PRESENTERS:Betty-Lou Kristy, Director, Centre for Innovation in Peer Support/TEACH

Christina Jabalee, Director, Centre for Innovation in Peer Support/TEACH

The Centre for Innovation in Peer Support, embedded in Support & Housing – Halton, promotes and facilitates themeaningful engagement, empowerment and enhanced capacities of and support to people with lived experience andtheir families as well as effective peer support services regionally, provincially, nationally and internationally.

Values in Action:Using QI to Promote Values Driven Service Delivery that

Transforms Organization and System

Meet the Team: Centre for Innovation in Peer Support

Christina Jabalee, Co-Director

cjabalee@shhalton.org Betty-Lou Kristy, Co-Director

bkristy@shhalton.org

Lisa McVey, Admin Assistantlmcvey@shhalton.org Jody Orr,

Embedded Evaluator (Part Time)

Robyn Priest, International

Advisor & Trainer(Part Time)

Working Together

MH & A Leaders

Peer Position Network

Peer Position Supervisors Network

Definitions from the CentreWhat is peer support? “Peer support is intended to be rooted in hope throughan empowering and empathetic relationship between people who have asimilar life experience or circumstance in common” – Centre for Innovation in PeerSupport*

Who is a peer worker? “Someone who has a similar life experience orcircumstances to yours. They have engaged in special training and skilldevelopment to enhance their ability to support you in living the life you want.”- Centre for Innovation in Peer Support*

*These definitions were created with the collaboration of the Peer Position Network (40+ peer staff from over 11 organizations) and Peer Positions Supervisor Networks (25+ Peer Supervisors from over 11 organizations)

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Intentional PEER SUPPORT…….

is NOT

• Helping/Enabling (a driver, medication drop off etc.)

• Friendship

• Tokenism

• Someone who needs special treatment

• Anyone with lived experience

• Therapy/counselling/sponsor

• Pushing an agenda

• Being a mole/spy

• Having “superior” recovery/wellness

• ONLY VOLUTEER POSITIONS5

IS• Skilled expertise

• Trained and mentored

• Experiential knowledge

• Intentional

• Unique role in the system

• Identified as a core service

• Completes a multi disciplinary team

• Authentic engagement

• An equally valued staff member

We provide system support to organizations whohave peer support staff, through training,implementation, evaluation & research, capacitybuilding, knowledge brokerage, and qualityImprovement.

Currently support:• 60 peer support staff• 30 peer support supervisors• Across 30 programs

Centre- Scope of Practice

Development, Implementation, System Transformation & Sustainability

7 Areas of Reflective Practice Person Directed Services Developing a New Role in a System Emergence Governance Service Integrity Communities of Practice “Marrying” all of those

Engaging and supporting 11 Mississauga Halton LHIN funded & accredited Health Service Providers (HSPs) with over 40 peer support workers, 24 peer supervisors across 25 different programs in community, residential & hospital settings . Active engagement and support provided to many other HSPs & organizations ; plus regional, provincial, national & international collaborations.

6 Priority Streams Training Implementation Evaluation & Research Capacity Building Knowledge Brokerage Quality Improvement

6 Spheres of Influence/Impact11 Accredited HSP Partners

Supporting Authentic Roll Out: How does the Centre do that?

• Engaging all stakeholders• Stay grounded in common values and language • Knowledge Exchange events, opportunities• Communities of practice• Developing guidelines • Consistent messaging and training for peers, supervisors, teams and systems• Developing a tool to address role clarity and impact/outcome• Recognizing it was more than introducing a new role, it was system transformation. • Reminding everyone it is about relationships…with everyone.

