Peer Wellness Coaching - New York Association of Psychiatric

Report
This is Our Time!
Taking Peer Wellness Coaching
to New Groups and New Partners
Tanya Stevens, Peer Services Division Director
[email protected]
Elizabeth R. Stone, MA, CASAC
[email protected]
Coleen Mimnagh, Certified Peer Wellness Coach
[email protected]
NYAPRS 2010 Annual Conference
www.nyaprs.org
Shery Mead 2004
 “In peer support we come together with the intention
of changing our patterns,
getting out of “stuck” places,
building relationships that are respectful, mutually
responsible and
potentially mutually transforming.
 We validate each other for our ‘personhood’ rather
than our ‘patienthood’…
[we] see each other’s behavior through
the lens of personal experience rather than through
the lens of illness.”
2
Key Elements of Peer Support
Sharing, validating and normalizing similar experiences
Building empathy, sharing opportunities for connection
and knowledge
Building honest mutually responsible relationships
Based on the intention to change patterns and get unstuck
•Full respect for each of our
unique processes of
change
•Willingness to challenge
each other
Peer Support Models: Helping
People and Systems to Get Unstuck
Peer Bridging:
Alternatives to Long term or ‘Revolving Door’ Use of
Inpatient Care
Peer Health Care Coaching:
Support for Improved Self-managed Health and Recovery
Peer Crisis Support and Respite:
Alternatives to Chronic Use of Emergency/Inpatient Care
Peer Brokered Self Direction:
Alternatives to Chronic Community Institutionalization
Restoring Lives, Redirecting and Saving $
NYAPRS Peer Bridger Project
Background
Funded by:
New York State Office of Mental Health
New York’s Community Reinvestment Act of 1993
Combining Two Top Criteria:
Reducing State Hospital Census
Promoting Peer Support
Development Team:
Dr. Edward Knight
Dr. Cheryl MacNeil
Harvey Rosenthal
Chacku Mathai
Shery Mead
The Peer Bridger Lens
“We support each other to
get out of the hospital,
stay out of the hospital and
get the hospital out of us.”
NYAPRS Peer Bridger Model
Basic Elements
 Involvement in Mutual Support Meetings in the
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Hospital and in the Community
Developing a Mutually Responsible Peer
Relationship
Strengthening/Modeling Community Adjustment,
Wellness Self-Management and Relapse
Prevention/Crisis Management Skills
Connecting with Natural and Service-Based
Supports and Community Resources
Infusing Recovery And Cultural Competence In
Hospital And Community Service Settings
NYAPRS Peer Support
Core Values

