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Active Engagement and Services for Crisis Outreach and Warm Handoffs (October 25, 2018)

Active Engagement and Services for Crisis Outreach and Warm Handoffs (October 25, 2018)

All right welcome everybody. Good
afternoon and welcome to the Recovery LIVE! This event is brought to you by the
Substitution Abuse and Mental Health Services Administration Bringing Recovery Supports
to Scale Technical Assistance Center Strategy, otherwise known as BRSS TACS.
Our TA center is dedicated to increasing access to recovery supports. We achieve
this work through a variety of mechanisms, including a lot of TA focus
on system transformation and the development of peer-run recovery
communities and family and youth led organizations. We’re very fortunate to
have some really awesome presenters who will be talking about active engagement
and services for crisis outreach and really warm handoff. I’m really excited to
first present Mindy Harrison. She’s the director of the Peer Support Specialists
Network of Maine. And Brandon George, the director of the Indiana Addiction Issue
Coalition, which advocates for a substance use disorder recovery through
public talks and education. I’ll be turning things over to them shortly, but I just
want to go over a couple of housekeeping items. Recovery LIVE events are
different than your usual webinars. First, they are much more exciting and interactive. We really want you to engage directly with us. I see a lot of you are already
typing in the chat box. Please keep that up. We have
a lot of poll questions and we do want you to raise questions as they come up
for you, but we’ll also have a Q&A at the end, but feel free to kind of fire them
up as they go along and we’ll do our best to either answer them as we go or
answer them as we go or answer them on the back end. Everybody
that’s on the webinar currently is in listen-only mode. We would love to talk with each one of you, but that’s just not possible because there’s so many of you.
We have several resources on this topic available for download in our resource
box. To download a file, highlight the name of the document and hit the
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re-watch the presentation using the link. So if you really love and want to watch
it again it will be available. Today’s session will last about an hour. As
you’re listening to this content, you feel your organization may
need technical assistance around this or any other topic, please copy the link
from our online TA request form from the instructions box. As people are arriving
today, we actually already posted one poll question. I see a bunch of you
have filled it out already. If you hadn’t got a chance to, please take a couple of
seconds and fill that out. Let me just take a quick peek and see what
people’s roles are. So you have a lot of peers in the room, which is awesome.
Nothing about us without us. That’s what I always say when it comes
to peers. The second biggest group is we got a lot of supervisors here
and a lot of social workers. Yay to my fellow social workers, that’s
what we like to see. Alright, so as we get done with the poll, I’d like to turn it
over to Brandon, or is it Mindy that’s going first? Sorry I lost my spot. I think
we are going over to Mindy I believe. Oh you’re muted Mindy. I am. There is a couple
of quotes on this slide that are really about the effective integration,
prevention, treatment, and recovery services that peers lend in the
substance use community. Regardless of specific roles, people are finding that
peer support staff can also enhance organizational culture and add a crucial
element to the treatment team that really complements existing services
within those structures. Peer support specialist is an individual with lived
experience who’s experienced life challenges. They may have or may be
receiving mental health services and supports of their own.
Peer recovery coaches are a little more prone to supporting people with
substance use issues and experiences, that’s really what the recovery coach is
geared towards, whereas peer support specialist traditionally support people
that are having mental health challenges. Both types of peers provide different
kinds of connections in navigating recovery support systems and resources,
which include professional as well as non professional or peer led services.
Warm handoff is a long-standing strategy in the social services medical world to
transfer care from one system into another or community system team
outside of inpatient settings or hospital settings. So with that, warm
handoffs is what the focus is today, and there’s a couple areas where that
happens more so than others. The one that we’re going to really talk a lot about
today is peers in the ED’S, in the emergency departments. What the role is,
what it looks like in different areas. We’re fortunate in Indiana,
we’ve been recipient of, my organization specifically, about six SAMHSA grants, and
two of them have been heavily built around the recovery supports and
recovery community supports, and over the last handful of years, peers have been
making their entrance into the emergency departments, and we’re lucky, we’ve had a
project going for several years at this point with Indiana University and
actually Eskenazi Hospital called Project Point that we’ll talk about and
they have really been carrying a lot of the water, one of the PowerPoints
attached for download, Doctor Brucker, could see some of their amazing work,
because they’re really the group that’s figured out what the bumps and
bruises, how to get some of the stuff done, and unfortunately it’s not a
one-size-fits-all approach though, and if you’re on here and you’re thinking about
putting peers into your emergency department, you really need to take a
make up of what your town or your city looks like. The group we’re just talking about with Eskenazi, they have multiple coaches that
are full-time, and that’s great when you’re talking about a larger city where
you have the need and the demand to have people around on call, day and night,
sometimes over night for some hospitals, where as rural emergency departments may
only have one overdose or two overdoses a week and you’re not going to need
somebody there 24/7. You’re going to have to have more on call, have contracts
possibly with local community mental health centers or other recovery
community organizations that can help get them to the hospitals when in need.
