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What if Everyone Embraced Recovery?

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Peer supports is the key to transformation of mental health systems and the start of a bonafide social movement, akin to the revolutions we've seen with the disability community.

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What if Everyone Embraced Recovery?

  1. 1. What If… Everyone Embraced Recovery DAVID W. COVINGTON, LPC, MBA CEO & PRESIDENT, RI INTERNATIONAL ADELAIDE 2018
  2. 2. “No, You Can’t.”
  3. 3. What Does It Mean… To Live in Community
  4. 4. HiringPeerStaff “No, You Can’t.”
  5. 5. HiringPeerStaff “No, You Can’t.”
  6. 6. HiringPeerStaff “No, You Can’t.”
  7. 7. HiringPeerStaff “No, You Can’t.”
  8. 8. HiringPeerStaff
  9. 9. What If… I Don’t Move to the Back of the Bus
  10. 10. What If… I Am Not Afraid
  11. 11. What If… My Answer is… Yes, I Can
  12. 12. “[In the disability empowerment movement] we don’t have a token seat at the table. We lead the table.”
  13. 13. Celebrate the 25th Anniversary of the Americans with Disabilities Act
  14. 14. Same Struggle Different Difference
  15. 15. What If… I Don’t Move to the Back of the Bus
  16. 16. What If… I Am Not Afraid
  17. 17. What If… My Answer is… Yes, I Can
  18. 18. Polling Question #2The Americans with Disabilities Act gives civil rights protections and guarantees equal opportunity in public accommodations, employment, transportation, government services, and telecommunications. The ADA also applies to Mental Health. A. True B. False
  19. 19. “We stand on the doorstep to make momentous progress in advancing the cause of this new civil rights struggle started by the work of President Kennedy over 50 years ago.” New Civil Rights Struggle
  20. 20. What If… Everyone Embraced Recovery
  21. 21. What If… I Don’t Move to the Back of the Bus
  22. 22. What If… I Am Not Afraid
  23. 23. What If… My Answer is… Yes, I Can
  24. 24. Do things TO people Do things FOR people Do things WITH people Few peer leaders & care Peer driven system 1 2 3 4 5
  25. 25. The First Support Groups Alcoholics Anonymous The 12-Step program of substance recovery founded in the early ‘30s provided a demonstration of the power of self-help and support from a “peer” although the “peer” was called a “sponsor.” There is evidence Native Americans were doing something of the same as early as 1772.
  26. 26. A Mind That Found Itself Clifford Beers Galvanized the mental hygiene reform movement and founded the organization that would later become Mental Health America, which led to systematic reforms and continuous advocacy presence
  27. 27. I Am Not Afraid Judi Chamberlin “On Our Own”
  28. 28. National Council on Disabilities Report “Patient privileges, such as the ability to wear their own clothes, leave the confines of psychiatric facility, or receive visitors, should instead be regarded as basic rights”
  29. 29. Primary Era: 2000 - present
  30. 30. First Clubhouse Model John Beard (Fountain House) in New York revolutionized the old “day treatment” programs to a new approach where those served were “members” and not “patients,” and given meaningful roles in the clubhouse and community.
  31. 31. Center for Psychiatric Rehab William Anthony & Boston University “There is a revolution brewing in the field of severe mental illness… It is a revolution in vision – in what is believed to be possible… It will be up to consumers and family members to lead this [recovery].” In 1973, 13 leaders formed Psychiatric Rehabilitation Association (PRA)
  32. 32. WRAP Mary Ellen Copeland First structured tool for self-help for individuals with mental health challenges. The key concepts of WRAP (hope, personal responsibility, education, self-advocacy, and support) laid the foundation for self-help recovery.
  33. 33. On June 22, 1999, the US Supreme Court held that unjustified segregation of persons with disabilities constitutes discrimination in violation of the Americans with Disabilities Act and stated that people with psychiatric disabilities are legally entitled to live in communities of their choosing Lois Curtis
  34. 34. Peer Support as Science Surgeon General’s Report on Mental Health Introduced “self-help groups” and peer supports as an emerging evidence based practice and chronicled the history of the recovery movement
  35. 35. Medicaid-billable Service Wendy Tiegreen & Larry Fricks Georgia was the first state to have peer supports approved by CMS (Arizona followed the next year) and laid the ground work for a national sea change with more than 20 states following suit. Recovery Innovations began using the phrase “Peer Support Specialist” in 1999.
  36. 36. CMS Guidelines
  37. 37. Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks
  38. 38. WELL & WHAM In 2001, Recovery Innovations married peer support with education by creating WELL (Wellness and Empowerment in Life and Living) as a new self-help approach to the former case management approach of compliance and monitoring of “activities of daily living.” In 2012, the Center for Integrated Health Solutions (SAMHSA/HRSA) created WHAM (Whole Health Action Management)  2-day, in person peer support training  Set whole health and resiliency goals  10 Health and Resiliency Factors
  39. 39. Don Berwick What ‘Patient- Centered’ Should Mean: Confessions Of An Extremist
  40. 40. Towards a Recovery System of Care Perspective Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Traditional Psychosocial Rehabilitation Philosophy/Continuum Peer-Driven Care Peer-Driven System Motto Done to Done for Done with Done by Character- istics Clinical team identifies goals and develops service plans. Compliance with directives is point activities. Strong dependence on system & artificial (paid) supports with no individual risk taking or family engagement. Genuine voice and participation with some support for individual risk taking & engagement in natural supports. Self-directed care is core value with peers holding some leadership and advocacy positions within the system. Many roles filled by peers, including workforce, governance, etc. a token gesture. Core Value Clinically sound professional services & stability Safety and security with a goal of stability Personal recovery through collaboration Personal recovery through self- directed care Culture change through peer leaders and staffing Person(s) Compliant Dependent Respected (Voice) Leader Empowered Subservient Institutionalized Involved Advocate Leaders Staff Member Prescriptive Caretaker Partner Consultant Peers Directive Protector Guide Support Advocate Organization Clinically driven Protective Collaborative Recovery driven Peer-driven Provider is expert Risk Averse Engaging Person is expert Peer-staffed Risk Taking Discouraged Blocked Supported Encouraged Expected 1950 Compliance/ Directive 1980 Dependent/ Care Taker 2010 Voice & Participation Present Action & Leadership Future Peer-Driven System
  41. 41. Which of the following are reasons a peer staff at a Community Mental Health Center should be terminated? A. Sleeping with a client B. Not showing up to work the first day C. Stealing from the organization D. Being re-hospitalized for mental health E. Reporting hearing active hallucinatory voices
  42. 42. Difference
  43. 43. DifferenceDifference
  44. 44. Difference Bluegrass Fan Father Son Difference Husband Brother Uncle
  45. 45. Difference Bluegrass Fan Father BossSon Difference Husband Clinician MBA Business Owner Brother Uncle Employee
  46. 46. Difference Biker Bluegrass Fan Father Boss Friend Son Difference Husband Clinician Speaker MBA Business Owner Brother Southerner Uncle Runner Employee
  47. 47. Difference Biker Bluegrass Fan Father Geek Boss Traveler Friend Gamer Son Difference Sports Fan Husband Clinician Speaker MBA Business Owner Brother Southerner Uncle Runner Employee
  48. 48. Difference Contribution Biker Bluegrass Fan ConnectedFather Geek Boss Traveler Friend Gamer Son Difference Sports Fan Husband Clinician Speaker MBA Business Owner Brother Southerner Uncle Runner Employee
  49. 49. Difference Contribution Biker Bluegrass Fan ConnectedFather Geek Boss Traveler Friend Gamer Son Difference Sports Fan Husband Clinician Hopes & Dreams Speaker MBA Business Owner Brother Southerner Uncle Runner Employee
  50. 50. Difference Contribution Biker Bluegrass Fan ConnectedFather Geek Boss Traveler Friend Gamer Son Difference Sports Fan Husband Clinician Hopes & Dreams Speaker MBA Business Owner Brother Southerner Uncle Citizen Runner Employee
  51. 51. Disability/ Difference
  52. 52. Recovery/ Ability
  53. 53. Lived Expertise
  54. 54. Me too
  55. 55. What If… I Don’t Move to the Back of the Bus
  56. 56. I Am Not Afraid What If…
  57. 57. My Answer is… Yes, I Can What If…
  58. 58. 1. Organizational commitment 2. Quality training pre-employment 3. Recovery training for all staff 4. Job-specific peer support roles 6. “Tipping point” critical mass 7. Develop career ladder 8. Parity for peer workers 9. Remember, it’s real work, not sheltered work or therapy
  59. 59. Traditional Language Recovery/Opportunity Consumer Guest Sub-acute Psych Inpatient Living Room 23 Hour Observation Retreat 24/7 Crisis Walk-in Front Lobby Crisis Center Recovery Response Center Crisis Opportunity Intake Recovery Partnership Assessment Getting to Know Each Other Psychosocial History Telling My Story Treatment Plan Recovery Solutions
  60. 60. What If… I Don’t Move to the Back of the Bus
  61. 61. What If… I Am Not Afraid
  62. 62. What If… My Answer is… Yes, I Can

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