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An electronic circular of the Coalition's Center for Rehabilitation and Recovery
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No. 101-1 March 2014
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The Center for Rehabilitation and Recovery provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects. Parachute NYC: Dream, Deployment, Data For many mental health advocates, Parachute crisis respite centers—short-term refuges that help people in distress regroup—are a dream. Funded by the city through a federal grant, they follow several empowering recommendations from the Substance Abuse and Mental Health Services Administration, such as the principle that “recovery is supported by peers and allies.” In addition, as RECOVERe-works noted in Peer Support Services: The Next Game Changer in Behavioral Health, peer support services can reduce the rate of re-hospitalization, a major cost in the health care system. Respite care would also appear to have fewer iatrogenic complications—problems due to medical care—than hospitalization, as we mention in Post-Hospitalization Syndrome and Its Relevance to Peers. Now that Parachute NYC has been funded, we can hardly wait for outcomes data. Will this innovative program live up to its promise? Will managed care and other stakeholders make the less expensive, less restrictive respites (vs hospitals) the default option for crisis care? Will payors adopt a model that uses fewer professionals, and more paraprofessionals with lived experience? For a glimpse of the future, let’s listen to colleagues, and guests, who have pulled the ripcord. Perspectives on Crisis Respite Centers from Staff The Parachute Model Osman Mariano, MA, Director, Bronx Crisis Respite Center, Riverdale Mental Health Association What is a Parachute crisis respite center? A Parachute crisis respite center is a place where people can go when they need a break. When things become too stressful, the normal route is to go to the emergency room, or an inpatient facility with lock-down. There you don't go to school, or work, or have a social life. At a respite center, on the other hand, you can receive care, and still do these things. We work with people in crisis in a way that lets them remain integrated in the community, a way that is as least disruptive as possible. A second key feature of Parachute crisis respite centers is that they are peer-run. Our peer support staff has been through crises like those of the people they help. Our staff is in recovery, and can model successful recovery. In addition, our staff is trained in Intentional Peer Support. A third key feature is that we provide continuity of care. Guests work on a wellness plan that they can continue to use when they return to the community. And our mobile crisis team can support a former guest in the community for up to a year. Clearly there are a lot of advantages to the model. Are there any weaknesses? We have a three-year grant from the city which allowed us to open in October 2013. After that, we need to make sure we don’t run out of funding. Given how much money is saved with Parachute services—since a night in the hospital is about $1,000, vs about $230 in a crisis respite center—it seems that Medicaid, or other insurers, or health homes, or the state, would want to fund us. Almost all our guests are on Medicaid, and it would cost Medicaid about $17.6 million to provide Parachute NYC crisis respite centers and mobile crisis units for four boroughs. This would represent a three-fold savings of almost $52 million compared with treatment as usual. In short, once we are able to link up with a funder, not only would guests benefit from care tailored to their needs, but taxpayers would win, too. The challenge is hooking up with the funder for the future. Katie Linn, Program Director, Brooklyn Crisis Respite Center, Services for the UnderServed (SUS) The Parachute program in Brooklyn is sometimes called “the pilot within the pilot.” Why? We’re different from the other Parachute programs because we help people having a first break, or people within a year of experiencing mental health symptoms. We primarily work with people age 18 to 30, but collaborate closely with the New York City Children’s Center to help adolescents of 16 and 17. We think of symptoms as ways to communicate that something is happening, and we listen to them. We explore what the voices are saying, or why a guest feels so down. A more traditional center or hospital might focus on symptom management, and rely on medication, thus muting the symptoms and their messages. We are also supportive, and sensitive to trauma. We want to avoid re-traumatizing guests with a history of trauma. Will guests want to avoid going to hospitals after they go to a crisis respite center? I think our society is embedded in a culture of crisis, where people call 911 as a first resort. I hope we have planted the seed, and we’re the beginning of a cultural shift. However, the decision to use traditional avenues of coping with crisis rests not so much with our guests as with their families, providers, and policymakers. The Connection between Guest