Another thing we want to talk about is how does that work when people are on
call. How do we get peers into the departments and a lot of times that’s through
the clinical staff or the nursing staff. Again, it’s going to depend a lot on the
hospital setup. One of the hospitals that we have peers in they actually have a
whole wing that is treatment, that involves IOP, and they’ve got clinical
staff on there, that got peers on their staff, and they can just go down
essentially to the emergency department when people come in, and in other cases
it’s going to take them a half-hour, hour to show up, and that coverage is going to
vary dramatically as well. Indiana has a wide variety of areas. We are, you know,
mostly rural, but we have Indianapolis, Gary, Evansville, some larger cities, and
so one of the main benefits I think that we found out is we’ve got a couple
different models. Some hospitals have full three shifts going on, 7:00 to 3:00,
3:00 to 11:00, 11:00 to 7:00, and having somebody there all the time,
and then we have other ones that are on two shifts a day, and then something
really new that’s happening is we’re doing virtual peers with Indiana
University health. They have got 700 hospitals that they’re providing virtual
services for to help access some of, you know get people into the right services
and provide peer supports where wouldn’t be able to do so normally. So we
talked a little bit about the decisions that people have to make, and whether
they are going to directly hire peers or whether they are going to contract them
out. Some of the drawbacks to hiring them directly is one, the HR departments at
hospitals, they have a whole bunch of in-house counsel and their whole goal is
to make sure they’re not opened up to liability, and not sure if everybody out
here is aware of it, but a lot of people in our field of peers have criminal
history because the criminalization of drug use. So it’s presented a major
barrier over the last couple years of getting peers hired in. One way to, unless
they get around it, but to eliminate that barrier is to contract out the services
with an organization that already has a relationship with the hospital. Has made
that part of the process much smoother, but at the same time you
don’t have them there all the time and they’re not on call so there is a delay
in getting them over, and the other part that really ends up being an issue is
when a peer works inside of a specific organization, they have to follow that
organization’s rules, and what we’ve seen in some areas of Indiana and around
recovery community organizations and centers, if somebody goes into that
center and they are attached to a treatment provider, that peer really isn’t
giving them the wide array of services. They’re most likely going to get into
that treatment provider system, and to me that’s one of the main benefits of
peers is they’re supposed to be independent, they’re supposed to be
apolitical, they’re supposed to get people wherever they need to go. So I think that
there’s a real benefit to the contracting, they’re not beholden to one
treatment service and it allows them to operate a little bit more area. Was
hoping to a quick question. Sorry. I think that is
where I want to move on at. Mainly just noting that when peers, regardless
of their role, whether they’re contractors, whether they’re hired, you
know they’re supposed to be walking resources, you know, medication is a big
part, a hot topic right now, especially when people are coming in from OD’s,
and it’s something that there has to be the resources set up, Devin’s going to
talk later about building relationships with people in the community, but having
set up or either doctors in the emergency departments are doing carry
over scripts for a couple days, and having relationships with doctors to make
sure that people are, because we lose a lot of people in between those day or
two. As we all know that the window is very very small to help people, and if we
do not get hold of them while they are in there, if we send them out and withdrawal and
we send them out for a week, we usually know that we’re going to lose that
person. So it’s a critical point and I want to make sure that we make note of
it. All right, real quick I just want to take
comment on the poll and throw in a funny story. When the first emergency room in
the northern suburbs of Philadelphia started a warm handoff program, they had
all of their peers there from 9:00 to 5:00 on Monday through Friday, and they
figured out that most of the overdose incidences were happening over the
weekend and at evening, and really what that told me they didn’t have peers
integrated in their development team. So that’s part of the reason we’re asking
this poll question is, you know, how are your peers integrated in your staff. So
it seems like a lot of people have hired peer support specialists. Some people are having them in meetings. What I guess, one thing we guess, we
need to may work on for a future webinar or Recovery LIVE! is making sure that our
peers are receiving supervision because that’s definitely a big thing. Thanks
everybody for filling that part out, and I’m gonna hand it over to Mindy.
