Promising Practices for Social Inclusion: Peer-Provided Respite Care—Innovative Practices that Promote Wellness and Recovery
November 2011 » Issue 32
Letter from SAMHSA
“A broad range of services and supports beyond traditional treatments for mental and substance use disorders can help people manage their recovery from mental and substance use disorders. Behavioral health care and support should also be more responsive to the needs and direction of people in recovery and their families.”
—Leading Change: A Plan for SAMHSA’s Roles and Actions, 2011–2014
In Leading Change: A Plan for SAMHSA’s Roles and Actions, 2011–2014, SAMHSA observes that the Affordable Care Act and the Mental Health Parity and Addiction Equality Act make insurance coverage and traditional behavioral health care available to more people. However, this legislation does not necessarily give more people access to the recovery supports important to many peers.
“Social inclusion … is achieved when all have the opportunity and resources necessary to participate fully in economic, social, and cultural activities which are considered the societal norm.”
Bouchey, Fremstad, Gragg, and Waller, 2007
SAMHSA’s Recovery Support Initiative, one of eight strategic initiatives outlined in Leading Change, emphasizes the importance of incorporating alternative care options into the services available to people experiencing mental or substance use disorders. This strategic initiative highlights the need for the active participation by people in recovery in the development and implementation of a broader array of care and support services. It also provides a framework for moving communities and service systems to become more socially inclusive.
This issue of the SAMHSA ADS Center Information Update focuses on peer support, and specifically:
- Offers innovative community approaches for peer-run support programs and services
- Shares one woman’s experience with peer respite services that helped her avoid hospitalization during a recent emotional crisis
- Describes a new community program that uses Intentional Peer Support, a form of communication that builds a reciprocal relationship between staff and residents
- Outlines a national public health education program that is teaching people how to assist someone experiencing an emotional crisis through supportive connections that promote empowerment and reengagement
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Teleconference Summary: Peer Respite Services—Transforming Crisis to Wellness
The SAMHSA ADS Center sponsored a free training teleconference on August 4, 2011 entitled “Peer Respite Services: Transforming Crisis to Wellness.” The teleconference, which featured presentations by Dr. Peggy Swarbrick, Sherry Jenkins Tucker, and Steve Miccio, highlighted the following topics:
- The evolution of peer respite services, components of successful programs, and research showing outcomes that support this progressive model of recovery support
- Practical strategies for core operational functions, such as funding peer respite services and training the workforce including Certified Peer Specialists
- How peer respite services can help to shift community systems and supports—families/friends, housing, employment, justice, mental health—to be more trauma informed, socially inclusive, and recovery driven
If you were unable to participate in the teleconference, or would like to listen to it or view the slides again, you can access it here.
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In My Experience: Peers Helping Peers Promotes Healing and Recovery
Mael Dinnell shares her experience at 2nd Story Respite House, where peers helping peers makes all the difference:
It started with a whisper. Soon intrusive voices were yelling at me. “You deserved every bit of it.” I was scared to go into the shower. People were shouting at me from cars and bikes: “We’ll get you!”
Naturally I became nervous, vigilant, and antsy. I didn’t want to go to the hospital or local crisis house facility. … I needed an infusion of community and a situation in which I could “reality check” as much as I needed to. 2nd Story Respite House in Santa Cruz was new—2 months old—and as a mental health facility broke free of the ancient paradigm of provider, client, and the impassable boundary between them. The staff was trained in Intentional Peer Support, or IPS, and trauma intervention. The facility is based on the new and largely unexplored idea that peers can best help peers—not as a substitute for provider-oriented hierarchy, but as a complement to it.
Read Mael’s story and support others by sharing your own.
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A Community Model: Santa Cruz, California 2nd Story Respite House
By Respite House Staff & Guests, 2nd Story Respite House
2nd Story Respite House is moving towards a revolutionary transformation in mental health care. We exist because inspired people with lived mental health experiences connected with Santa Cruz County mental health program administrators, sharing their view that a Federal Mental Health Transformation Grant should be written and submitted. Mutual goals were negotiated to reach a vision of a peer-run respite house that would theoretically decrease hospitalization costs for the county while providing a valuable life experience for the mental health client. This Substance Abuse and Mental Health Services Administration grant application was approved to fund a peer-run respite house for 5 years, during which time data will be compiled to determine whether or not this community model is cost and more importantly, spiritually effective.
Intrinsic in the vision of our program is Intentional Peer Support, or IPS, a form of communication that promotes a reciprocal relationship between staff and residents, encouraging mutually responsible relationships and self-agency. Through connection, sharing worldviews, negotiating mutuality, and moving towards more fulfilling lives, we operate within the new paradigm of trauma-informed care rather than the medical model. We offer a comfortable, clean, furnished house in a quiet, safe neighborhood, fully staffed with people who identify as trauma-informed individuals and/or mental health peers. We also offer conversation, good food, musical interludes, walks, assorted adventures, and a challenging atmosphere where people are invited to examine the way we create ourselves in relationship to the world and each other.
