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hello. i'm ivette torres, and welcome to another edition of the road to recovery . today, we'll be talking about peer-to-peer support services for mental and substance use disorders. joining us in our panel today are- leah harris, communications and development coordinator, national empowerment center, washington, dc; tom hill, director of programs, faces & voices of recovery, washington, dc; michael d. little, forensic advanced certified peer specialist coordinator, philadelphia department of behavioral health and intellectual disability services, philadelphia, pa;

monica scott, outreach substance abuse counselor, baltimore substance abuse systems, inc., baltimore, md. tom, peer-to-peer services is an increasingly unique and an important part of a recovery-oriented system of care, of systems whether municipal or state systems, that are looking to set up a recovery-oriented system of care. what is peer recovery support? peer recovery support is it involves people with lived experience of both addiction and/or mental health and in recovery, and it's using that lived experience as the fulcrum, or the leverage, to do the services. they're non-clinical, they're strength based, and they work on building trust with the person, and i would also say they are also mutually reciprocal, so the person giving help also gets help in the equation.

very good. and leah, talk to me, i mean, we have both the substance use disorder and the mental health consumer recovery concepts that we are going to be talking about today in the show. so, tell me a little bit about, is there any difference in terms of recovery peer support between substance use disorders and those that are suffering mental illness? i'm sure there are differences, depending on the context in which the services are offered, but typically, the value system is extremely similar, that the concepts that tom mentioned earlier of this idea of self-determination and mutual support and really recovering a life worth living, using that lived experience to help others and to gain a sense of empowerment over your own life, and so they are very similar in that respect. and the services can be very specific, too.

if somebody expresses the desire to go back to school, they can get help with that. whatever kind of community supports they want to link up with, all of these services and programs help to decrease isolation, which is a really, really fundamental concept to recovery, is relationships and community. yes, it's building community and building relationships. absolutely. michael, let's talk about the criminal justice system, and how important is a recovery peer-to-peer support system, once that person is leaving one system and coming back to a community? well, you know, during that reentry process, reentry starts when the person becomes incarcerated. you know, we have to be able to engage a person and try to motivate him while he's incarcerated early in his incarceration. that way, his thought process starts to, you know, change, and being able to engage that particular person, it's just not just about peer support.

those correctional officers also have to be a part of that peer, you know, culture because they're spending forty hours plus, you know, working with individuals. having that forensic cps in a person's life is monumental because, you know, it's trust building. and also, as tom had mentioned, that lived experience of incarceration, you know, person knowing that, "ok, i've been behind these walls, and here i am outside these walls now, and i'm working. this is the kind of blueprint that i utilized, you know, for my recovery process also." not to say that everybody's blueprint is gonna work, but you know, it's one of the things that's educating people and giving them a time, you know, for them to reflect on how they want to reenter back into society. and, michael, were you in that system before, and now you're out, and you're working with that community? yes, i'm formerly incarcerated, a returning citizen. and i also spent time in a halfway house, you know, which

i think halfway houses are monumental, as opposed to just being thrust back into society, you still need that structured environment, you know, to regain your own empowered self and identify what's goin' on in your life and how you can move forward. it's really about trying to find what's going to work for you in that process of incarceration. so, you know, incarceration is something that touches a lot of people's lives. a lot of families have somebody that's incarcerated. absolutely. how did you determine that you wanted to become a peer support person? during my incarceration, i started taking some self-help groups. and once i started taking the self-help groups, you know, looking around at the room, i said, you know, i wanted to become one of the facilitators of the groups because i still needed some more time myself in the groups, also.

so, i became a facilitator, and next thing i knew i was in a therapeutic community, also facilitating in the therapeutic community. and just being able to assist the counselors and the therapists during that process, i felt that was something that i wanted to do. it engaged you. once i was on the streets, yes. very good. monica, let's talk about what distinguishes peer recovery support from other approaches that support people in recovery. well, one of the major things that peer support does is it gets the individual who is being supported the opportunity to get shared life experiences from a person who has sustained recovery or has had long term recovery, to be able to effectively transition back into society. a lot of times, clients or what we call peers, are more receptive to an individual who has been or who traveled

the path that they're attempting to travel. a lot of times, the clinical aspect is great while they're in treatment. however, when the transition from moving from treatment to society happens, most individuals are kind of like not as receptive to clinicians trying to dictate or trying to assist with them transitioning back into society, so that's where the peer recovery, the advocate or the peer recovery coach, comes in, to effectively share their experiences with them, to say like, "look, i've experienced what you're experiencing. the same anxieties, the same fears that you have, i've had. this is how i was able to transition from point a to point b." and they're a little bit more receptive because they understand that just because i'm in treatment, doesn't mean that i can't be successful transitioning into society. so, it's a little bit more, it allows the peer to be able to