Programs with Staff Peer Support PositionsACTT Live-In Treatment Program (HOPE Place)

Addictions (Punjabi Community Health Services ) Mental Health (Punjabi Community Health Services)

Adult Community Treatment (PAARC) Mississauga Halton Opioid Program (PAARC)

Adult Inpatient (Halton Health Care) Older Persons (PAARC)

Adult Inpatient Mental Health Program (Trillium Health Partners)

one Link (Halton Health Care), one Link (Trillium Health Partners)

Aftercare / Continuing Care (HOPE Place) Opioid Outreach and Treatment Services (ADAPT)

CAPIS (Halton Health Care) Outpatient Clinic (Halton Health Care)

Community Withdrawal Management (PAARC) Peer Mentorship Program (CMHA – Halton)

Community Withdrawal Management Services (ADAPT) POSSE (Support & Housing – Halton)

Employment Peer Mentor Program (STRIDE) Social Recreational Program (SHOP)

HOMES (SHOP) TEACH/Peer Initiative (S&H-H)

Just Be You (Support & Housing – Halton) Transitional Aged Youth Program (ADAPT)

We also engage and train:

• Peers in sex trade work• Peers in street outreach• Peers in overdose

prevention sites• Peers in the shelter

system• Family peer workers• Supervisors of peers in

the corrections system

Spectrum of Peer Support

Mental Health Commission Canada MHCC

There is evidence on Peer Support

The evidence …

Helpful Resource!

Slide From Keeley Phillips, Self- Help alliance, Centre of Excellence, CMHA waterloo Wellington

Was authentic peer work being offered?

We implemented so many new positions, quickly, in mainstream mental health and substance use/addiction settings; known for challenges in

implementation.

What has emerged from the peer support worker survey suggests

great complexity in what peer support

workers are doing and in how they are doing it

Each service provider had unique expectations

about roles and responsibilities for

“their” peer support positions.

Role clarity and role definition were identified

as top priority for the peer support workers, the peer support supervisors,

and the agencies employing the peer

workers.

“Such lack of clarity of purpose can act as the seed for all other implementation issues identified…” Harrison & Read, Challenges Associated with the Implementation of Peer Staff Roles in Mainstream Mental Health and Addiction Agencies, May 2016.

Luckily we were selected to be coached by Excellence Through Quality Improvement Projects (E-QIP) for the next step!

…….we started working with E-QIP and discovered QI diagnostic tools such as Fishbone and the 5 Whys which enabled us to create problem & aim statements.

What became clear….• We could not measure the outcomes of peer work in our region if we did not know

if authentic peer work (based on the values) was being provided to people.

• We needed to find a way to measure the perceived values based behaviours people receiving services were/or were not experiencing to create baseline data.

• There was little research on directly what values based behaviours looked like. (Provincial Systems Support Program’s (PSSP) Evidence Exchange Network EENet) housed at Centre for Addiction & Mental Health (CAMH) completed a literature review for us to support this)

• We needed to have everything informed by people engaging in services (and caregivers)

• We needed to ensure a credible research methodology process/rigour, so our work could be seen as evidence in our region to continue moving peer work forward.

What did we do first? (Co-creation)

• Went to the people who know!

• We used the values from the Mental Health Commission of Canada that were created with focus groups of people with lived experience and peer workers.

• We asked people receiving peer services what values based service looked like in action.

We created a validated tool to measure…1. Integrity- Is peer work actually taking place

2. Quality- How are people feeling about services/peer services

3. Impact- Do people feel peer work is impacting what the evidence has said it does.

Initial Findings from 90 surveysIntegrity

The mean (average) score for all items was very positive, meaning there was a high degree of perceived alignment between the way peer support workers behaved and the values of peer support.

QualityPeople reported significantly more positive emotions about peer support than they did

about services prior to engaging in peer support (e.g.. 70% experienced negative emotions about services in general BUT reported 80% positive emotions regarding the peer support service they received)

ImpactMore than 80% agreed or strongly agreed that having peer support:

• Helped them be more hopeful about their life• Gave them more confidence to tell health providers what they need

• Helped them deal more effectively with crises in their lifeBetween 75% - 79% agreed or strongly agreed that having peer support:

• Helped them get connected to appropriate supports and services• Improved their ability for self-care

• Decreased their need for emergency and crisis services

We are currently wrapping up our accelerated roll out blitz!

