Peer-to-Peer Support

							Effective Strategies for Providing Family-to-Family Peer Support within Systems of Care

Presented at the 2008 Training Institutes, Nashville, TN, July 16-20

Partners
National Federation for Children’s Mental Health Elaine Slaton & Kameisha Bennett Cuyahoga (Ohio) Tapestry System of Care Teresa King & Chris Stormann Kentucky Partnership for Families and Children Bill Hobstetter & Vestena Robbins Impact Family Advocacy Project Association for Children’s Mental Health (Michigan) Malisa Pearson & Amy Winans One Community Partnership (Florida) Maria Delmoro, Beverly Wilkinson & Norín Dollard Nebraska Family Support Network Eve Bleyhl & Connie Hammitt Families Together in Albany County LuAnn McCormick & Brooke Schewe Advocacy Services for Kids (ASK) Geisela Lawson, Dianne Shaffer & Carolyn Sullins

Acknowledgements
Special thanks to Barbara Friesen, Eric Bruns, Al Duchnowski, Krista Kutasch, Brigitte Manteuffel, Kimberly Hoagwood, and Gary Blau

This work is funded in part by the Substance Abuse and Mental Health Services Administration’s Center for Mental Health Services, the National Federation of Families for Children’s Mental Health and Macro International, Inc.

AGENDA
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Research Highlights  Discussion about outcomes Parent Partner Program Models  Matrix and Community examples  Discussion/Implementation Drivers Training Tools
 

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Completing a Parent Partner Support Plan (PPSP) Training Tools – Parent Advocate Activity Form-Administrative (PAAF-A) Training Tools – Parent Coach Activity Form-Outcomes (PCAF-O)

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Closing Questions & Evaluation

Parent to Parent Support Literature
What can we learn from the literature base on parent to parent support?

Review of the Literature on Parent to Parent Support
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Purpose
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Examine evidence of the effectiveness of Parent to Parent Support Examine key elements to consider when designing a program
Search engines: PsycINFO, ERIC, OVID Published during or after 1990 Key terms: social support groups, mental health, parent to parent support group, parent, and children

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Method
  

Review of the Literature on Parent to Parent Support
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Results
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10,000 articles were narrowed to 5000 reviewed for inclusion 31 met criteria Categories: Topical discussion, descriptive, qualitative, quasiexperimental, random control design Sub-categories: Mental health, disability or chronic illness, general parenting

State of the Research
 Few published studies examining peer to peer support in the context of families of children with serious emotional disabilities
 Family Associate Approach (Elliott, Koroloff, Koren, & Friesen, 1998)  Parent Connections (Ireys & Sakwa, 2006)  Keys for Networking (Adams et al., 2006)

State of the Research
 Studies of peer support are more abundant in other areas
 Adults with serious mental illness  Chronic illness  Veteran support

 Growing base of literature on Family Support  Not always peer delivered support

Literature Highlights Definitions
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

26 of 31 articles reviewed defined parent to parent support General definition of parent to parent support:

“parents coping with children with a variety of problems (e.g., mental health and chronic illness) and parents who have shared a similar experience and can offer support in various forms.”

Literature Highlights Types of Peer Support
 Emotional Support  Instrumental Support  Informational Support  Affirmational/appraisal

Literature Highlights Concepts and Theories
 Social Support  “Weak Ties”  Emotional Reactions to Offers of Help

Literature Highlights Concepts and Theories
 Social Comparison Theory  Empowerment  Experiential Knowledge

Literature Highlights Concepts and Theories
 Theory of Reciprocity  Social Learning Theory  Contrived versus Natural Supports

Key Findings/Results
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

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Much has been written but few rigorous evaluation studies exist There is little consistency in definition, key elements, or outcomes Of the 9 rigorous studies only 3 focused on mental health

Key Findings/Results


Results are encouraging
Parent to parent support is valued by parents  Improves emotional functioning of parents  Increases empowerment  Supports service initiation


Key Findings/Results
Parent Connections
(Ireys & Sakwa, 2006)

