Peer Run Respites: Research and Practice Sae Kim Morgan Pelot
Peer Run Respites Overview Crisis as an Opportunity for Growth & Change Voluntary, non-medical program for individuals experiencing crises • or 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
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 As defined on PeerRespite.net: 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.
Peer Organizations: Peer-Run • Board of directors is at least 51% peers • Meaning peers staff, operate, and oversee the respite at all levels Peer-Operated • T he board is not a majority peers but the director and staff are peers • Often attached to a traditional provider Mixed • Embedded in traditional provider but have peer staff • Peers do not have to be in leadership roles
Types of Peer Support: Ø Mutual support / self-help Ø Peer-run respites Ø Drop-in centers Ø 1:1 peer mentoring Ø Health navigation Ø Recovery learning communities Ø Recovery coaching
Peer Respite Essential Features Survey documented by nationwide biennial survey 2010 2012 Examines changes in respite: 2014 Ø Operations 2016 2018 Ø Funding Ø Staffing Ø Evaluation N=11 Ø Guest experience N=10 Ø Capacity N=17 Ø Activities Ø Policies N=22 N=31
Minimum criteria defined by consensus panel Staffing • 100% of staff have lived experience Leadership • All leaders have lived experience Governance • The peer respite is either operated by a peer-run organization OR has an advisory group with 51% or more members having lived experience
2018 Survey Response Rate, Data collection All peer respites listed in the PeerRespite.net Directory were eligible for the online survey if they were currently operating 100% response rate – 31 respondents
PREF 2018 Operation Highlights What activities contributed to the founding and initial financing of peer respites? Collaboration with county or state behavioral health 15 22 department 10 Community organizing 12 7 Government grant 12 2 Collaboration with a managed care company 4 0 Other* 4 5 Legislative bill 3 2016 (N=22) 0 Private grant* 2 2018 (N=31) 0 Collaboration with state Medicaid agency* 2
PREF 2018 Operation Highlights What sources did respites receive funding for in the last fiscal year? Private foundation 3% Private donations (other than from foundations) 1% County or local behavioral health Managed care agency company or 45% Medicaid contract 5% Other 3% State revenues or grants 36% SAMHSA or other federal agency 7%
PREF 2018 Operation Highlights Peer Respite Annual Budgets 8 8 2014 (N=17) 2016 (N=20) 2018 (N=30) 7 7 6 6 6 5 5 5 5 4 4 4 4 4 4 Includes: 3 3 • Not funded Less than $100,000 • 2 • $100,000-149,000 1 1 • $150,000-199,000 1 0 $200,000 - $299,000 $300,000 - $399,000 $400,000 - $499,000 $500,000 or more $100,000 - $199,000 Includes: • $500,000-749,000 • $750,000-999,000 • More than $1million Each include two budget range survey options DO NOT DISTRIBUTE
PREF 2018 Policy Highlights Some peer respites have eligibility requirements that guests must meet in order to stay. Ø Receiving services through public mental/behavioral health system: Ø 27 out of the 31 did not have this requirement Ø Remaining 4 respites had this requirement Ø Other policies include: Ø Suicidal thoughts Ø Self-Injurious behavior Ø Housing stability Ø Intoxication while at respite Ø Possession of illegal substances at respite
PREF 2018 Policy Highlights Do you have a rule or policy that prohibits you from having people stay when they express thoughts of suicide? 100% 14% 18% 90% 23% 14% 80% 70% 19% 35% Other suicide policy 60% 50% Restriction on people who have a plan 40% 73% No restriction 30% 58% 47% 20% 10% 0% 2014 2016 2018 (n=17) (n=22) (n=31)
PREF 2018 Policy Highlights Do you have a rule or policy that prohibits you from having people stay when they are engaging in self-injurious behaviors? 100% 18% 90% Restriction on those 29% 0% 0% 5% engaging in behavior 80% 70% Restriction on those 10% who express 3% 60% thoughts/feelings* Restriction on those 50% 19% with recent behavior* 40% 77% Other 30% 39% 20% No restriction 10% 0% 2016 2018 (n=22) (n=31)
PREF 2018 Housing Instability Policy 2014 2016 2018 100% 5% Prohibits people without housing 90% 24% 26% 27% 80% Prohibits people without housing unless they have 70% 0% a place to go after they 19% 29% leave 60% Takes those who do not 50% have permanent address 0% 41% 16.13% but prefer not to** 6% 0% 40% No restriction based on housing status 30% unless that is the only 26% reason for wanting to 9% 41% 20% stay* Other policy 10% 6% 18% No restriction based on 6% housing 0% n=17 n=22 n=31
PREF 2018 Policy Highlights Do you have a rule or policy related to intoxication in the peer respite? 100% 6% 6% 90% 16% 28% 80% 16% 70% Stay out of communal areas 60% Leave respite until sober 28% End stay 50% More than once, end stay* 40% 0% 40% Other intoxication policy No restriction* 30% 0% 20% 39% 23% 10% 0% 0% 2016 (n=18) 2018 (n=31)
PREF 2018 Policy Highlights Do you have a rule or policy related to the possession of illegal substances? 100% 10% 14% 90% 80% 70% 48% 60% 57% Other possession 50% Remove substances End stay 40% 30% 42% 20% 29% 10% 0% 2016 (n=21) 2018 (n=31)
What does the research show? Ø Type of program Ø Is it peer-run, peer-operated, mixed? Ø What is the definition of peer respite? Ø Study design Ø Control or comparison groups Ø Observational Ø Qualitative Ø Outcomes Ø Cost efficiency Ø Reducing use of emergency services Ø Program evaluation Ø Satisfaction
Research on Peer Respite Outcomes Ø Use of emergency services Ø 70% less likely to use emergency services (Croft & Isvan, 2015) Ø Days at respite associated with fewer hours of inpatient and emergency services (Croft & Isvan, 2015; Dumont & Jones, 2002) Ø Personal improvements Ø Reduction of symptoms (Greenfield, et al, 2008) Ø Improvements in healing and empowerment (Dumont & Jones, 2002)
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