Moderator: Jane Tobler
August 4‚ 2011
2:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are in a listen-only mode until the question-and-answer session. Today’s conference is being recorded. If you have any objections you may disconnect at this time. I would now like to turn the call over to Jane Tobler. Thank you‚ you may begin.

Jane Tobler:Hello‚ and welcome to Peer Respite Services: Transforming Crisis to Wellness. Today’s webinar is sponsored by the Substance Abuse and Mental Health Service Administration Resource Center to Promote Acceptance‚ Dignity‚ and Social Inclusion Associated with Mental Health‚ also known as the ADS Center.

SAMHSA is a lead Federal Agency on mental health and substance abuse and is located in the US Department of Health and Human Services. Please join the ADS Center listserv to learn more about social inclusion including upcoming webinars‚ new resources‚ and events.

This webinar will be recorded. The presentation‚ audio recording‚ and a written transcript will be posted to SAMHSA’s ADS Center Web site at promotacceptance.samhsa.gov later this month.

The views expressed in this training event do not necessarily represent the views‚ policies‚ and positions of the Center for Mental Health Services‚ the Substance Abuse and Mental Health Service Administration‚ or the US Department of Health and Human Services.

Our presentation today will take place during the first hour and will be followed by a 30-minute question-and-answer session at which time you can press star-1 on your telephone to ask a question.

We are pleased to learn about a variety of peer respite models today as well as the research that shows the effectiveness of these services. Our excellent presenters will share how peers‚ people with lived experience‚ are trained to assist people through an emotional crisis to build mutual trust and to encourage people to engage personal support and wellness resources that lead to empowerment and recovery.

Our first presenter today is Dr. Peggy Swarbrick who is a national expert in promoting wellness for mental health and addiction recovery. Peggy directs the Institute for Wellness and Recovery Initiatives at Collaborative Support Programs of New Jersey.

An author of numerous publications‚ research articles‚ and other resources Peggy is also a professor at the University of Medicine and Dentistry of New Jersey’s School of Health Related Professions. Peggy will provide an overview of peer respite models and the evidence that supports the efficacy of these innovative services. Welcome‚ Peggy.

Dr. Peggy Swarbrick: Thank you‚ Jane. I’m really happy to be here today to talk today with you about the peer respite service model that’s been really evolving in the last couple of years. What I want to do in this time that I’m going to share with you a little bit about the - a model before our other two speakers present some the - really - the - on the grounds of the work that they’re doing in implementing this important service.

What I want to do is share just basically how this model has evolved based on some very practical experiences of people in recovery as well as some of the empirical support that has been helping to build the model.

I want to first start us to think about the idea of a crisis and basically when we think about the peer respite model it’s generally a service that’s evolved to help people in crisis. And when we think about a crisis‚ crisis are things that happen to most any of us that are listening to this - on this call. Whether we’re someone who’s in recovery or someone who’s struggling with a mental‚ emotional - any kind of issue‚ and/or just living a life in society we all encounter crisis. It can happen to us at any time.

During this time we know that what happens for people is that there’s feeling upset‚ people feeling anxiety‚ feeling stressed and many of us have that-that feelings and that anxiety and stress will impact us in many different ways of our wellness‚ physically‚ emotionally‚ spiritually‚ economically‚ occupationally.

A crisis affects us in all of those different areas. And I think as we can think about this model and how it’s evolved and why it’s so important this crisis period of time that all of us have‚ it would be important for us to reflect on what actually helped us to resolve‚ manage‚ and get back on with our life.

There’s a few key elements that have evolved in developing peer crisis respite services that are essential to making this effective. We can think personally about the people that helps us or the environment that helps us and/or the tasks that we were helped with‚ to help us successfully managing that.

When we think about that during that crisis it’s the people that often are really the key elements in making us successfully work through that and move forward in our areas of wellness. People tend to - or we can think about ourselves and for people in general generally have a desire and are susceptible to people‚ the interactions of other people‚ could be people individually or can be groups.

Often this support comes from - and in the model that we’re talking about‚ peers; people who have shared this experience. It also can be from family members‚ spiritual counselors‚ or other healthcare professionals. That support is very essential in helping a person through this time.

And central to the work of what a person can do to help is someone who can be providing sense of hope to help the person to manage the sense of getting through this or successfully dealing with it as well as getting a sense of empowerment where people are given choices‚ people are given opportunities to exert more autonomy and control over what’s happening in their other areas of life. These are central things that help people in crisis.

What tends to be available though when a person’s in crisis is often people are put into the hospital in this crisis period to help them deal with what is usually termed the symptoms of the illness‚ the symptoms that tend to manifest.

And though this can be helpful at some times for some people‚ it often is problematic on a number of levels because at a time when a person most needs some type of support and opportunities to develop some kind of control and management of the issues that they’re dealing with‚ they’re put into a hospital that tends to focus solely on the symptoms of - that the persons managing rather than looking at the crisis and helping the person deal with the underlying causes of the crisis itself.

During the focus when we typically focus narrowly on the symptoms‚ usually typically only with one focus‚ which often is just medication seeming as the only key thing that’s going to work for people‚ we forget about helping the person gain more control‚ focusing on coping skills‚ giving people more autonomy over the situation‚ which are most important‚ the skills that a person needs during a crisis.

Often too the hospital doesn’t provide that much needed support that I identified previously that can help a person have that hope‚ have that empowerment‚ as well as be there in a way that’s in a supportive manner to help the person through that crisis.

The other things about the hospital‚ though it can be sometimes helpful for people‚ it often is very costly as well as has emotional and spiritual impacts that are not so positive for people. Particularly being so focused on the symptoms and focused so narrowly it tends to overlook the person and is not person centered‚ looking at people wholisticaly‚ mind‚ body‚ spirit as well as all of the eight dimensions of wellness. And this lack of a wholistic focus on people is sometimes missing the target that’s so important for the person.

Often too we hear over and over again from our peers that the hospitalization experience often is traumatic and/or retraumatizing which is very much an area that we’ve just started to look at more closely in that as I see you’re going to hear about the peer respite models does a real wonderful job of recognizing the impact of trauma and the retraumitization that often hospitalization is doing for people.

So at a time when people most need the support of a family or friends or someone that they can care about they’re often isolated in emergency rooms or psychiatric departments‚ not having full access to those supporters who could be so important for them.

So what we do see is that over time there’s been - and this is been on a while as you’ll see in the articles that I’ve listed as your references‚ there’s been a - for quite a while a recognition of having a crisis alternative. And there is literature and evidence that you see in some of the articles that have been published that people have wanted alternatives.

And we hear from people saying that they’d like to have something in the community‚ not necessarily an inpatient setting. We’re seeing that there are - there is this support that has developed - that has identified this peer support model and respite services that may or may not be delivered by peers but it’s often maybe not available as much. So we’re seeing more and more thankfully and you’re going to hear about these wonderful services that are being developed a lot now more and more.

This limits - this unavailability of having these services available to people is often undermines recovery we believe very strongly when people don’t have options‚ don’t have choices‚ are not treated in a wholistic nature. If we think about the ten components of recovery -- choice‚ self determination‚ wholism‚ very central‚ often not present in inpatient hospitalization.

So there is this growing evidence and this growing development of these crisis alternatives. The respite services - I want to take a minute for you to think about the term respite. Respite is a term that talks about grief. When you think about it and you look in the dictionary it’s defined as relief‚ a breather‚ having breathing space‚ breathing room‚ that’s what respite services do. It’s a promising alternative that provides people that opportunity to get that support in a way that can be helpful for people differently.

