Peer Support Glossary

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Peer Support Glossary is STILL UNDER CONSTRUCTION

“Words are the source of misunderstandings”—Antoine de Saint-Exupéry, Le Petit Prince (1943)

Words Matter.

Language can have a huge impact.

Humans generally communicate with each another primarily through body language.  According to Albert Mehrabian, a professor who published a book titled Silent Messages in 1971, his research led to a conclusion and theory about face-to-face communication:

  • Words account for 7% of the overall message
  • Tone of voice accounts for 38% of the overall message
  • Body Language accounts for 55% of the overall message

The definitions herein will likely evolve over time and may be imprecise or incomplete in early drafts. 

Notably, in the effort to simplify and be concise with words, the meaning may become diluted or lost.  For example, a student of ancient biblical languages discovered 7 rich variations of what was translated to the mere word “judge” in a recent English version of the Bible, thereby limiting people’s understanding and in some cases leading to potentially serious misunderstandings.

We invite you to be part of the solution, bringing clarity through input and feedback.

Thank you in advance.

Alternative — One of two or more possibilities (Oxford University, Lexico)

Alternatives — An annual national conference in the USA bringing consumers and ex-patients together to network and share results of scholarship and program development; its roots date back to 1969 generally held on college campuses.  Support and funding formalized in 1985.  The peer recovery movement advanced alternative understandings to traditional biomedical models of mental illness including trauma-informed paradigms (e.g. the social model) viewing distress as a response to marginalization and violence.  The conferences have also highlighted the importance of the peer voice and peer support in transforming the system from its focus on maintenance to promoting recovery. These achievements were recognized in the 2003 report of the President’s New Freedom Commission on Mental Health; its vision statement begins: “We envision a future when everyone with mental illness will recover…” The report also states that “consumers,” along with family members, would drive this recovery movement. (NEC)

Alternative Medicine — Treatment used in place of conventional medicine (NIH NCCIH)

Complementary Medicine — Diagnostic and therapeutic disciplines used together with conventional medicine. (NIH NCCIH)

Conventional Medicine — Treatment widely used and accepted by most health professionals. (Wikipedia)

Integrative Healthcare — Bringing conventional medicine and complementary medicine approaches together in a coordinated way to treat the whole person rather than individual symptoms, systems, organs, components, etc. (NIH NCCIH)

Timeline:

Recent history in USA of public investments in “Complementary and Alternative Medicine” (CAM), now referred to as “Complementary and Integrative Health”.  Link: https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-center-complementary-integrative-health-nccih

Sources:

NEC. (2019). Alternatives Conference: Our History.  Last viewed online 2020 Jun 01 at: https://www.alternatives-conference.org/our-history.

NIH. National Center for Complementary and Integrative Health.  Last viewed online 2020 Jun 01 at: https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-center-complementary-integrative-health-nccih.

NIH NCCIH.  Complementary, Alternative, or Integrative Health: What’s in a name? Last viewed online 2020 Jun 01 at: https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name.

Oxford University. (2019). Lexico: Alternative.  Last viewed online 2020 Jun 01 at: https://www.lexico.com/en/definition/alternative.

Strauss, Lang and Schnurr. (2019). Complementary and Alternative Medicine (CAM) for PTSD.  Last viewed online 2020 Jun 01 at: https://www.ptsd.va.gov/professional/treat/txessentials/complementary_alternative_for_ptsd.asp. US Veterans Affairs.

Wikipedia. (2019).  Conventional Treatment.  Last viewed online 2020 Jun 01 at: https://en.wikipedia.org/wiki/Conventional_treatment.

Behavioral Health — The promotion of mental health, resilience and wellbeing; the treatment of mental and substance use disorders; and the support of those who experience and/or are in recovery from these conditions, along with their families and communities.

Source:

Closed Meetings — Meetings marked as “closed” are intended to be attended by solely persons with direct applicable lived experience to the topic at hand, allowing greater anonymity and confidentiality. 