Thank you. So I’m going to talk a little bit about peer support specialists within
emergency departments. More specifically for mental health and crisis kinds of
support. The agency that I work for, Amistad Inc, based out of Portland, Maine,
has been overseeing in emergency department program since 2002. We have
seven peer support specialists that work within there, and a lot of what we try to
do is go in and connect with people, which is often on what may very well be
the worst day of their life. You know through conversation, sometimes kindness, you
know getting them a turkey sandwich or ginger ale or playing a hand of cards with them. So you know we meet with everybody whether, you know,
they’re having really extreme experiences or, you know, as you know for
medical terms may be experiencing extreme psychosis. We work with people when they’re experiencing crisis. Sometimes it can be somebody
who’s lost their child or is experiencing homelessness and really
seek to create community connections for them or natural support. A big piece of
what we see within the psychiatric emergency department is the people that
are the top utilizers of that state often really don’t need that level of
support. So that is really where the peer support had started from was trying to
connect people to the community resources so they would utilize those in
place of coming to the emergency department which most people are aware
cost quite a lot more than a couple of hours of peer support services. So within
the ED, we talked about community resources for the people that are in
there, which often include things like mental health treatment facilities,
recovery resources, peer led groups, peer centers that are accessible. We can
really discuss what they’re lacking for basic needs, which include sometimes
health insurance or housing and point them in to a direction for
a wide variety of different groups and individual supports that are available
in the greater Portland area. So that’s a lot of what we do within that setting is
really suggest alternative places for them to go to on. Amistad Inc has been around
since 1982. We operate three recovery centers as well as the street outreach
program. We just open Maine’s first medically assisted treatment residents
for women. And we have peer support specialists within the emergency
department as well as at our state psychiatric hospital, which we’ve has
held that contract since 2006. So all of the staff working within these settings
are required to attend the intentional peer support model which was developed
by Shery Mead back in 2006. If you go to Vermont and do the training or some
place else because they do travel internationally tho offer those trainings. It
is only a five day program. What we have done here in Maine, because we did work
alongside Shery, to implement the pilot model is we have adopted that as our
recognized state certification programming and people attend one full
day a week for eight weeks and at the end they take a final written exam and
then they’re required to have quarterly supervisory type meetings. It used to be
called co-supervision that didn’t really support the mutuality that IPS
kind of encompasses, what’s been changed to co-reflections, and they’re also
required to take to a minimum of two continuing education classes per year. Once a year they are expected to sit down and do what is called a fidelity
review to be sure that they are working within the fidelity of the intentional
peer support model, and I think that this training is really what has made these
programming so successful because not only are they practicing intentional
peer support with the people that they support in the various settings and in
the emergency departments, but our staff really go above and beyond to practice
the tasks with the other staff and the other treatment team members as well
which has really helped us to work within these systems
successfully. Something that I like to share about that is our team up at the
state psychiatric hospital also trained an intentional peer support. Often the
other hospital staff will find themselves in the peer support office
getting support from that team that they’re not getting through other places
in the hospital which is pretty pretty unique. All of our programs are a mixture
of state funding, city block grant dollars, and we do have several private
funders as well that make our street outreach program possible. We do contract
with outside agencies and mental health agencies to provide peer support
specialists within those settings as well as we’ve provided supervision for
agencies who are just getting peer support specialists up and running and
integrated within their teams and they’re not really sure how to supervise
them. So those are some of the things that we have offered historically and
currently continue to offer. We were at Maine Medical Center, which is one of
Maine’s largest hospitals. We worked with in the emergency department there, which
has a specific locked psychiatric unit. We’ve been there from 2002 until last
year, 2017. We did just recently move our contract over to Mercy Hospital who
seems to be a little bit more in line with our values and what we’re hoping to
provide to people. We have, we’re there seven nights a week from 5 o’clock to 11
o’clock at night, but we also have people available to meet with folks at the
hospital off hours and we also try to bridge them into some of our other
existing programs or if we know of other peer programs within different
traditional agencies. We’ll meet with people and support them bridging that
gap. So our outreach programs are funded primarily by private lenders and also
through the block grant dollars. We work with the city to kind of reduce the
amount of long-term stayers at the shelters. So really trying to support
them in getting housed and finding other resources in the
community instead of just hanging out like at the resource center all day,
which is one of the larger day programs for us in Portland, Main. What’s kind of
unique about our outreach program is that if there’s somebody who’s
experiencing significant mental health issues on the street or really having
extreme experiences, the police have been known to call our outreach workers in
place of bringing the people to jail or to the hospital, which is really kind of
unique and something that we’re pretty proud of. We do give the inmates in the
correction facilities as they’re nearing the end of their stay there and support
