Peer Run Respites: Research and Practice Sae Kim Morgan Pelot - - PowerPoint PPT Presentation

Peer Run Respites: Research and Practice

Sae Kim Morgan Pelot

Peer Run Respites Overview

• Voluntary, non-medical program for individuals experiencing crises
• r emotional distress often arising from challenges related to

mental health needs, substance uses, and other emotionally distressing events or trauma

• Operated by peers who also have shared experiences, offering 24/7

peer support

• Home-like setting with emphasis on self-directed healing, mutual

learning and growing

• Non-medical peer support: No clinical supervisors, counselors, or

medical staff on site

Crisis as an Opportunity for Growth & Change

Benefits of Peer Run Respites

• Building trust-based relationships with others who also

had similar difficult life experiences

• Mutually beneficial connections
• Sense of hope and empowerment
• Access to different modalities of recovery and holistic

approach to wellness

Monarch House Peer Run Respite

Staying at Monarch House

1.Potential Guest Conversation over the phone 2.Guest Entrance Process 3.Respite Stay Lasting Up to 5 Overnights 4.Check-Out Process 5.One-month and Three-Month Follow-Up

A Day at Monarch House:

Self-directed journey to wellness & Forging mutually supportive relationships

Guest Feedback

“Monarch House allowed me the space to not have to think about my every day stressors. I was able to have space and time just for me without having guilt. I was able to slow down enough to realize just how many things I had been dealing with and that I was still surviving even though I felt like a failure in so

• much. Others in my family or friends would not have

understood me as much as others who have lived experience with anxiety, guilt, depression. I didn’t have constant worry or fear during my stay and can say that I am able to go back to my life a little bit more refreshed.”

Guest Feedback

“I was welcomed as a friend and felt at home.” “I felt very safe and welcomed for the first time in months. It was a very beautiful place, very calming space.” “I had a safe place to go that wasn’t an in-patient in a crisis. I was able to unwind from my stress.” “I like the freedom, trust, and space I had.” “This is where my journey begins. And I thank all of you for the support I needed. I’ve always been ashamed to ask 4 HELP.” “It gives just enough support and hope to continue the journey. It shows hope and allows faith to grow with myself within the community.”

Resources

ONLINE GROUPS

• Western Mass RLC’s compilation of online groups: https://tiny.cc/RLConline
• Western Mass RLC Discord Server: https://tiny.cc/RLCDiscord
• Peer Support Space’s Digital Community Gatherings: M-F 12PM

https://zoom.us/j/284580732; 6PM https://zoom.us/j/659519104

• Monarch House Daily Peer Support Session: 12PM-5PM meet.google.com/drq-

ydfu-cje WARMLINES

• National Warmline Database: warmline.org
• eCPR Warmline: 920-931-2572

PEER RUN RESPITES

• Peer Respites Action and Evaluation: https://www.peerrespite.net/
• National Empowerment Center – Crisis Intervention Alternatives:

https://power2u.org/crisis-alternatives

• WI DHS Peer Run Respites: https://www.dhs.wisconsin.gov/peer-run-

respite/index.htm

Definition

A peer respite is a voluntary, short-term, overnight program that provides community-based, non-clinical crisis support to help people find new understandings and ways to move forward. It operates 24 hours a day in a homelike environment.

As defined on PeerRespite.net:

Peer Organizations:

Board of directors is at least 51% peers

• Peer-Run
• Peer-Operated
• Mixed

The board is not a majority peers but the director and staff are peers Embedded in traditional provider but have peer staff

• Meaning peers staff, operate, and oversee the respite at all

levels

• Often attached to a traditional provider
• Peers do not have to be in leadership roles

Types of Peer Support:

ØMutual support / self-help ØPeer-run respites ØDrop-in centers Ø1:1 peer mentoring ØHealth navigation ØRecovery learning communities ØRecovery coaching