This alternative to hospitalization including the respite services also is a significant cost savings that can have - for people in society as well as we’re seeing‚ you know - you’ll hear from some of the data and previous studies‚ has a very‚ very positive impact on quality of life‚ socialization domains‚ vocational‚ people’s emotional status socially‚ many‚ many areas of quality of life.

As well as there’s been surveys that have been done in different areas that indicates that people prefer crisis intervention‚ peer support model as an alternative to inpatient‚ things like phone help lines‚ peer support services‚ as well as the crisis respites we’re going to hear about today.

And what we do know is that we’re seeing this growth and we’re seeing thankfully many‚ many more states funding and supporting these developments of crisis alternatives.

Very much as one piece is cost containment‚ it is much more cost effective‚ but also it is as we move towards a recovery-oriented system as you’re going to hear about‚ the model is fully in line with the recovery oriented system as well as very much in line with helping people in recovery and moving towards the wellness in the different dimension of wellness.

So I’ve laid out here a little bit of a framework for us to think about peer respite services‚ thinking about the model‚ how it’s helping people in the elements of a crisis‚ and what would be important to have - when a person or ourselves is in crisis or is nearing crisis‚ what do we need. You’ll see in the - here I’ve given you some references that clearly give us some empirical data‚ some conceptual framework for this model.

And as I’ll talk about later‚ I’m hoping more and more you’re going to hear about some great services that are available‚ get them going‚ and we’re going to learn more about the research of how they truly are helping people.

So thank you very much and we’ll - and I’ll answer the questions as we move along.

Jane Tobler: Peggy‚ thank you so much for helping us understand the growing body of evidence for peer respite services as a viable and innovative alternative to psychiatric hospitalization and also how these alternative services promote choice‚ self determination‚ and progress for recovery oriented systems.

Our next expert today is Sherry Jenkins Tucker‚ Executive Director of the Georgia Mental Health Consumer Network. She is a certified peer specialist and holds the credentials of ITE or I’m the Evidence that recovery works. Sherry oversees the Georgia-based peer support Whole Health Program. She received a 2010 Isaiah Ulysses Advocate Award from the United States Psychiatric Rehabilitation Association and the 2009 Clifford W. Beers Award from the Mental Health America.

Sherry will share the trauma informed wellness focused philosophy of the three support - peer support and wellness respite center she oversees in Georgia and the intentional peer support model that is infused throughout the program including staff training and supervision. Welcome Sherry.

Sherry Jenkins Tucker: Thank you so much‚ Jane‚ and thank you so much for having me on this webinar. It’s wonderful to be here with Peggy and Steve. As Jane said‚ I’m here to talk about the Georgia Mental Health Consumer Network‚ Peer Support Wellness and Respite Centers. And I’m sure you all would like to know what we are.

The Georgia Mental Health Consumer Network operates three peer support wellness and respite centers here in Georgia. We have - we’re a peer operated alternative to traditional mental health services. And we focus on wellness‚ not illness‚ and that’s a very important philosophy and practice that we have.

Peer support wellness and respite centers are trauma-informed environment. We recognize that trauma is far too common. We maintain an atmosphere of respect and dignity and we can’t begin to address the totality of an individual’s healthcare or focus on promoting health and preventing disease‚ both tenants of healthcare reform‚ unless we address the trauma that precipitates many chronic diseases.

Focusing on trauma‚ why is this important? Trauma is now considered to be a near universal experience of individuals with behavioral health concerns. From 55% to 99% of women in substance abuse treatment‚ substance use treatment‚ and from 85% to 95% of women in the public mental health system report a history of trauma‚ with the abuse most commonly having occurred in childhood.

Peers have contended for years that the question is what happened to you and not what’s wrong with you‚ which is typically the question that the traditional mental health system has asked and has asked‚ so it changes the conversation to say what happened to you. It changes our way of thinking about ourselves when we think of - when we reframe it to what happened to me.

You’ll see a picture here of the first peer support and wellness center that we developed. This one is in Decatur‚ Georgia. We just brought up two new service sites in North Georgia. I’m happy to report that Georgia closed a regional hospital‚ which would be called a state hospital any place else. And one of the consequences of that was the funding from the state to our organization to develop two new peer support wellness and respite centers. And they came up on June 30‚ 2011 so we’re very excited about it.

The peer support wellness and respite centers‚ all three of them have daily wellness activities. They have respite beds and we have 24/7 warm lines with each of the centers. With regard to daily wellness activities‚ daily activities address whole health‚ wellness‚ and having a life in the community.

We’re very interested in developing a support for people to live and grow in the communities of their choosing as opposed to developing a mini-mental health center run by peers. And we call our activities wellness activities as opposed to groups because‚ again‚ we’re about focus - we’re focused on wellness‚ not illness. And we’re focused on supporting people with moving forward with their lives according to their choosing.

We have all different types of wellness activities but a sampling of them is Whole Health and Smart Shopper‚ creative writing‚ the Wellness Recovery Action Plan commonly know as (WRAP)‚ a creation of our friend Mary Ellen Copeland. We have several activities‚ natural activities in the community‚ and of course bowling is one of those.

We have a job readiness activity that’s about supporting people with going back to work or finding a job or moving forward with their career. We have trauma-informed peer support group.

We have Double Trouble in Recovery commonly called (DTR) and this is a 12-step modeled opportunity for people to come together and to look at and address both their recovery from mental health and their recovery from addictive diseases because many of us and many of the people that come to the peer support wellness and respite centers are people who have experienced recovery or are experiencing recovery from mental health and addictive disease concerns.

We also have all various different types of activities with exercise‚ recreational‚ mindfulness‚ relaxation‚ and so on. We focus on a whole—a whole health‚ mind‚ body‚ spirit orientation.

We have three respite beds at each of the centers. To access a respite bed a person can conduct the proactive interview and this is about establishing a relationship with a person. And we get to have a conversation with the person to find out what they need when they feel that they need 24/7 peer support. And we get to tell them about what they can expect from us‚ from our model it’s very self-directed‚ it’s about moving forward. And so we help people to understand what they can expect from us.

It’s an alternative to psychiatric hospitalization. The best opportunities for growth often arise during crisis situations and their outcomes. And so we support people with engaging in crisis in a different way and actually growing from crisis as opposed to being left harmed and traumatized by crisis.

The focus is on learning and growing together. It’s focused on learning‚ not helping. And 87% of our respite guests report that accessing a respite bed kept them out of the hospital and so we’re very excited about that statistic.

We have 24/7 warm lines where people can get peer support over the phone‚ any time of the day or night‚ any day of the year. We rely on our lived experience and employ active listening rather than offering advice and direction because we believe that everyone has the answer inside of themselves. And so we support people with finding their own answers to their-to their dilemmas to what they consider to be their problems.

Peers throughout the state of Georgia utilize our warm lines 24 hours a day. And we have a partnership with the Georgia Crisis and Access Line‚ which is a single point of entry to access services and crisis support here in Georgia.

And they can do a warm - the Georgia Crisis and Access Line can do a warm transfer to us where if they have someone on the phone which they asses is really desiring peer support versus crisis access they can do a warm transfer and stay on the line with the person until we come on the line and get orientated to the situation.

And we also can do a warm transfer to the Georgia Crisis and Access Line where we can stay on the phone with someone that we determine is having a - is desirous of crisis services that are beyond what we have to offer. And so we can do a warm transfer to the Georgia Crises and Access Line‚ so it’s a wonderful‚ it’s a wonderful supportive relationship and people can also access traditional services there as well.

Intentional peer support is the model for our services. Everybody that works for us at the peer support and wellness centers first are trained as certified peer specialists through the Georgia Certified Peer Specialist Project. Then they receive intentional peer support. Intentional Peer Support has four tasks.