them and getting linked to sober housing. You know a couple of our street outreach
peers also operate sober housing programs which is really neat. So we can
bridge that gap and make sure that they have a place to go to get set up and get
back to work and you know really just try to reach resources that aren’t
always available to them when they’re not able to meet with peers within those
settings. All right. So one of the things that Mindy touched on, I’m
gonna spend a lot of my time talking about is supervision piece that they
helped provide in ED settings for people that haven’t been doing it, it’s a
vital vital role. So I talked about having a variety of
settings. We’ve got about five rural counties that have the peers. We’ve got a
couple major hospitals in Indianapolis and the virtual stuff going on but I
think everybody, really when they’re getting this started, has to decide what
they’re really doing. Are we hiring a recovery coach or a peer recovery
specialist just so that we can check a box and say that we now have a recovery
coach and have another service that we provide on the side, or are we really
trying to switch our system over and get it a more recovery oriented system and
making an organizational change to offer recovery support services,
which we know is a key component of the the continuum of care for substance use
disorders, and simply it, we’ve seen this go wrong before where organizations will
hire a coach, put them in an ED by themselves or with one other person, and
they have no support, they don’t have any other people that they can bounce stuff
off of, they don’t have a way to sharpen their skills, Phil Valentine’s and seek
our calls at coach on an island, and I think that’s the perfect way to put it,
you’ve got a coach literally out there on an island. A lot of times they might
end up being the only person in the organization that knows about peers. So
how do they supposed to get proper supervision if they know
more than anybody else in the building? So I think that it’s important when
people are brought on, that teens are educated. You know a lot of times
therapists think that peer coaches are there to take their job. That they’re trying
to get bachelor’s level and high school level people and they can pay less to do
the same job and that’s just couldn’t be further from the truth. You know peers are complementary piece to the treatment team, they’re not taking
any spots, and actually what it allows therapists to do and doctors for that
matter is practice to the top of the licensed. Therapists can stop stay on the
phone for 15-20 minutes making calls to recovery residences and in other places
and they can actually worry about the therapy part of it. So when we introduce
peers, we’ve got to have staff meetings, we’ve got to tell people what their role
is. We’ve seen it happen on both sides. We’ve had some recovery coaches that
ended up taking out trash and answering phones and we’ve had other
recovery coaches that were told to do biopsychosocial assessments, neither of
which are within the scope of work or what recovery coaches should be doing. So
we can’t have other supervisors making decisions and telling people to stuff do
stuff that’s outside of their scope of work. Critical, critical, critical. After
the first several years with IU, one of the things we were
to look back on and see you at ICU, the biggest gap was supervision, and with
this being a newer position, I mean coaches have been around for over a
decade, but it’s only really caught on over the last handful a year. So there’s
not the infrastructure within organizations and we really think
the gold standard is if you’re going to bring peers into your organization,
you’re going to have a department of them, you’re not going to have that coach
on the island or a sub-department of them that is part of the clinical team
and it will allow people to get the proper development and direction that
they need. So what that would look like is the supervisor either, what we would
prefer is that the supervisor actually go through the recovery coach training
or at the very very least go through supervision training so that they do
have that knowledge of what a peer role is supposed to do and what they’re not
supposed to do, and to also make sure that they are getting their continuing
education. Peers, just like other professions, I know in Indiana we’ve got
to have 40 CEUs every two years. So there has to be ongoing continuing education.
Making sure that people are getting the latest information and who’s supervising,
who’s overseeing, making sure it’s happening at the company, paying for it,
are they investing in peers the same way that they would invest in every other
profession that they have in there. So it’s a critical part, we think that one
hour of direct supervision, every peer should have, you would have more than
that throughout the week. One thing that we’re doing in Indiana, that we certainly
aren’t the first to this party, but Project ECHO, Extension for Community
Health Care Outcomes, is a great training mechanism especially when you
have rural areas. What it allows States to do or areas to do is train people in
rural areas with a hub essentially at the hub and spoke model where you’ve got
a variety of team members, psychiatrist, addiction doc’s, peers, attorneys, all in
one area so people can log on from all over the state and get information from
experts and whatever that area is. So one more thing I want to touch on before I’m
done which outside of supervision I think is
the most important piece is making sure that peers have self care and wellness.
One thing we completely missed was the impact it was going to have on peers
working in acute trauma situation and making sure that peers are taking care
of themselves, promoting an atmosphere in which they’re allowed to.
I know Project Point, specifically with Eskenazi, they actually pay their coaches
for wellness days. I think it’s once a month you can, on the
company’s dime, go out and do a activity that’s wellness related. They’re allowed
to go to recovery meetings on the clock. Obviously there needed to be
communication with the staff and there’s a board that says when they’re in and
out. But this really is a critical piece of it because if those coaches aren’t
taking care of themselves, there’s no good to anybody else. So supervision, self-care, two things to definitely watch for during
implementation. All right, awesome, great job Brandon, and I just want to take a look at this pole.