EXAMPLE:

A closed meeting for people coping with addiction to alcohol who are seeking recovery would be intended for attendance only by people coping with addiction to alcohol who are seeking recovery. 

Separate meetings may exist specifically for spouses, daughters/sons, siblings, parents, and others — who may be affected by the topic of addiction to alcohol but not addicted to alcohol individually.  Sometimes people have multiple role(s) and may both be coping with addiction to alcohol seeking recovery — and may also be a parent, sibling, child, relative, etc. of someone coping with addiction to alcohol.

TIP / SUGGESTION:

If you are unsure whether a meeting is  “Open” or “Closed” check with the meeting leader or facilitator ahead of time before the meeting to get clarification.  If in doubt, it is probably best to consider the meeting “Closed” unless marked “Open.”

IMPORTANT:

It is also very important to clarify your role(s) and intent(s) up front if for any reason you are attending other than for your own personal direct interest or concerns with the meeting or group topic.  For example, if you would be attending a meeting to observe as a student, as a researcher, or as a concerned family member, relative, neighbor, caregiver, or natural support – then an “Open” meetings would likely be more appropriate; role(s) and intent(s) should be shared up front at once at the start of a meeting, keeping in mind many meetings and support groups have rules on confidentiality that are expected to be honored.

See also “Open Meeting” for comparison.

Co-Occurring — Experiencing two or more health challenges at the same time or one after another, such as mental health and addiction.

Source:

Wikipedia. (2020). Dual Diagnosis.  Last viewed online 2020 Jun 01 at: https://en.wikipedia.org/wiki/Dual_diagnosis

Consumer — a person who self identifies as a person with lived experience seeking recovery from trauma, addictions and/or mental health challenges, and/or as  a person labeled as such, and/or as a person who is receiving or has received services for such. 

Sources:

Allen, John and Alan Q. Radke, MD, MPH; Joe Parks, MD; Thomas J. Ruter, MPA; and Peggy Swarbrick, Ph. D., OT, CPRP.  (2010).  Consumer Involvement with State Mental Health Authorities, Seventeenth in a Series of Technical Reports.  Alexandria, VA: National Association of Consumer/Survivor Mental Health Administrators (NAC/SMHA) and National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council.  Last viewed online 2020 Jun 01 at: https://www.nasmhpd.org/sites/default/files/Consumer%20Involvement%20with%20Persons%20with%20SMI%20Final%20Part%201…rev%282%29.pdf.

Definition / Explanation Forthcoming

Definition / Explanation Forthcoming

Crisis — a time of intense difficulty, trouble, or danger.  a time when a difficult or important decision must be made.  the turning point…when an important change takes place  (Oxford)

Sources:

Oxford University (2019). Oxford University. (2019). Lexico: Crisis.  Last viewed online 2020 Jun 01 at: https://www.lexico.com/en/definition/crisis.

SAMHSA. (2020).  National Guidelines for Behavioral Health Crisis Care – A Best Practice Toolkit.  Rockville, MD: SAMHSA.  Last viewed online 2020 Jun 01 at: https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf.

Crisis Lines — dedicated telephone lines that are staffed to accept calls at all times (24 hours per day, 7 days per week, 365 days per year), to listen, to refer, and to dispatch support based on the assessed need of the caller (SAMHSA, p.8, plus added language)

Examples include but are not limited to:

Sources:

SAMHSA. (2020).  National Guidelines for Behavioral Health Crisis Care – A Best Practice Toolkit.  Rockville, MD: SAMHSA.  Page 8. Last viewed online 2020 Jun 01 at: https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf.