In the IPS model‚ the tasks include connection which is the core peer support‚ which is all about what we do and it’s about building trust. And we have to work at it and both parties have to work at it. And what you do with connection is you notice when it’s there and when it’s not and you have to be willing to work on keeping it connected.

It’s about working with people from the perspective of understanding their worldview and mutually understanding each other’s worldview. It’s helping each other understand how we’ve come to know what we know‚ how to come - how we’ve come to think what we think‚ and it’s a complicated thing how we know what we know because it’s what we’ve lived‚ what our families have lived‚ what our communities have lived‚ and so on.

The next task of Intentional Peer Support is mutuality. The mutuality is redefining help as co-learning in a growing process and it’s about developing a relationship of mutual respect and reciprocity so it’s very reciprocal. It’s a give and take. And it’s about moving toward. It’s not about getting away from something‚ it’s about moving toward something. It’s about growing and developing and learning.

The Intentional Peer Support model focuses on learning versus helping. Help has a potential to foster dependency‚ that’s very much rooted in the traditional system and we’re much more about learning. Learning emphasizes mutuality in emotional distressing situations that would otherwise be stopped or interrupted and we’re all about supporting people with their growth.

Staff training‚ all staff are certified peer specialists trained in the warm line protocol‚ CPR‚ First Aid‚ the Georgia Mental Health Consumer Network policies and procedures because‚ of course‚ the peer support wellness and respite centers are projects of the Georgia Mental Health Consumer Network.

We train everybody in peer support whole health and WRAP‚ Wellness Recovery Action Plan. Trauma informed peer support created by Beth Filson who is also a certified peer specialist and an expert on trauma-informed care. And everyone receives training on Intentional Peer Support created by our friend Shery Mead‚ which‚ of course‚ is the basis of our model.

Co-supervision is a big part of this approach. And staff meet as a team and with their supervisors on a monthly basis and as needed‚ it’s all very relational that our whole model is about relationships with everyone and among everyone. The tasks of Intentional Peer Support are used during each co-supervision and actually with all the work we do with our wellness activities with our warm line calls and so on.

And it creates an opportunity for staff to maintain IPS informed relationships‚ which again‚ it’s the basis of our model.

You’ll see the appendix here and that is something that you can read through on your own time but it gives you some examples of actually the four tasks of Intentional Peer Support and practice.

I have some resources here‚ you can go to the Georgia Mental Health Consumer Network Web site and learn more about us‚ the Georgia Peer Support Wellness and Respite Web site‚ which is part of the Georgia Mental Health Consumer Network Web site and you can see‚ you know - you can see pictures of our places‚ videos of the Director.

Jamie Lynch is also a videographer and there are wonderful videos. You can learn much more about the centers and actually see them too. And you can even see our evaluations from over the years.

I’ve also referenced the Georgia Certified Peer Specialist project Web site‚ Shery Mead’s Web site‚ and you can learn more about Shery Mead and her work from the last two resources. Thank you very much.

Jane Tobler: Thank you Sherry‚ and thanks for sharing your approach including the importance of trauma-informed services as well as how Intentional Peer Support reinforces the importance of learning and growing together.

Our third speaker today is Steve Miccio‚ Founder and Executive Director of Projects to Empower and Organize the Psychiatrically Labeled‚ Inc. or PEOPLe‚ Inc. PEOPLe‚ Inc. is a consumer advocacy agency located in Dutchess‚ Ulster‚ Orange and Putnam counties in upstate New York. Under Steve’s leadership PEOPLe‚ Inc. has developed a hospital diversion house called Rose House in two counties and a peer advocacy program in a hospital emergency room.

Steve will share with you the philosophy‚ environment‚ and peer engagement strategies used in their provision of services. He will also share the results from the work they have done comparing PEOPLe’s peer run hospital diversion program outcomes with traditional psychiatric inpatient program outcomes including impressive cost-savings data found in using the hospitals diversion program.

Welcome Steve.

Steve Miccio: Thank you‚ it’s nice to be here. It’s nice to be working with Peggy and Sherry as well. It started. Over the past ten years we’ve been running our diversion house which really is focused on breaking the cycle of going from home to crisis to hospital and a lot of that came through our own personal experiences and understanding that the hospital wasn’t always the best place for us to be.

Emergency rooms were definitely not the best place for any of us to be. And so this alternative was created and started‚ again‚ a little over ten years ago. So we’ve been doing this for a little while and certainly learned a lot from it‚ which has been really helpful for us.

Just to give you an idea‚ we’re talking about these diversion houses‚ you can see the houses here. They’re‚ you know‚ rich with instruments and we have exercise equipment and all kinds of things in them. But just to give you an idea of what it’s like when folks come to the house is most of the people come into the house very rigid.

They’re used to the traditional experience of crisis and coming in scared‚ maybe traumatized‚ not really understanding exactly what the house is about and what we’re going to do‚ what we’re going to work on.

And it’s nice to see a transition in most people that come to the house where it’s not that you see people come in rigid but you see them leave breathing‚ and that’s what happens when they come to the Rose Houses that we have. We have two now. And it’s interesting that the pattern is pretty similar for a lot of folks where they come into the house‚ they’re oriented to the house.

We do go through a full orientation of explaining what we’re doing‚ what - you know‚ they should expect from us‚ what we expect from them. But then they kind of tend to isolate in their room for a day or so. And eventually they start coming out of the room and almost asking and sometimes literally asking the question‚ who are you and what am I doing here.

And then we really start to work on the recovery and they’re looking at their crisis and looking at wellness and moving forward in it. So I just wanted to give you a little idea of how it works and most times by the time people are ready to leave they - not only are they breathing but they also want to work or volunteer at the house‚ which is really where we’ve gotten our best staff from. So it’s been a opportunity to also employ folks as well.

These are the two houses that serve three counties right now. The one on the left is more of a lake house. It literally is on a lake so it’s really a nice environment to be in. The one on the right is an old farmhouse and is also quite a very comfortable house to be in.

Now in designing the diversion houses‚ where we started other kinds of common sense ideas came to us as we were continuing to offer this service. And not only did we have the hospital diversion house but we did naturally create a warm line.

We didn’t intend to have a warm line in the house but then it just kind of happened because we were there 24/7 and people needed someone to talk to and we were available so we became a warm line or support line as many people are calling it now.

We also realized that people don’t want to loose their homes and they might be in some kind of crisis. And they certainly don’t want to go to the hospital. So we employ in-home peer companions that will come to your house or come meet you in the community somewhere and work on wellness skills and activities to look at crisis and‚ you know‚ kind of get through those emotional‚ stressful times.

So that they don’t have to be hospitalized. We’ve got very involved in social inclusion because another piece of diversion is really having something to do in your life and having a purpose. And social inclusion certainly does that‚ and I’ll talk a little bit more about nights out as we go along but it’s basically getting a night out and doing something that you enjoy and that you choose to do.

Then we have emergency room department advocacy which are peer advocates working right in the emergency department of the hospital so that when you are in a crisis and coming to the hospital you’re greeted by a peer that will say‚ here’s what you’re about to go to‚ I’m up here.

I’ve been through this and I’m here to advocate with you‚ and that’s exactly what they do. They advocate in the emergency department and they keep things kind of moving along but they make sure that the basic needs of individuals are met as well. So it’s been a real success of having peer advocates in the emergency departments.

And then we moved it over into clinics as well because there were people that went to clinics that didn’t really get along with their therapist or didn’t understand what they were going through when they were at the clinic‚ didn’t feel that they had any advocacy or they were in treatment.

