October 2013 presentation on Magic of Peer Supports (YouTube) - http://bit.ly/PeerDrivenSystems In 2012, Magellan was directed by the Arizona Department of Health Services to reinvest $27 million in enhanced services for individuals with serious mental illness but who lacked Medicaid (AHCCCS). In partnership with the state and community, hundreds of peer and family roles were hired to work alongside case managers, clinicians and medical staff to create something truly different. The decade of recovery in the 1990s must now yield recovery and peer supports being adopted by systems.

1. The Magic of Peer
Voice: From
Token to Core
System
DAVID COVINGTON, LPC, MBA—
CRISIS ACCESS, LLC
crisisaccess.com

2. It All Starts With
Peer Voice
Acknowledgements:
Larry Fricks
Gene Johnson & Lori
Ashcraft
Eduardo Vega

4. Polling Question #1
Which of the following best characterizes
your agency approach to peers?
Level 1 - We do services to people
Level 2 - We do services for people
Level 3 - We do services with people
Level 4 - We have peer-driven care &
leaders
Level 5 - We have a peer driven system
of care

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
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
Alcoholics Anonymous 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. Judi Chamberlin
―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‖

11. From Privileges to Rights
National Council on Disabilities
Report
Judi Chamberlin
―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
Lois Curtis
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

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. Don Berwick
What ‗PatientCentered‘ 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.
Eduardo Vega &
John Draper
In 2014, a National Action Alliance for Suicide
Prevention Task Force will publish “Activating
Hope” (provisional title) that will challenge
these norms.

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. Phil Pangrazio
―[In our movement] we don‘t have
a token seat at the table. We lead
the table.‖

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

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

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
Traditional Psychosocial Rehabilitation
Philosophy/Continuum
Done to
Done for
Done with
Motto
Level 4
Level 5
Peer-Driven
Peer-Driven
Care
System
Done by
Clinical team
Strong dependence Genuine voice and
Many roles in the
Self-directed care is
identifies goals and
on system &
participation with
system are filled
a core value with
develops service
artificial (paid)
some support for
by peers, including
Characteristi
peers holding some
plans. Compliance supports with no
individual risk
workforce,
leadership and
cs
with directives is
individual risk
taking &
governance, etc.
advocacy positions
focal point
taking or family
engagement in
Not a token
within the system.
activities.
engagement.
natural supports.
gesture.
Culture change
Clinically sound Safety and security Personal recovery Personal recovery
through peer
professional
with a goal of
through
through selfCore Value
leaders and
services & stability
stability
collaboration
directed care
staffing
Compliant
Dependent
Respected (Voice)
Leader
Empowered
Person(s)
Subservient
Institutionalized
Involved
Advocate
Leaders
Prescriptive
Caretaker
Partner
Consultant
Peers
Staff
Directive
Protector
Guide
Support
Advocate
Member
Clinically driven
Protective
Collaborative
Recovery driven
Peer-driven
Organization Provider is expert
Risk Averse
Engaging
Person is expert
Peer-staffed
Discouraged
Blocked
Supported
Encouraged
Expected
Risk Taking
1950
1980
2010 Compliance/
Present Directive
Dependent/
Care Taker
Voice &
Participation
Action &
Leadership
Peer-Driven

41. Polling Question #4
Which of the following are reasons a
CBHC peer staff member should be
terminated?
A.
B.
C.
D.
E.
Sleeping with a client
Not showing up to work the first day
Stealing from the organization
Being re-hospitalized for mental health
Reporting hearing active hallucinatory
voices

42. Recovery Innovations‘
Education Center
Lori Ashcraft
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
Gene Johnson
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. Contact Us
Email
david.covington@crisisaccess-co.com
gene@recoveryinnovations.org
Social Networking
http://www.linkedin.com/in/davidwcovington
https://twitter.com/davidwcovington
https://www.facebook.com/david.covington
http://www.youtube.com/davidcovington
crisisaccess.com