Our 2nd Story Respite House offers folks, those who work there and those who come to stay, who traditionally have been underrepresented, mistreated, and abused, an opportunity to remember their inherent value of being persons with a place in community and, as identified in the U.S. Declaration of Independence, their "unalienable rights, that among these are life, liberty and the pursuit of happiness."
For further information, visit https://www.facebook.com/2ndStoryRespite#!/ 2ndStoryRespite or call 831-466-0967.
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A National Model: Emotional CPR
By Lauren Spiro, Director, National Coalition for Mental Health Recovery
eCPR is a public health education program designed to teach anyone to assist another person through an emotional crisis.
Emotional crisis is a universal experience—it can happen to anyone, at any time. Our approach is holistic, hopeful, and empowering. Through practicing eCPR, we learn to better understand seemingly unusual behaviors that can accompany an emotional crisis. Rather than labeling someone with a “mental health problem,” our approach assumes that the person is facing an experience that overwhelms his or her ability to cope. We learn how to form supportive connections so that we act as a bridge between a person in distress and the community at large, supporting people to make a full, timely return to a life that has meaning and purpose for them.
The three components of eCPR are C = connecting, P = emPowering and R = revitalizing.
- Connecting begins with being fully present for the other person, listening with our full attention, which creates emotional safety, cultivates hope, validates the person, and communicates care.
- EmPowering assists the person with regaining a sense of mastery, accessing his or her inner wisdom, and planning for the future. EmPowering is based on a “power with” as opposed to “power over” relationship.
- Revitalizing helps people re-engage in relationships, roles, and routines that support living a full and gratifying life
Laypeople certified in eCPR can help others recover from severe emotional distress, trauma, and/or disasters, thus preventing unnecessary use of costly hospital emergency rooms and mental health services. When people feel that they have a meaningful and valued place in the community, they are less likely to “act out” and hurt themselves or others. Thus, eCPR helps build stronger and more resilient communities.
For further information, please visit the Web site http://www.emotional-cpr.org or e-mail firstname.lastname@example.org.
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More Information: Social Inclusion Programs, Technical Assistance Tools, and Research
This section includes highlights from the ADS Center’s online resource collection, a searchable database of 1000+ research articles, brochures, guides, toolkits, and resource organizations. You can search our resources by audience or topic at http://promoteacceptance.samhsa.gov/default.aspx.
Please note: The descriptions below are pulled from or based upon the language provided on the organizations’ Web sites.
Promoting Systems Transformation
The National Empowerment Center (NEC) Web site section on peer-run crisis alternatives provides resources on peer-run crisis services in various areas, information on starting a peer-run alternative program, and evidence-based research materials on peer-run crisis alternatives. To access this section, visit http://www.power2u.org/peer-run-crisis-alternatives.html .
The Diversion Respite Manual of Projects to Empower and Organize the Psychiatrically Labeled (PEOPLe), Inc. will help guide others in developing hospital diversion services for individuals with mental disorders in their communities. The outline of this manual is currently available; the downloadable manual will be available at the following link later this year: http://login.npwebsiteservices.com/PEOPLE/DiversionRespiteManual.asp .
“What Recovery Means in Acute Care,” a webinar put on by the Recovery to Practice Project, discusses the integration of peers in acute care settings, ways of creating climates of recovery, and outcomes from a trial of a peer-run crisis residential alternative to psychiatric hospitalization. You can access webinar files through this link, http://www.dsgonline.com/rtp/webinars/9.16.2010.html .
The Memphis Crisis Intervention Team (CIT) is a first responder program for police officers that provides crisis intervention training to enable officers to better respond to calls involving people with mental and substance use disorders who are experiencing a crisis. A map on their Web site includes contact information for CIT programs currently in operation throughout the U.S. To learn more about this innovative program visit their Web site, http://cit.memphis.edu/index.php .
The National Association of Peer Specialists is a nonprofit organization dedicated to promoting peer specialists throughout the United States and improving treatment for those with mental disorders through peer support. To learn more, visit http://www.naops.org or call 616–676–9230.
Depression and Bipolar Support Alliance Peer Specialist Training features a nationally developed curriculum that prepares participants to be peer specialists who provide recovery-focused services. To learn more, please visit http://www.dbsalliance.org/site/PageServer?pagename=training_certified_peer_specialist .
Vets4Vets is dedicated to using peer support to help veterans recover from the psychological injuries of war. To learn more about the resources, support groups, and workshops offered through Vets4Vets, visit http://www.vets4vets.us .
Vet to Vet is a consumer/provider partnership program where veterans in recovery learn to provide peer counseling through which both people learn and grow. The organization is dedicated to helping veterans rejoin their communities as fully participating members. To learn more, visit http://vet2vetusa.org/Home/tabid/37/Default.aspx .
NAMI Peer-to-Peer is a peer-led learning program that provides tools to help participants maintain their wellness and recovery and be better prepared to deal with an emotional crisis. For more information, visit http://www.nami.org/template.cfm?section=peer-to-peer .
The National Coalition for Mental Health Recovery’s section on peer-run respite provides information and video resources on peer-run respite services as an alternative approach to healing and recovery. For more information please visit their Web site at http://ncmhr.org/peer-run-respite.htm .