And now they get to - the first door that they go by in one of our clinics is the peer advocate’s office where they can work with the peer advocate on wellness plannings and also mediation between the therapist and the person getting services is done there too. So there’s a lot of outflow from just starting a hospital diversion house.

There are three vital components to success in the house and these are the philosophies we live by and that is the philosophy of recovery‚ the environment is very important‚ and engagement is very important. Our philosophy is simple; it’s that recovery is the expectation.

Again‚ as Peggy was talking earlier‚ not really defining what recovery is. We’re not defining what crisis is. It’s what a person perceives is recovery or a crisis so what we expect is that people can do better if they utilize our services and if we’re doing our services well.

The core values that we have drive our behavior. We literally have core values that we created and then we actually put behaviors behind our core values so that when you walk into our house or walk into our services you can see those core values because it’s driving our behavior and it’s what we believe in. So core values like recovery and respect and all different types of‚ you know‚ values that agencies have many times are actual values that we practice.

We believe in mutual respect‚ we believe in transparency and honesty. The shared experience provides a lot of hope. Rethinking crisis is a major philosophy that we have‚ and then competent and compassionate staff is really a must in operating a successful diversion house.

Engagement is number two‚ which is building a trusting relationship‚ reducing any fear of punitive actions and many times people will come to the houses and they will feel that if they are open and honest that they will be punished for their behaviors. And they quickly learn that they will not. And they can come in and also be suicidal and talk about the suicide and the staff are trained in suicide intervention so that they can handle these types of situations.

And we’re not going to jump in and call 911 or send someone to the hospital or‚ you know‚ have them go run to the clinic. We’re going to do the intervention‚ take them to a safe place‚ and then decide together where it is they want to go. So we really reduce the punitive actions to zero in the houses. The houses are also voluntary by the way. People are not mandated to these houses at all so people don’t have to stay at the houses.

Mutuality promotes possibilities for change and the staff are well-trained and developed in other saving crisis and in doing their jobs and focusing on what our mission is.

The environment is very important as well. It needs to be safe and inviting‚ it needs to be clean and home-like. We believe when you walk into a hospital emergency room you certainly are going to see the plastic chairs‚ the bright lights‚ the smells‚ everything that’s going on. It’s very hectic in there.

Very different at the Rose House or the diversion house that we have and other houses that we’ve helped create‚ very warm greetings by people‚ by the staff that are there‚ even the guests are very warm when other guests come to the house. We like to have educational materials available‚ recreational materials‚ privacy and as you saw in the photo‚ a lot of professional instruments‚ art equipment‚ things like that are in the houses.

And this is what people get when they come to the house‚ there are expectations‚ but they aren’t - it’s not one sided. There are expectations that they should expect from us as a service provider‚ as a peer diversion service‚ and there are expectations that we have as people come into the house and you can read through these. But it’s important to be clear with your expectations so that people know exactly what they’re doing there. There is no question‚ that reduces a lot of trauma‚ reduces a lot of fear and it works really well in building relationships and building trust with people when they come into the house.

The services that are available are very similar to Sherry and what she has down in Georgia. We do a lot of the same stuff so it just makes sense‚ it all works. And it’s - the way we do it though is people come in and there’s an actual menu of services that they choose themselves as to what kind of structure they want while they’re staying at the house.

We don’t pick any structure. We don’t program people in any way. We don’t tell them when they have to do group or take meds or anything like that‚ it’s really driven by the guest‚ him or herself‚ in deciding what it is they want to do while they’re staying at the house.

Staff and team wellness is vitally important. You need to deliver a competent and quality-driven diversion service and it’s not easy to do. When you’re listening to and caring for people who are in emotional crisis it can really take a toll.

And what that means when I say take a toll‚ people can burn out very quickly because you’re seeing people at their worse or in critical situations most of the time. You’re also seeing triggers that can trigger staff that have been through similar experiences if they hear the stories and they can put them into a certain level of distress at times.

So it’s important for us to also maintain a healthy staff and we really focus on developing our staff to make sure that they can be healthy and they have the support system necessary so that they can do their job. So we do remove the hierarchal support system where we’re all equal in the organizations because we developed these things called team agreements.

And the team agreements are pretty simple. You’re getting your team together and you’re talking about your mission of your organization‚ what you’re trying to do. And while you’re talking about that stuff‚ you’re deciding how does the team want to treat each other because in many environments and many work situations people start to talk about each other as far as employees go.

And that can really take the focus away from the mission of what you’re trying to do in your service because if people are more focused on the he-said/she-said and the structural problems that might occur in your organizations they’re not going to focus on the guests. So when a team develops this agreement they develop it together and they all agree to it and they all sign off on it.

So these team agreements have really helped and are actual tools that hangs on the walls of the division houses that we’ve helped open. And when there’s a situation that comes up the staff can simply turn to that and say‚ according to the team agreement‚ you know‚ we’re supposed to use our abilities to make good decisions and I felt the decision was made for me and I want to talk about that.

And they can completely do that without any repercussion and they’ll get full support for doing that because we have agreed to do this together. So that’s real important for the organization and to going forward‚ any organization should really think about something like that.

So I want to talk about some totals in 2010 we served 227 non-duplicated folks. They stayed for 748 days‚ which were overnights really. We had over 1200 warm line calls.

And I will say that probably more warm line calls that are listed because I’m sure that - in fact‚ we know that our staff don’t always write down our warm line calls and that might happen with you too if you have a warm line or a support line where not everything is written down. So we know we’ve had at least 1253 calls in 2010.

And then the offsite visits were the peer companions going to people’s homes and that was 72 visits for the year.

So we took the 748 overnights and we took the figures of the - the average figures of the hospitals of our region‚ which is about $1400 and that’s $1.047 million. The Rose House annual cost is only $264‚000 so if you look at it as savings it’s about $783‚000 or $783‚000 that we’re not putting to billing Medicaid or utilizing any community services or other community service dollars.

That doesn’t take into account if there may have been medical needs for people or if they go to the hospital‚ they have to the triage of medical‚ which can be - that can add to the bill sometimes or if they have to be brought by ambulance or brought by police which can also increase the cost. So that’s just the bear minimum cost savings that the house can deliver.

So we wanted to get some research done on the house. So we started that in 2009 and - no‚ 2010‚ I’m sorry‚ and we’re I - no‚ 2009‚ we’re in our second year of the study. And we had one study that was completed and has been published now. And College of St. Rose was responsible for helping us with the study and we measured three things. We measured the treatment measures‚ the experiences with staff measures‚ and the experience with the environment measures.

So on the treatment measures we’re looking if people were being greeted warmly compared to a hospital‚ if the orientation to the program is better than our hospital‚ nonjudgmental staff‚ explanation of the program‚ expectations. You can see here trauma sensitive treatment‚ the whole list of treatment measures.

And the results were that 64% of the respondents indicated that they experienced these elements at the Rose House compared to 22% at the inpatient hospital settings. Now the research was good for us too because when we saw the 64% it was good‚ it was better than the hospital‚ but we felt it could be better. So we did make modifications to the House and to our orientations that improved the way we are working with the folks that come to the House now.

The experience with staff measures‚ the active listening‚ respect of the folks or guests‚ it should say guests but it’s a study and they used clients in research so you’ll see the word client or consumer come up every once in a while. But we do refer to everyone as guests.

The encouragement of interaction between peers‚ the encouragement of recovery and the availability of 24/7. And the results were that 76% of respondents experienced those elements at the Rose House and only 32% experienced it in the hospital.

The measures of experiences with the environment were the quality of the physical environment‚ comfortable settings‚ the guest private space‚ meal availability tailored to the guest schedules‚ guests’ abilities set their own schedules. By the way‚ the meal availability is many people that will come to the house will say‚ you know‚ when’s dinner‚ when’s breakfast‚ when’s lunch.