I think, what I see here, is that everybody thinks that we need recovery
coaches all over the place from police departments, crisis team, ED’s,
institutions of higher learning, outpatient programs, and I just think
that that is so spot-on and it really kind of helps those transition to our
next slide is that we cannot put peers in a box. You know peer, this is your lane, this is where you belong, the only place you could be, because far too often the fact
that people with substance use disorder are criminalized and relegated over
there, you know we have to be advocates for our clients that are you know
experiencing some kind of crisis and we have to get out of our lane and go into
other lanes because we have to build relationships. When somebody comes in and experiencing a mental health or
substance use disorder crisis, we have to know all the resources in the community,
right, we have to be the social worker, we have to be the case manager, we have to know
who the good therapists are in town, what are the good treatment centers, we want
to know who could I call over at the police station to get something
sorted out. We also have to be able to deal with all the other issues that are
coming up for our client. Oftentimes they’re coming in with a substance use
disorder, but they also have housing insecurity or food insecurity
and we want to be able to point them to all those resources and have the
relationships to make that happen because in a world where everybody is
Googling everything, we know as behavioral health professionals, you’ve
got to have somebody cell phone number. You got to be able to call them up. Johnny,
what’s going on, I got a client here, they have this and this and this need,
and because you have that relationship, did you take time to invest in that
person, that relationship, you’ll be able to, one, have smoother handoffs for your
clients. It will also be easier to make a referral because when you call the 1-800
number, it’s a lot harder to get what you need done, and I think it’s a reciprocal
thing, right. If there’s an outside agency and they know that you’re there at the
hospital doing warm handoffs, somebody may call you, hey, we just had a thing with
Johnny, we’re gonna bring him in, make sure you’re there, come on in now, and so
it really goes both ways, and I just didn’t want to get out of this
webinar without taking a chance to really kind of talk about how important
relationships are in the social service world. So we’ve got a ton of questions
that came in first. Thank you so much Brandon and Mindy. We’re gonna really put
you to work and get a ton of questions. The first question that came up for me,
Brandon, when you were talking about the hospital shifts, you said that
some programs are doing the kind of three shifts per day. You know my wife is
a nurse and they work 12-hour shifts at her hospital and you had mentioned
that some of the recovery coaches are doing 12-hour shifts. What do you think
it’s best, what’s the feedback you’re hearing what’s best for their coaches
and also what do you think is best for their consumers. The three 8-hour
shifts and the twelve hour shifts. Well I think that we want as much
coverage as possible. You made note earlier this idea that people only overdose during bankers hours, so to speak, isn’t going to be accurate. I don’t know,
my personal experience, I wasn’t, I guess I was up for overdose any time of day,
but I think that the more coverage the better, is the best practice in
general. One thing that I thought was unique that Mel Reyes from Project Point,
their program director over there, I was talking to her last week and she had
talked about, there’s two Saturdays that they don’t always have weekend coverage,
but they do have coverage on two specific Saturdays. Guess which ones
those are. Well the one after the first and the fifteenth of the month because
people are collecting checks during those times and they were able to look back on their
data from the first couple years and realize that there are these huge
types of visits, and that’s just from from, you know we don’t talk about data
enough in our world, we’re way behind on it, but that’s a good example of
hospitals using that to figure out when they do need coverage. Looking back on
when the overdoses have been or when people present and reacting to that and
making sure they’re being as efficient as possible. All right. Thank you so much.
Just as a quick follow-up question, how do we really prioritize, you
know we know that hospitals work on a 12-hour system. Like I said my wife was
in there, she works 12 hours, everyone’s at hospital works 12-hour shifts, how do
we protect the mental health of our peers when they’re working in that kind
of 12 hour long long, maybe 3 12 hour shifts a week and then four days off, how
do we support them to make sure their wellness is a priority. That was a follow-up
question from Gloria. Gloria, I think that one of the things on the
slide around and stuff you know self-care and wellness,
one of the things referred to Project Point and Eskenazi because they’ve
been doing it the longest they worked out the most kinks, and they pay their
coaches to attend recovery based meetings, whatever their preference is,
and I mean they have to write it on the board so all the doctors know that
they’re gone and they’re out of the building, but pretty much, as long as
there’s not something demanding at any time, they can go and make sure they’re
getting the care they need. We also have a monthly meeting
in the community called Peers United, and that is a support group specifically for
peers. So they can go, and I’m not talking specifics or staffing, but they’re
getting support. So peers that are new into these settings have the rapport
that the first handful of peers did not have for the last couple years when they
were figuring this stuff out. All right awesome,
and then Mindy, we had a question come in. I know that there’s all these different
terms, peer recovery specialists, recovery coach, and all these other terms in
between. What is really the difference in your opinion between peer
support specialists and recovery coach? Well I would say recovery coach is
really geared towards people who are experiencing substance use issues. That’s
the big difference. I cringe a little bit when we talk about
intentional peer support as being only for mental health though, that’s
something that I’ve gotten really hung up on, because the model itself is really
about relationships and I think that that can really work across the board. What I have found, my experience is, what is really different is that
intentional peer support is a little less directive. So it’s really about
supporting people with where they’re at and where they want to go. Like making their own goals and moving towards something instead of like this
is really what you should be doing. We don’t do that. So that’s definitely