Changing Community Perceptions and Influencing Local Systems
PEOPLe, Inc. networks and collaborates with current systems, including local hospitals, to counter prejudice and discrimination through educational and social programs and to remove barriers to quality care for individuals with mental disorders. Learn more about PEOPLe, Inc. by visiting their Web site, http://www.projectstoempower.org .
The NEC Directory of Peer-run Crisis Services provides a list of various peer-run alternatives to psychiatric hospitalization that are currently operating in a number of communities throughout the United States. You can view this NEC list through the following link, http://www.power2u.org/peer-run-crisis-services.html .
A Case Study of the Peer-Run Crisis Respite Organizing Process in Massachusetts explores one group’s efforts to develop peer-run crisis respites (PRCRs) in their State. Information on different models of PRCRs, organizational processes, and successful methods used to help inform other communities are also discussed. To access this study, please visit http://ncmhr.org/downloads/Ostrow_Groundhogs-case-study.pdf [PDF - 706 Kb] .
In this book, Mental Health Self-Help: Consumer and Family Initiatives, the history of the mental health self-help approach is discussed, as well as views on how consumer/survivor advocacy is enhancing health care for individuals with mental disorders, helping the consumer movement grow, and changing systems. http://www.amazon.com/Mental-Health-Self-Help-Consumer-Initiatives/dp/1441962522 .
Supporting Personal Wellness and Recovery
The Virginia Organization of Consumers Asserting Leadership, or VOCAL, promotes recovery from mental disorders, self-determination, and peer leadership. They also work to change the current health system and develop alternatives for people with mental disorders. To learn more, please visit their Web site, http://www.vocalvirginia.org .
Wellness Recovery Action Plan (WRAP) is a guide for people to develop their own individualized plan to maintain wellness and address crisis and other challenges related to one’s mental disorder. With WRAP, people use wellness tools to help themselves develop a personal action plan. Learn more about this plan through the following link, http://www.mentalhealthrecovery.com .
The Georgia Mental Health Consumer Network Peer Support, Wellness, and Respite Centers provide an alternative to hospitalization for individuals with mental disorders through temporary residential support where peer support, respite, and other activities are offered. For more information please visit their Web site at http://www.gmhcn.org/wellnesscenter/index.html .
“Crisis and Connection” and other articles by Shery Mead describe different approaches to peer support and her work, which highlights the importance of connecting with others and establishing quality relationships. Through her Web site, she shares links to articles that include topics on recovery, crisis, and research on peer support. To learn more about these resources, please visit http://www.mentalhealthpeers.com/booksarticles.html .
This article, “Nuts and Bolts: A Technical Assistance Guide for Mental Health Consumer/Survivor Self-Help Groups,” highlights the important role that consumers/survivors can play in the recovery of others. Also, in this article, people leading consumer/survivor-run organizations share recommendations to others who want to develop their own organizations. To access this publication, visit http://www.mhselfhelp.org/resources/view.php?resource_id=705 .
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Information and Research
Agar-Jacomb, K., & Read, J. (2009). Mental health crisis services: What do service users need when in crisis? Journal of Mental Health, 18(2), 99–110. doi: 10.1080/09638230701879227
Allen, M., Carpenter, D., Sheets, J., Miccio, S., & Ross, R. (2003). What do consumers say they want and need during a psychiatric emergency? Journal of Psychiatric Practice, 9(1), 39–58. Retrieved from http://journals.lww.com/practicalpsychiatry/Abstract/2003/01000/ What_Do_Consumers_Say_They_Want_and_Need_During_a.5.aspx
Bologna, M. J., & Pulice, R. T. (in press). An evaluation of a peer-run hospital diversion program: A descriptive study. American Journal of Psychosocial Rehabilitation.
Greenfield, T. K., Stoneking, B. C., Humphreys, K., Sundby, E., & Bond, J. A. (2008). A randomized trial of a mental health consumer-managed alternative to civil commitment for acute psychiatric crisis [PDF - 265.5 Kb] . American Journal of Community Psychology, 42(1–2), 135–144. doi: 10.1007/s10464-008-9180-1
Hopkins, C., & Niemiec, S. (2007). Mental health crisis at home: Service user perspectives on what helps and what hinders . Journal of Psychiatric and Mental Health Nursing, 14(3), 310–318. doi: 10.1111/j.1365-2850.2007.01083.
Landers, G. M., & Zhou, M. (2009). An analysis of relationships among peer support, psychiatric hospitalization, and crisis stabilization [PDF - 179.45 Kb] . Community Mental Health Journal, 47(1), 106–112. doi: 10.1007/s10597-009-9218-3
Lyons, C., Hopley, P., Burton, C. R., & Horrocks, J. (2009). Mental health crisis and respite services: Service user and career aspirations . Journal of Psychiatric and Mental Health Nursing, 16(5), 424–433. doi: 10.1111/j.1365-2850.2009.01393
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ABOUT SAMHSA ADS CENTER
This update is from the SAMHSA ADS Center (Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health). SAMHSA ADS Center is a program of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services, Office of Consumer Affairs. We encourage you to share this information with others and to post it in your own newsletters or email lists.