Enhancing Meaningful Consumer Participation

1. Enhancing Meaningful Consumer Participation A Panel Presentation by San Francisco County 6th Annual Integrated Services Conference April 16, 2008

2. Workshop Panel • Alecia Hopper: MHA-SF Public Policy Coordinator • Maria Iyog-O’Malley: SF County MHSA Coordinator • Sandi Robison: Administrative Dir, Pathways to Discovery • Jeff Schoenfeld: Program Dir, FSA Adult and TAY FSPs • Michael Wise: SF County MHSA Implementation Specialist and Editor, Transformation Times

3. Overview of Presentation • Overview of consumer employment in San Francisco’s mental health system • Administration perspective • Consumer perspective • Program perspective

4. Overview of Consumer Employment • Peer Internship Program • Leadership Track to Peer Internship Program • Vocational Rehabilitation Agencies • Peer-run Centers

5. CBHS and MHA-SF Partnership • To accomplish MHSA’s principle of wellness and recovery • Provide meaningful employment for consumers • Collaboration to hire and support six consumer implementation specialists at CBHS • Draw from MHA-SF’s long history of consumer advocacy • Employer role (CBHS) and support role (MHA-SF)

6. CBHS Administrator’s Perspective • Prepare management for consumer supervision • Offer a “buffet” of work focus areas: • Homeless • Integration/primary care • Contracts/budgets • Community Relations • Community Planning • Youth/family focus • Consumers self-determine focus areas • Support System for Peer Staff

7. MHA-SF Administrator’s Perspective Functions of MHA-SF in the Partnership • Provide support and training about MHSA vision • Weekly MHSA implementation specialist staff meeting • Monthly support group for specialists and other CBHS consumer staff • Train implementation specialists and city contractors on MHSA vision /requirements of the MHSA and on how working affects benefits

8. MHA-SF Administrator’s Perspective Successes • Meaningful participation of consumers from the inside • MHSA Implementation Newsletter Challenges • Balancing support needs and ensuring needed results • Ensuring understanding of MHSA and county policies to support participation slide

9. Consumer Perspective Michael Wise

10. Consumer Perspective Sandra Robison • Director of Pathways to Discovery • Working Consumers Support Group • Next steps – Back to school

11. Program Perspective Jeff Schoenfeld

12. Peers in the Work Place • Empowerment/Motivation for Recovery • Participating in the system that assisted them • Peers tend to develop relationships with our clients faster and more naturally then other staff • Peers remind the rest of the staff group of the amazing potential that our clients’ possess • Peer involvement expands the cultural parameters of the program. Peers bring an “insiders” perspective and sensitivities to their advocacy work done on the clients behalf. • Peers as Pioneers: breaking new ground, being a leader in their field

13. Challenges to Integrating Peers into the Work Place Work Readiness a) Levels of Education b) Levels of Experience c) Ability to Communicate computer skills ability to put actions into words (written and verbal) documentation

14. Challenges: Relapse Mental Health Issues Difficulties have included: a) difficulty getting out of bed in the morning b) paranoia around certain clients or concerns for safety in the community c) difficulty concentration/completing documentation of their work

15. Challenges: Relapse Substance Abuse Issues Difficulties have been: a) using to cope with feelings of inadequacy b) using due to triggers of clients’ usage c) using due to feeling isolated within the staff group d) using causing strained relationships with clients and other staff e) using causing difficulties concentrating and completing documentation of work

16. Challenges: Peers as Pioneers • Lack of Respect a) hotel staff and RCF staff b) collateral workers who may be unclear who Peer is c) own staff group either intentionally or unintentionally d) at times it can feel like there is a lack of respect coming from everyone except the client

17. Other Challenges Challenges not related to Relapse 1) Boundary issues Understanding one’s role, including the limits of that role 2) Reverting back to “street behaviors” as a short cut to engaging with clients

18. Strategies to Cope with Challenges • Basic Skills Training • a) mental health 101 • b) substance abuse 101 • c) basic computer skills • d) basic writing skills • e) basic problem solving skills

19. Strategies (continued) Relapse Prevention a) Work hard to develop trusting relationships between Supervisor and Peer b) Understanding that Relapse is part of Recovery, have a plan in place c) Allowing for staff to have recovery time without the fear of losing their job

20. Strategies (continued) Relapse Prevention (continued) d) Bring back the staff person in a mindful way. There may be some fence mending that needs to be done with staff and clients around issues that may have surfaced when staff was using. e) Peer Support group f) Quality Supervision

21. Lessons Learned • System need to be prepared to supervise consumers / Not enough support for working consumers • Relapse / Coping • Use of EAP in addition to other resources to cope with stressors in work environment • Trainings for consumers applying for county jobs

22. Lessons Learned • Work to clarify role of consumers • Invited to meetings but not equal participation • Alphabet soup in meetings • Feel like guests at the table • Benefit of County and Advocacy agency partnership • Successful model of consumer involvement in county mental health system

23. Future Directions • Integrated support systems • Full time Consumer Employment Manager • WRAP program for CBHS working consumers • Roving support group / job coach • Clarify use of reasonable accommodations

24. Future Directions • Continued consumer participation in MHSA as other components roll out • WET and PEI trainings • Upcoming RFP for all behavioral health services – incorporates MHSA principles • Expanding the number of implementation specialists • Revisions to the peer internship program