florence

I wonder at the bravery of people in North Carolina who are standing down and not leaving in their voluntary evacuation. 1.5 million people? How the hell? What the hell?

Are we planning on building ocean deep brakers to cut incoming water surges? Imagine the number of lives saved. Property saved.

They’re saying power will be lost for “weeks” and the Mayor of the small town being hit the hardest has an attitude of “get out now and don’t blame me if you…”  I’ve friends on both poles who say, “yeah, right, go dude!” and then Quakerlike peeps who cringe at the assumption of bad will.

Hurricane Florence.

I had originally set out to write a brilliantly woven story or blog about the storm, set in particular people’s lives and how it manifests into multivarious outcomes and climaxes and sad points, if any at all, but here I sit with a fever from the Flu.

And yet, even so, I wonder now about my mortality. Am I dying? At this age. My age.

I have had a good life but a short one. A mere half century and some change. I have yet to walk Machu Picchu and the Great Wall (my mother’s unmet goal), and I’d like to see either the South or North Pole. Leningrad, Moscow, Poland. Train in during winter. See it like Jack Reed and Louise Bryant did before Lenin in ’17.

I want to revisit Bourdeaux where my parents and Florence (my sister) was born in 1960. Visit Alcocer with the thick white walls and cold interior lit by only the wood burning firepits they cook on there. See Toledo and have picnics in the foothills with the cactus and the pine trees and it smells like cedar. Wake up only with light beside Beloved and walk fifty feet for hot crispy oily sweet churro’s to dip and eat with cafe con leche.

I have yet to scale up the webbed care network and health home that is replicable.

I’m too young to die yet. My woman to love. My woman to love me.

Were my sister Florence actually sitting here with me she would be languid and assured, smiling as she cradles a cup of coffee and I would be touched.

 

 

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calm down

When my mother was dying from cancer in 2008, my dad told me that there were 22 others living on Trailwood Avenue who were positive for some type of cancer concurrently. “There’s a lawsuit,” I told my dad. We were driving and it was warm outside and the air smells like Central California does in the Fall. Fog, basically.  There is no mystery that most probably embedded land subdivisions were watered by wells driven by the local growers and irrigation seepage will occur. Their water is screwed, no less. Now more than ever with the heat that will not stop and wells are drying. People are stealing their neighbor’s water in California.

My mother died in ’08 and my only sibling died from cancer at 53 years old in ’12 (also in November).

And so at my age, I have superseded the mortality for both, my biofamily and that of the <25 year early morbidity for people living with an SPMI who have received continuous US Community Public Mental Health services for at least 25 -30 years.

Which is worse? Cancer or the US Public Community Mental Health System? I’m laughing because I’m really not joking.

This writing’s intent is to at least touch upon the notion of how disease, chronic illnesses and malhealth – when not self-managed or self-cared for – will manifest physically and you will die sooner than later, probably.

Things to practice then:

  • Mindfulness.
  • Intentionality.
  • Carefully discerning that which takes your concern(s).
  • Be Kind to yourself and to others.
  • Love.
  • Be loved.
  • Adore.
  • Be adored.
  • Get that energy of others that is hurtful away from you.
  • Work your body out.
  • Practice Releasing.
  • Live gentler.
  • Walk with all of your senses as often as you can.
  • Get REM Sleep.
  • It’s okay to let yourself dream.
  • Walk in water.
  • Talk with your best friend.
  • Live.
  • Breathe.
  • Learn.
  • Teach.
  • The day is short. The night is shorter. Mind your time.
  • Harm no others.
  • Protect yourself and what’s yours.
  • Run. Run. Run.
  • Strength.
  • Power.
  • Know that you are immortal.

 

 

 

 

 

 

 

 

 

 

The Certified Peer Specialist: Role & Action in Crisis Intervention

jen pong

I will be writing, here, about the functional components for a discerning intentionally driven and mutual peer-based Certified Peer Specialist’s portfolio of peer services deliverables within the behavioral health crisis intervention role(s) when BH is co-located with PH in a fully integrated community public health model.

To include the following:

1.0 The Certified Peer Specialist work on a tag-team recovery and peer based triage team with co-supports providers;

2.0 Peer crisis response must be entirely peer-led or peer driven and be at least 100% CPS in order to provide care, supervised by a CPS, CPRP, QMHP.

3.0 1st Trauma Informed Responder to individual in crisis (e.g., experiencing a psychosis, ideating with plan) alongside Clinician;

4.0 Utilize peer self-directive strengths based Dialogue and emotional CPR (Fisher & Spiro, 2013); for crisis intervention and de-escalation;

5.0 Peer to Peer Supports (e.g., Behavioral Health, Physical Health and Wellness Coaching Supports, Public Health (e.g., HIV/AIDS/HCV/STD), continuum of care, integration, health and human services liaison, f2f care and peer support, family, community supportive integration and strengths building);

6.0 Warm Line;

7.0 Peer Respite Whole Health & Wellness Center;

8.0 Training required for CPS providing crisis and/or respite peer supports;

9.0 Documentation and Data Evaluation & Surveillance;

10.0 Capacity building;

11.0 Cultural attunity;

12.0 Medication optimization (e.g., Robert Whitaker’s “Anatomy of An Epidemic” influenced work;

13.0 PBHCI BH + PH health and wellness solution peer supports;

14.0Silence Voice - 2012-10-30_172373_nature.jpg TRAUMA INFORMED CRISIS RESPONSE, WRAP, WHAM, IPS, eCPR

Peer Services in Behavioral Health Care Integration Workshop, June 14-17, 2015 (University of Wisconsin-Stout)

The Certified Peer Specialist in Behavioral Health Care Integration

I’m presenting “Peer Services in Behavioral Health Care Integration” with Heidi Levy, MA (Community Access, NY) at the University of Wisconsin-Stout’s National Institute on Rural Alcohol and Drug Abuse Conference 2015.  We will present a Certified Peer Specialist centric triage model of care offering a peer services | supports portfolio of public health care service deliverables in co-located behavioral and physical health care environments.