• Perceived Availability of Social Support • Maternal Mental Health

Key Findings/Results
Family Associate Approach
(Elliott, Koroloff, Koren, & Friesen, 1998)

•Service Initiation

•Empowerment
•Reducing Barriers to Service Initiation •Barriers to Continuing Services

Key Findings/Results - continued
Keys for Networking
(Adams et al., 2006)

• Movement of parents toward family and system advocacy along a 10 point continuum (TPA)

Literature Highlights Identified Gaps
 Few studies specific to families of youth with SED
 What can we learn from other areas of study? How do we increase studies with our population?

 Matching peers is viewed as important but little guidance offered
 What strategies can we use to ensure that providers of peer support are “matched” with the recipient?

Literature Highlights Identified Gaps
 Person-Environment Fit
 How do we know what type, amount and length of support is needed/desired?  What are the outcomes of  Individual vs Group?  Community/neighborhood based?  Partnering with care coordinators?

Literature Highlights Identified Gaps
 Sustainability
 What organizational, structural, and financial mechanisms support sustainability of peer support services?  What is the growth model for family supports and cross-system collaboration with agencies outside of mental health (e.g. juvenile justice, child welfare, drug and alcohol, jobs and family services).

Discussion – Family Outcomes
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  

Effectively communicates needs & wants Comfortable to disagree with team members Knowledge of child serving agencies involved with Knowledge of parental role in treatment process

Discussion - Family Outcomes (continued)
 Actively engaged with service providers  Independently attends team meetings  Linked to family support sources within community  Knowledge of services & supports available to family  Increased satisfaction with services  Reduced caregiver stress

Implementation Drivers
PARTICIPANT EVALUATION
CONSULTATION, COACHING, & MENTORING

DATA TO SUPPORT DECISION MAKING

INTEGRATED & COMPENSATORY
ADMINISTRATIVE SUPPORTS

PREPARATION & TRAINING

PARTICIPANT RECRUITMENT & SELECTION

SYSTEMS INTERVENTIONS

National Implementation Research Network at the Louis de la Parte Florida Mental Health Institute

Discussion


What are the administrative structures supportive of family-to-family peer support
   

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Part-time vs. Full-time Geographic factors Rural vs. Urban Internal vs. External „contract‟ employees Supervisor “Allies” within home agency Medicaid Child Care Fund

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Financing mechanisms
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Discussion System & Agency Outcomes
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Collaboration amongst parent partners and child serving agencies Integration of family driven & youth guided practices within child serving agencies Shared power with families Increased family involvement in individual treatment, system planning, service implementation, and evaluation of child serving systems

Discussion - Sustainability




Equitable, sustainable funds allocated to support family-to-family peer support programs Equitable, sustainable funds to support ongoing training, development, and evaluation of family-to-family peer support programs

Critical Elements Matrix
 Purpose

Identify common elements of peer-to-peer support models  Establish core model for assessment
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 Current
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Status

Completed recently, on PPAW group site, looking forward to dialogue on matrix today and via listserv in the future

Critical Elements
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Titles Hiring Agency, Location, Funding Training, Supervision, Certification Outcomes and Measurement Tools Additional Tasks*

*Parent Partner Core Tasks


May 2008, members of the PPAW agreed upon the following list as the common core tasks of a Parent Partner providing peer-to-peer support:
     

Provide information Support and advocacy Help navigate the system(s) Empower the family member Help family member understand option and make informed decisions Promote productive partnerships between parents and professionals.

