The Division of Mental Health Ramps Up Peer Support Planning

As announced earlier on this site, the DMH had developed a grant for increasing the number of eligible peer support staff for CABHAs.  (For more information, see article re: grant).  But leadership is also realizing that our issue in North Carolina is not so much availability of persons with peer support certification, but the issue of making this cost-effective and otherwise feasible so that more providers are interested in offering it. 

Some of our complications in North Carolina come from having to define the service narrowly enough that the Centers for Medicare and Medicaid (CMS) would approve the new definition.  Unfortunately, in so doing, many are concerned that the service was so tightly defined that this could put us on shaky ground. Because North Carolina’s definition has emphasized tighter clinical supervision structures than other states, we hope we do not find that it diminishes the focus on mutual engagement between persons with the lived experience of having a mental illness, on hope as a sustaining therapeutic foundation, and on the personal responsiveness of a peer specialist  to his or her client.  Furthermore, the requirement for specified supervisory staff makes the service more expensive to our providers.  I urge readers to call for sufficient funding for peer support, because the step to truly integrating sufficient, quality peer support into our mental health system is possibly one of the most important steps North Carolina could make in helping to turn the tide of institutionalization and frequent crises.

DHHS Calls Workgroup                                                                                                         The Department of Health and Human Services is taking these potential concerns seriously, working ahead of the July 1 go-live date when peer support becomes an enhanced service for eligible consumers.   In anticipation of the transition, it has called a workgroup of peer specialists, provider agency directors who have long embedded peer support in their services, staff from the Division of MHDDSAS and staff from the Division of Medical Assistance and others from the Department of Health and Human Services.   The first meeting was a three hour discussion this past Tuesday.

The topics which arose in the discussion were mutually interesting to participants, regardless of background.  Much of the discussion from the first meeting revolved around training:    1.  Training of Supervisors who will oversee and support peer specialists;   2.  Training of organizations so that they can integrate peer staff into their environments in ways that support the staff and the services; and   3.  Training for Peer Support Specialists that will help them adjust to the operational tasks such as documentation, communication with others about client progress, and time management.

The other issue that was discussed was quality:  How will the workgroup develop quality indicators that speak to a set of long-term, recovery-oriented outcomes that the Director of the Division of Medical Assistance, Dr. Craigan Gray, has endorsed. 

To see the newly approved service definition, click here.  Link is also listed, below.  Scroll to pages 95 thru 104 for the full definition.

http://www.ncdhhs.gov/dma/mp/8A.pdf

This work group is very focused and open to learning from each other.  It’s cause is very important–high quality peer support available across our state.  If you feel you have some specific input that would help the workgroup process, please contact Mr. Bert Bennett (bert.bennet@dhhs.nc.gov) or Ms. Starleen Scott-Robbins (starleen.scott-robbins@dhhs.nc.gov) and ask if you can participate in the next meeting, which is this Tuesday the 22nd.  There is a clear phone line for teleconferencing.

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Update Services with Peer Support and Reduce Everyone’s Costs!

Peer Support began in parts of the US long ago enough that research is reflecting great results! The following article, Peer Support Explosion, was written by consumer leaders who had begun peer-based innovations in years past and is published by the College of Behavioral Health Leadership (aka ACHMA).  It’s pretty exciting stuff, and North Carolina should develop its vision and its funding for Peer Support so that we can use it in ways that reduce personal costs to citizens with mental illness while reducing costs to the state!

Peer Services Explosion: The Time is Now!

Harvey Rosenthal, Executive Director, New YorkAssociation of Psychiatric Rehabilitation Services; Sandy Forquer, Senior Vice President, OptumHealth Public Sector; Steve Miccio, Executive Director, PEOPLe, Inc.

          Terrible fiscal times create the political will to implement big changes, including some long overdue ones that involve changing how and where we serve people with psychiatric disabilities.

          We’ve long known that far too much money is avoidably spent in institutional settings, including state and local hospitals, emergency rooms, homeless shelters, prison and jails, adult homes, and the like. And we’ve come to focus on the striking truth that people with psychiatric disabilities are too often the physically sickest (dying 25 years earlier than the public), least employed, and among the most costly groups that our public health care systems are failing to properly engage and serve.

          For example, in New York, we’ve found that Medicaid spends 15 times more per year on people with mental health, substance use, and major medical conditions than the average Medicaid beneficiary and that 70% of the $800 million spent annually on avoidable inpatient readmissions are for that same group.

          We know we can save lives and dollars by reorganizing our services to make them more integrated, better coordinated and, more focused on wellness and prevention. We have a host of promising tools to accomplish this – many of which can and must play prominent roles in our national move to health care reform, health homes, and new managed care designs.

          For example, our health care systems all too often demonstrate insufficient empathy, persistence, and a true understanding of what daily challenges our most vulnerable face, including trauma, addiction, extreme poverty, and hopelessness. Our system is a much-too-passive one, waiting in vain for people who don’t expect to get help or who can’t get past the chaos, crisis, and poverty in their lives to show up. To compound that, these folks are far too often deemed non-compliant and candidates for forced treatment instead of better treatment.

