Housing Options and the Integration of Peer Support Services Stephanie Cline, MS, LMFT, LAC Cameron Stone.

Housing Options and the Integration of

Peer Support Services

Stephanie Cline, MS, LMFT, LACCameron Stone

Need for affordable housing create challenges for the mentally ill

• For many people with serious mental illness, the risk of homelessness is just around the corner. There are many precipitating factors.

• Housing can be as important to recovery as medication, yet the mental-health system struggles to meet the demand for safe, affordable housing. To make matters worse, some clients' behavioral problems make then unwanted tenants.

Affordable housing needs for mentally ill

• Without affordable, stable housing, many people remain in a constant state of crisis. They circle in and out of the jail, hospitals, and shelters

• After going into a community hospital for emergency treatment of a mental-health problem, some patients remain longer than necessary because of a shortage of beds in extended-care facilities and step-down programs.

• State hospitals become faced with over crowding

Need for affordable and/or supported housing on the rise

• Many of those in homeless shelters have mental illnesses and substance abuse disorders, according to data provided by the NAMI. In some cases, it's difficult for mental-health workers to persuade clients to seek help. It also can be difficult to meet clients' needs even after they appeal for help due to lack of resources and/or other barriers.

• Sometimes, people with serious mental illness get kicked out of housing because they may cause landlords grief. Making it difficult for them to find another landlord willing to rent to them again.

DEPARTMENT DESCRIPTION/SERVICES PROVIDED/PROGRAM GOAL

Residential Services are designed to assists consumers to gain the necessary skills to transition into independent living. Services are designed with the consumer to support his or her recovery, enhance quality of life, reduce symptoms, restore or improve functioning, and support community integration.

The intent is for persons participating in services to move toward optimal use of natural supports and self-help, gain greater control of their lives and increase participation in the community, gain greater self-sufficiency or slowing of the declines associated with aging and build greater choices.

To accomplish this goal, consumers may receive a variety of services in accordance with published practices; including targeted case management, community psychiatric support and treatment, psychosocial rehabilitation-group, psychosocial rehabilitation-individual, peer support and attendant care.

Residential Care, Inc.“A Place to Belong”

• Residential Care Inc. was developed in 1991 as a supportive living program for men and women recovering from mental illness. The residential facilities are an essential building block for many in recovery. The services are designed to provide smooth, effective transition from treatment to independent living. Residents enhance social, independent and daily living skills by interacting individually and in groups developing new ways to cope with the symptoms and impact of their illness.

• Residential Care offers an array of housing options, as well as special programs that emphasize developing personal relationships and basic life skills training. Housing programs include Group Homes, Transitional Housing, Independent Housing, Emergency Veteran Housing, Offender Housing, and Senior Housing.

Housing Options: Mental Health Association (MHA)

GROUP HOMESThe Group Homes provide a positive personal development experience designed to help each resident live in the community successfully. All residents have goals based on personal needs and strengths which they pursue towards living in their own apartments or homes. Our staff works with each resident to develop a learning program based around individual needs.

Crisis HomesSERVICES OFFEREDMHA Crisis Homes is a supportive living service designed to empower and assist men and women recovering from mental illness. Staff will work collaboratively with you to develop skills necessary for independent living. We will work most closely in the areas of:*Daily Living Skills *Transitional Living Skills *Medication Management *Safety

HOURSWeekdays: 3:00 p.m. until 9:00 a.m. the following dayWeekends: all day Resident is expected to attend the crisis home groups, an external day program or be involved in vocational or educational activities Monday through Friday, 9:00 a.m. to 3:00 p.m. CHARGES FOR SERVICESCrisis Homes provide Attendant Care, Psychosocial Rehabilitation Individual and Group, and Targeted Case Management services (if applicable) as appropriate. All services are billed to the clients Medicaid card. ORIENTATION Each person staying at the Crisis Home will be given a thorough orientation to the program. Staff will ask you to fill out several forms, including a residential agreement and a personal property inventory. You will need to give staff your medications and a current medication profile, signed by your doctor.