• Delivered to all peer service participants in our 11 original partner agencies.

• We have over 300 surveys completed and are seeing the same trends!

• Our system wide analysis will be available in a few months.

• Evidence to share!!

Brainstorm

• How could you make these perception results come to life?

• What data points exist in your organization that would help capture the peer support impact?

• What could you use as baseline data to begin thinking about QI?

Survey & the “How To Manual” Coming Soon!

We love to share!

Overall Health Care System TransformationProvincial and National Mental Health and Substance Use/Addiction

Strategies, Initiatives, Policies, Engagements & Care Provision

Mississauga Halton Local Health Integration Network (LHIN) Mental Health and Substance Use/Addiction System

Health Service Providers (HSPs) Providing Peer Support

Peer Support Supervisors

Peer Support Workers

People Engaging Services

Spheres of Influence/Impact

Peer Staff and Peer Supervisor Surveys

• Surveys focus on implementation, and the perceptions of peer staff and peer supervisors regarding communication, support/collaboration, wellness and recognition of values based peer work.

• We created 2 surveys to understand the experience of implementation from peer staff and peer staff supervisors.

• We used feedback from focus groups and discussions in the Peer Position Network and the Peer Supervisors.

• We crossed walked their experiences with Centre for Excellence in Peer Support/CMHA Waterloo Wellington’s “Challenges in Implementation of Peer Staff into Mainstream mental Health and Addiction Agencies” 2016 and Philadelphia Implementation Promising Practices tool kit.

Peer Staff and Peer Staff Supervisors (con’t)

• We sent out the survey to our original 11 partners agencies. Our response rate was 14/21 supervisors and 31/42 peer staff

• Asked for agreement (or not) with statements that reflect factors that we know help to effectively facilitate integration of peer staff into mainstream programs and services but also maintain the integrity of peer support (i.e., alignment with values of peer support) (a couple of stand alone statements)

• Calculated mean scores for each statement.

Also, anything 3 and under was noted as an area for

improvement

Brainstorm

How have you; or how can you address some of the areas for improvement?

Two Examples of How this Information Inspired Change

1. EQIP coaching around peer support implementation in a hospital inpatient setting

2. Realigning an organizations values

Ensuring Authentic and Accessible Peer Work

The Excellence Through Quality Improvement Network Project (E-QIP) Cohort 2

Example #1

Our EQIP Cohort 2 Team

• Debbie Bang -lead-meeting organizer and meeting Chair• Abel and Laura- Data Coaches • Chalean Bates and Ed Castro Executive Sponsor• Daniel Greig and Kevin Tregunno- Voice of Direct Service,

Peer Support• Betty-Lou Kristy and Christina Jabalee- Team Leads & Jody

Orr- Evaluation and Research Support

First we collected the evidence…….

People are Experiencing High Peer Work Integrity, Quality and Impacts:

• “I have attended multiple sessions with peer support workers A and B. They are both phenomenal and encourage me to get better. A consistently shares his/her experiences and specifies how they may relate to the group which is a breath of fresh air. B also consistently writes on the board, including ways to cope with my illness in situations when medicine does/may not help. A and B both consistently keep us up to date with current and relevant information as it pertains to housing, volunteering and other relevant information.”

• “I feel heard. Highly supportive, encouraging and empathetic.”• “He/she makes me feel like my future will be a solid and positive life experience.”• “Not embarrassed anymore cuz (sic) of the amazing support from peer support worker A and

peer support worker B.”• “It allowed me to feel understood because they [peer support workers] listened to our concerns

with compassion (true) and patients need to feel a true sense of being cared for without feeling like being a burden.”

Patient/Client Story:But some clients may be limited in their access to authentic peer support based on the lack of

understanding of peer roles on the inpatient unit.