SEE ALSO: Crisis, Crisis Services, and Warmlines

Crisis Services  — services available for anyone, anywhere and anytime — 24 hours per day, 7 days per week, 365 days per year including:

  1. crisis lines accepting all calls and dispatching support based on the assessed need of the caller
  2. mobile crisis teams dispatched to wherever the need is in the community (not hospital emergency departments)
  3. crisis receiving and stabilization facilities that serve everyone that comes through their doors from all referral sources. (SAMHSA, p.8)

Core elements of a crisis system must include:

  1. Regional or statewide crisis call centers coordinating in real time
  2. Centrally deployed, 24/7 mobile crisis
  3. 23-hour crisis receiving and stabilization programs; and
  4. Essential crisis care principles and practices. (SAMHSA, p.10)

In too many communities, the “crisis system” has been unofficially handed over to law enforcement; sometimes with devastating outcomes. The current approach to crisis care is patchwork and delivers minimal treatment for some people while others, often those who have not been engaged in care, fall through the cracks; resulting in multiple hospital readmissions, life in the criminal justice system, homelessness, early death and suicide.

There is a better way.

A comprehensive and integrated crisis network is the first line of defense in preventing tragedies of public and patient safety, civil rights, extraordinary and unacceptable loss of lives, and the waste of resources. (SAMHSA, p.8)

Perhaps the most potent element of all, in an effective crisis service system, is relationships. To be human. To be compassionate. We know from experience that immediate access to help, hope and healing saves lives. (SAMHSA, p.9)

Sources:

SAMHSA. (2020).  National Guidelines for Behavioral Health Crisis Care – A Best Practice Toolkit.  Rockville, MD: SAMHSA.  Page 8. Last viewed online 2020 Jun 01 at: https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf.

SEE ALSO: Crisis

Culturally-Responsive Services — service offerings that are RESPECTFUL OF AND RELEVANT TO the beliefs, practices, culture and linguistic needs of diverse consumer/client populations and communities whose members identify as having particular cultural or linguistic affiliations by virtue of their place of birth, ancestry or ethnic origin, religion, preferred language, or language spoken at home.

Sources:

OCADSV. (2020). Webpage: FIND HELP: Search by Type of Services, Culturally Specific and Culturally Responsive Services.  Last viewed online 2020 Jun 01 at: https://www.ocadsv.org/find-help/by-services

Cultural-Specific Services — service offerings created BY AND FOR specific cultural communities with an emphasis on the voices of people with relevant lived experience (trauma, mental health, addictions, etc.)

Sources:

OCADSV. (2020). Webpage: FIND HELP: Search by Type of Services, Culturally Specific and Culturally Responsive Services.  Last viewed online 2020 Jun 01 at: https://www.ocadsv.org/find-help/by-services

Family Support — provision of peer delivered services to people defined as family to the individual. It includes support to caregivers at community meetings, assistance to families in system navigation and managing multiple appointments, supportive home visits, peer support, parent mentoring and coaching, advocacy, and furthering efforts to develop natural and informal community supports. (OAR 309-019-0105 (44)).

Family — the biological or legal parents, siblings, other relatives, foster parents, legal guardians, spouse, domestic partner, caregivers, and other primary relations to the individual whether by blood, adoption, or legal or social relationships. Family also means any natural, formal, or informal support persons identified as important by the individual. (OAR 309-019-0105 (43)).

Sources:

Oregon Secretary of State. (2019). Oregon Administrative Rules (OAR), Chapter 309 Health Systems Division Behavioral Health Services, Division 019, Section 0105 Definitions, Items 43 and 44.  Portland, OR.  Last viewed online 2020 Jun 01 at: https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=242798

See also Peer Support and Peer Support Specialist

Integrated Care — Coordination of general, physical and behavioral health care. This can involve integrating mental health, substance abuse, and primary care services to produce the best outcomes for people with multiple health care needs.

Source:

Lived Experience — A representation of the experiences and choices of a given person, and the knowledge that they gain from these experiences and choices. (Kennedy)

NOTE:

Willingness to self-identify as a person with lived experience (P.L.E.), is an individual choice. 

NOTE: There are considerations to weigh before disclosing the details of what an individual has survived.  Being thoughtfully considerate and limiting shares of explicit details to safe spaces (e.g. confidential appointments with adequately trained persons) may prevent or reduce vicarious or secondary trauma (e.g. nightmares, anxiety, etc.), particularly for younger persons. 