Well‚ we turn to them and say‚ well‚ when do you want it because you’re making it. People do make their own food‚ cook their own food at our houses. And we feel that that’s‚ you know‚ empowering‚ it drives self determination‚ it gives them something to do. It’s just normal for us to‚ you know‚ expect people to make their own meals.

The overall results‚ 78% indicated Rose House has those elements. Only 18% were in the hospital setting. The hospital diversion services‚ positive outcomes were the reduction of stigma‚ the increased community integration‚ the decrease in hospitalizations.

In a two-year look back we looked at 2009 and we did a survey. We experienced 90% of the Rose House alumni had reported no hospitalizations since the diversion house experience‚ and that’s pretty close to what Sherry had seen which is about 87% I think she said‚ which was pretty good numbers.

So here we have - I just threw in the appendix‚ the menu of services so you can get an idea of the kind of activities that people can choose. In the house itself it’s an actual menu and they just check off what they want and what they are interested in doing. We thought that was just kind of a novel idea and will gain interest for people to want to do something.

And then back here we have some more resources. We will have a diversion manual that we made in partnership with us and behavioral health and that should be done - completed very soon and will be available on our Web site. And then we will have a strategy to get that out to folks as well. And that will be a free document so people can have a manual that kind of really outlines how to go about opening a diversion service. So we’re excited to get that done and get that out to folks.

And that’s it so thank you very much for your opportunity.

Jane Tobler: Thank you‚ Steve. The results of your research really show that what you’re doing is working so that is very exciting to see.

Before we open up the lines to our callers we would like to hear from our speakers on their visions. So Peggy‚ we’re going to go back to you. What’s your vision?

Dr. Peggy Swarbrick:Okay‚ what I like to envision is that when people are in crisis and they feel that they need that support they’re going to get in an environment that’s safe‚ judgment free‚ and a caring setting. And I think that the services and support should be accessible to people‚ from what you’ve heard strength-based just like Sherry and Steve talked about.

Also what they’ve talked about‚ trauma-informed and respect people’s individuality‚ privacy‚ and cultural needs. The other thing very important to this vision is that the supports are available without coercion or the use of seclusion including both - including physical‚ manual‚ and/or chemical restraints‚ which are used far too much.

My hope is that the Federal‚ State‚ and local agencies as well as we can look to foundations and corporations will look to fund research into these models so we can show that these models and other healing approaches will really be available and be able to see how we can help support people to enhance their wellbeing.

Jane Tobler: Excellent‚ thank you Peggy. Sherry‚ what is your vision?

Sherry Jenkins Tucker: It is there’s a wellness center on every corner so people can access what they want and need to recover and maintain wellness and thrive in their chosen community to their fullest potential.

Jane Tobler: Excellent‚ thank you. And Steve‚ what is your vision?

Steve Miccio: Peer crisis diversion/respite services are no longer alternative‚ that are the evolved paradigm of mainstream care in all communities offering practical informed choices and knowledge that addresses crisis in a way that does not amplify or exacerbate trauma.

Jane Tobler: Those were excellent. You are not only visionary—Steve‚ I am so sorry.

Steve Miccio: That’s okay‚ there is more…

Jane Tobler: You have a lot of vision to share.

Steve Miccio:The community does embrace these services in my vision and practices strong partnerships. And I just want to add that there is an example of this strong partnership in Nebraska at the Kia House where they have made an excellent relationship with their hospital and their police departments better than any I’ve ever seen and so I really think that’s a model that we really should learn from going forward.

And then the last of my vision is that peer diversion services are evolved and introduce standards of care that are compassionate‚ humane‚ respectful‚ trauma informed‚ and recovery driven.

Jane Tobler: So it’s even better when you added the rest of the vision‚ thank you‚ Steve. And thank you to all of our speakers. We will take questions in just a minute but we did want to show that the - our speakers have provided some great resources at the end of their slides and also on Slide 64‚ there’s some additional resources for you to learn more about peer and respite services.

So now we will go on to our callers. If you would like to ask a question please dial star-1 on your telephone and you’ll be placed in the queue. Give your operator your first name if you do not wish your full name to be announced‚ then only state your first name.

And I do want to let people know that we would really like to get to as many questions as we can. We have a lot of people that have called in and that are on the web with us. So we would just ask if you could limit yourself to one question that would be great and we can get to lots of questions that way.

So once the operator announces your name‚ you may ask your question‚ and once you ask your question your line is going to be muted so it may give the speakers and an opportunity to answer. So we will go to our first question. Operator‚ could you give us our first question please?

Coordinator: Alfred‚ your line is open.

Alfred: Yes‚ I’d like to know is this causing any problems with any of the other centers and the doctors?

Jane Tobler: I’m sorry‚ Alfred‚ once again‚ what is your question?

Alfred: Is this causing any problems with any of the other centers and doctors?

Jane Tobler: You’re asking is it the peer respite services that they’re providing causing problems with other centers or doctors?

Alfred: Yes‚ are they coming down on you. Are they causing a problem for you?

Jane Tobler: Okay‚ so–okay‚ great. So the question is are other centers or other doctors‚ is it a causing a problem that you’re doing this because of competition‚ something like that‚ right?

Sherry Jenkins Tucker: Alfred‚ this is Sherry. We have not—I’m happy to report that we have not experienced that. We’re very clear to identify that what we have to offer is an alternative and it’s - for many people it’s a complement. We actually support people with accessing whatever care and treatment they desire to access to recovery and maintain their wellness. And so the peer support wellness and respite centers that we have the good fortune to operate have actually been received well by the more traditional provider community.

Jane Tobler: Great‚ Sherry. Peggy?

Dr. Peggy Swarbrick: Yes‚ I’ve not experienced any - I - there’s - I’ve not experienced any direct - I do hear that it’s perception of some competition so I understand Alfred’s question because there is this sense but I don’t - I think once places or people see what’s happening like the great work that you’ve heard from Sherry and Steve and some of the others that are going on‚ I think people start to see it and then they understand that this is a really good thing.

It’s not perceived as competition as much. But I definitely believe—I’ve heard this in time but I think once people see it happening and seeing the evidence of it working that kind of goes away.

Jane Tobler: Excellent‚ thank you‚ Peggy. Steve‚ what about you?

Steve Miccio: Yes‚ I would just say we did in the beginning when we started about ten years ago because we were starting really from nothing and our goal was to really make it better for people and not have them go to the hospital but‚ of course‚ it was a small house. But the perception from a couple of the hospitals was that it was going to affect their capacity.

And as we got to know them and built our service and as they got to see us and get to know us the relationship became more cohesional and we’re great partners now with all of the hospitals that we serve in our area.

Jane Tobler: That’s excellent‚ thank you‚ Steve. We actually had an email question that kind of follows up to that‚ Steve‚ so I’ll ask you that about this as well‚ which is please address how you overcame barriers in the community when initially developing and opening as well as getting funding for your program.

So this person is wondering about barriers in your community‚ which you’ve kind of talked a little bit about‚ but also about getting funding.

Steve Miccio:Yea‚ well‚ the funding in the beginning was from closure of a hospital‚ state hospital‚ and it was called investment funds so that reinvestment money was put out to a bid and I created the proposal to open a house and they awarded it to us through the state.

The second house that we’ve just recently opened was funded by the county because they saw the value of the house and the other counties that we were serving. And so they went into the county legislature and they really fought to get the funding to open a house in their own county.

