by EMP Education — pdf. On August 31, 2012, President Obama signed an executive order instructing the. VHA to hire 800 peer-to-peer

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Peer Specialist Toolkit Implementing Peer Support Services in VHA This document is a collaborative project between the VISN 1 New England MIRECC Peer Education Center, and the VISN 4 MIRECC Peer Resource Center. Contributing authors: M att hew Chinman, Kevin Henze, and Pat ricia Sween ey. Edited by Sha ron McCarthy

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page 3Acknowledgements We thank Dan O™Brien-Mazza, National Director, Peer Support Services,Psychosocial Rehabilitation and Recovery Services, Mental Health Services. Dan has fully supported this project, and given expert help with many details in this document. We thank members of the VISN 4 Peer Resource Center Advisory Committee: Sara Chapman, Lisa Fitzsimmons, Diana Hoke, and Steve Stanley, who reviewed several versions of this document and made thoughtful contributions. Sara also provided extremely helpful technical support and guidance in developing the toolkit. We thank Erin Klugh, Visual Information Specialist at VAPHS, who provided us with the graphic design layout in a timely and helpful way. We thank Mala Shah, VISN 4 MIRECC Research Associate, for her gracious help with technical editing on several versions. We especially thank all those peers who ar e working everyday in the VHA, for their pioneering efforts to provide an essential support for Veterans across the country. Some of the content in this toolkit was develo ped with support from two VA Health Services Research & Development grants, PEers Enhancing Recovery (IIR 06-227) and Improving Care of Veterans by Using Consumers as Mental Health Providers (IIR 02-009-1).

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Table of Contents 1. Who are Peer Specialists and what do they do? 3 2. What does the research say about peer support? 5 3. Why should we hire Peer Specialists? 7 4. What are some common misperceptions about peer support providers? 9 How do I build support for Peer Specialists and integrate them onto my team? 11 Stage 1: Exposure Tips Stage 2: Adoption Tips Stage 3: Implementation T ips Stage 4: Practice Tips 6. Technical details of hiring Peer Specialists in VHA 21 7. What about training for Peer Specialists? 23 8. What should I know about supervision of Peer Specialists ? 27 9. Where can I go for additional help? 33 10. References 35 11. Appendices 37

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1 Who are P eer Specialists and what do they do? Peer support occurs when people with the same types of problems help each other. There are different kinds of peer support, including peer support groups, organizations, and providers. Peer Specialists (PSs) and Peer S upport Technicians ( PST s): In VHA, PSs are VA employees who help Veterans with serious mental illne sses and substance use disorders to successfully engage in their treatment. The Peer Specialist is the newest of the two classifications for peer support providers employed in VA , but the competencies expected of PSTs are the same. Therefore, for the sake of simplicity we will use the term, fiPeer Specialistfl or fiPS ,fl throughout the rest of this toolkit. Peer Specialists promote recovery by sharing their own recovery stories , providing encouragement, instilling a sense of hope , and teaching skill s to Veterans. These services are provided by an appropriately qualified, VA -employed Peer Specialist . In VHA, PSs have defined competencies and are trained to use their liv ed expe riences to help Veterans identify and achieve speci fic life goals related to recovery. The comple te list of expected competencies can be found in Appendix 1 in the Department of Veterans Affairs Peer Speci alist Training Manual. The training manual can be found on the VH A Office of Mental Health Services Peer Support Services SharePoint: 20Services/Forms/AllItems.aspx. A helpful tri-fold brochure is ava ilable to int roduce the role of VA peer support provider s entitled , Understanding Peer Support Services in Veterans Health Administration (VHA) . This brochure is available for download and printing on the Peer Support Services SharePoint noted above. page 3

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What do Peer Support Prov iders do? DO DON™T DO Facilitate peer support groups Share their own recovery stories Advocate for Veteran consumers Act as role models of recovery Provide crisis support Communicate with clinical staff Act as a liaison between staff and Veterans Work on a variety of clinical team s Provide outreach & educate VA facility staff and Veterans about peer support services Provide psychotherapy Do other people™s jobs or fulfill other people™s roles in the facility Collude with Veteran consumers against clinical staff Cross boundaries Support Veteran consumers in their self -destructive or illegal behaviors Criticize clinical staff in front of Veteran consumers page 4

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Research also shows some challenges, both i n and out of VHA: Role confusion: Lack of clarity about peer support providers™ duties Staff resistance: Less supervision and support Exclusion from treatment team meetings Unequal treatment: Encouraged to volunteer for peer support roles rather than have paid position Lack of a viable career path Lack of access to medical records Relegated to grunt work Questioning reasonable accomm odations and scrutiny of sick leave This toolkit will address these challenges and provide strategies for preventing many of these challenges from occurring. page 6

