Harnessing the Power of The Lived Experience

2014 Drug Court InstituteMartha Ekhoff MA, CPS, ALWF

Session Objectives

Gain understanding about:• Recovery and Resiliency• Peer Recovery Support Services • The Value of Lived Experience• The long history of peer support• The research that has demonstrated the evidence base

of peer support

Substance Abuse and Mental Health Service Administration (SAMHSA’s)

A process of change through which individuals improve their health and wellness, live a self-directed life, and

strive to reach their full potential.

Working Definition

of Recovery

Recovery Happens When:

HopeIn what’s possible

Recovery

Empowers this process

StrengthsFocused on

Goals are intimately

personal

Principles of Recovery

• Person-driven• Occurs via many pathways• Is holistic• Is supported by peers• Is supported through relationships• Is culturally-based and influenced• Is supported by addressing trauma• Involves individual, family, and community

strengths and responsibility • Is based on respect• Emerges from hope

Four major domains that support recovery

Health: Overcoming or managing one's disease(s) as well as living in a physically and emotionally healthy way.

Home: A stable and safe place to live.

Purpose: Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society.

Community: Relationships and social networks that provide support, friendship, love, and hope.

What is Peer Support?

• Peer support is social emotional support,frequently coupled with instrumental support, that is mutually offered or provided by persons having a mental health condition to others sharing a similar mental health condition to bring about a desired social or personal change (Gartner & Riessman, 1982).• Peer support is “a system of giving and receivinghelp founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful”(Mead, Hilton, and Curtis 2001,pg. 135).

Understanding the value of lived experience

Self-disclosure and using one’s own story as means of enhancing the value of the service is an important dimension of the recovery mentoring or coaching role. In addition, a peer mentor or coach implicitly holds himself or herself out as a recovery role model. As described by William White, this core competency entails “modeling of core recovery values (e.g., tolerance, acceptance, gratitude); the capacity for self-observation, self-expression, sober problem-solving; recovery-based reconstruction of personal identity and interpersonal relationships; freedom from coercive institutions; economic self-sufficiency; positive citizenship and public service.” (White, 2006)

Formalized Peer Support History• History extends back to

Philippe Pinel at the end of the

18th Century – Jean

Baptiste Pussin• In contemporary form, emerges

from Mental Health

Consumer/Survivor Movement• Resurrected as a strategy for addressing the gap

between treatment and “a life in the community” • Is now reimbursed by Medicaid in many states

1st Peer Supporter

Jean Baptiste Pussin

1st Peer Supporter

The Role of “Peers” in Moral Treatment and Beyond

• Pinel did not remove the shackles from the inmates at the Bicetre, Pussin did

• Pinel observed and described Pussin’s approach in documents

• Pussin and his wife established more humane treatment of patients with mental disorders – known today as moral treatment

• Pussin’s approach relied heavily on peer workers (convalescing patients, which is what Pussin was when he was hired)

• Dorothea Dix’s crusade was fueled by her own experiences of psychosis as well as her sense of social justice

• Role of peers in “therapeutic communities”

Earlier in the 20th Century

Harry Stack Sullivan

People with psychosis are much more fundamentally human than otherwise

Suffered from psychosis himself, and hired recovered and recovering patients to be staff

Early 20th Century: Origins of AA and Peer Support

• The origins of Alcoholics Anonymous can be traced to the Oxford Group, a religious movement popular in the United States and Europe in the early 20th century. Members of the Oxford Group practiced a formula of self-improvement by performing self-inventory, admitting wrongs, making amends, using prayer and meditation, and carrying the message to others

• In the early 1930s, a well-to-do Rhode Islander, Rowland H., visited the noted Swiss psychoanalyst Carl Jung for help with his alcoholism. Jung determined that Rowland’s case was medically hopeless, and that he could only find relief through a vital spiritual experience. Jung directed him to the Oxford Group.

• Rowland later introduced fellow Vermonter Edwin (“Ebby”) T. to the group, and the two men along with several others were finally able to keep from drinking by practicing the Oxford Group principles.

Early 20th Century: Origins of AA and Peer Support

• One of Ebby’s schoolmate friends from Vermont, and a drinking buddy, was Bill W. Ebby sought out his old friend at his home at 182 Clinton Street in Brooklyn, New York, to carry the message of hope.