effectively move from one level to the other- very good. -and know that they have somebody to support them. excellent. tom, let's continue on that note. if i was coming out from either a treatment program or a therapeutic community, or even if i was in a mutual support group, but i felt that, you know, that one hour, even once a day or whatever, was not really connecting me, what would a peer support program provide for me? well, it's a good question. and first of all, you know, we always tell peers they're not counselors, so they don't give advice, they don't diagnose, but they're also not 12 step sponsors, and i think that's an important distinction. but a peer-to-peer experience, as someone's entering the community from whatever-a treatment or institution-the peer will help them have a soft landing and provide them with community resources, such as? community connection- -well, housing, education, employment, venues to that,

maybe it may be something like childcare. it could be instrumental, it could be emotional, it could be educational, or it could be what we call affiliational. so, affiliation means connection to family, community, to other people that are in an organized recovery environment. and those things are really important if somebody feels like they're entering a community that's recovery friendly, as opposed to recovery hostile. and for a lot of folks that enter communities, communities don't understand recovery and don't really know how to support that. so, that's a part of this larger recovery orientation that peers are a part of. and how has the system itself, the recovery support system or now the peer-to-peer support system, changed over time, tom? i know you started with the programs back in 1998 when samhsa- -was able to put together the first grand proposals that

went out on the street for these services. well, that was called the recovery community support program, which changed to the recovery community services program in 2001. and so between 1998, there were advocacy grants that switched over to peer services, and the advocacy is still an important part of that, but, you know, samhsa had the foresight that if they harness the energy that was happening in the recovery community, they could sort of seize these organizations. so, 15 years later, if you look across the country and you see recovery community leaders, many of them came out of that 1998 cohort that samhsa provided the funding and the resources for. and so, in that 15-year span, amazing things have happened. so, rcsp-that's the name of what we call that grant-some are direct descendants of that, but that's filtered out to lots and lots of communities that haven't had those grants

but have started that kind of organizing and those kinds of peer services all across the country, so it's been very, very exciting. very good. leah, i want to hear from the mental health community. how have the programs evolved? i believe they started back in 2005 or so? i mean, you could say that there's been a movement of people really even since the early '70s who've been seeking for peers and people with lived experience to have more of a voice in the programs, policies, services, everything that affects them directly. so, that's been growing slowly over time, but you know now, instead of being on the fringes or on the margins, we're much more represented at the tables, in all those areas that i mentioned in helping to set policy and helping to determine programs, and the delivery of services. there's been a move much more towards collaboration with mental health professionals and people with lived experience, so it's that kind of spirit of collaboration that

i think is really enriching the way in which mental health care is delivering, and it's increasing over time. and so, the peer-to-peer is also very similar to the substance use disorders? and as a matter of fact, i suspect that now both systems are dealing with the mental health is also has co-occurring conditions, so you deal with substance use disorders, as well as- right. -as the substance use disorders also has, you know, people that suffer with co-occurring, as well. but when we come back, we'll continue to talk about peer-to-peer support. we'll be right back. [music] peers are a really important part of recovery, regardless of where you are. so, any time you can relate to someone in the recovery process

who has shared the same experiences, whether that's an experience in jail or an experience in the military, these are important ways in which people can engage with each other. and the recovery process, we learned a long time ago, that people who experience, who share their own personal experiences are much more able to engage each other, they're much more able to support each other in approaches to recovery. so, especially for those who have experienced jail or other kinds of criminal justice involvement, it's really important for them to be able to talk to someone else who's experienced that, as well. peer recovery is very important, both in the substance use arena and in the more psychologically oriented arena, because people with lived experiences can have a certain amount of authenticity that a professional without

lived experiences might not have. the professional role tends to be more hierarchical by definition and it requires a certain mode of interacting, and people in need of services benefit from that. but, they also benefit from somebody who has, quote, "been there, done that," who can recognize when symptoms are arising. [music] at times, the path to recovery from a mental and substance use disorder may be unclear. at times, the path may be rocky. at times, the path may be wandering. but laying a strong foundation, with the support of others, makes all the difference. for information on mental and substance use disorders, including prevention and treatment referral, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music]

early in my recovery, i learned two things. i learned the power of giving back and volunteerism and service and i learned how that promoted my own recovery. and i also learned how to be a change agent, and that if i didn't like the way something was, that i had the empowerment to go ahead and try to make changes with that. and when i first started working with peer services, those two things were essential ingredients in why peer services worked because in the recovery community, in the addiction recovery community, folks are pretty well trained to give back and know the value of service and volunteerism. and also that if something needs changing, we have the experience of changing ourselves, and we've learned how to do that on a larger scale.