See: Strategic Sharing Workbook:Youth Voice in Advocacy (PDF format)

QUOTES:

Website link: Lived experience and how to include it

Video link: https://youtu.be/zG5_0PvjaKs

Excerpt(s):

“We are experts by experience—people who have lived with mental health conditions, people who’ve been suicidal, people who are trauma survivors. That is just as valuable as the kind of academic credentials that people earn. And it’s incredibly important that we work together as partners.” – Leah Harris, MA

Website link: About Us: Lived Experience as Lived Expertise (02/15/2019)

Excerpt(s):

“Ultimately, lived experience is about recognizing the expertise each of us brings to the table. The old saying “nothing about us without us” still rings true today—people who have been affected by suicide know firsthand what can help address it. Let’s consider the incredible value of the lived experiences we each bring to our daily lives and work to ensure that the voices of those who have lived through crises are given a priority seat at the prevention table.”

…”Without hearing stories of survival and loss, we can’t know what we’re missing.”

– Adam D. Swanson, MPP, SPRC Senior Prevention Specialist, Education Development Center

Source(s):

Harris, Leah. Lived Experience: What it is and how to include it (video).  Suicide Prevention Resource Center.  Last viewed online 2020 Jun 01 at: http://www.sprc.org/micro-learning/leah-harris-lived-experience-what-it-how-include-it.   Video: https://youtu.be/zG5_0PvjaKs

Kennedy, Ian. (2003). Patients are experts in their own field. BMJ (British Medical Journal). Last viewed online 2020 Jun 01 at: https://www.bmj.com/content/326/7402/1276

Lulow, E., & Federation of Families for Children’s Mental Health. (2012). Strategic Sharing Workbook: Youth Voice in Advocacy. Portland, OR: Research and Training Center for Pathways to Positive Futures.  Last viewed online 2020 Jun 01 at: https://www.pathwaysrtc.pdx.edu/pdf/pbStrategicSharingGuide.pdf

Swanson, Adam D. (2019 Feb 15). About Use: Lived Experience as Lived Expertise. Suicide Prevention Resource Center (SPRC).  Last viewed online 2020 Jun 01 at: http://www.sprc.org/news/about-us-lived-experience-lived-expertise

Wikipedia. Lived Experience. Last viewed online 2020 Jun 01 at: https://en.wikipedia.org/wiki/Lived_experience

Mental Health — A person’s condition with regard to their psychological and emotional well-being.  (Oxford University, Lexico)

Mental Health — Emotional, psychological, and social well-being.  Affects how people think, feel, and act. Affects how people handle stress, relate to others, and make choices. Important at every stage of life. May be impacted by:

  • Life experiences, such as experiencing or witnessing trauma, abuse, marginalization, pain, stress, etc.
  • Family history / relationships / social supports / co-regulation
  • Biological factors, such as genes or brain chemistry
  • Social determinants of health (basic needs, safety, shelter, food, healthcare, etc.)

     What is Mental Health? (MentalHealth.gov)

    • Excerpt(s):
      • Mental health [and wellness] allows people to:
        • Realize their full potential
        • Cope with the stresses of life
        • Work productively
        • Make meaningful contributions [and/or connections] to their communities

Sources:

Oxford University. (2019). Lexico: Mental Health. Last viewed online 2020 Jun 01 at: https://www.lexico.com/definition/mental_health.

US DHHS.  What is Mental Health?  Last viewed online 2020 Jun 01 at: https://www.mentalhealth.gov/basics/what-is-mental-health

mHealth — an abbreviation for mobile health, the delivery of healthcare services via mobile communication devices such as mobile phones, tablets, and wearable devices such as smart watches used for health services delivery, data collection and information transmission. (Wikipedia)

Source:

Wikipedia. mHealth. Last viewed online 2020 Jun 01 at: https://en.wikipedia.org/wiki/MHealth

Open Meetings — Meetings marked as “open” are generally intended to be open to attendance by individuals with direct applicable lived experience to the topic at hand, as well as friends, family members and/or natural supports.