Site Presentations


Families Together in Albany County (NY)


Brooke Schewe & LuAnn McCormick
Eve Bleyhl Geisela Lawson, Dianne Shaffer, Carolyn Sullins

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Nebraska Family Support Network


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Advocacy Services for Kids – Kalamazoo


Families Together in Albany County in Partnership with Albany County Department for Children, Youth and Families

Portals of Entry / Parent Partner Locations

Albany Co. Children‟s Mental Health Clinic Parent Partners: 1 present at every intake Colonie FRC (Suburban) Parent Partners: 3.5 FTE Albany FRC (Urban) Parent Partners: 4 FTE

FAMILIES & YOUTH

Hilltown FRC (Rural) Parent Partners: 2 FTE

Albany Co. Single Point of Access (for highest-needs youth) Parent Partner: 1 present at every intake

Families United Network FRC (attached to residential program/facility) Parent Partners: 3.5 FTE

Families Together in Albany County in Partnership with Albany County Department for Children, Youth and Families
Parent Partners are the CARE COORDINATORS for the system of care offering: Parent Partners are family members of children or youth with social, emotional or behavioral concerns representative of his/her community. One-on-One Support & Advocacy Information and Referral Parent Support Group Facilitation Assistance & Education in Navigating Systems Help in Acquiring Services Wraparound Facilitation Parent and Youth Trainings Coordination & Facilitation
Mission: Families Together in Albany County represents a system of care designed to significantly improve coordination of, access to, and effectiveness of services for children and youth with serious emotional disturbance who may also have behavioral concerns. The system of care will enhance community-based, culturally competent, and family-driven services to support and empower children and youth and their families. Core Values: Family Driven, Youth Guided, Community-Based, Strength-Based, Culturally and Linguistically Competent.

A Private Non-Profit agency, empowering families raising children with mood, behavior and emotional disorders, by providing support, training and advocacy skills, and collaborating with community partners to improve the system of care for children.
Family Support Partners are embedded in the following sites
EDUCATION Portage Community High School & Valley Center AVOCACY SERVICES FOR KIDS Telephone intake MENTAL HEALTH Kalamazoo Community Mental Health & Substance Abuse Services

JUVENILE JUSTICE 9th Circuit Court

CHILD WELFARE Goodwill Industries

Lessons learned • Administrative supports (Logistics): placing people in different agencies is difficult. It takes lots of meetings and collaboration. We deal with the following issues while at the sites: no internet, no office space, too much down time

• System Interventions (Outcomes): Unable to measure individual youth outcomes, so it is a challenge to come up with what would entice Juvenile Justice to pay for a Family Support Plan in their facilities
• Data to Support Decision Making (Effectiveness): Demonstrating how the model would be beneficial. ASK currently provides funding. How do we entice the other community partners to provide the funding and structure for a FSP in their facilities

The Nebraska Family Support Network (NFSN) • Founded in 1991 as a statewide advocacy organization to provide support and services to families with children with mental illness/behavioral disorders.

• Support / help to understand court documents/achieve case plan requirements Supportive presence at family team meetings, IEP meetings…
A bridging presence between families and care coordinators/case managers Identifying needs / making referrals to community resources/service providers Attend AA and/or other support groups to help with initial comfort level Assistance in securing housing, furniture, clothing, food, medication, paying utility bills, etc. Support in creating a budget, keeping track of appointments, seeking employment… Providing a nonjudgmental “ear” for families to share concerns and challenges Support groups and educational opportunities for parents and youth

In early 2007 NFSN lost our funding and we nearly closed our doors.

One year later we are back in a big way! 
Following are lessons learned from this challenging time.

• Professional provider and public service realms can be dismissive of Family Organizations/Peer Mentoring programs as providing informal (perceived as fluff) services. • It is not enough to just be awesome advocates for families. Family Organizations have to be highly accountable, highly transparent, collaborative, knowledgeable, and professional in all interactions. • Comprehensive Data Collection is essential for accurately reflecting the scope of NFSN‟s impact and outcomes. • NFSN staff have to assertively, yet collaboratively, claim our place at the table to ensure our families have a voice.

• It is imperative for NFSN staff to understand and have conviction regarding our role in the system of service for children‟s behavioral health.