and michael, i'm going to come back to you, related to the justice system. as we're trying to get the affordable care act implemented, how is it that now we're going to incorporate some of these reintegration or community integration efforts into that whole aca? is that plausible to say that that's going to be something that we're looking at, right now? well, you know, in the up-and-coming future, having that affordable care act is going to be monumental in a person's recovery process that is transitioning from state correctional facilities, as well as regular state mental hospitals. how so? well, you know, if a person doesn't have health care, you know, oftentimes when you're going into treatment, you're going to need some kind of medicaid or medicare to be able to be seen during this process.

you know, we also know that several of the programs are closing, you know, because of the lack of medicaid and resources for treatment. you know, treatment is one of the things that is an ongoing process and monumental in everyone's recovery process. you know, it's not just criminal justice involved, it's not just people with mental health challenges, it's people around america, you know, if there's a lack of insurance, you know, to pay for care. very good. monica, you're an outreach coordinator. yes. do you see both individuals that are in recovery and bring them to peer-to-peer support, and if so, you find me in the street, i talk to you, and i go, "monica, you know, i think i want to be able to do a program that

provides me with peer support." then what happens? the majority of the individuals that i see are on the street that are still actively using or that may be in a recovery community or transitional living setting that may need additional support. such as? such as there's an individual who says, "i'm a recluse. i really don't get along with individuals. i'm kinda shy with going to the meetings. i don't really speak out, or i don't know how to engage an individual for that type of support." so what happens is, i would possibly link them with one of the peer recovery advocates, to say, "this person kinda has the same, similar story that you have, and they're going to help to work with you to get you engaged in services, to get you acclimated with meeting new people and getting you the support that you need that you're not able to reach out and obtain yourself, but to help to bridge the gap between isolation and

community involvement." so, that individual, you know, i would set up a meeting with that individual and the peer to be able to foster the initial connection and then allow the peer support coach or the peer mentor to be able to work independently with that individual to get them engaged, to be able to get them connected to whatever additional services they may need, to be able to continue to foster long-term recovery. and, tom, let's talk about timing here. at what point should one who has a substance use disorder problem or a mental health problem engage in a peer-to-peer support? is it before i go into treatment, is it during my treatment, or is it after i come out? yes. [laughs] there's never a bad time to engage somebody in the process. so, it could be while somebody's waiting for a treatment slot,

it could be to support their treatment experience, it could be a safe landing, like i said, after treatment, or it could be for the many folks who don't go to treatment. so, it's a whole range of times when it's appropriate for peer work, and i think that, you know, it's largely used as sort of stabilizing early recovery, but it's determined by how long people need it. and for folks who have long term recovery, sometimes they may need peer support but also giving that peer support is also a way to also bolster their recovery. michael. being able to engage a person at each one of those different levels is key to that process because everybody's-there's no cookie cutter approach to recovery. i may have some questions, you know, later in my treatment process, recovery process, that could have been answered early on, if i had had some kind of peer support prior to me getting at a certain situation in my life.

i think that engaging a person at inception, you know, is key. i think it'd be more beneficial to a person to be able to become feeling safe and comfortable around someone who is going through that same, particular process. yeah, and a specific example that came to mind when people were talking was the importance of having peers in, let's say, in a psychiatric emergency room, for example. i mean, what can often be a terrifying experience for someone who's already in emotional distress, that person can help them understand what's going to be happening, find out what they need, you know, inform them of their rights, all of these really important things that somebody would completely miss if, possibly, there wasn't a peer there to help out. that makes absolute sense. monica, let me go back to you and note that if in fact-and tom alluded to this-i still, i'm still using,

i can still go into a peer support program and say, for example, "you know, i'm still an active user, either alcohol, drugs, but i want to find out more about where i can get help." yes. what usually takes place is that if i encounter someone at one of the peer support centers that is seeking treatment, one of the things that i try to do is i kind of try to start the process at that moment, even if it's myself being the peer recovery support person to that individual, that they may not be initially ready to engage in treatment services, but letting them know that when you're available, when you're ready to be able to start the process, we call that the pre-contemplation or the contemplation phase of the stages of change. and what happens is to let them know that i remember when i wasn't ready for treatment, and people told me that this is what i needed or this is what i wanted, you know,