one of the significant differences that I’ve seen between the two, and I don’t
think that, and Brandon you can certainly speak to this if I misunderstood here,
but I don’t think that a recovery coach would go support somebody that was only
experiencing mental health challenges, whereas intentional peer support
does. Alright thanks for saying that. Well I was just going to
say you’re right, I mean it’s something that’s important, there are distinctions,
and the value in the peer is in their their lived experience. That’s
that’s what makes them uniquely qualified to do stuff. So you’re right, if
somebody is presenting just with SMI, it’s not going to be appropriate for
recovery coach I don’t believe to engage. They don’t have the training, the
training doesn’t consist of that stuff, and recovery coaches are really, there’s
got that lived experience and can provide some hope, but being resource
brokers and being able to actually get people into places. Unfortunately we live
in a time, somebody, I didn’t create this, I don’t want to take credit for it, but
they talk about the substance use treatment,
you shouldn’t have to know somebody to get help, and the way that our system is
set up is, if you don’t know somebody, you’re really in a tough spot, and the
recovery coaches help out with that, and it’s sad that we have to do it, but you
know Billy the recovery coach, he knows the people at the recovery residence. So he
can place a phone call and say hey, I know you guys got 15 on the waiting list,
but I need you to make sure that you know this guy’s going to call every day,
and he’s going to be prepared to come in, and I always say cash in any favors, but
but having the connections, making calls, setting stuff up for people, our window
is so small to help people and if people don’t feel good about where you’re
sending them, they don’t feel like that, you know, and so idea of warm handoff
that people are and they’re expecting the person to be coming, the person knows
that they’re expecting them, and they feel comfortable in the situation. It’s
just a really critical aspect of all this. Right. So you know I think a lot of
us saw in the summer there was some outbreaks of overdoses that were not
related to opioids. Washington DC, Connecticut, New York, around those kind
of synthetic cannabinoids. Somebody comes to the ER experiencing a overdose that’s
not related to opioids. Are we seeing receiving recovery coaches getting
sent in, should they be sent in, Mindy, what do you think? I can’t speak to
recovery coaches. I mean that we would certainly send our IPS folks in, no
matter what it was that they overdosed on, and I think that’s something
that’s unique about the work we do. We’re not requiring them to follow a treatment
plan, we’re not requiring them necessarily to stay abstinent, you know,
we’re just planting seeds, and maybe are you ready to do something differently,
and when you are, we’re going to be here. Awesome, and Brandon … you mentioned it Devin because, so we had, I think it was
21 or 27 overdoses specifically around spice at one of our shelters down
here, and one of the things that it’s getting cleared up now, but originally
the funding, the federal money, was specifically around opioids. So the
grants that were paying for the coaches and the ED’s, the person had you have
narcan administered to them in order to be engaged, and we found out the hard
way was you have people coming in and withdrawal from alcohol, and
benzodiazepine, or cocaine, or all these other substances, and they couldn’t
engage, and luckily we had some good people in leadership, they’re able to
clear those barriers, but these are the type of growing pains that we don’t want
other people to have to experience. So now please take advantage of BRSS TACS
and SAMHSA. If you need technical assistance, reach out to them, get input
from people that have done some of the stuff so these organizations don’t have
to make the same missed steps when it comes to this type of stuff. Right. So
obviously we’re seeing this kind of a little bit of division between
our mental health peer specialist, our substance use disorder peer specialist, but I
really think it’s important that we cross train because a lot of times
hospitals won’t have both. So how do we prepare our SUD recovery coaches and our
mental health peer specialists to work with the other side of the aisle and
what are some good resources that we could share with the audience today?
Ladies first. Mindy go ahead. So I mean here in Maine, we have both
available to people. All of the staff that I employ or trained in IPS, but
we’ll also be having them trained in the recovery coach model as well. So this
is actually something kind of new for me, and a little biased. I really like the
intentional peer support model, but I’ve had several people tell me when they were early on in recovery, they really, they have no idea what they were
doing and what works for them was having somebody be like this is what you need
to do and really helping them lay out the steps for that. So I think just
making sure if you have staff that have those experiences, that those
trainings are accessible for them. There’s a ton of different models on
there. They have the SMART Recovery model you can do online, and I
know that the recovery coach model is more and more accessible to people
across the country. So I think if you have somebody with both experiences, supporting them to get trained, and being open to maybe doing things on an
individual basis instead of just following the fidelity to either model.
Right, right, right. So have a lot of tools in your tool belt is what I’m hearing you
say. Absolutely. Yes. All right. Brandon? Well I think that was
a great response. I’d hate to muddy it up with anything I have. I’m going to
leave it there actually. All right. So you know I think part of the
reason that warm handoff became so popular an area of interest for policy
makers and hospital administrators is that the average person had a
hard time understanding the idea that somebody would be experiencing this accidental poisoning with opioids presented the hospital and then
not be admitted, not engaged in services, what other services are
available for people out there that just
experienced this overdose, but they don’t want to stop, they don’t want to engage in
treatment right now. What other services are available that maybe some of your
people down in Indiana could connect them with? So peer
recovery coaches, part of the CPR training, it follows a harm reduction
approach, and it’s person-centered, and that’s when it goes after. We’re happy,
actually our governor, when he got in last year, he lowered the threshold for
counties to be able to open low threshold service centers, syringe
service centers is what we like to call them, stay away from the stigmatizing