          Our peer service community has many exciting answers:

 Peer wellness coaches in New York, Georgia and Tennessee are building those relationships and bringing that hope and persistence, hitting the streets each day to find, engage, and help connect people to the support and help they desperately need.

 Peer-run crisis respite houses in New York and New Hampshire are helping people get ahead of their next relapse, while avoiding costly, chronic ER and inpatient stays.

 Peer brokers in innovative care coordination programs in New York and self-directed care models in Pennsylvania and Texas are helping to redirect funds spent in long-term treatment and day services to allow people to get the wellness care, transportation assistance, internet access, and job support they really need to move on.

 In New York, peer bridgers have helped thousands to successfully transition from state hospitals to the community and are now being deployed to help do the same with “high needs” Medicaid managed care beneficiaries and, starting next month, with adult home residents and re-entering former prisoners with psychiatric disabilities.

 The current budget crisis also forces policy makers and our broader mental health community to recognize the huge fiscal and personal cost of keeping people in “chronic low-demand” services for life, fostering avoidable dependencies and keeping people out of the workforce and the broader community unnecessarily. States and localities must, now more than ever, turn to models that promote recovery, wellness, employment, asset development, and community integration – both to save lives and dollars.

          In these ways, policy makers looking for responsible savings and recovery, rehabilitation, and self-help proponents can use this crisis to make historic changes to advance the much-sought, long-overdue transformation of our service systems.

 Focus on Peer Bridgers and Wellness Coaches                                                                  Under a contract with the New York State Chronic Illness Demonstration Program (CDIP), OptumHealth is partnering with the New York Association of Psychiatric Rehabilitation Services (NYAPRS) to provide peer bridger services to individuals in Queens diagnosed with substance abuse or mental illness who need to be engaged or who need support in their recovery.

          Utilizing a recovery model, the peer bridgers help get people with complex medical and behavioral health conditions into treatment and support those in active recovery to stay on track.

          The CIDP identifies patients who are at risk for recurring high health care costs and multiple hospitalizations and seeks to improve the management and coordination of their care. Peer bridgers, individuals who are successfully managing their own recovery and have completed the requisite NYAPRS Peer Bridger and certified Peer Wellness Coaching training programs, help individuals bridge the gap between the structure of an inpatient program and the open environment of the community.

          As a supportive and trusting relationship develops between the consumer and the peer bridger through regular contact over a period of time, the bridger offers a sense of hope, peer mentoring, health literacy education and support, advocacy, and recovery, community, and crisis management skill building. This service embraces the recovery model and provides tools for coping with and recovering from a mental illness and/or a substance use disorder. See more at http://www.nyaprs.org/peer-services/.

          Additionally, new technologies, such as OptumHealth’s NowClinic, allow peer specialists to access a doctor 24/7 using a webcam and their computer from wherever the member may be when they meet.

          Interestingly, the project was developed during informal discussions in Santa Fe at the 2006 ACMHA Summit, with the first public presentation on this model and peer crisis respite services (see below) at the 2009 Summit.

 

 

Focus on Peer Crisis Respite Services

PEOPLe, Inc. has developed an internationally replicated peer crisis respite house approach that supports people to better manage crises, stay out of emergency rooms, and avoid inpatient stays. It operates two such programs in New York – Rose House in Orange/Ulster counties and a new one in Putnam County. The Rose House is an innovative and unique peer-run hospital diversion facility where individuals seeking temporary residential or respite care can stay for one to five nights. Services at the Rose House are designed to help “at-risk” individuals break the cycle of learned helplessness and recidivism through 24-hour peer support, self-advocacy education, and self-help training. Guests are taught to use new recovery and relapse prevention skills and to move away from what are often long histories of cycling from home to crisis to hospital, year after year.

          Rose House-styled programs have been adopted in Lincoln, Nebraska and the Netherlands, with research from the New York and Nebraska programs demonstrating upwards of a 68% reduction in avoidable emergency room and inpatient admissions and interactions with ambulance services and police.

See more at http://www.projectstoempower.org/.

Advocates Take a Stand to Prevent Discrimination in Community Colleges

Community colleges have served as a pathway to recovery in the lives of some North Carolina citizens. The local academic settings provide for more supportive interactions between student and educators as well as among a diverse population of students. And because they are more affordable to many, they have become by default the best setting for a person whose life has been interrupted or has been difficult because of experiencing a disabling or potentially disabling condition. However, we learned recently that our state’s community college leadership have been considering rule changes that would allow a college not to admit a person based on subjective information or perception.  This was done, it is said, in response to the shootings at Virginia Tech two years ago. 

So advocates began contacting each other and the press regarding the rule language.  It turns out that Disability Rights North Carolina knew about this and responded with their own letter in November, but now the issue is hot and live (the community college board voted about this on Friday, January 21st), and several organizations, including NAMI NC, NC Mental Hope, and NC CANSO have also written and shared their letters.

If the Rules Review committee for the community college board does not reconsider, we will need to move this for the attention of the legislature.  We’ll keep you posted!