And I think what we’re going to see in the very near future is that diminished care organizations are seeing the value in these homes and they’re going to also start to put some money towards these diversion houses. So I think there’s some real opportunities out there that we need to be looking at and building relationships with the managed care organizations.

Sherry Jenkins Tucker: Here in Georgia we’ve been very fortunate to have the backing of the Department of Behavioral Health and Developmental Disabilities‚ our Mental Health Authority here with regard to funding our centers.

The-the two that we just opened have had a great deal of community support from both of the communities that we opened them in‚ people who advocated to have these locations‚ these sites opened in their counties and because of the closing of a regional hospital and we also have a Department of Justice settlement‚ the state has been able to bring forward resources. So we’ve been able to open the two new locations and all three are funded by the state.

We have had some barriers in the - we did have some barriers with our first center about a year after we were opened. We had a what we called NIMBY‚ not in my backyard situation with some of the people in the neighborhood and we actually had to‚ you know‚ fight to be able to stay in the neighborhood because‚ of course‚ all the locations are residential in their nature.

I mean that’s part of what you want to create is a‚ you know‚ home-like setting for people so that they can relax and feel like they have a safe haven to stay in during respite.

Also‚ we were able to successfully—we were able to successfully hurdle all the barriers and now we’re a very valued part of the neighborhood and kind of beloved. So it’s‚ you know‚ wonderful.

Jane Tobler: That is wonderful. Thank you‚ Operator‚ could we go to our next question please?

Coordinator: Mary Sally‚ you may ask your question.

Mary Sally: Yes‚ I—basically what I want to do is I want to take a proposal—I’m a peer specialist and I work in a behavioral health agency and I want to take a proposal to the agency‚ to the CEO‚ and to put together how it’s going here. And I just want to know how to do that piece. I guess that’s my question.

Jane Tobler: Excellent‚ thank you. Steve‚ do you want to address that?

Steve Miccio: Well‚ I don’t know how soon you want to it but the manual‚ if we can get it out in a short time would be great but otherwise I would suggest contact one of us to help you out with that. Our contact information I think will be on here. So I would suggest that you reach out to us and we’ll certainly love to help you. And there it is.

Jane Tobler: Excellent‚ and for everybody their contact information is on Slide 66. Operator‚ next question please.

Coordinator: Tom Risinsky‚ you may ask your question.

Tom Risinsky: Thank you‚ Peggy‚ Sherry‚ Steve‚ excellent job. One thing I might have learned from my peer counseling endeavors is there’s usually one or two key components to the client’s motivational drive to want to recovery and find themselves and so many scattered pieces of their lives torn apart altogether.

My question is how might we as a team find and use the best scenario possible for your clients to help themselves to transfer the healing ability to the client so the client eventually becomes self reliant and no longer requires mental health services as we know mental health services today?

In other words‚ the client becomes his or her own counselor‚ psychiatrist‚ and mentor? And I put this synopsis at the end‚ discover recovery as never before and help clients help themselves open up their own unique recovery doors. The question was‚ how can we transfer healing ability to the clients so they can become self-reliant?

Jane Tobler: Okay‚ great‚ Sherry or Steve?

Steve Miccio: Well‚ it’s a - wow.

Sherry Jenkins Tucker: Big one‚ yes.

Steve Miccio: That’s a paradigm shift. I mean that’s an evolution of the traditional services and I think that’s part of what we’re doing is we are exploding the myth of tradition by showing that there are other ways to help people have - be self determined and be independent and look at crisis and not have to use that‚ you know‚ same system that many have used for so many years.

So I wish it was a very fast process but I think it’s just going to be the constant infusion of our services‚ our techniques‚ and our innovations to really make it have the vision that you’d like to see.

Sherry Jenkins Tucker: Right‚ and we create - you know‚ we created a model that’s orientated toward‚ you know‚ self direction‚ supporting people‚ you know‚ with their strengths‚ supporting people with moving toward what they want to move toward‚ and being kind of guide by sight.

You know‚ all of us who work at the‚ you know - at the peer support wellness and respite centers are people on our own recovery journeys and so with that we - you know‚ we certainly have stories to tell and we can be a set of model of self direction and recovery and resiliency that supports people with moving forward with their own recovery and wellness.

Jane Tobler: Excellent. Operator‚ can you go to our next question please?

Coordinator: Lynn Forgale you may ask your question.

Lynn Forgale: Hi‚ this is Lynn Forgale from San Mateo County‚ California. We just opened a respite center here in California in Santa Cruz and my question is the medications that clients come in with or the medications that some of the clients‚ the consumers may be on‚ how are they managed in respite housing to avoid any confusion that they’re doing well. I’m afraid they may be taking or over taking or not medications that are prescribed. Is that monitored at all?

Jane Tobler: Great question‚ Sherry and Steve?

Sherry Jenkins Tucker: We do not monitor people’s medications. We support them with providing them with a lockbox with a key to be able to - you know‚ to keep their medications safe. And if they choose to take medications they have that opportunity to do so. But we don’t monitor medications and we neither - you know‚ we don’t - people - it’s self directed so people choose to do what they think is right with all of the facets of what they’ve experienced in respite and with wellness activities and so on. So it’s completely self-directed for us.

Steve Miccio: And the same goes for us too at the Rose Houses. People are self-directed and have a lock box and take their own medication.

Jane Tobler: And another question we received via email‚ which is very close to that was what is your relationship with the local mental health clinic?

Steve Miccio: Well‚ I can speak to the clinics here is that we have a very close integrated relationship. We attend their meetings‚ they attend our meetings. We have constant communications with the clinics. It’s real important to have that‚ you need that relationship and building that relationship because there are times when people come to the house and they really need a different level of service than the house can offer.

So we can speak with the clinic and we can get help in‚ you know‚ helping that individual. We don’t speak for anyone but we just have that relationship where if the person needs a different level of help or support they can call and then we have that relationship with the clinics where they will attend to it immediately.

Sherry Jenkins Tucker: And we’re lucky here in Georgia‚ and I spoke to it‚ we have the Georgia Crisis sand Access Line so all levels of service are a single phone call away. And so if someone needs additional support beyond‚ you know‚ the peer support that we have to offer then we’ll support them and assist them with being able to access whatever different or greater level of service that they would desire.

So it’s a mutually beneficial relationship and they also refer‚ you know - let people know about us. And‚ you know‚ we have a lot of people who come to us‚ say‚ from the Dekalb County Crisis Center‚ which is just up the street for example.

Jane Tobler: Great‚ thank you. Operator‚ our next question please.

Coordinator: Paula‚ you may ask your question.

Jane Tobler: Paula?

Coordinator: Paula‚ your line is open‚ please check your mute button. We’ll move on to the next question. Yvonne‚ you may ask your question.

Yvonne: Yes‚ forgive me for my question and I guess it’s sort of a follow up to what Lynn was talking about. Two parts‚ who are you Rose House and respite services—who is it not for?

And this question comes up a lot because we’re looking at doing something in Northern Virginia‚ how - what kind of liability insurance? Is it like an apartment insurance? It’s certainly is not‚ like‚ the same as the special insurance and forgive me for asking that question.

Jane Tobler: Excellent‚ Yvonne. So the question is who is this not for and how do you deal with restrictions and liability insurance. So I would say Steve and Sherry.

Sherry Jenkins Tucker: The peer support wellness and respite centers in Georgia would not be for anyone who didn’t want to be part of it. I mean it’s a - we have an open access philosophy but if a person - it isn’t something that a person can be mandated to or forced to come to. It’s a self-referral kind of thing. So if you want to come you can come.