EXAMPLE:

An open meeting for people coping with addiction to alcohol who are seeking recovery would be intended for attendance both by people coping with addiction to alcohol who are seeking recovery, as well as friends, family members and/or natural supports. 

TIP / SUGGESTION:

If you are unsure whether a meeting is  “Open” or “Closed” check with the meeting leader or facilitator ahead of time before the meeting to get clarification.  If in doubt, it is probably best to consider the meeting “Closed” unless marked “Open.”

IMPORTANT:

It is also very important to clarify your role(s) and intent(s) up front if for any reason you are attending other than for your own personal direct interest or concerns with the meeting or group topic.  For example, if you would be attending a meeting to observe as a student, as a researcher, or as a concerned family member, relative, neighbor, caregiver, or natural support – then an “Open” meetings would likely be most appropriate; role(s) and intent(s) should be shared up front at once at the start of a meeting, keeping in mind many meetings and support groups have rules on confidentiality that are expected to be honored.

See also “Closed Meeting” for comparison.

Peer — an equal, someone with whom one shares demographic or social similarities. (Penney)

Peer — an individual or a family member who has similar life experience, either as a current or former recipient of substance use or mental health services, or as a family member of an individual who is a current or former recipient of substance use or mental health services. (OAR 309-019-0105 (70)).

Sources:

Allen, John and Alan Q. Radke, MD, MPH; Joe Parks, MD; Thomas J. Ruter, MPA; and Peggy Swarbrick, Ph. D., OT, CPRP.  (2010).  Consumer Involvement with State Mental Health Authorities, Seventeenth in a Series of Technical Reports.  Alexandria, VA: National Association of Consumer/Survivor Mental Health Administrators (NAC/SMHA) and National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council.  Last viewed online 2020 Jun 01 at: https://www.nasmhpd.org/sites/default/files/Consumer%20Involvement%20with%20Persons%20with%20SMI%20Final%20Part%201…rev%282%29.pdf.

Oregon Secretary of State. (2020). OAR (Oregon Administrative Rules) Chapter 309 Health Systems Division Behavioral Health Services, Division 19 Outpatient Behavioral Health Services, Section 0105 Definitions, Items 44 and 70. 309-019-0105 (44), (70).  Salem, OR.  Last viewed online 2020 Jun 01 at: https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=242798.

ORS (Oregon Revised Statutes). Forthcoming.

Penney, Darby.  (2018 Feb 10). Who gets to define peer support?  Foundation for Excellence in Mental Health.  Last viewed online 2020 Jun 01 at: https://www.mentalhealthexcellence.org/gets-define-peer-support/

Penney, Darby. (2018). Defining “Peer Support”: Implications for Policy, Practice, and Research. Advocates for Human Potential, Inc.  Last viewed online 2020 Jun 01 at: https://www.ahpnet.com/AHPNet/media/AHPNetMediaLibrary/White%20Papers/DPenney_Defining_peer_support_2018_Final.pdf.

SEE ALSO: Consumer, Peer Support, Lived Experience

PeerGalaxy — a web-based portal and community of peer run organizations, peer supporters, peers and allies created with a vision to provide 24/7/365 real-time access to peer telehealth including peer support and wellness activities via telephone and rich online platforms.

Source:

PeerGalaxy.com Developer

Peer Run Organization — an organization in which peers constitute a majority (51% or more) of the board or advisory group, the executive team, and a majority of staff, including volunteers. Peers are individuals identifying as persons with lived experience of trauma, emotional distress, mental health challenges and/or addictions, and/or as persons who have received labels as such, and/or as persons who have received services in psychiatric and/or social service systems addressing such experiences.

In addition, two subtypes of Peer Run Organizations were described in a research study (Ostrow, 2014) consistent with a fidelity standard (Campbell, 2009) as:

  • Peer-Controlled Organizations — at least 91% of members of the board of directors are persons with lived experience.
  • Peer-Directed Organizations — between 51% and 90% of members of the board of directors are persons with lived experience.