2012 2010

N=11 N=10 N=17 N=22 N=31

Peer Respite Essential Features Survey

Examines changes in respite: Ø Operations

Ø Funding Ø Staffing Ø Evaluation

Ø Guest experience

Ø Capacity Ø Activities Ø Policies

documented by nationwide biennial survey

2014 2016 2018

• 100% of staff have lived experience

Staffing

• All leaders have lived experience

Leadership

• The peer respite is either operated by a peer-run organization OR has

an advisory group with 51% or more members having lived experience Governance

Minimum criteria defined by consensus panel

2018 Survey Response Rate, Data collection

100% response rate – 31 respondents

All peer respites listed in the PeerRespite.net Directory were eligible for the

• nline survey if they were currently operating

PREF 2018 Operation Highlights

15 10 7 2 5 22 12 12 4 4 3 2 2 Collaboration with county or state behavioral health department Community organizing Government grant Collaboration with a managed care company Other* Legislative bill Private grant* Collaboration with state Medicaid agency*

2016 (N=22) 2018 (N=31)

What activities contributed to the founding and initial financing of peer respites?

SAMHSA or

• ther federal

agency 7% State revenues

• r grants

36% County or local behavioral health agency 45% Private foundation 3% Private donations (other than from foundations) 1% Managed care company or Medicaid contract 5% Other 3%

PREF 2018 Operation Highlights

What sources did respites receive funding for in the last fiscal year?

PREF 2018 Operation Highlights

DO NOT DISTRIBUTE

1 5 3 4 4 1 4 4 5 6 7 6 5 4 8

1 2 3 4 5 6 7 8

$100,000 - $199,000 $200,000 - $299,000 $300,000 - $399,000 $400,000 - $499,000 $500,000 or more 2014 (N=17) 2016 (N=20) 2018 (N=30)

Includes:

• Not funded
• Less than $100,000
• $100,000-149,000
• $150,000-199,000

Includes:

• $500,000-749,000
• $750,000-999,000
• More than $1million

Each include two budget range survey options

Peer Respite Annual Budgets

PREF 2018 Policy Highlights

Some peer respites have eligibility requirements that guests must meet in

• rder to stay.

Ø Receiving services through public mental/behavioral health system: Ø Remaining 4 respites had this requirement Ø Other policies include: Ø Suicidal thoughts Ø Self-Injurious behavior Ø Housing stability Ø Possession of illegal substances at respite Ø Intoxication while at respite Ø 27 out of the 31 did not have this requirement

PREF 2018 Policy Highlights

47% 73% 58% 35% 14% 19% 18% 14% 23%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2014 (n=17) 2016 (n=22) 2018 (n=31) Other suicide policy Restriction on people who have a plan No restriction

Do you have a rule or policy that prohibits you from having people stay when they express thoughts of suicide?

PREF 2018 Policy Highlights

77% 39% 5% 19% 0% 3% 0% 10%

18% 29%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2016 (n=22) 2018 (n=31) Restriction on those engaging in behavior Restriction on those who express thoughts/feelings* Restriction on those with recent behavior* Other No restriction

Do you have a rule or policy that prohibits you from having people stay when they are engaging in self-injurious behaviors?

41% 18% 6% 6% 9% 6% 0% 41% 26% 0% 0% 16.13% 29% 27% 19% 24% 5% 26%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

n=17 n=22 n=31 Prohibits people without housing Prohibits people without housing unless they have a place to go after they leave Takes those who do not have permanent address but prefer not to** No restriction based

• n housing status

unless that is the only reason for wanting to stay* Other policy No restriction based on housing

2014 2016 2018

PREF 2018 Housing Instability Policy

PREF 2018 Policy Highlights

0% 23% 39% 0% 0% 40% 28% 16% 28% 16% 6% 6%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2016 (n=18) 2018 (n=31) Stay out of communal areas Leave respite until sober End stay More than once, end stay* Other intoxication policy No restriction*

Do you have a rule or policy related to intoxication in the peer respite?

PREF 2018 Policy Highlights

Do you have a rule or policy related to the possession of illegal substances?

29% 42% 57% 48% 14% 10%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2016 (n=21) 2018 (n=31) Other possession Remove substances End stay

What does the research show?

ØType of program

Ø Is it peer-run, peer-operated, mixed? Ø What is the definition of peer respite?