Honest, direct communication

Power sharing and mutuality

Building hope and faith

Empathy and mutuality

Personal responsibility and accountability

Valuing and creating community

Not using “symptoms” or “illness” as a reason to
not meet each other’s needs

Learning to work through conflict

Being accountable to the relationship

Understanding trauma is central
NYAPRS Peer Bridger Project
Services
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Skill teaching
Social and emotional support
Recreation and companionship
Development of self-advocacy
Mutual peer support
Participation at weekly peer support
meetings
 Development of wellness selfmanagement WRAP plans
 Discovering community (community
guides)
NYAPRS Peer Bridger Project
Reframing Crisis
WRAP and Wellness Self-Management Tools
Forming Communities of Support
Dealing with “Big Feelings”
Keeping Your Power When Things Break Down
NYAPRS Peer Bridger Project
2009 Data
Numbers of Matches
Total
# of people referred to the project
368
# of people in matches
339
# of people referred from the hospitals
129
# of people who self-referred
239
# of new matches since 1/1/09
312
Additional Data for 2009
Number of Transitions
Total
# of people released from state psychiatric centers
205
# of people who left psych centers who have not
returned for three months or more
199
# of people who transitioned from on-grounds residences 138
# of people who transitioned from inpatient to on-grounds
residences or independent living
186
Total # of people who were discharged
320
# of people who were assessed to be discharge ready
and who were waiting for community housing
123
Reducing Re-Hospitalization
In 2008, the Peer Bridger Project worked with 251
individuals and 190 of those consented to the
release of their hospitalization data. After a
preliminary review of this data, approximately 136
of these individuals were not re-hospitalized in the
state psychiatric centers in 2008.
That means that approximately 72% percent of the
people we worked with were able to stay out of the
hospital for the following year.
2007 Data on Peer Support
Meetings and Staff Trainings
Peer Support Meetings held in State PCs
33
Peer Support Meetings held in the community 31
Average # of people attending each meeting
Total # of people served in meetings
Plus:
148 hospital and
community trainings
conducted by the
Peer Support
Specialists
13
1,300
wellness matters
On average, individuals with a psychiatric diagnosis
die 25 years earlier than people in the general
population.
Sixty percent of premature deaths can be attributed
to medical conditions that are frequently caused by
or worsened by controllable lifestyle factors such as:
• poor diet and nutrition
• smoking
• substance abuse
• limited physical activity
• difficulty accessing consistent medical care
Morbidity and Mortality in People with Serious
Mental Illness NASMHPD October 2006
15
Wellness is . . .
an individual’s personal perception
of reaching his or her full potential
by achieving a better quality of life
in conjunction with mind, body and spirit
16
National Health Care Reform Focus:
More Integrated Coordinated Effective Care
 Focus on ‘moving further upstream’ with prevention & early



