Documentation andMaintaining Peer Support ValuesPresented by Amy Pierce, CPSMarch 21, 2018

Documentation andMaintaining PeerSupport ValuesPresented by Amy Pierce, CPS,Via Hope PSI Field Liaison

Learning ObjectivesParticipants will:1.Identify 3 Reasons for Documentation2.Identify 3 Ways to Maintain Peer Values While Documenting3.Identify and Understand 2 Ways to Complete Collaborative Note Writing

“Peer Support is a system of giving and receivinghelp founded on key principles of respect, sharedresponsibility, and mutual agreement on what ishelpful. Peer Support is not based on psychiatricmodels and diagnostic criteria. It is aboutunderstanding another’s situation empatheticallythrough the shared experience of emotional andpsychological pain.”Shery Mead

What is the value of peersupport?

Core Values of Peer Work Foster hope and help people find meaning and purpose in life Preserve dignity and counter stigma, shame, and discrimination Connect people to peer supports Promote community connectedness

Core Values of Peer Work cont’d Engage and support family and friends Respect and support cultural, ethnic, and/or spiritual beliefs andtraditions Promote choice and collaboration in care Provide timely access to care and support(The Way Forward: Pathways to Hope, Recovery, and Wellness with Insights from Lived Experience)

Texas CPS Core Values

Other Key Concepts Self-Determination Trauma-Informed Hope Resiliency- CPS support individuals in their right to decidetheir own best path to recovery- CPS recognize that individuals may have experiencedtrauma in the past, and our words, actions and environment should nottraumatize those we support- CPSs instill hope in others and are living examples that the changehappens and recovery is real.- Resiliency and strength are valued and modeled by CPS asthey share their lived experience and support others on their recoveryjourneys.

Documentation:Why do we need it?

Why do We Need Documentation? Quality Assurance Fiscal Responsibility Communications

Today we are looking specifically at MedicaidBillable services

A Continuum of Helping RelationshipsPeers as Providers ofConventional ServicesPsychotherapyIntentional, onedirectionalrelationship withclinical professionalsin service settingsIntentional, one-directionalrelationship with peersoccupying conventional casemanagement and/or supportroles in a range of serviceand community settingsCase ManagementIntentional, onedirectional relationshipwith service providersin a range of serviceand pport & ConsumerRun ProgramsIntentional, voluntary,reciprocal relationshipwith peers in communityand/or service settingsPeers as Providers ofPeer SupportIntentional, one-directionalrelationship with peers in arange of service andcommunity settingsincorporating positive selfdisclosure, instillation of hope,role modeling, and supportContinuum of Helping alrelationship withpeers incommunitysettingsReciprocal13Davidson, L.; Chinman, M.; Sells, D.; & Rowe, M.: Peer support among adults with serious mental illness: Areport from the field. Schizophrenia Bulletin, 2006, 32: 443-450.

Texas Administrative CodeTitle 25Part 1Chapter 416Subchapter ARule 416.3Health ServicesDepartment of State Health ServicesMental health-Community-Based ServicesMental Health Rehabilitative ServicesDefinitions(35) Peer provider--A staff member who:(A) has received:(i) a high school diploma; or(ii) a high school equivalency certificate issued in accordance with the law ofthe issuing state; and(B) has at least one cumulative year of receiving mental health services for adisorder that is treated in the target population for Texas.

Fiscal Responsibility

Services Peer Specialists Can Bill forunder Psychosocial Rehab Skills Training Medication ManagementMust be documented in a specificfashion to meet Medicaid Standards

What About Our “Peer” Responsibility?

How Do We Provide Documentation AsWell as Honor Our “Peerness”

TAC Documentation Requirements Name of individual and where service was provided Type of Service Provided The specific goal or objective addressed The date service was provided The start and end time of the service The location the service was provided Signature of staff member providing the service Any pertinent event or behavior relating to the individuals treatment whichoccurs during the provision of the service The individuals response including the progress or lack of progress inachieving recovery plan goals and objectives

An Example of an Organizations Prompts Date Service Provided: Location of Service: Collaboratively Documented - yes or no Service Provided: Purpose of Service: Intervention Utilized: Individuals Response to Service: Plans for Follow Up:

Resiliency Unleashed Training & Consulting 2016

There Are As Many SkillBased Words As There AreLeaves On A Tree

Sample Individual Progress NoteData/Service Type: PSS met with Amy at her home on 3/20/2018 to provide psychosocialrehabilitation servicesTreatment Plan Objective: Healthy food and nutrition/Diversionary ActivitiesMethod Used: Wellness Recovery Action Plan, Modeling, Instruction, Demonstration,SupportDescription of Training: PSS instructed Amy on the preparation technique for stir friedvegetables, placing an emphasis on cleaning technique, as well as chopping technique asrequested by individual. PSS demonstrated preparation technique and shared from herown lived experience how chopping vegetables and cooking has been a diversionaryactivity that she uses in her own life. PSS supported Amy as she prepped the vegetablesand completed the recipe.Response to Training/Progress: Amy shared that knowing her PSS had difficultiescooking in the past and has since found that cooking is a wellness tool for her gave Amythe confidence to attempt to make the stir fry that she was wanting to try. Amy stated“I did it, I really cooked a meal and it was good - vegetables really can be good, and thechopping was really soothing to do. I think I will try this again this week.”Plan for Follow Up: Amy states she will make this meal again this week and will identifyanother diversionary activity she wants to work on the next time we meet on 3/25/2018