ØStudy design

Ø Control or comparison groups Ø Observational Ø Qualitative

ØOutcomes

Ø Cost efficiency Ø Reducing use of emergency services Ø Program evaluation Ø Satisfaction

Research on Peer Respite Outcomes

ØUse of emergency services Ø70% less likely to use emergency services (Croft &

Isvan, 2015)

ØDays at respite associated with fewer hours of inpatient and emergency services (Croft & Isvan, 2015;

Dumont & Jones, 2002)

ØPersonal improvements ØReduction of symptoms (Greenfield, et al, 2008) ØImprovements in healing and empowerment

(Dumont & Jones, 2002)

Research on Peer Respite Outcomes

ØCost Comparison ØAverage psychiatric hospitalization cost for respite-users $1,057 compared to $3,187 for non- users (Dumont & Jones, 2002) ØSatisfaction ØReported needs met and likeliness to return (Burns-

Lynch & Salzer, 2001)

ØHigher treatment satisfaction (Burns-Lynch & Salzer, 2001;

Dumont & Jones, 2002; Greenfield, et al, 2008)

ØMixed responses (Siantz, et al, 2018)

Directions for Future Research

• Involving peers in research (Croft, et al, 2016; Shields, et al, 2019)
• Peer Respite Evaluation (Ostrow & Croft, 2015)
• Outcomes research
• Comparison studies

Resources

DO NOT DISTRIBUTE

• PeerRespite.net
• Ostrow, L. & Pelot, M. (2019). Results from the 2018 Peer Respite Essential Features Survey Guest Stay Policies Report:

Capacity, Activities, Eligibility. San Luis Obispo, CA: Live & Learn, Inc.

• Ostrow, L. & Pelot, M. (2019). Results from the 2018 Peer Respite Essential Features Survey Program Operations Report:

Funding, Staffing, Evaluation. San Luis Obispo, CA: Live & Learn, Inc.

• Croft, B. & Isvan, N. (2015). Impact of the 2nd Story Peer Respite Program on Use of Inpatient and Emergency Services.

Psychiatric Services 66(6), 632-637.

• Dumont, J. & Jones, K. (2002). Findings from a Consumer/Survivor Defined Alternative to Psychiatric Hospitalization. Outlook,

Spring 2002, 4-6.

• Greenfield, T. K., Stoneking, B. C., Humphreys, K., Sundby, E., & Bond, J. (2008). A Randomized Trial of a Mental Health

Consumer-Managed Alternative to Civil Commitment for Acute Psychiatric Crisis. American Journal of Community Psychology, 42, 135-144.

• Burns-Lynch, B. & Salzer, M. S. (2001). Adopting Innovations – Lessons Learned from a Peer-Based Hospital Diversion
• Program. Community Mental Health Journal, 37(6), 511-521.
• Siantz, E., Henwood, B., McGovern, N., Greene, J., & Gilmer, T. (2018). Peer Respites: A Qualitative Assessment of Consumer
• Experience. Administration and Policy in Mental Health and Mental Health Services Research, 46, 10-17.
• Croft, B., Ostrow, L., Italia, L., Camp-Bernard, A., & Jacobs, Y. (2016). Peer Interviewers in Mental Health Services Research.

The Journal of Mental Health Training, Education, and Practice, 11 (4), 234-243.

• Shields, M., Scully, S., Sulman, H., Borba, C., Trinh, N., & Singer, S. (2019). Consumers’ Suggestions for Improving the Mental

Healthcare System: Options, Autonomy, and Respect. Community Mental Health Journal, 55, 916-923.

• Ostrow, L. & Croft, B. (2015). Peer Respites: A Research and Practice Agenda. Psychiatric Services 66(6), 638-640.

Sae B. Kim Executive Director Wisconsin Milkweed Alliance executivedirector@milkweedalliance.org (715) 505-9482 www.milkweedalliance.org Morgan Pelot, BA, BS Research Assistant Live & Learn, Inc. San Luis Obispo, California morgan@LiveLearnInc.net www.LiveLearnInc.net