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intervention services to prevent ‘complex medical and
behavioral health conditions’ from becoming chronic costly
health conditions;
Emphasis on wellness & person centered care
Improved coordination of care and use of evidenceinformed approaches
Decreased overuse and underuse of services
Dramatically improve the management of chronic health
conditions for the 45% of Americans with one or more such
conditions whose treatment = 75% of total medical costs
17
The NYS Challenge: Improving Care, Reducing
Costs for People with ‘Chronic Illnesses’
“20% of NYS Medicaid beneficiaries account for a significant
amount (75%) of the program’s expenditures.”
“These beneficiaries have multiple co-morbidities, are
medically complicated and require services across multiple
provider agencies.”
“Due to their multiple and intensive needs, their care can
often be fragmented, uncoordinated and ..duplicative.”
Included in these special populations are recipients with
chronic conditions, mental illness, chemical dependency,
HIV/AIDS, developmental disabilities and mental retardation,
and individuals requiring long term care.”
NYS Department of Health CDIP Request for Proposals 2008
The Promise of Peer Health Care Coaching:
NYAPRS Proposal to OptumHealth CDIP
 Most healthcare systems don’t appreciate the crucial
importance of relationship, of fostering hope for change, of
being available before and during crises: they often
passively wait in vain for people whose struggles, whose
lack of financial and transportation resources and whose
lack of hope and connection make them appear to be ‘non
compliant no shows.’
 We know…we are those ‘high cost high needs’ people with
medical and behavioral health conditions.
 Building on our Peer Bridger experience, NYAPRS Peer
Wellness Coaches can help bring hope and proactive,
personalized, mobile ‘real time’ relationship-based help.
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The Promise of Peer Health Care Coaching:
NYAPRS Proposal to OptumHealth CDIP
UMDNJ or CUNY Trained and Certified Peer Wellness
Coaches are uniquely skilled at:
Active outreach and engagement
Reinforcing accurate information about medical
conditions and self management care approaches
Providing ongoing support and reinforcement,
including cues, reminders and prompts to follow up on
medicine, health appointments, exercise, use of the
nicotine patch, etc.
 Conveying the power of relationship and personal
support
A Peer Wellness Coach
is
Someone Who
Shares experiences and hope
Uses communication skills
Uses motivational questions
Assists with challenging perceptions
Assists with inner strength building
Assists with problem solving
Asks permission before giving a suggestion
Assists with goal setting
Assists with strategic planning
21
Peer Support in OptumHealth’s
Chronic Illness Demonstration Project in NY
NYAPRS Peer Health Care Coaching
 Assist With Locating And Enrolling Consumers
 Provide Individual Health Coaching and Support
 Provide Health Focused Peer Support Groups
 Link Individuals With Local Mental Health Supports
 Assist With Relapse Prevention Activities,
 Actively Participate In Enrollee Treatment Planning
PEOPLe, Inc
 Peer And Staff Training On Recovery And Relapse
Prevention
 Possible Establishment Of Crisis Respite Residence
CIDP Peer Wellness Coaching Activities
• Using provided contact information, seek out identified
Medicaid recipients to explain program, encourage them to
enroll in program, and complete initial enrollment forms
• Engage enrolled individuals to form trust-based relationships
that foster hope for positive change and personal
empowerment
• Examine lifestyle factors that impact health and wellness with
enrolled individuals
• Utilize tools with enrolled individuals to discuss and plan for
changing to behaviors that will lead to improved health selfmanagement
• Help enrolled individuals identify and engage with a range of
community-based supports
• Serve on Project Management Subcommittees
23
Peer Wellness Coaching Basics
Motivational Dialogues toward Healthy Living
•Asking helpful questions
•Building self-confidence
•Connecting with personal goals
•Focusing on what’s important
Realistic Possibilities
•People may not be ready for change
•It may take numerous attempts to change a lifestyle behavior
•Lack of personal motivation hinders someone’s willingness to change
•Minimal patience “Wanting what you want, when you want it”
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LIFE WHEEL BALANCE
DIMENSIONS
Physical
Emotional/Mental
Financial
Social
Spiritual
Environmental
Occupational
Intellectual
HOW IT IS VS. HOW I WANT IT TO BE
25
Explaining Illnesses
(Explanatory Models of Illness)
People from different cultures and backgrounds have
different ways of explaining
• what caused their illness,
• what it is called,
• the course it takes and
• what can help them.
26
Differing Views
•
Some people think their illness is hereditary
• Others believe that it is caused by their
environment
• A few even think it may be caused by
supernatural forces
• Then there are those who are not sure of the origin
of their illness
27
We can work with
varied understandings of
illnesses by . . .
Asking questions
(What, Why, How and
Who)
Educating ourselves
on different beliefs and
cultures
Having respect and
empathy
28
Wellness Assessments
DIMENSIONS
Overall Physical Health
Nutrition
Physical Activity
Sleep / Rest
Relaxation / Stress
Management
Environment
Medical Care / Screenings
29
Assess Your
Strengths, Needs & Barriers
1. What are your personal strengths?
2. What do you want to change or