Sample Overarching Group NoteData/Service Type: PSS met with group on 03/21/2018 to provide skills trainingGoal/Specific Skill Trained On: Wellness Recovery Action Plan/WRAPOverview/What is Recovery?Method Used: Modeling, Instruction, Demonstration, Support,Description of Training: PSS modeled effective communication skills through theuse of open ended questions, body language, as well as active listening skills.PSS instructed the group on the use of WRAP as a way of becoming well andstaying well for long periods of time. PSS demonstrated the use of the toolthrough sharing examples from their own lived experience. PSS supported thegroup in discussing and writing about the topic with reference to their ownpersonal experience.

Let’s Practice!

What skills were used in this Peer Supportinteraction?

Date Service Provided: 03/21/2017 Location of Service: Austin TX Collaboratively Documented - yes or no Goal/Specific Skill Trained On: Method Used/Intervention: (ex. Supporting,demonstrating, engaging, role-playing, empowering Description of Training: (What did the Peer SupportSpecialist do) Response to Training/Progress: (What was theindividuals experience) Plan for Follow Up:

Option AMethod Used/Intervention: IMR, CBT, WRAP, Coaching, modelingDescription of Training: Mary is experiencing symptoms of her illness,which is impeding her ability to be out in the world. PSS identified thatMary had negative thinking around singing, and that she has a socialanxiety disorder that inhibits her ability to be in public places. PSScoached Mary to use positive thinking as a wellness tool. PSS modeledsinging as a wellness tool and helped Mary identify singing as a wellnesstool that she has used in the past.Response to Training/Progress: Mary was engaged in the conversationsthat we had today as evidenced by PSS’s experience of her responses.Mary identified her anxiety as a barrier to going to an upcoming wedding,which shows that she is accepting her illness.Plan for Follow Up: Mary must use the wellness tools of deep breathing,3X per day, she must also sing 4 X per day in the days leading up to thewedding, and she will use her CBT skills to navigate negative thinking.PSS will meet with Mary again in 1 week to discuss how she feels abouther social anxiety disorder

Option BMethod Used/Intervention: WRAP, Active Listening Skills, ModelingDescription of Training: PSS used open ended question to explore waysin which Mary had been successful in the past in navigatinguncomfortable experiences using examples that Mary already has in herWRAP plan to explore increasing her wellness tools to support her inAttending her cousin’s wedding. PSS modeled singing as a wellness toolwhen Mary requested support in singing a song. PSS shared from her ownlived experience the power of wellness tools that we have used in thepast and being able to reconnect with them.Response to Training/Progress: Mary actively participated today and wasable to identify multiple wellness tools to not only support her in anevent she will be attending but reconnected with other ones she has usedin the past. Mary stated that when she left she “felt a lot better”, andthat she has a plan to attend the wedding by getting in “a couple ofsongs before I go in”, and that “finding my music again has beenhealing.”Plan for follow Up: Mary states that she will continue to work ondeveloping her wellness tools and will meet again with PSS next week

Option CMethod Used/Intervention: Singing, Breathing, EffectiveCommunication SkillsDescription of Training: PSS communicated effectively with Maryas evidenced by Mary’s willingness to share fully about her socialphobia and by singing with PSS the song “Lean On Me.” Mary’ssinging with PSS is evidence that she trusts PSS. PSS alsoencouraged Mary to use deep breathing as a wellness tool(especially on the days leading up to and including her cousin’swedding).Response to Training/Progress: Mary agreed with everything thePSS said to do, so she is working her WRAP plan.Plan for Follow Up: Mary will continue to work her WRAP plan asdirected by the PSS and will meet with PSS in a week.

Collaborative Documentation:Another Key to Honoring the Individual Person Driven Approach Interactive Process The individual is engaged in the documentation process by providing inputand perspective on their service and progress

Collaborative Documentation:Utilizing A Template Specific To Your Organization Date Service Provided: Location of Service: Collaboratively Documented - yes or no Service Provided: Purpose of Service: Intervention Utilized Individuals Response to Service: Plans for Follow Up:

Sample Collaborative Group NoteTemplate

Lessons Learned Use the person’s words whenever possible Use human experience language while writing the note - rememberwe are in a peer provider role, we are not clinicians Use collaborative documentation whenever possible Stay connected with my experience of having notes written about me- the impact of reading them years later Just the facts - stick to the facts of what occurred, no judgement orassessment Make sure I am meeting all the quality measures for a note that alsomeets the fiscal requirements of the agency When in doubt, ask

“A life lived with integrity - even if itlacks the trappings offame and fortune is a shining star inwhose lightothers may follow in the years tocome.”Denis Waitley, Self-Help Author and Motivational Speaker

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