate member preference with a
primary focus on increased access to care and member engagement to promote quality and affordable health
care. Ensuring the appropriate service is readily available, when and where the member needs it can reduce the
need for more costly intensive services such as acute hospitalization – ultimately ensuring better member health.
Our latest technology innovation will be developed to promote streamlined member access and enhanced
engagement via Telehealth services.
Program Overview
A strong Magellan/State of Nebraska Telehealth partnership will provide key learning for both organizations and
ensure we are well positioned in a rapidly changing healthcare landscape.
Telehealth can be used to overcome some of the barriers to accessing and benefiting from clinic-based services.
Interaction via Telehealth makes it possible to extend care beyond time and geographic constraints. The widening

5. prevalence of technology and market forces indicate Telehealth will become a new standard in the delivery of
healthcare services through increased efficiency, enhanced collaboration and improved access to care.
Program Goals
 Expand access to Behavioral Health services via Telehealth
 Achieve increased member and provider satisfaction through a best in class online solution
 Enhance preference based treatment options that minimize location boundaries and increase ‘just in
time’ care availability
 Improve access in rural areas with limited geoaccess
 Enhance clinical outcomes with seamless member and provider experience
 Reduce no-show rates and empty appointments for clinicians
Program Objectives
 Provide a state of the art platform to facilitate the ‘right care’ at the ‘right time’ regardless of geographic
constraints between State of Nebraska members
 Maximize provider network utilization and capacity via online availability
Program Eligibility
 Age and service exclusions to be determined in coloboration with stakeholders
Telehealth Program Services and Workflows
During the implementation period the following referral mechanisms will be explored:
Referral Source
1. State of Nebraska care coordinator referral
2. Magellan care coordinator referral
3. Behavioral health clinician referral
4. Hospital/Facility referral for Members discharging to rural communities
5. Members find the system on there own
Magellan will work together with stakeholders to finalize the programs engagement strategy.
With Magellan’s Telehealth solution, patients and providers can come together to have clinically meaningful
online visits, at any time and from any location.
How It Works
1. A Telehealth consultation begins when a patient selects a suitable provider from those available – A
member will access through the Magellan specific portal.
2. The member will enter a virtual waiting room and from that entry point will be able to schedule an
appointment with a preferred provider.
3. The provider reviews the patient’s clinical information and the live conversation begins using video,
chat and/or phone.
4. During the conversation, the provider discusses symptoms, diagnoses, and prescribes medications, as
clinically appropriate.
5. At the conclusion of the appointment the member and the provider will decide on follow up
appointment needs and next steps for the member.

6. Coordinated Care
 Providers can conduct online visits with specialists, without arranging a referral or an additional visit.
For example, the behavioral health provider and his or her patient can consult with another specialist
in real-time, during an actual office visit.
Practice Workflow
 Built-in capabilities allow providers to interact with patients the way they do in the office – involving
staff with intakes, assigning diagnoses and procedure codes, writing prescriptions, suggesting follow-
ups, making referrals, reviewing lab results and scheduling future visits.
Program Design
Telehealth Process Flow (Breakthrough Behavioral)
MemberMagellan
TelehealthWeb
Platform
Provider
Provider Documents
Session and Provides
Necessary Follow Up
Information to Member
Electronically (Next
Appointment, Prescriptions,
etc)
Member is
Redirected to
Telehealth
Online Portal
(Breakthroug
h)
Member will
logon to state
specific URL
Member can
look through
provider
search
functionality
or through
link located
on Online
Portal
Member creates
online profile on
BT platform
Member
searches for
preferred
provder
Member request
appointment
Provider confirms
appointment
Via Secure
Connection
Member and
Provider
Conduct
Session
Provider
Submits Claim
for Service
Rendered to
Magellan
Magellan adjudicates
claim
Performance Criteria
Magellan will work with stakeholders to develop follow-up protocols to ensure new programs are sustainable,
develop success metrics and regularly publicize results with providers.