Enhancing Meaningful Enhancing Meaningful Consumer Participation Consumer Participation

A Panel Presentation by San Francisco A Panel Presentation by San Francisco CountyCounty

66thth Annual Integrated Services Conference Annual Integrated Services ConferenceApril 16, 2008April 16, 2008

Workshop PanelWorkshop Panel

• Alecia HopperAlecia Hopper: : MHA-SF Public Policy CoordinatorMHA-SF Public Policy Coordinator

• Maria Iyog-O’MalleyMaria Iyog-O’Malley: : SF County MHSA SF County MHSA CoordinatorCoordinator

• Sandi RobisonSandi Robison: : Administrative Dir, Pathways to Administrative Dir, Pathways to DiscoveryDiscovery

• Jeff SchoenfeldJeff Schoenfeld: : Program Dir, FSA Adult and TAY Program Dir, FSA Adult and TAY FSPsFSPs

• Michael WiseMichael Wise: : SF County MHSA Implementation SF County MHSA Implementation Specialist and Editor, Specialist and Editor, Transformation TimesTransformation Times

Overview of PresentationOverview of Presentation

• Overview of consumer employment in Overview of consumer employment in San Francisco’s mental health systemSan Francisco’s mental health system

• Administration perspectiveAdministration perspective

• Consumer perspectiveConsumer perspective

• Program perspectiveProgram perspective

Overview of Consumer Overview of Consumer EmploymentEmployment

• Peer Internship ProgramPeer Internship Program

• Leadership Track to Peer Internship Leadership Track to Peer Internship ProgramProgram

• Vocational Rehabilitation AgenciesVocational Rehabilitation Agencies

• Peer-run CentersPeer-run Centers

CBHS and MHA-SF CBHS and MHA-SF Partnership Partnership • To accomplish MHSA’s principle of wellness To accomplish MHSA’s principle of wellness

and recoveryand recovery• Provide meaningful employment for Provide meaningful employment for

consumersconsumers• Collaboration to hire and support six

consumer implementation specialists at CBHS• Draw from MHA-SF’s long history of consumer Draw from MHA-SF’s long history of consumer

advocacyadvocacy• Employer role (CBHS) and support role (MHA-

SF)

CBHS Administrator’s CBHS Administrator’s PerspectivePerspective• Prepare management for consumer Prepare management for consumer

supervisionsupervision• Offer a “buffet” of work focus areas:Offer a “buffet” of work focus areas:

– HomelessHomeless– Integration/primary careIntegration/primary care– Contracts/budgetsContracts/budgets– Community RelationsCommunity Relations– Community PlanningCommunity Planning– Youth/family focusYouth/family focus

• Consumers self-determine focus areasConsumers self-determine focus areas• Support System for Peer StaffSupport System for Peer Staff

MHA-SF Administrator’s MHA-SF Administrator’s PerspectivePerspective

Functions of MHA-SF in the PartnershipFunctions of MHA-SF in the Partnership• Provide support and training about MHSA vision• Weekly MHSA implementation specialist staff Weekly MHSA implementation specialist staff

meeting meeting • Monthly support group for specialists and other Monthly support group for specialists and other

CBHS consumer staffCBHS consumer staff• Train implementation specialists and city Train implementation specialists and city

contractors on MHSA vision /requirements of contractors on MHSA vision /requirements of the MHSA and on how working affects benefits the MHSA and on how working affects benefits

MHA-SF Administrator’s MHA-SF Administrator’s PerspectivePerspectiveSuccessesSuccesses• Meaningful participation of consumers from

the inside• MHSA Implementation Newsletter

ChallengesChallenges• Balancing support needs and ensuring

needed results• Ensuring understanding of MHSA and

county policies to support participation slide slide

Consumer PerspectiveConsumer Perspective

Michael WiseMichael Wise

Consumer PerspectiveConsumer Perspective

Sandra RobisonSandra Robison

• Director of Pathways to DiscoveryDirector of Pathways to Discovery

• Working Consumers Support GroupWorking Consumers Support Group

• Next steps – Back to schoolNext steps – Back to school

Program PerspectiveProgram Perspective

Jeff SchoenfeldJeff Schoenfeld

Peers in the Work PlacePeers in the Work Place• Empowerment/Motivation for RecoveryEmpowerment/Motivation for Recovery

• Participating in the system that assisted themParticipating in the system that assisted them

• Peers tend to develop relationships with our clients faster Peers tend to develop relationships with our clients faster and more naturally then other staffand more naturally then other staff

• Peers remind the rest of the staff group of the amazing Peers remind the rest of the staff group of the amazing potential that our clients’ possesspotential that our clients’ possess

• Peer involvement expands the cultural parameters of the Peer involvement expands the cultural parameters of the program. Peers bring an “insiders” perspective and program. Peers bring an “insiders” perspective and sensitivities to their advocacy work done on the clients sensitivities to their advocacy work done on the clients behalf.behalf.

