The document discusses the history and evolution of the peer support and recovery movement in mental health. It outlines key developments such as the establishment of support groups like Alcoholics Anonymous in the 1930s, the clubhouse model pioneered by Fountain House in the 1940s, and advocacy led by Judi Chamberlin for patient rights in the 1970s. More recent developments discussed include the establishment of peer support as an evidence-based and billable service, the growth of peer-run organizations, and a shift toward more peer-driven systems of care where peers represent a significant portion of the workforce and hold leadership roles. The document advocates for continuing this transition to prioritize peer voice, inclusion, and empowerment at all levels of the mental

1. Empowering People
for Recovery
DAVID COVINGTON, LPC, MBA—
RECOVERY INNOVATIONS, INC.
http://davidwcovington.com

2. 2
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3. In mental health,
it all starts with
peer voice &
inclusion in
system design
and leadership
Key to Person-Centered Care

4. Polling Question #1
Which of the following best characterizes your agency approach
to patients (peers)?
Stage 1 - We do services to people
Stage 2 - We do services for people
Stage 3 - We do services with people
Stage 4 – In addition to clinical/medical staff, we have a
few peer leaders and/or ancillary peer supports services
Stage 5 - We have a peer driven system of care, where
peers represent more than 25% of staff

5. What Have We
Learned

6. 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

7. 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.

8. 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.

9. “On Our Own” Published
Judi Chamberlin

10. “There are real indignities and real
problems when all facets of life are
controlled—when to get up, to eat, to
shower—and chemicals are put
inside our bodies against our will”
Judi Chamberlin

11. From Privileges to Rights
Judi Chamberlin
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”

12. 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)

13. 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.

14. Polling Question #2
The 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

15. Olmstead Decision
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

16. Cemetery Projects

17. 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

18. Medicaid-billable Service
Georgia’s 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.

19. CMS Guidelines

20. DonBerwick
What ‘Patient-
Centered’ Should
Mean: Confessions Of
An Extremist

21. Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

22. 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

23. Suicide Attempt Survivors
Policy decisions related to the suicide
prevention field have historically been made
by three groups: researchers, clinicians and
family members of those who died by suicide.
There have been hundreds of support groups
nationally for those bereaved by suicide but
few examples of similar peer opportunities
for those struggling with suicide.
In 2014, a National Action Alliance for Suicide
Prevention Task Force will publish “Activating
Hope” (provisional title) that will challenge
these norms.Eduardo Vega &
John Draper

24. The Gift of Peer
Support

25. Polling Question #3
Which of the following best characterizes
research surrounding peer services?
A. Peer supports found less effective than
non-peer professional counterparts
B. Equally effective
C. More effective
D. There have not been credible studies

26. Focus of Research

27. ABIL’s Phil Pangrazio

28. “[In our movement] we don’t have a
token seat at the table. We lead the
table.”
Phil Pangrazio

29. “Revolutions begin when people who
are defined as problems achieve the
power to redefine the problem”
John McKnight

30. Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks
The Gift of Peer Support
There is a sense of gratitude that is
manifested in compassion and
commitment.

31. The Gift of Peer Support
There is insight into the experience
of internalized stigma.
Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

32. The Gift of Peer Support
Peer specialists take away the “you
do not know what it’s like” excuse.
Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

33. The Gift of Peer Support
They have had the experience of
moving from hopelessness to hope.
Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

34. The Gift of Peer Support
They are in a unique position to
develop a relationship of trust with
their peers.
Courtesy of Appalachian Consulting Group, Ike Powell and Larry Fricks

35. The Gift of Peer Support
The gift is circular and fosters
recovery by affirming the ability of
peers to play meaningfully roles in
other people's live and society.
Courtesy of Eduardo Vega (MHA of San Francisco)

36. Peer Driven
Systems by Next
Tuesday

39. Peer-Driven System

40. Recovery Empowerment Continuum Characteristics
Perspective Level 1 Level 2 Level 3 Level 4 Level 5
Traditional Psychosocial Rehabilitation
Philosophy/Continuum
Peer-Driven
Care
Peer-Driven
System
Motto Done to Done for Done with Done by
Characteristics
Clinical team
identifies goals and
develops service
plans. Compliance
with directives is focal
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 a
core value with peers
holding some
leadership and
advocacy positions
within the system.
Many roles in the
system are filled by
peers, including
workforce,
governance, etc. Not
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 & ParticipationPresent
Action & Leadership
Future Peer-Driven System

41. Polling Question #4
Which of the following are reasons a CBHC
peer staff member 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. Recovery Innovations’ Education
Center
1. Organizational commitment
2. Quality training prior to employment
3. Recovery training for all staff Supervisor and
leadership training
4. Job-specific peer support roles
5. “Tipping point” with critical mass of peer support
workers
Courtesy of Recovery Innovations & Gene Johnson

43. Recovery Innovations’ Education
Center
6. Develop career ladder to the peer support discipline
7. Parity for peer support workers; supervision and
support, performance expectations, pay, promotion,
ethics
8. Remember, it’s real work, not sheltered work or
therapy
Courtesy of Recovery Innovations & Gene Johnson

44. Peers Make a Difference. If she can
do it, then so can I!

45. Three Forces

46. Psychiatric Inpatient Asylums
Primary Era: 1800 - 1972

47. Community Mental Health Centers
Primary Era: 1963 - present

48. Psychiatric Rehabilitation
Primary Era: 2000 - present

49. Symbolic Peer Leadership
Primary Era: 2010 - present

50. Peer Driven Systems of Care
Primary Era: Emerging Innovation

51. Recovery Empowerment Continuum Characteristics
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
Characteristics
Clinical team
identifies goals and
develops service
plans. Compliance
with directives is focal
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 a
core value with peers
holding some
leadership and
advocacy positions
within the system.
Many roles in the
system are filled by
peers, including
workforce,
governance, etc. Not
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 & ParticipationPresent
Action & Leadership
Future Peer-Driven System

52. Peer Leadership & Workforce

53. Welcoming Environments

54. Recovery Coaching/Values
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

55. 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
Recovery Language

56. Polling Question #2
The 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

57. New Civil Rights Struggle
“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.”

58. DEC’s Phil Pangrazio
“[In the disability empowerment movement]
we don’t have a token seat at the table. We
lead the table.”

59. Contact Us
CEO & President
David.Covington@recoveryinnovations.org
Social Networking
http://davidwcovington.com
http://davidwcovington.com