language, but this is a place where people can get things to make
sure that they’re staying healthy, yes syringes are one of them, but also
alcohol swabs, a variety of things, and they’re also
interacting with people a lot of times that are in recovery themselves. So I
wish we had more of those options available in Indiana. I think we have
eight counties right now that do have them, and a lot of times this is actually,
I know the poll asked all the different areas where we can implement peers, and
we talked about jails, and treatment centers, ED’s, well we’ve also found that syringe service programs in health
departments are a great place to put peers into. Scott County, which
once it got so much attention because of HIV epidemic that occurred, now is a
beacon of hope for the recovery community. They’ve got 43 trained
recovery coaches in a town of like 25,000, They’ve got like thirty percent
of the peer workforce, not that much, but about about eighteen or twenty percent
of it in that one small county and a lot of them are coming through the health
department providing those services. Awesome. Thank you. Yeah I think that those low threshold programs are really important because we
do know that people that engage with syringe service programs are actually
five times more likely to enter treatment than their peers who are not
engaged. Well we got a lot of questions coming in. One that I thought was really
interesting that I haven’t really seen the best answer to is sometimes
we’re lucky enough to be able to take somebody right from the ER to an actual
intake at a residential treatment bed. What do we think is best? Do we want to be
transporting those clients? Do we want to see them transporting themselves? Brandon, how about for you? What do you think is best? What you see that’s
working? So it’s definitely varies and obviously if somebody wants treatment we
want to get them in. Most of the ED’s that I’m aware of, they are not allowing
peers to transport people. That being said, just because they’re not, they are
setting up agreements with transportation and services. It’s easy in
the metro area there’s a whole bunch of transportation, it gets harder in rural,
but they’re almost, I think they’re doing a recovery share a ride in several
counties to where there are people, a lot of them peers, willing to, it’s almost like recovery Uber or something along those lines for those
rural and hard-to-reach areas where transportation is an issue, but getting
them there is the important part, them showing up, not so much who takes them. I think that’s awesome – recovery Uber. Somebody trademark that. So we
know a lot of times that our peers also are advocate and a lot of
times when they go into the hospital settings or law enforcement settings or
other non-traditional settings with peers, they actually need to be advocates
and educate the doctors and the nurses. I believe we saw Tony talking a little bit
earlier in the chat box about how she was able to educate a nurse that she
worked with about her role and how when she connected with a peer, the nurse
was like, oh my god can you be here all the time?” What kind of feedback
are you hearing from your staff about their process educating
the more educated or higher credential team members about what it is
they do and why lived experience matters. Mindy? We’ve designed pamphlets and
handouts [inaudible] work is overseeing this network the last
five or six years, we’ve developing a toolkit, and I mean there’s a lot of
really great resources out there, but obviously it has to be specific to the
state that you’re working in and the model that you’re utilizing, so I found
that it was really helpful in the ED to let the nurses know and have
something available for them because there’s a lot of turnover in those
places, that they could pick up and read about and know that our staff were
actually trained. They weren’t just these people with lived experience
coming into their emergency department. They’ve undergone extensive training and
they have to keep up on that and that’s been really really helpful as
far as educating them, but we’re also fortunate to have the consumer, the peer
support network here in Maine, and myself and some other people are available to
go around to agencies and do trainings for people who are interested in what it
is we’re doing and that’s been really helpful. Awesome. You think you can get those resources, the
pamphlet to share with the people that are on this? Sure. Brandon do you
have any thoughts on that? How our staff or our peers can educate the people that
they work with on their teams, regardless of the setting? We are, look we
are the advocates out there in the community, and what I was really shocked
to find out is, I don’t know how it is in every state, but the amount of continuing
education for doctors is minimal. It is really really low. If you have hospital
admitting privileges, then hospitals set what you have to have, which is,
it may have a pretty good standard, but a lot of primary care physicians don’t
have to have any continuing education. So it’s all at their discretion. So think of
what’s changed over the last ten years when it comes to substance use disorders.
Think about how the evidence-based practices have come around. We have
to be that voice for the recovery community that we’re out there, and
physicians, primary care, nurses, jails, sheriff’s, a lot of people want to help, the
just don’t have the proper information. I don’t like medication. It’s trading a drug for a drug. They need to be told
that no, you’re trading a drug for a medication. A medication that’s proven to
save people’s lives. It reduces mortality by about 50 percent. We have to be
advocates for peer supports. Treating this as a chronic condition. I think
that’s our role in the community. Right. I couldn’t agree more and just
to piggyback that and respond to what Katie Bechler had said, it’s
hard to hate up close, and a lot of people have things they make up in their
mind about people that use drugs or have mental health concerns and when they’re
on a team working with somebody every day that’s in recovery from a substance
use disorder or a mental health concern, they can see that a lot of their
judgments that they had or preconceived notions are wrong, because people do
recover from all kinds of problems and then quite often we thrive in that
recovery and we go on and dedicate our lives to helping other people, but that’s
another reason why we need peers is to educate
our doctors. So this is a tough question, but I have no idea the answer to, so I’m
going to toss this out to either one of you. With recovery coaches being
contracted by a third party and not officially hospital staff, how
do we tell, if you were talking to a new recovery coach or peer specialist, think
about getting this work how do they protect themselves from a liability