Discussion
Recruitment and Selection Preparation and Training Consultation, Coaching, & Mentoring Participant Evaluation Data to Support Decision Making Administrative Supports that Facilitate Implementation Systems Intervention
Participant

Impact Family Advocacy Support Program
• Association for Children’s Mental Health – Statewide Family Network for Michigan • Impact Lead Family Contact and 3 part-time Impact Family Advocates • Contracted providers of peer support, advocacy, education, and information & referral, and family involvement throughout the Ingham County system of care

• Purpose:
– – – – – – Directs Family Support work Reinforces Family Driven goals and strategies Focuses time, resources, and intensity Supervision tool Outcome monitoring tool Integrate into Wraparound plans
• Role clarification • Mutual Responsibility

Case Example
• Review the Family Scenario • Identify:
– – – – – Family make-up Housing status Safety concerns Legal status Ability to access resources adequate to meet needs

• Family Advocate Support Plan
– Relationship with service providers
• Better communication • Ability to self-advocate

– Appropriate services at school
• Ability to self-advocate • Increased skills to resolve concerns

– Increased confidence in parenting child with SED
• Less stress • Connected, not feeling alone

Impact Family Advocacy Support Plans
• Process
– 1st home visit orients family to Impact, ACMH, and Impact Family Advocacy Support Program. Family tells their story and Family Advocate listens for concerns, prior experiences, and asks clarifying questions. – 2nd home visit explores in detail with the family how they have experienced services in the past and what need areas they identify as most important to be addressed. – 3rd home visit dialogues with family about possible strategies the Family Advocate can support them in to address the need areas identified. The family and the Family Advocate co-create their plan. – The Impact Family Advocate Support Plan is then integrated into the Wraparound Plan

• Things to Keep in Mind:
– Need areas must fit within the role of the Impact Family Advocate – Family Driven – Shared responsibility – Skill Development oriented – Sustainable change

Interactive Case Example
• Review the Family Scenario • Identify:
– – – – – Family makeup Housing status Safety concerns Legal status Ability to access resources adequate to meet family needs

Exercise
• Based on the information provided, identify the following:
– 2-3 possible needs the family may have – Possible strategies/activities the Family Advocate could assist the family with to address their needs

Cuyahoga Tapestry System of Care (Cleveland, Ohio)

Parent Coach Activity Form (PCAF-O)
Page 1 Page 2
Page 2 Section 1

Section 1 Page 2, Section 2

Section 2

Section 3

PCAF-O Section 1
Aisha Muhammad Hough Alissa Young 08/12/2007 n/a June 2008 Jane Smith 44105 John Smith 8888

Required Fields for Section 1: • PC Name (first and last) • Report Month/Year • Collab Name • Caregiver Name (first and last)

Fields to be filled when known: • Date Open (PC’s 1st face-to-face) • Date Closed (if this month) • Youth Synthesis ID
KSU will provide a report back to the PC’s each month that will include the names, zip codes and Synthesis ID’s of youth in their previous month’s caseload. This information can be used to complete the next month’s form, if applicable.

• Care Manager Name (first and last)
• Caregiver Zip Code • Youth Name (first and last)

PCAF-O Section 2

2/02/08 2/10/08 2/18/08 2/20/08 2/22/08

120 15 90 30 45

FT2 SG2 SA2 FC3 LEG1

TR1

JJ1

Add detail information on page 2, referencing the line# for this meeting

PCAF-O Page 2

8888, Smith

5

Left message for an attorney at the public defender’s office regarding youth’s pending case. Received fax of paperwork from attorney to send to parent for upcoming appointment with legal aid.

PCAF-O Section 3

Witnessed vast improvements in the youth’s attitude toward his family and improvements in his behavior at school. All are happy with new IEP placement.