The orientation is for adults who are people who self identify as‚ you know‚ being in recovery from mental health and many people are in recovery from mental health and addictive disease challenges. And we have—we have liability insurance with the Georgia Mental Health Consumer Network so it covers our centers.

Jane Tobler: Great‚ Steve‚ how about you?

Steve Miccio: Yes‚ we have the full liability plus we have professional insurance on all of our staff and then the usual - since we do some driving‚ we have drivers insurance as well for all of our staff at our agency.

People that really don’t fit into coming to the house are people that can’t follow the guest agreement basically. Which is‚ you know‚ having respect for others in the house and respect for the staff and‚ again‚ wanting to be there. You know‚ it’s not mandated at all for anyone to be there and you have to want to be there to want to work on something different in your life that’s going to improve your quality of life.

We - you know‚ there have been cases or situations when people haven’t been well physically and we just don’t have‚ you know‚ any kind of medical staff or supervision that we can offer to folks so we have had people that have come and gotten physically sick and had to leave but other than that it’s really - you know‚ self service that people want to be there. And if they want to be there they’re most likely going to do well there.

Sherry Jenkins Tucker: And it’s the same‚ exactly the same with us what Steve’s saying.

Jane Tobler: Great‚ Operator‚ could we go to the next question please?

Coordinator: Meg Harts‚ you may ask your question.

Meg Harts: Hi‚ personally I’d like to just thank whoever put these three speakers together because they’re just - we are so lucky as a person-centered healthcare reform movement to have all three of you. Hi Peggy‚ and hi Steve. I have one question and I’d like to ask Steve.

I’m really impressed with your research and just coming up with the numbers. Can you tell me‚ first‚ who actually did your research? Who crunched the numbers? And who actually designed it? Did you do that all yourself or did you hire out for it?

Steve Miccio: We did that with the College of St. Rose in partnership with them. We sat down and we talked about what it is we wanted to measure and what we wanted to - we’re not researchers so‚ you know‚ we needed to get their help.

And so they helped us design the research and they did all the - they had some graduate students working on it and then they had a - two professors overseeing the entire project. And we’re still continuing that project. It’s - we’re in our second year of measuring and going forward. We’re finally getting some longitudinal data out of it as well.

Jane Tobler: Great‚ Operator‚ next question please.

Coordinator: Eiley Boylan‚ you may ask your question. Ms. Boylan‚ your line is open. Please check your mute button.

Eiley Boylan: Hi‚ can you hear me?

Jane Tobler: We can hear you.

Eiley Boylan: I live in Baltimore City in Maryland and I would like to know who is thinking of starting a respite center here if anybody there knows or who would I get in touch with?

Jane Tobler: That is a great question.

Dr. Peggy Swarbrick: Well I would - one of the things I forgot to mention in my piece‚ this is Peggy‚ on Page 14 is listed the National Empowerment Center Web site‚ Power2U.org. There’s a listing of all - they sort of keep a listing of all of the services that they are aware of so you can check that. I don’t believe there is any in that region but I think if you keep looking there - but the other piece is to do it - I know in our state here in New Jersey we’ve - we’re going to be funding them.

So I would ask your - some of the state authorities are looking to fund these as pilots. So you might want to contact somebody in your state or county level to see because there - I’ve been hearing a lot more‚ and I know particularly in our state‚ there are some funding being available to develop pilots.

But again‚ look at Slide number 14 and the National Empowerment Center has a great resource on this and that would be a place where I’d really keep your eyes open for more good resources on crisis peer alternatives.

Sherry Jenkins Tucker: In addition to what Peggy said‚ Maryland also has an organization called On Our Own of Maryland and they’re the consumer organization in Maryland so they would be a logical entity that might be interested. So they also may be somebody that you might want to contact.

Jane Tobler: So for those that are on the web we’ve gone to that slide‚ it’s Slide number 14‚ and it is www.Power - the number 2‚ the letter U; Power2U.org so that’s the place to check. And one of our emailers is from Michigan so she wants to get one off the ground in Michigan. So Michelle‚ check that but she also wants to know how long will it take before centers like this are open and operating in every state?

Steve Miccio: In another week.

Jane Tobler: You’re going to take care of that the next week. I thought you were on vacation.

Sherry Jenkins Tucker: Steve‚ be realistic. End of August‚ okay. Earliest. Labor Day earliest.

Dr. Peggy Swarbrick: Those of you on the call can make that happen‚ I think - you know‚ hearing about this‚ looking at the resources‚ getting the ear of the various funding sources in your area‚ getting the ears of the local advocacy organizations‚ and - like‚ for example‚ in our agency we’re looking to just do this our self as well.

Sometimes you don’t even have to wait for the state or the county to fund it. If you see a need and you want to try it I think this is another way to work with your Board of Directors‚ get some foundations. I think the more and more we can see that - you know‚ if we see the need‚ we see it’s going to fit‚ we start small‚ I think both Sherry and Steve both start small‚ but they grew it and you see the success that they have.

So encourage everyone on the call to - if you’re really interested to start the groundswell of it.

Jane Tobler: Well‚ I think we have over 300 people on the call and there’s only 50 states so it might be the end of August before they all open. So we have another question that came in the email which is can consumers from other states where services may not be as good be supported at your wellness center? And that’s from Lynn Slotsky.

Steve Miccio: I can speak to that and say that people have shown up from all over the country on our doorsteps and we don’t turn anyone away. That’s probably my safest answer.

Sherry Jenkins Tucker: I can answer much in the same vein as Steve‚ we actually are a service that is funded by and for Georgians but we certainly have had people who have shown up at our door and we have welcomed them.

Jane Tobler: Great‚ Operator‚ could we go to the next caller please?

Coordinator: Anthony‚ you may ask your question.

Anthony: Hi‚ thank you‚ I think I sent in the question via email but the question is for Steve as well as Sherry‚ could you share with us your annual budget and your staffing pattern please? Thank you.

Steve Miccio: Our annual budget for the houses is between $265‚000 and $280‚000. And our staffing patterns are we have - during the day we have two staff on because we have a lot of meetings Monday through Friday that need to be attended. And then the second shift is one staffer‚ or it should be one staff.

And I will say that in Nebraska they have a volunteer on every shift which is really nice and we started to implement that as well at our houses. And it’s working out pretty nice for everybody. So having those volunteers that want to be there‚ that want to be a part of that is really‚ I think‚ a good thing.

Sherry Jenkins Tucker: And for our centers we have an annual income of $325‚000 a year. We have one full-time director‚ two full-time staff‚ four part-time staff and the staffing is similar to what Steve talked about‚ two during the day and one in the evening‚ one at night. And then at two of our centers we actually have staff that live in‚ a director lives in one and a CPS staff lives in another.

Jane Tobler: Excellent‚ we have another question from email‚ kind of a different slant which is please talk about how you use spirituality to assist or support people through crisis? So Steve or Sherry or - and Sherry‚ how do you use spirituality to assist or support people through crisis?

Sherry Jenkins Tucker: Well‚ we certainly‚ as I’ve spoken before‚ we’re self-directed orientated place and so we support people with what they want support with. And we have also have wellness activities that would be orientated towards spirituality‚ you know‚ including‚ you know‚ our mind‚ body‚ spirit‚ wellness activities‚ things like yoga and there are certainly other activities that I’m blocking on the names at this point that are orientated towards that.

And people can practice what they choose because it’s self-directed and so there’s no prohibition to that as long as you don’t treat anyone else disrespectfully with that orientation.

Steve Miccio: And we’re pretty much the same.

Jane Tobler: Excellent. Operator‚ next question‚ please.

Coordinator: Gladys Christian‚ you may ask your question.