Long Term Group HomesSERVICES OFFEREDMHA Group Homes is a supportive living service designed to empower and assist men and women recovering from mental illness. Staff will work collaboratively with you to develop skills necessary for independent living. • We will work most closely in the areas of:• Daily Living Skills • Transitional Living Skills• Medication Management• Safety

CHARGES FOR SERVICES• Each person living in the Group Home pays rent and Residential Fees which are based on the amount of income

you receive. Rent is determined by the HUD calculation for rent. Residential Fees are also based on your income, with the minimum Residential Care fee of $50 and a maximum fee of $350. You are also responsible to pay a one-time security deposit that is due at or before move in. The security deposit is $50.00 or the amount of the first month’s rent whichever is more. Supported Housing funds are an acceptable form of payment for rent and residential fees.

• Group Homes provide Attendant Care, Psychosocial Rehabilitation Individual and Group, Peer Support, and Individual. Al services are billed to the clients Medicaid card.

ORIENTATION

• Each person staying at the Group Home will be given a thorough orientation to the program. Staff will ask you to fill out several forms, including a residential agreement and a personal property inventory. You will need to give staff your medications and a current medication profile, signed by your doctor.

Intensive Supportive Housing

The ISH program design is to make sure that each resident is able, to the maximum extent possible, live independently and explore natural supports and engage in community life increasing their potential to return to vocational pursuits. The program will offer daily psychosocial groups at ISH and community settings in a variety of domains supplemented with direct service support to assist with building necessary skills for greater independent living.

ISH focuses on four key areas: • Vocational & Educational• Relationships & Social Skills• Daily & Independent Living • Medication & Symptom Management

All residents will be required to participate in services provided by ISH staff and as outlined by the program expectations. Any resident who choose to not engage in the allotted hours per designated services as identified will be unsuccessfully discharged from the program for lack of compliance.

Medication Supervision:

The goal of the ISH program is to teach the residents to independently manage their medication. As part of the program, the resident will participate in a medication management program that has four phases. Each phase will require the resident to use a medication planner. The ISH program will supply each resident with a medication planner and lock box. Baseline is approx. 2mth duration for each phase; resident must master each individual phase before moving to the next. If the resident is not following the guidelines of each medication phase staff reserves the right to move the resident back a phase until previous skill level is mastered. At time of successful discharge from the ISH program it is expected that the resident have mastered all medication supervision phases and is ready for full medication independence.

ISH Medication PhasesPhase I – Upon entering the ISH program the resident will be placed in Phase I of medication management. During this phase the residents’ medication will be locked up in a cabinet to be accessible only through staff. Staff will supervise medication intake and document this in the residents chart at each supervision time. Staff will monitor the resident filling a medication planner every week, and staff will work with the resident to ensure they are able to contact the pharmacy for refills of medication prior to running out of a medication. PRN medications will have to be requested through staff. Phase II – During phase II the resident will be given a lock box by staff, both the resident and staff will have keys to access the lock box. Staff will work with the resident once a week to fill their medication planner; the medication planner will then be placed in the locked box. All other medication will be kept in the locked cabinet, accessible only through staff. At the time of medication supervision the resident will need to bring their planner to staff and staff will monitor and document the medication intake in the residents chart. PRN medications will have to be requested through staff.

Phase III – In Phase III the resident will fill the medication planner weekly in staff’s presence; the planner will then be placed in a locked box. All other medication will be kept in the locked cabinet, accessible only through staff. The resident may take their medication independently, and staff will check their planner the following day, and document in their chart whether or not the medication was taken out of the planner. PRN medications will have to be requested through staff.

Phase IV – Once the client successfully is taking their medication daily with no reminders, they will be able to keep all of their medications in their locked box – including their planner and bottles of medication. The resident will fill their planner once per week and bring it to staff for review, they will also notify staff of which medications they reordered. Staff will document once per week in the residents chart that the planner was filled and whether medications were reordered.

Emergency Housing for Veterans

• Transitional Emergency Housing is designed to serve only veterans who meet criteria as set forth by the VA.

• Referrals are made to MHA through the local Veterans Administration.

• Veterans can reside in an emergency housing for up to 30 days and/or longer pending approval by the VA.