The lack of role clarity was noted by Peer Staff and Supervisors in the Peer Staff Survey and the Peer Staff Supervisor Survey

• Peer Workers noted the level of understanding among hospital staff as 3.5/5. • Peer workers also perceived their role as less valued in comparison to other

staff roles (PS 3.7/5) then their supervisors did (S 4.33/5).

Still waiting on the full results from Inpatient Staff. Preliminary scan shows there in an unclear understanding of peer work.

We want to increase the understanding so we can increase the positive impacts of peer support to patients.

Root Cause:

• The value of peer support is not widely understood in the circle of care.

Change IdeasIncrease understanding and promotion of peer support

1. Psychiatrist to present article on peer support evidence at journal club. (# of Attendees, Post-survey, # that read article and watched recording of journal club)

2. Peer support info pamphlet will be co-created with patients, nurses and peer workers and included and explained to all new patients on the unit. (# of pamphlets given out, number of inquiries about peer support to nurses and peers.)

3. Impact on your organization beyond the project and project team:Just bringing the EQIP project to Trillium created a shift in understanding and impacted immediate change to the Peer Staff roles even before data collected or change ideas. EQIP 2.0 was a change idea!

Inspiring and Supporting the Realigning of an Organization’s Values

Example #2

Longstanding Embedded Peer Initiatives that Began to Evolve the Culture

Turned Values into Action and Created a Survey

Discussion

• Where do we go from here?

• What support does our province need to continue to shift culture and service informed by people with lived experience, and also inspire more peer staff service options?

Final Thoughts:

Key Messaging

• Its not about US and THEM…its about all of us.

• We all want the best care possible for those we love and ourselves

• Our system is always growing.

“When People With Lived Experience (PWLE) are trained and take on peer support positions within the substance use and/or mental health systems AND

when they are seen and supported as valued members of the service team, capacity within these systems will grow. This will be reflected in more

compassionate, responsive & equitable, recovery focused substance use and mental health systems and workplaces as well as in increased satisfaction

among people using services.

This initiative strives to ensure every person will be recognized, appreciated and respected for the unique person they are on their unique journey and to

ensure that care provision is adaptable to the fluctuations in peoples’ recovery”

The Centre’s Theory of Change

The Centre has been recognized as a provincial Promising Practice by Provincial

Systems Support Program’s (PSSP) Evidence Exchange Network (EENet)

housed at Centre for Addiction & Mental Health (CAMH)

We are thriving and driving change through innovation, excellence and

continuous quality improvement processes. The emergent nature of

innovation allowed us to carve a unique identity as a recognized leader.

http://eenet.ca/resource/centre-innovation-in-peer-support-improving-lives-in-mississauga-and-halton

• 2017 Recipients of the Ontario Peer Development Initiative (OPDI) Lighthouse Innovators Award- The Initiativewas selected based on multiple criteria: Creative partnering; Peer driven research and evaluation; Peerleadership in system design & creation; Innovation in peer delivered service; Funding of peer driven services;Quality Improvement; Health Equity; Fostering consumer survivor initiatives(CSI)/peers to provide expertise &evidence.

• 2017 Recipients of the Addictions & Mental Health Ontario (AMHO) President’s Shield Award- The award ispresented to an individual/team who has demonstrated leadership in the field of mental health and addiction;Proactively identifying novel and creative ways to improve upon processes or service delivery; Implementingchange in a positive manner and striving to ensure its success; Building strong relationships that support a highlevel of trust and credibility; Leading with behaviours reflecting equity, diversity and inclusion; and Providingoutstanding contributions to the field of mental health and addictions.

• 2016 Association of General Hospital Psychiatric Services (AGHPS) Celebrating Innovation Poster PresentationAward - The Initiative was the recipient of this award after being selected to present for the AGHPS 6th Summit’sPoster Session on Celebrating innovation. The feedback was that this initiative (with peer support withinhospitals, regional support strategies, and LHIN funding commitments) should be the provincial standard.