• Bill W. had been a golden boy on Wall Street, enjoying success and power as a stockbroker, but his promising career had been ruined by continuous and chronic alcoholism. Now, approaching 39 years of age, he was learning that his problem was hopeless, progressive, and irreversible. He had sought medical treatment at Towns Hospital in Manhattan, but he was still drinking.

• Bill was, at first, unconvinced by Ebby’s story of transformation and the claims of the Oxford Group. But in December 1934, after again landing in Towns hospital for treatment, Bill underwent a powerful spiritual experience unlike any he had ever known. His depression and despair were lifted, and he felt free and at peace.

• Bill stopped drinking, and worked the rest of his life to bring that freedom and peace to other alcoholics. The roots of Alcoholics Anonymous were planted.

Mid-20th Century

• Narcotics Anonymous was established in New York City in 1949 by Danny C.

• In 1956 Rae L. assumed the leadership position for New York City’s NA

• Rae L. worked for the Narcotics Coordinator’s Office of the New York City Department of Health52

• She became the first NA member working in a paid role within what would soon be an emerging field of community-based addiction treatment.

Hope is more than an emotion Hope is:• A way of thinking or a cognitive process

• A thought process made up of a trilogy of goals, pathways, and agency.

Hope happens when:• Have the ability to set realistic goals • Are able to figure out how to achieve those goals • Believe in ones self

Hope is a combination of setting goals, having the tenacity and perseverance to pursue them and believing in our own abilities.

C.R. Snyder 2003

ResiliencyResiliency refers to the capacity of a human being to survive and thrive in the face of adversity. It is a term that can be applied to people of any age.

Five of the most common factors of resilient people:• Resourceful • Good-problem solving skills• Seek help• Believe they can manage their feelings and cope• Social support available • Connect with others

Brene` Brown

(2010)

Statement of Evidence Based August, 2007 letter from the Administrator of Center on Medicare and Medicaid Services stated:• Peer support services are an evidence-based mental health

model of care which consists of a qualified peer support provider who assists individuals with their recovery from mental illness and substance use disorders.

Empirical Evidence to DateLarry Davidson, Professor of Psychiatry and Director of the Program for Recovery and Community Health Yale University School of Medicine and Institution for Social and Policy Studies reports:• First generation studies showed that it was feasible to hire

people in recovery to serve as mental health staff• Second generation studies showed that peer staff could

generate equivalent outcomes to non-peer staff in similar roles

• Third generation studies are investigating whether or not there are unique contributions that peer support can make

(Pillars of Peer Support Summit 2012)

Evidence to Date

Evidence for the effectiveness of peer recovery support for individuals with substance use disorders: moderate

Two randomized controlled trials and one quasi-experimental study were of sufficient quality to rate the level of evidence as moderate. Primary outcomes included:

• Improved relationships with providers and social supports

• Reduced rates of relapse

• Increased satisfaction with the overall treatment experience

• Increased treatment retention

What are Recovery Support Services?

As a complement to treatment—which aims to reduce or eliminate illness, symptoms, and relapse— recovery support services aim to increase recovery capital.

Substance use,Symptoms,

Relapse Triggers

Recovery Capital

Treatment Recovery Supports

Recovery Capital is . . .

“the quantity and quality of both internal and external resources that a person can bring to bear on the initiation and maintenance of recovery” (White, 2006) In contrast to people who achieve “natural” recovery (without care), many people with addictions entering treatment have never had much recovery capital or have dramatically depleted such capital by the time they seek help.

Summary of Studies on Peer Recovery Support Services Providers

Larry Davidson PhD, Yale School of Medicine stated that when these services are provided by someone with lived experience of an illness and in recovery, they promote such positive experiences and benefits as: • Hope and positive role modeling; • recovery education and mentoring; • assistance in navigating social service and recovery service

systems; • assistance in asset mapping and connecting with community resources, • welcoming community destinations, • informal community associations that support recovery.In a review of the overall outcomes of peer support services, Davidson reported that they promote improved health behaviors, improved clinical outcomes, and improved quality of life.

Peer Recovery Support Supports the Journey of Recovery

Recovery means

a full life in the community where our illness and/or addictions does not get in the way of achieving our hopes and dreams.

QuestionsMartha Ekhoffmartha.a.ekhoff@optum.com208-914-2234