• While in the home medications are kept locked up and monitored by house staff.

• Veterans are encourage to work on their goals while in the home which may include obtaining housing, a job, volunteerism and/or development of personal skills.

• AA groups are offered on sight if needed.• Transportation is provided by the facility daily to VA

appointments.• Facility provides meals, and essential items for comfortable room

and board.• Vet to Vet Compeer Mentoring services are offered to any

veterans interested in being matched with a Compeer Vet Mentor.

Summary of MHA Housing Options

• Short term crisis homes (co-ed, holds 6, 2 houses)• Long term group homes (co-ed, holds 15, 2 LTGH)• Intensive Supported Apartments (dual occupancy)• Veteran Emergency Housing (16 beds, designated for VA referrals)• Offender Housing (4 beds designated for KDOC referrals)• Senior Housing (3 apartments)• Shared Housing (1 apartment complex and 1, 3 bdrm house

option)• Independent Living (4 apartment complex, including Pittsburg, KS)• Commercial Apartment Complex (24 units)

Peer Support Services • Peer support is getting help from someone who has been there. People

with similar experiences may be able to listen, give hope and guidance toward recovery in a way that is different, and may be just as valuable, as professional services.

• A Peer Specialist is a person who is actively engaged in his/her own recovery, and who volunteers or is hired to provide peer support services to others engaged in mental health treatment.

• Peer support is a key concept in the recovery approach and in consumer-operated services programs. Peer support is distinct from other forms of social support in that the source of support is a peer, a person who is similar in fundamental ways to the recipient of the support; their relationship is one of equality.

How Peer Support is helpful?

• When a person is housed in any of MHA’s housing program they are offered peer support services that is usually provided in the community and home setting.

• Peer support services helps build greater independent living skills through development of coping skills and connection to natural occurring resources and supports.

• Peer support helps clients move beyond resiliency of the mental health system and encourages them to use their learned skills to be more independent and how to utilize community resources to get their needs met.

• Rescare Peer Mentors provide outreach services to anyone that moves out of an MHA supported housing option into independent living for a minimum of 6mth to ensure a successful transition.

MHA Peer Support & Peer Mentoring Programs

• Certified Peer Support (CPS)• Substance Abuse Peer Mentor• Common Ground – Peer Led• Peer Support IDDT Groups (Seeking Safety,

Double Trouble)• Illness Management & Recovery (IMR) • Compeer Vet to Vet Mentoring• Senior Companion

Certified Peer Support (CPS)

• A Peer Support Specialist is a person who has progressed in their own recovery from alcohol or other drug abuse or mental disorder and is willing to self-identify as a peer and work to assist other individuals with chemical dependency or a mental disorder. Because of their life experience, such persons have expertise that professional training cannot replicate. This is not to be confused with peer educators who may not consider recovery a suitable goal for everyone and may focus instead on the principles of harm reduction.

• There are many tasks performed by peer support specialists that may include assisting their peers in articulating their goals for recovery, learning and practicing new skills, helping them monitor their progress, assisting them in their treatment, modeling effective coping techniques and self help strategies based on the specialist's own recovery experience, and supporting them in advocating for themselves to obtain effective services.

Kansas Certified Peer Mentor – Substance Abuse

The Kansas Certified Peer Mentor (KCPM) is responsible for utilizing his/her own recovery story to help consumers to develop skills necessary to their own recovery. The goal of peer support is for the consumer to regain control of his/her own life and recovery process by helping consumers to develop a network for information/support, assisting consumers to regain the ability to make independent choices and take a proactive role in recovery

The Peer Mentor will demonstrate competency in substance abuse recovery and the ability to self-manage recovery with on-going coping skills. The Peer Mentor will be expected to provide the majority of consumer contact in community locations that concur with where the consumer lives, works, attends school, and/or socializes.

Position Responsibilities include:• Provide peer support services in accordance with the consumer's treatment plan goals.• Maintain accurate and timely documentation of service provision. • Assist consumers in obtaining or sharing information in a group or individual setting to aid in

the recovery process.• Assist and teach consumers to communicate, advocate, and make informed choices in all areas

of their lives which include, but are not limited to: medications, diagnosis, treatment, housing, employment and education.