• Peers as Pioneers: breaking new ground, being a leader in Peers as Pioneers: breaking new ground, being a leader in their fieldtheir field

Challenges to Integrating Peers Challenges to Integrating Peers into the Work Placeinto the Work Place

Work ReadinessWork Readinessa) Levels of Educationa) Levels of Educationb) Levels of Experienceb) Levels of Experiencec) Ability to Communicatec) Ability to Communicate

computer skillscomputer skillsability to put actions into wordsability to put actions into words(written and verbal)(written and verbal)documentationdocumentation

Challenges: RelapseChallenges: Relapse

Mental Health IssuesMental Health IssuesDifficulties have included:Difficulties have included:a) difficulty getting out of bed in the a) difficulty getting out of bed in the

morningmorningb) paranoia around certain clients or b) paranoia around certain clients or

concerns for safety in the concerns for safety in the communitycommunity

c) difficulty concentration/completing c) difficulty concentration/completing documentation of their workdocumentation of their work

Challenges: RelapseChallenges: Relapse

Substance Abuse IssuesSubstance Abuse IssuesDifficulties have been:Difficulties have been:a) using to cope with feelings of inadequacya) using to cope with feelings of inadequacyb) using due to triggers of clients’ usageb) using due to triggers of clients’ usagec) using due to feeling isolated within the c) using due to feeling isolated within the

staff groupstaff groupd) using causing strained relationships with d) using causing strained relationships with

clients clients and other staff and other staff e) using causing difficulties concentrating e) using causing difficulties concentrating

and and completing documentation of completing documentation of workwork

Challenges: Peers as Challenges: Peers as PioneersPioneersLack of RespectLack of Respect

a) hotel staff and RCF staffa) hotel staff and RCF staff

b) collateral workersb) collateral workers

who may be unclear who Peer iswho may be unclear who Peer is

c) own staff groupc) own staff group

either intentionally or either intentionally or unintentionallyunintentionally

d) at times it can feel like there is a lack d) at times it can feel like there is a lack of respect of respect

coming from everyone except the coming from everyone except the clientclient

Other ChallengesOther Challenges

Challenges not related to RelapseChallenges not related to Relapse

1) Boundary issues1) Boundary issues

Understanding one’s role, Understanding one’s role, including the including the limits of that rolelimits of that role

2) Reverting back to “street 2) Reverting back to “street behaviors”behaviors”

as a short cut to engaging with as a short cut to engaging with clientsclients

Strategies to Cope with Strategies to Cope with ChallengesChallenges

Basic Skills TrainingBasic Skills Training

a) mental health 101a) mental health 101

b) substance abuse 101b) substance abuse 101

c) basic computer skillsc) basic computer skills

d) basic writing skillsd) basic writing skills

e) basic problem solving skillse) basic problem solving skills

Strategies (continued)Strategies (continued)

Relapse PreventionRelapse Prevention

a) Work hard to develop trusting a) Work hard to develop trusting relationships between Supervisor and Peerrelationships between Supervisor and Peer

b) Understanding that Relapse is part of b) Understanding that Relapse is part of Recovery, have a plan in place Recovery, have a plan in place

c) Allowing for staff to have recovery timec) Allowing for staff to have recovery time

without the fear of losing their jobwithout the fear of losing their job

Strategies (continued)Strategies (continued)

Relapse Prevention (continued)Relapse Prevention (continued)

d) Bring back the staff person in a mindful d) Bring back the staff person in a mindful way. way.

There may be some fence mending that There may be some fence mending that needs to be needs to be done with staff and clients done with staff and clients around issues that may around issues that may have surfaced when have surfaced when staff was using.staff was using.

e) Peer Support groupe) Peer Support group

f) Quality Supervisionf) Quality Supervision

Lessons LearnedLessons Learned

• System need to be prepared to supervise System need to be prepared to supervise consumers / Not enough support for working consumers / Not enough support for working consumersconsumers

• Relapse / CopingRelapse / Coping

• Use of EAP in addition to other resources to Use of EAP in addition to other resources to cope with stressors in work environment cope with stressors in work environment

• Trainings for consumers applying for county Trainings for consumers applying for county jobsjobs

Lessons LearnedLessons Learned

• Work to clarify role of consumersWork to clarify role of consumers– Invited to meetings but not equal participation Invited to meetings but not equal participation – Alphabet soup in meetingsAlphabet soup in meetings– Feel like guests at the tableFeel like guests at the table

• Benefit of County and Advocacy agency partnership

• Successful model of consumer involvement in county mental health system

Future DirectionsFuture Directions

• Integrated support systemsIntegrated support systems

• Full time Consumer Employment Full time Consumer Employment ManagerManager

• WRAP program for CBHS working WRAP program for CBHS working consumersconsumers

• Roving support group / job coachRoving support group / job coach

• Clarify use of reasonable Clarify use of reasonable accommodationsaccommodations

Future DirectionsFuture Directions

• Continued consumer participation in Continued consumer participation in MHSA as other components roll outMHSA as other components roll out

• WET and PEI trainingsWET and PEI trainings• Upcoming RFP for all behavioral health Upcoming RFP for all behavioral health

services – incorporates MHSA principlesservices – incorporates MHSA principles• Expanding the number of Expanding the number of

implementation specialistsimplementation specialists• Revisions to the peer internship programRevisions to the peer internship program