that they were there to support me when i was ready to engage in services. so, to let them know if they have some sort of contact information that i can call, they can call me or i can call them to say, "hey, look, you know. how are you doing? you know, what's going on with you?" you know, if they have any type of medical conditions, "have you been to the doctors lately? have you been taking your medication?" all of those kinds of things are part of the peer support process, to be able to let them know that not only do you need to recover from the drugs but there are medical issues that you need to recover from, as well. very good. tom, i'm going to ask the critical question. michael talked about medicaid, medicare, coverage of services for health. if i walk in to these peer-to-peer, am i going to have to pay you money? well, i think that depends on the state. i mean, all of that's changing with the affordable care act, so there's going to be opportunities for it to be reimbursed and paid for by

a variety of government and private payers because the landscape's changing. but i think for the most part, we've tried to build peer services so they're either very low cost or free. i always say it's not the country club set we're serving here; it's folks who really need it and often don't have health insurance yet , right now, or the money to pay for that. all that will change, but it's the accessibility and the affordability that really make peer services, i think, really engaging and really valuable. and, michael, if folks are referred from the court system, they're automatically covered and the units of care are taken care of? no that's, like tom says, it's case by case, you know, benefits have to be cut on. and one of the things is that, you know, i know guys that are transitioning that i deal with, you know, first thing they want to talk about is how i get my benefits cut on. this way, they can get some money in their pockets,

get to see the treatment people that they need to see on a continuum basis because, you know, really it's about continuity of care. you know, if we're getting services inside the walls, we need to be able to keep those things turned on and acclimated asap. and i want to come back and continue this conversation and touch on something that you just said. if i'm coming out of an institution, i may need housing services, so let's talk a little bit about that when we return. for more information on national recovery month, to find out how to get involved, or to locate an event near you, visit the recovery month web site at recoverymonth.gov. your path to recovery isn't like mine. you have your own struggles with mental health issues. your own challenges with substance use disorders.

you also have your own abilities and strengths. but when you need a hand- reach out, until you find one. for information on mental and substance use disorders, including prevention and treatment referral, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music] the services that are offered here at phoenix house, the next step program, include housing and case management. so, the housing piece has to do with the people that are living here, the clients, supporting each other, holding each other accountable in their recovery. the case management aspect has to do with all of those pieces of someone's life that helps them move towards independence. so, setting up recovery support services as they relate to

support groups, aa or na, sponsor, network, mental health, and medical needs, as well. next step's really, really good at tying you in with all the services that you need. being blind, i have to be sort of dependent on people, and it's a custom setting. i mean basically, they find out what you want, and then the counselors at next step write up a service plan and make sure that you get in contact with everybody you need, and it's really helped a lot. they helped me do my resume; they helped me find my housing. i've benefited a lot from it. it's, it's-they put me through school, they pay for all my schooling. i was in school, so they paid for all my schooling, all my books. you know, it's nice to know that there's someone you can go to, to say, "look, i need help with something. can you help me?" and then be able to help you. it's a big, big stepping-stone for me because i never was able to have people that would help me. now, people come to bat for me all the time, and that's awesome.

the phoenix house, the next step program, really does work. all the pieces that support recovery include employment, housing, benefits that you might need- sometimes people need food stamps. so, things that give you enough stable foundation that you don't find yourself, what we call, between a rock and a hard place, where you turn to your substance, and the peers are just a big part of that aspect. so, you have the clinical piece that happens, then somebody needs to break that down for them and say, "here's what this really means, and this is how you actually do this." the empathy that we have and understanding that we have with a peer can allow them to come up and out of situations that they normally couldn't. recovery doesn't start at 8 and end at 4:30, and for me, i'm a phone call away at any time. and for them to be able to pick up the phone and someone actually be there on the other end of it and help guide them through the process of recovery, it's instrumental to their recovery.

you can get advice, you can get anything that you need from a group of people like this 'cause they've all been through the same thing i've been through, and we're all here for one thing, and that's to get back on our feet and to move on. [knocking] i think the whole goal of the next step is to take someone who is struggling, when pretty much every aspect in their life, and get them back on their feet, get all their ducks in place, so to speak. and my job here is to be, basically, their assistant in getting that done. and that is such a rewarding feeling to know that somebody has done all of this, and i've helped them become more independent, and now they can really be supportive of themselves on their own, once they leave. they need to understand that i go through the same thing that they go through, and it's ok.