• Model effective coping skills and self-help strategies to consumers

Common Ground

• Common Ground is a web-based application that helps people prepare to meet with psychiatrists or treatment teams and arrive at the best decisions. Common Ground addresses this challenge by helping us prepare before the appointment, so that during the appointment we are ready to work with our doctor to find the best decisions for our treatment and recovery.

• Before the appointment, Common Ground helps the client prepare a 1-page Health Report that summarizes how we are doing and what our concerns are. Additionally, Common Ground links us to information about our treatment and suggestions that help us manage our disorder and make progress in our recovery.

• During the appointment, the Common Ground Health Report acts like an amplifier, helping our doctor quickly understand our goals, concerns and progress. Together the client and provider arrive at a shared decision about the next best steps for treatment and recovery. The shared decision is printed out so the client can bring it home as a reminder about what they will do to help themselves before the next appointment.

How Common Ground Works

Before each appointment with your medication provider, a client can visit the Decision Support Center. There the client will meet with a Peer Specialist who will guide them in answering a series of questions about their health and wellness since their last appointment.

With Common Ground a client can:Complete a health report, take charge of health galas, access health related info. watch recovery stores and print resources

Peer Support IDDT Groups

Seeking Safety What is it?Peer led groups focused on addressing substance abuse and trauma and making a daily plan for safety, finding community resources and supports, making sure all participants have emergency number like sponsor, supports, help lines, cm’s number, peer support numbers and in emergencies crisis and requesting a CIT officer.

Illness Management & Recovery

The Illness Management and Recovery (IMR) program is a step-by-step evidence based program that gives people information and skills to help them set and achieve personally meaningful recovery goals. It can be provided in an individual or group format usually taught by certified peer specialists.

The goals for IMR participants are for them to:• make progress toward their personal goals and toward recovery• learn about mental illness and strategies for treatment• decrease symptoms• reduce relapses and hospitalizations

The IMR program includes

• assistance in developing participants personal definition of recovery

• assistance in identifying and pursuing their personal goals• approximately 12 to 18 months of weekly sessions using a

series of educational handouts• active practice of skills during sessions and at home• involvement of significant others (with their permission)

to increase their understanding and support• at least one IMR wrap-up session to help participants sum

up their progress and make plans for the future

Strategies and skills learned in IMR educational handouts include:

• Recovery Strategies• Practical Facts about Mental Illness• The Stress-Vulnerability Model• Building Social Support• Using Medication Effectively• Drug and Alcohol Use• Reducing Relapse• Coping with Stress• Coping with Persistent Symptoms• Getting Your Needs Met in the Mental Health System• Healthy Lifestyles

Why have a peer in IMR?

“ [To] help people understand each other because they’ve ‘been there,’ share similar experiences, and model a willingness to learn and grow. Help change patterns, and make them feel safe and accepted. And help people move beyond their perceived limitations,” while assisting them with developing and achieving their goals.

Peer Support and IMR facilitators roles are to:

• work side by side with participants• provide information• teach strategies and skills to help them manage symptoms and make

progress toward recovery• help them break down goals into manageable action steps• regularly (weekly) follow up on their goals and support the steps they are

taking towards them

Peer Mentoring ProgramsThe Vet-to-Vet Mentoring Program

Will match a veteran with a fellow veteran in need of a supportive friendship. Through these friendships, the goal is to help with the recovery process of PTSD, depression, anxiety and the effects of head trauma so that veterans served by Compeer can be as successful in their civilian life as they were in their military career. Volunteer training and ongoing staff support are provided. Volunteers will typically spend 1-2 hrs per week with their match.

The Senior Companion Program

A community service whereby senior volunteers, age 55 and older, provide companionship and friendship to isolated and lonely seniors and simple chores/in-home assistance to disabled seniors to allow them to remain living independently. Respite services for family members/caregivers is also provided. These services add to the quality of life to frail elders and their unpaid family caregivers.

Questions & Answers

Agency Website: www.mhasck.org

Housing Questions: email: [email protected] 316.685.1821 x 294