and Peer Counselor Dylan Zev, Respite Specialist, Brooklyn Crisis Respite Center, Services for the UnderServed How do peer staff help guests? The main way peer staff help guests is to identify with them, and share that identification with guests. That gives rise to hope. Guests think, “A person in a paid capacity has it together, and works, and socializes, even though they were once in my position.” The mere existence of a peer respite specialist means someone has been in similar circumstances, and is all right now. How do guests react to being helped by a peer, versus a non-peer professional? It varies by guest. For a lot of guests, it engenders greater trust. Also, peer staff are not working as professional experts—because a psychiatrist, for example, usually relates to a patient in a psychiatrist role, versus a peer role, or both roles. Therefore, there is mutuality between the peer and the peer respite specialist. There is more equality. National Empowerment Center executive director Daniel Fisher, MD, PhD, once told RECOVERe-works that recovery occurs through relationships. Is that what happens in a crisis respite center? Absolutely. Guests are in a relationship with a respite specialist who isn’t trying to fix them, but to learn. This enables guests to feel more in control, and to have hope that things don’t have to stay as they are, to believe that change is possible. How do you feel personally, as a peer respite specialist, when you help peers? It is empowering to be able to take the pain I’ve felt, and my experiences, and connect and support guests, rather than isolating them. It’s unusual to have these particular experiences add to my social value. The Future of Parachute Crisis Respite Centers Lauren D'Isselt, Director, Manhattan Respite Center, Community Access How does a crisis respite center staffed by peers fit the vision of Community Access? Community Access has for many years sought to create an alternative to hospitalization that would promote wellness and recovery in a non-restrictive environment, while avoiding the trauma often experienced by individuals being admitted to a psychiatric hospital. The agency has a longstanding organizational goal to employ at least 51% of staff who have lived experience within the mental health system. In fact, one of our stated values is that we believe that people with psychiatric issues should have a voice in promoting social justice and positive change within the mental health community. This is very aligned with who we are as an agency. Is there anything you would change about these centers to improve them? I think it is too early for me to say what could be improved about them, since, so far, feedback from guests has been overwhelmingly positive. We hope to expand our admission criteria to reach an even larger community going forward. Are these crisis respite centers the wave of the future? I believe so. It is not only a less expensive model, but more importantly, a very person-centered approach to recovery and wellness. As the landscape of insurance and healthcare changes, respites are going to emerge more as a cost-effective option. However, that is only part of the story; a respite center is a place where a person can connect with others who may have had similar experiences, and work through a crisis in a healing, and nurturing, environment that promotes personal growth, introspection, understanding, and wellness and recovery skills to move forward. How can staff—including peer staff—and administrators maintain both funding, and enthusiasm, for these centers? Enthusiasm is no problem. Every guest who comes through is unique, and this creates a dynamic environment with extraordinary possibilities for change, healing, and growth. We are at the mid-point of our grant funding, but we have many interested parties, including insurance and managed care companies, that see crisis respite centers as worthwhile, cost-effective endeavors that promote improved quality of care, better individual outcomes, and savings. Leslie Lusterman, LMSW, Associate Director, Residential Services, Queens Crisis Respite Center, Transitional Services for New York, Inc. You are right in the middle of opening a Parachute crisis respite center in Queens. What is the biggest challenge you have faced? To open our center in March, we had to convert a community residence center to a crisis respite center. That meant we had to find an appropriate place for all the residents. What are you finding easier than expected? The providers at the other three Parachute crisis respite centers are very welcoming, and share the information they’ve acquired in the months since they’ve opened. Our staff is really excited about this venture, and has been going to training What advice do you have for anyone else opening up a Parachute program? You have to embrace the concept of a hospital diversion plan with peers. If you don’t buy into that model, it won’t work. The Parachute Experience: Reflections from Guest A Comfortable and Personal Solution Karen S, Guest, Community Access What brought you to the Parachute program? I was in a downward spiral, and I had the ready-to-jump-off-the-roof feeling. My case