Parent Coach Activity Database

Parent Coach Most Frequent Services (April – May 2008)
Total Families Served: 28
18 16 14 12 10 8 6 4 2 0

Meetings Attended by Parent Coaches (April-May 2008)
Other Court Meeting 1% 3% Welcome Meeting 9% School Meeting 5% Telephone 9% Home Visit 42% Therapy Meeting 9%

Family Team Meeting 21%

Medical Meeting 1%

Average Duration of Meetings in Minutes
(April – May 2008)
160
140 120 100 80 60 40 20 0 Court Family Team Meeting Meeting Home Visit Medical Telephone School Welcome Therapy Meeting Meeting Meeting Meeting Other

April May

May 2008 Meeting Attendees

Informal 10%
Formal 23%

Core 67%

Care Manager Participation in Family Team Meetings with Parent Advocates Full-time Care Managers April 2007 (N=149)

No. Meetings Attended w/ Parent Advocate

25 20

15 10

5 0
00 3p 00 5d 01 5r 01 6p 00 8d *0 01 p 01 2p 00 2d 01 3p 00 6e 01 0r *0 04 d 01 1e 00 9e 01 7r 01 8e 0 PE 23p PC PE onn PC on n
Care Manager Code Number Care Manager Participation in Family Team Meetings with Parent Advocates

Parent Advocate Reported Participation with Care Managers in Family Team Meetings December 06 - April 07 (N=471)

160 140
Number of Meetings

149

120 100 80 60 40 20 0 Dec'06 Jan'07 Feb'07 Month Mar'07 Apr'07 57 78 91 96

Page 1

PAAF-A

Page 2

Section 1 Section 2 Page 2, Section 1

Section 3

Section 4

Page 2, Section 2

Section 5

PAAF-A

Page 1, Sections 1 & 2

Ebony Young Murtis H. Taylor

February 2008

Family Empowerment

n/a

Mediation
02/12/08 90

Working together as a family unit

02/08/08 120 JFK High School Tamekah Jones 41

Murtis Taylor John Smith 22

PAAF-A

Page 1, Sections 3, 5 & 5

2 4 2

2 2

   


  2
The friend of a family came to see what Support Group is like, no agency yet.



3 2

PAAF-A

Page 2, Section 1

Susan Linus Jack Shephard Eva Gutierrez

Ben Linus Aaron Shephard Hugo Saez Gutierrez

John Locke Mary Murphy Maria Sanchez

2/2/08 2/12/08 2/2/08

Charles Austen

Kate Austen

John Locke

Renee Richardson

2/14/08

Family & youth need a lot of assistance with school and educational issues.

PAAF-A
Youth Empowerment Tapestry Program Overview 04-09-2008 30 min CCN

Page 2, Section2

n/a 12

Parent Advocate Activity – Administrative Version Database

PAAF-A

Summary Data

Total-to-Date (April and May) 12 16 6 25 1 1 2 5 5 11

PA's Reporting in May Parent Coach Referrals Made Families Seen in Office Support Group Attendees Applewood Bellefaire/Village Network Catholic Charities Community Wrap PEP Other (Community Residents) Support Group Topics Healthy Relationships Signs of Mental Health Stress & Coping Skills Summer Camp Support Group Duration (ave) Community Presentations Presentations Attended Presentations Facilitated Presentations Facilitated & Attended Ave # Persons in Attendance

2 2 2 2 115.5 27 10 13 4 27

Contact us
Florida, Broward County Maria Delmoro medelmoro@bellsouth.net Norín Dollard dollard@fmhi.usf.edu Beverly Wilkinson Beverly@mhabroward.org Kentucky Bill Hobstetter Bill.kpfc@fuse.net Vestena Robbins Vestena.robbins@ky.gov Michigan Malisa Pearson acmhmalisa@aol.com Amy Winans ajwinans@aol.com

Albany, New York LuAnn McCormick lmccormick@uamail.albany.edu Brooke Schewe bschewe@ftnys.org
Ohio Teresa King tking@cuyahogacounty.us Chris Stormann cstorman@kent,edu Fédération of Families Elaine Slaton Eslaton@ffcmh.org Kameisha Bennet KBennett@ffcmh.org

Nebraska Eve Bleyhl ebleyl@nefamilysupport.org Connie Hammitt cbhammitt@yahoo.com
Kalamazoo, Michigan Dianne Shaffer diannes@askforkids.org Carolyn Sullins carolyn.sullins@wmich.edu Gisela Lawson giselal@askforkids.org