Gladys Christian: Okay‚ thank you. My question is - in establishing this do you have to have a memorandum of agreement or contract or be endorsed through a company or agency? Or is this—or is the respite service business independent?

Steve Miccio: We are independent. We have contracts with local county and with the city but we don’t - but we’re an independent organization. I don’t know if that’s answering your question.

Sherry Jenkins Tucker: Same with us‚ we’re a 501(c)(3) non-profit organization so we’re an independent organization but we have a contract with the State of Georgia‚ the Department of Behavioral Health and Developmental Disabilities which funds the work that we do‚ deliverables of the work that we do.

Jane Tobler: Operator‚ next question please?

Coordinator: Becky‚ you may ask your question.

Becky: Yes‚ I have a couple of questions. And the first question I think I’ve already got an answered‚ the staff are paid‚ okay. And the next two is how long can someone stay in a respite bed? And are there - are the guests charged any fees for anything like food or anything like that? Those are my two questions.

Jane Tobler: So how long can they stay and are they charged anything.

Becky: Yes.

Jane Tobler: Okay‚ thanks.

Steve Miccio: Okay‚ at the Rose Houses they can stay one to five days‚ and that was designed because many folks have gone to the hospital and end up the hospital really only - usually by the time they’re admitted they’re ready to go home. And so we know that we can do a lot of work in five days if somebody’s going to stay there that long‚ and we do a lot of that work.

And then - I’m sorry‚ the other question was - the food‚ we used to provide the food but now we ask people to bring their own. However‚ we do have staples if there are people that just don’t have any money and can’t afford to bring their own food. We do have some dry goods and cereals and macaronis and things like that that they can have free of charge.

Sherry Jenkins Tucker: And with the peer support wellness and respite centers here in Georgia people can stay up to seven nights and we provide food.

Jane Tobler: Operator‚ next question please?

Coordinator: Stacy Garrett‚ you may ask your question.

Stacy Garret: Hi‚ my question is about funding also. I’m looking at your budget for Rose House on Screen 44 and that just seems so incredibly low‚ $264‚000. Did you say you have ten staff people?

Steve Miccio: No‚ I didn’t say how many but we do have two full-time and then we have five part-time and then per diem staff that are always on call. I will say that the house really - it’s under budget from what we get. What I didn’t say is what we contribute through our own agency which is usually between $10‚000 and $25‚000 additional each year to make up for the loss in the budget that I posted there.

But that’s the budget that we’re given by the state or by our contractors. Our new house though is funded quite a bit more and it’s a much healthier budget.

Stacy Garrett: How do you‚ how are - how do you get money just through contracts through the counties or do you also - can you charge insurance companies? Or where does the money actually come from other than state or county contract?

Steve Miccio: Any additional monies‚ we have other services that we do where we have income such as rep pay shift. We also do a lot of training and we charge for training. We have a whole emersion training for the diversion services so people can come to our house and stay for a week and learn how to run a house. And there’s a charge for that. So the money that we make on those kinds of activities are what help funds other parts of the house.

Jane Tobler: Great‚ Operator‚ next caller please.

Coordinator: Felton‚ you may ask your question.

Felton Macky: Yes‚ my name is Felton Macky. I’m calling from Concord‚ California from Mental Health Consumer Concerns. My question is how does - how do you keep your - I mean not keep them but how do you differentiate your staff with the consumers and the learning mode versus overdoing it into the helping mode? You know‚ sometimes we get so caught up in doing - we end up doing more than we should do‚ that’s the question.

Steve Miccio: Yes‚ I think if you look at Shery Mead’s training of the Intentional Peer Support that teaches you how to really not be an enabler and not be too much of a helper and learning how to listen‚ validate‚ and‚ you know‚ address together those issues going forward in life and we have a very similar training at the Rose Houses as well.

A lot of the training is done on how to listen‚ how to validate‚ how to be respectful in sharing one’s stories when people are ready for it‚ how to use motivational interviewing‚ and that really keeps us from‚ you know‚ being that helper or going into that helper mode.

So we’re very cognizant of that at all times too and it’s a question that we’ll always have in our meetings is are we doing the right thing‚ are we helping too much‚ are we enabling. And we look at that as a team constantly.

Sherry Jenkins Tucker: Right‚ and we have a continuous training process so we keep working with people with the Intentional Peer Support model and other types of models to support people with staying on the path of learning versus helping. And then we also have co-supervision‚ which I talked about briefly in my formal presentation.

And co-supervision also supports us with being able to keep things on track and according to model as opposed from falling into learned habits that we have from our past interspaced with the system‚ traditional system‚ vigilance.

Jane Tobler: Excellent‚ we have our last question for today’s call and that is - and Peggy‚ I’m going to ask you first‚ what is the most important research to date we should be aware of? And it’s a two-parter‚ and the second one is‚ if we had a peer run center in every community how much would it save the United States?

Dr. Peggy Swarbrick: The first - the question was that the research‚ what’s the best research to look to? And then also - okay‚ I would - some of the things that I have listed on those references would be a good start to look at.

I think some of the Soteria House Research has a really good foundation for this model and really shows some of - we’re looking back to that that’s been done a while ago and some of the more recent studies on that. But I definitely would look to that because I think that those models really give us a lot of the foundation for this work that Sherry and Steve have talked about.

And the second part of the question was the savings that we would have‚ my mind isn’t moving into math right now but I definitely can tell you that I believe strongly‚ as I mentioned in one of my slides that fiscally we will definitely see an incredible cost savings as well as I think emotionally and spiritually for people. It’s going to be amazing across the dimensions.

And I think as one of the callers said‚ I think that a lot of this model has promise for people not needing costly services. So we’d have to sit down and do a little bit more further analysis but I do believe that this model could potentially be an amazing cost savings from a fiscal perspective as well as an emotional and spiritual - really as I said‚ healing for people to have something like this available for people. So I think it could have a tremendous impact.

Jane Tobler: Excellent‚ thank you that was a great answer. And all of the questions were very good‚ and we thank everyone for their questions and our experts for their answers.

If we were unable to take your question today you’re welcome to reach out to the speakers directly or contact the ADS Center at PromoteAcceptance@SAMHSA.HHS.gov. Contact information for each speaker is available on the Slide 66 and you can read more about the speakers on Slide 67‚ 68‚ and 69.

We value your feedback. Within the next 24 hours you will receive an email request to participate in a short‚ anonymous online survey about today’s training. It will take about five minutes to complete and we’ll use this information to determine what resources and topic areas need to be addressed by future training events.

As we mentioned earlier‚ the conference has been recorded and the audio recordings and transcripts will be available in late August on the SAMHSA ADS Center Web site.

If you enjoyed and learned from this training conference we encourage you to join the ADS Center ListServ to receive more information on recovery and social inclusion activities and resources. And visit the 10x10 wellness initiative to learn more about promoting wellness and decreasing early mortality for people with mental and substance abuse disorders.

As part of SAMHSA’s National Recovery Month‚ September 19 through the 25 will be National Wellness Week. Sign the pledge for wellness to learn more.

We’ve come to the end of our time today. If you have more questions or want to follow up‚ like I said earlier please contact the speakers directly or contact us. And for future reference‚ the ADS Center contact information is also listed for you on Slide 73.

On behalf of all of us at the SAMHSA ADS Center I want to extend our appreciation to Peggy‚ Sherry‚ and Steve‚ both for their extraordinary work on this very important topic and for taking the time today to educate us about peer respite and peer support services.

And finally‚ thanks to you‚ all of our listeners‚ for taking time out of your afternoon to join us. And thank you in advance for filling out the survey. Have a super day.

Coordinator: This concludes today’s conference‚ thank you for your participation‚ and you may disconnect at this time.