manager recommended the program, and I wanted to go there, rather than to a hospital, because I thought it would give me more attention, and be more personal. It was a better environment for me because it was more comfortable. You could go to breakfast, and sit, and know there would be someone to talk to. You could just ease your way into talking about your problems, and not wonder when you would see anyone, the way you might in a hospital. I think if I had had more of an emergency, though, my case manager might have called 911. What did you like most about the Program? Life didn't stop altogether, the way it would have if I'd gone to the hospital. That's a big difference. I had things set up before I came to the program, like a doctor's appointment. I didn't have to reschedule it. I could also have my personal things, like my phone. I was glad the environment was more like a home, and I felt more like I was interacting in a family setting. In a hospital, you really feel like you are in a hospital. Also, if you don't participate in a group at the hospital, the staff holds it against you. At the Parachute program, the staff wants you to attend, but it's okay if you don't. If you don't attend the group, you'll just get help one-on-one. What did you like least? I needed an iron. That's all! The Antidote to Hospitalization Margaret Hearn, Guest, Community Access Can you tell me about your experience at the Parachute crisis respite center? It was a godsend. I needed a place to rest, and get myself together. Before I went to the center, I was at a hospital. My doctor helped me get voluntarily admitted to the hospital because I was overwhelmed, and not eating. However, even though I was a voluntary patient, I was in a locked unit. It was very institutionalized; we wore scrubs. I was traumatized. I applied to get out, and the psychiatrist did not appreciate that. What was the respite center like? There I was treated with dignity. I was responsible for taking my meds, and taking care of myself. I was encouraged to strengthen myself. The center was an exceptional communal experience, where you made connections, and contributed. Your contributions were valued. Also, I could visit my dying father when I was at the respite center, whereas you’re not allowed out in hospitals. I feel being in the hospital set me back, while being in a respite setting was therapeutic, and allowed me to regroup. Coalition Wiki and Trainings for Parachute Running a Parachute crisis respite center necessitates hiring peer staff, and integrating peer staff into an agency that is usually dominated by non-peer professionals. How can managers meet this challenge? To present complementary perspectives, and practical guidance, the Coalition for Behavioral Health Agencies is developing a wiki for members, available without a password at coalitionparachute. A wiki is an online collection of resources which people can collaboratively add to, create, and edit. On February 18, the Coalition hosted, “Creating an Inclusive Workplace: Strategies for Supporting Peer Integration,” to explain reasonable accommodation, hiring, supervision, termination, and other personnel issues as they relate to peers. Afterwards, presenters Susan Salazar, JD, attorney at the employment law firm of Raff and Becker (far left), and Janis Tondora, PsyD, assistant clinical professor in the Yale Department of Psychiatry (far right), joined training participants Oscar Dimant and Deborah Cumberbatch of Services for the UnderServed. This month, the Coalition is hosting a free follow-up workshop, “Developing Policies and Procedures for Employing Peers in the Workplace.” For the event, Susan Salazar, and Janis Tondora, who led our discussions in February, will return. They will discuss the development of policies and procedures related to the employment of peers in the workplace. Sample templates will be made available. Register online now to reserve your seat for this event on March 27 from 1:30 – 3:30 p.m. at the Coalition. If you have any questions around employing peers in your workplace, we would love to know about them before the meeting so we can include them in the discussion. Please send your questions to [email protected]. Visit the New York City Department of Health and Mental Hygiene’s basic Parachute page for answers to practical questions about the program, including eligibility, and the number for referrals (1-800-LIFENET, or 1-800-543-3638). Elsewhere you can find out about mobile crisis teams, and support lines, that can dovetail with the services of the centers. Another Parachute page summarizes the foundations of this innovative program in the seven key principles in the Need Adapted Treatment Model (NATM), and in Intentional Peer Support (IPS). Three links on this page can guide you to in-depth information. View videos by the DOHMH and Community Access. You may also contact the four Parachute NYC programs directly:
Note: The names of some individuals have been shortened or changed at their request. Opinions in this newsletter may not reflect the views of the Editor or the Coalition of Behavioral Health Agencies, Inc.
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