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3 Why should we hire Peer Specialists ? Improved Outcomes for Veterans Peer support provides a wide variety of improved outcomes for Veterans. Research and experience have shown how peer support prov ider s can improve pro blems at the client level , and pr oblems relat ed to the overall treatment system. Below are examples of how peer support helps Veterans diagnosed with serious mental illnesses. How Peer Support Addresses Client and Treatment System Factors: Factors that contribute to poor outcomes for those with serious mental illnesses (SMI ) Client Factors Treatment System Factors Social isolation Disconnection with ongoing outpatient treatment Powerlessness & demoralization regarding illness Overburdened providers Fragmented services Lack emphasis on recovery, rehabilitation, empowerment Peer support services address each of the factors: Enhances social networks by role modeling facilitating peer support activities Engages clients; makes tr eatment more relevant through collaboration Activates clients; teaches coping & street smarts; provides hope through role modeling Supplements existing treatment; increases access Provides case management/ system navigation to increase access Emphasizes recovery: acts as liaison between consumer and sy stem focuses on meaningful life roles and community reintegration (Adapted from : Toward the Implementation of mental health consumer provider services , Chinman et al. 2006 ) page 7

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Peer Specialists are r equired as part of VHA System Transformation In 2003, the President™s New Fre edom Commission on Mental Health Report recommend ed using consumer providers , stating, “Because of their experiences, consumer providers bring different attitudes, motivat ions, insights, and behavio ral quali ties to the treatment encounter (p. 45).” VH A now requires the use of peer support pro vider s withi n mental hea lth . Seve ral regulations, guides, and laws describe how peer support providers are to be included in VHA programs. All these handbooks are found at cations/. These include: VHA Handbook 1160.01, Uniform Mental Health Services in VA Medical Centers and Clinics (2008) mandates the availability of peer support provider s: Peer support is one of the 10 fundamental components of recovery according to the National Consensus Statement on Mental Health Recovery (p. 4). fiAll Veterans with SMI must have access to peer support services, either on-site or within the communityfl (p. 28). Staffing models for VHA recovery programs stipulate including peer support providers: VHA Handbook 1162.02 Mental Health Residential Rehabilitation Programs states, fiPrograms must engage the Veteran in peer support while enrolled in the program and encourage the extension of peer support to outpatient care following dischargefl (p. 38). VHA Handbook 1163.05 Psychosocial Rehabilit ation and Recovery Centers (PRRC) states , fiAll facilities must design Peer Support Services for the treatment of Veterans with SMI including those with co -occurring disorders. Each facility must carefully assess the needs of service recipients and the availability o f competent resources to provide peer supportfl (p. 8) . Public Law 110-387, The Veterans’ Mental Health And Other Care Improvements Act Of 2008 further establishes the requirement for the use of PSs and their qualifications. You can read the details of the Act at W-110publ387/pdf/PLAW-110publ387.pdf . On August 31, 2012, President Obama signed an executive order instruct ing the VHA to hire 800 peer -to-peer support counselors for mental health care . page 8

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4 What are some common misperceptions about peer support pr ovider s? The material in this section is adapted from Mental Health Consumer Providers : A Guide for Clinical Staff (Chinman et al., 2008). The full document addresses many important questions about integra ting peer support prov ider s successfully . It is reco mmended reading as an introduction to peer support and can be download ed for free from Misperceptions about Peer Support Providers Non -peer sta ff and other stakeholders often ha ve concerns about employing peer support providers . Their attitudes are a key determinant in the success or failure of involving peer support prov iders within a health care organi zation . Below, we will lay out some common ly expressed concerns and respond to these misconceptions about VA Peer Specialists (PSs). Peer support providers cannot work full -time, either because of disability insurance or because of the responsibility. It should not be assumed that PSs cannot work full -time. Determination of the work schedule and workload should be tailored to the individual. Some individuals will be able to work full -time, while others may prefer to work part -time . Decisions about work load should not be predetermined based on peer status. Most VA Peer Specialist positions are for full -time employment. Often, full -time employment will bring in more money than the amount that could be lost in disability benefits the individual receives . PSs should be encouraged to seek financial benefits counseling before taking a PS job to be fully informed about the financial tradeoffs. Peer support providers cannot ful fill valuable roles in the treatment of Veterans . The purpose of having PSs is not to have fiextrafl people who can run errands and perform tasks others would prefer not to do. However , the role s and responsibilities of the PS are not exactly the same as other team members. For example, PSs usually do not have advanced degrees in psychology (PhD) or psychiatry (MD). They do not conduct formal assessments or diagnose Veterans. They do not prescribe medications or provide psychotherapy. However, they do have experience as mental health consum ers, and this experience makes them uniquely qualified to serve as recovery role models and provide services to Veterans in ways that are di fferent from non -peer providers. For example, PSs can be quite effective in using their lived experiences to engage Veterans into health care services for the first time. With appropriate training, PSs can effectively facilitate Wellness Recovery Action Plan (WRAP) groups and/or Illness Management and Recovery (IMR) groups to help Veterans with serious mental illnesses to develop and attain goals and better manage their illnesses. PSs are also Veterans themselves and can be helpful in treatment discussions about access to care and challenges Veterans face in navigating the VA health care system. page 9

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