point of view? Do they need insurance? Is their work supposed to cover that? As a social worker, if I was licensed, I would have practicing
insurance. What about peers? What do they do? I find the idea of liability just
comes from a very care based place. Obviously Amistad has insurance that
covers us, I can tell you in the 16 years we’ve been overseeing this program we
have never had any litigation against us for anything. I think just making sure
that the people you’re hiring are confident and trained. That’s the biggest
thing. How about you Brandon? How would you answer that if somebody
asked? Well I think that you need to make sure that, as an organization, you want to
make sure that you’re covered and you’re not open to it to a whole bunch of
liability, but there’s a lot of different positions where you have volunteers or
you have people in the community. Let’s not forget these are not clinical
positions. So while there may be a little bit of a parallel, that it’s
not a clinical position giving therapeutic advice. This is a peer
position and I think that really, I’m certainly not an attorney, I
don’t want to appear as one, but I think it lends itself to what Mindy said. I
think that it’s really kind of peer-based and we haven’t had a whole
bunch of issues. Right right right. So I know working in
Philadelphia, that our challenges with warm handoff are a lot different than
maybe in rural Indiana. Any tips? We’ve got people from all over, from
Baltimore to Alaska. What tips do we have for our rural partners that, you know, a
couple of things you got to keep in mind for rural warm handoff programs. For me, I
think it’s about aligning your resources. Recovery community organization
are really something that’s coming on. I hope that everybody’s on here has one of
their community. If not, I hope they’re talking about having it. The reason I’m
talking about this is because part of that creating one is getting all your
stakeholders at the table and all different people that provide resources
and so you know exactly what your community has and exactly what they
don’t have. So you can, one, advocate to fill those gaps, but you don’t
have peers making recommendations that aren’t going to be met within the local
community and also seeing if there is some resources that you can leverage
from surrounding counties possibly. It’s one thing to set up the virtual peers
and do a telepeer like they’re doing for a lot of
different rural services, but that doesn’t create all the other recovery
supports. It doesn’t create recovery housing. It doesn’t create the RCO’s.
It doesn’t create youth providers. So knowing exactly what we have, what we
don’t have and trying to leverage other resources in the region. Not everyone, we have 92 counties in Indiana, and we don’t need an RCO in all 92 of them. Some of
them are really small and may be that one RCO actually helped serve five or
six counties. So making sure that you’re working with the people, the communities
around you as well to fill gaps, not just your own. Right. How about you Mindy?
What do you think? What are our tips for our rural partners and Watchers. I think Brandon touched on a lot of it. Telecommunication. I find
myself doing a lot of live-streaming for trainings in Adobe. A lot of
phone support as well. So in Maine we’re pretty lucky that we have the
intentional warn line, which is a 1-800 number, you can get 24/7 intentional peer
support, which is pretty cool. So if that’s something that your state
doesn’t have, I would always suggest that, and I’m not as familiar with other
states, but I know something that’s working for us here is now that we
shifted to this section 92 billing system, they’re required to have
a peer support specialist on staff at all of the behavioral health home
agencies, which is not a home, but like more holistic mental health
services. So that’s really really helped in our role setting. I’m also in the
process, we are developing a statewide resource guide, which will probably take
me the next two years, but I think that when that is finalized, it can
be really something for the people in rural community. All right, awesome. So we
got a couple minutes before we wrap up. I just want to
give you both an opportunity to throw anything in that you felt like, oh
I want to talk about this one thing, but I forgot, and then I’ll roll to the ending
credits. I don’t really have anything. I’m really impressed with all of the
questions and just want to thank everybody for being so interactive.
Awesome. Brandon? I can’t agree with that far more. I was trying to
respond to as much as possible in the chatbox and just there’s been some
fabulous questions. I can feel the passion through the chat box
with the questions. We’ve treated substance use disorder in the
criminal justice system for so long, and we know it’s a disease now, we know
it’s a health care issue, but it’s gonna take a really long time to turn this
ship and really treat it like a chronic issue, and peers to me are the link in
between it being treated as an acute care issue and a chronic issue to
provide the ongoing support for years, just like we would any other
chronic condition, and we’ve got to get people
while they’re in those main entry points, while they’re in jail, while they’re in
emergency departments, and I couldn’t be happier for this movement, I
can’t be happier for the recovery community, I think this is a big part of
the solution, and just grateful to be involved in it at all. Awesome. Thanks B. I just want to thank,
first, here’s a bunch of resources every can check out. Feel free to click on
those links and remember that there are a bunch of links here in the toolbox
section and we will be sending everyone to transcripts and a link this webinar
has been recorded to go to watch and share with your
friends, put it out there. If you have any specific questions or want to learn some
more information, you can put in a TA request that is also available. If you
want to find out more about BRSS TAS, feel free to email them. We’ll reach out
for technical assistance. Also, I would sign up for the BRSS TACS listserv.
There’s always great information going on there. I can tell you that I’m really
passionate about warm handoff. I was super excited to be part of this. I know that
a lot of times, when somebody’s experiencing overdose, that may be
just another Tuesday for us, but for them that’s the worst day of their lives and
to be able to help be the launchpad to their recovery journey is just really
really exciting for me. After this webinar is done, when you click off,
there’ll be a quick survey, it only takes a couple of minutes, we want to know how
we can improve, how we can be better. So please take some time to that and again,
thanks for taking some time out of your afternoon and coming to participate with
us. We really appreciate it. Thank you all. Bye everybody.

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