Individuals with shared life experience of mental diversity play a vital role (e.g., Certified Peer Specialist) of providing peer services and supports in the mental health and behavioral health care settings (SAMHSA, 2013). The Certified Peer Specialist is effective in promoting behavioral change in service recipients they serve by increasing utilization rates and providing significant reductions in hospital admissions and re-admissions (Fedder, Chang, Curry, 2003).

The Certified Peer Specialist (CPS) provides for behavioral and physical wellness health coaching supports in an integrated setting (Swarbrick, M. (2013); Manderscheid, R (2013). The CPS is the vehicle that the US Peer workforce will initially exemplify the multitude of roles and is the only available source provider for peer services and supports where service deliverables are sustainably funded by the Medicaid and Manage Care Organization (MCO) peer supports in the ACA market. This is a public/private health care sustainable funding model.  Peer Services | Supports are a win/win wellness and whole health solution in today’s ACA environment utilizing peer-driven services (Vestal, C. 2013) to co-locate in behavioral and physical integrated care environments.

The Medicaid 1915 Community waiver, 1115 Medicaid waiver, and state by state Rehabilitation Option funding options offer direct solutions for viable peer supports via physical and behavioral health integrated delivery systems of care. The March 2014 DOL advent offering peer services supports a state and federal billing provides for additional sustainability.

Mitigating rising health care costs and a fundamental shift in reimbursement is occurring. “Patients” and organizations, alike, are inherently required to transition from an episodic, fee-for-service model of reimbursement to a new model that reimburses and encourages money in the pocket wellness and care across the health service continuum.

A wellness focus on prevention and coached self-activated management of chronic conditions that our population experiences with early intervention and prevention, care experience will improve, providers will be better able to deliver quality care seeing an overall reduction in costs.

Workforce Trends

The professional workforce in the future will be smaller, and the work itself will be different than it is today. Projections for nursing shortages and primary care physician shortages have been published widely, and the shortage of primary care physicians will only be exacerbated by increased demand for their services by 2014. This is due to the aging population, the addition of an estimated 32 million patients into the system as a result of ACA, and the increasing movement of chronic disease care into the ambulatory arena.

To function as seamless efficient teams, all health care professionals (both current and future) must be trained in inter-professional educational and cross-trained settings. This represents a major challenge for our centers of professional education to innovate in the redesign of both pre-clinical and clinical curricula.

The US Certified Peer Specialist (CPS) certification currently operates and is managed by an irregular un-uniform state by state “Recovery Waiver” Medicaid reimbursement mechanism limited to local mental health authorities clinical supervising teams offering psychosocial rehabilitation, medication compliance monitoring and various kinds of community resource linkage.

Technical, training and assistance services are commonly provided regionally by the State, or an oversight body requiring application for certification, certification training and continuing education training. Advanced trainings (e.g., Intentional Peer Support (IPS); Emotional CPR (eCPR); Trauma Informed Peer Support, Social Change and Trauma Healing; Mental Health First Aid (MHFA); Whole Health and Action Management (WHAM); Wellness Recovery Action Plan (WRAP) and other peer-led supports are offered without federal oversight or a national standardizing of core competencies or a national credentialing body.

As of April 2014, 39 states and the District of Columbia have established programs to train and certify peer specialists and 7 states are in the process of developing and/or implementing a program.  Appalachia Consulting (Fricks & Powell, 2015) contracted proprietary CPS curricula is used in 23 states.  Recovery Resources (Harrington, 2015) free CPS curricula is broadly used by the Department of Veterans Affairs and a limited number of states.  Recovery Innovations/Recovery Opportunities (Ashcraft, 2015) contracted and proprietary CPS curricula is also broadly used.  Fewer states utilize an in-state developed CPS curricula. There is minimal CPS certification reciprocity between particular states requiring application and testing to acquire state certification.

This unique rural alcohol and drug abuse conference provides participants the opportunity to personally interact with other rural alcohol and drug abuse professionals, federal agency representatives and nationally known institute faculty and resource individuals while accessing the latest in evidence-based practices for the improvement of rural services.

Co-sponsored by:

  • National Rural Alcohol and Drug Abuse Network, Inc. (NRADAN)
  • Scaife Family Foundation
  • SAMHSA: Substance Abuse and Mental Health Services Administration
  • SAMHSA: Center for Substance Abuse Treatment
  • US Department of Justice-Bureau of Justice Assistance
  • National Association of Drug Court Professionals
  • Wisconsin Council on Problem Gambling
  • Cenpatico/Centene Corporation

To register for “Peer Services in Behavioral Health Care Integration Workshop” and the conference, see: http://www.uwstout.edu/profed/nri/

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