improve?
3. What could / does get in the way?
Assess Your Level of Satisfaction
30
The Decision Balance
“helps you evaluate if the change you say you
want to make is really that important to you”
Dr. Rick Bothelo
Weighing the PROS and CONS
of your goal: Which is most
influential?
31
A Decision Balance
•Helps you understand why you might
stay the same (resistance to change)
•Helps you understand why you might
want to change (motivation)
•Encourages you to think more about
change
•Can help you put a plan into action
32
A Decision Balance
Reasons to
Stay the Same
• Benefits of staying
the same
• Concerns about change
1.
2.
3.
4.
5.
6.
Reasons to
Change
• Concerns about
staying the same
• Benefits of
Change
List benefits and concerns
Assign a value to each
Total the values
See which side has a greater total
List which factors have the greatest weight
Discuss what would have to shift for you to be
successful in making a desired change
33
What Helps
And
What Hinders
Conversation
34
Active Listening Involves . .
. (Stating back to the
•Responding to content
person what you heard him or her say, in your
own words)
•Responding to feeling (Stating the feeling you
sensed from what the person described)
•Responding to meaning (A combination of
content and feeling; lets the person know you
understand his or her experience / situation)
35
H. E. A. L. I. N. G.
COMMUNICATION
HE A D
EY E
UP
CONTACT
AT T E N T I V E
LE A N I N G
FORWARD
I NTERESTED
NO
DISTRACTIONS
G ENUINENESS
36
Open Ended Questions
. . . i nvo ke co nve rs at i o n
. . . d o n o t fe e l l i ke a q u i z
. . . d o n o t h ave a r i g ht o r w ro n g a n s we r
. . . a re u s e d s p o ra d i ca l l y t h ro u g h o u t t h e
co nve rs at i o n
37
Blocks to Listening
•Comparing
•Mind Reading
•Rehearsing
•Filtering & Dreaming
•Judging
•Identifying
•Advising
•Derailing & Placating
38
peers
helping
peers
•Identification
•Unique personal relationship
•Focus on growth and self-stabilization
•Building self-esteem and confidence
•Focus on the whole person – not just a diagnosis
•Realization of the importance of being selfinvolved in one’s recovery
•Providing a safe and trusting environment
39
Critical CDIP Role
 Our Queens peer wellness coaches helped find, engage
and enroll over 1/3 of identified beneficiaries.
 They helped OptumHealth staff successfully connect
with numerous community agencies that proved
helpful in finding or serving this group.
 Our coaches’ inclusion in OptumHealth’s weekly team
case rounds “gives the team the opportunity to learn
from our peer partners, and hear an additional
viewpoint on how to best manage the case being
presented. In addition it is a great opportunity to get
additional case referrals to peer support.”
40
Peer Wellness Coaching:
One Consumer’s Story
FIRST CONTACT
• Met him with his mother in their home
• Medicaid was inactive and he lacked meds –
called HRA, pharmacy & Optum staff
• Shared how knowing what to do was based
on personal experience
• Discussed how working with a peer could
help him achieve positive outcomes
41
Peer Wellness Coaching:
One Person’s Story
FIRST CONTACT
• Talked about her own recovery story and her
personal ways of maintaining mental,
physical and spiritual wellness
• Learned about and reflected value of his
accomplishments of 14-month sobriety,
leaving an unsafe residence and managing
diabetes
• Made a commitment to work together on
personally meaningful goals he sets
42
Peer Wellness Coaching:
One Person’s Story
SUCCESSES
• Helped expedite reinstatement of Medicaid
• Established trust and a good rapport based
on shared experiences
• Co-created a wellness plan with action steps
and means for accountability
• Encouraging him to focus on current
accomplishments rather than prior relapses
43
Peer Wellness Coaching:
One Person’s Story
SUCCESSES
• Motivating him by helping him recognize the
part he plays in his own wellness
• Attending 12-step meetings together to link to
natural supports in the community
• Continuing contact several times a week,
including on Fridays to review successes with
wellness plan
• Evolving mutually-supportive relationship
44
Moving Forward:
AmeriChoice/OptumHealth Peer Bridger Initiative
 New contract to work with 200+ identified NYC/LI
Medicaid Managed Care beneficiaries who have had
multiple re-hospitalizations and have not engaged
with outpatient services (‘high needs high cost’)
 Goals are to reduce re-hospitalization rate by 40% and
to improve ‘community tenure’ by 15%
 Similar objectives to CDIP: increase hope, support and
self care, increase connection to healthcare, reduce
avoidable ER and inpatient use
45
Moving Forward:
AmeriChoice/OptumHealth Peer Bridger Initiative
 6 trained NYAPRS Peer Bridgers/Wellness Coaches
with TRAC phones and cars, poised for prompt
engagement and outreach efforts and active, ongoing
support, real time crisis assistance.
 Complementing individual relationships and efforts
with peer support meetings in or around high use
clinics.
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This is Our Time
 National and state healthcare systems are focused on
improving care via greater focus on wellness and
prevention, especially for ‘high needs high cost’ people
with complex medical and mental health conditions.
 Peer bridgers/wellness coaches provide a critical new
resource: appealing, active, empathetic, engaging,
mobile, community based, positive support skilled at
helping people to gain the hope to get better via
improved self care and improved connection to
appropriate healthcare….before the next crisis.
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