Laysha Ostrow:

  • Peer-run organizations are consumer-operated services or self-help organizations that are staffed and operated by persons in recovery from mental illness with the mission of using peer support, recovery and illness education, and advocacy to promote wellness, empowerment, and recovery for individuals with psychiatric disabilities (Campbell et al., 2006).
  • Mental health peer-operated organizations have been defined as “programs, businesses, or services controlled and operated by people who have received mental health services” (Goldstrom et al., 2006, p. 95).
  • …there is growing literature on peer support in independent peer-run organizations… including…a fidelity scale developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) for consumer-operated service programs (Campbell et al., 2009).
  • Peer-run organizations are an important component of the consumer movement’s infrastructure in terms of linking mutual support with systemic advocacy and self-advocacy and providing the resources of a formal infrastructure to facilitate social change (Daniels et al., 2010).

Sources:

Campbell J, et al. (2009). Federal Multi-Site Study Finds Consumer-Operated Service Programs are Evidence-Based Practices. St. Louis, Missouri: Institute of Mental Health.

Chamberlin J, et al. (1978). On Our Own: Patient-Controlled Alternatives to the Mental Health System. New York: Hawthorn Books. 

Daniels A, Grant E, Filson B, et al. (2010). Pillars of Peer Support: Transforming Mental Health Systems of Care Through Peer Support Services. Atlanta Ga: The Carter Center.

Ostrow, L. (2014 Jun 13). Dissertation:  Mental Health Peer-Run Organizations Nationwide: Characteristics and Attitudes Towards the Affordable Care Act.  Baltimore, MD: John Hopkins University.  Last viewed online 2020 Jun 01 at: https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/38020/OSTROW-DISSERTATION-2014.pdf.

Ostrow, L., & Hayes, S. L. (2015). Leadership and characteristics of nonprofit mental health peer-run organizations nationwide. Psychiatric services (Washington, D.C.), 66(4), 421–425. Last viewed online 2020 Jun 01 at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382399/.

Ostrow, L., & Leaf, P. J. (2014). Improving capacity to monitor and support sustainability of mental health peer-run organizations. Psychiatric services (Washington, D.C.), 65(2), 239–241. Last viewed online 2020 Jun 01 at: https://pubmed.ncbi.nlm.nih.gov/24492900/.

Peer Run Respite — A voluntary, short-term, overnight program operating 24 hours per day in a homelike environment that provides community-based, non-clinical support for people experiencing intense emotional distress. Staffed, governed and operated by a peer run organization with at least 51% of people with lived experience of trauma, mental health, addictions, etc.

Sources:

Oregon Legislature. (2019). House Bill 2831 (HB2831) : Relating to residential peer support for individuals with mental illness who are in crisis; declaring an emergency.  Salem, Oregon. Last viewed on 2020 Jun 01 at: https://olis.leg.state.or.us/liz/2019R1/Measures/Overview/HB2831

Ostrow, Laysha. (2019). Peer Respites: Definition.  St. Luis Obispo, CA: Live & Learn.  Last viewed online 2020 Jun 01 at: https://www.peerrespite.com/criteria.

SAMHSA. (2017 Apr 12). Peer-run Respites: An Effective Crisis Alternative.  Presenters: Daniel B. Fisher, Bevin Croft, Val Neff, Camille Dennis, Jayme Lynch, Roslind Hayes, and Steve Miccio with Moderator: Oryx Cohen. NASMHPD.  https://www.nasmhpd.org/sites/default/files/Peer%20Run%20Respite%20slides.revised.pdf.

VIDEOS

Gainesville Peer Respite Center. (2015). Gainesville, FL, USA: Gainesville Peer Respite Center.  Last viewed online 2020 Jun 15 at: https://www.youtube.com/watch?v=JNVwlmUayiE

Peer Support — a process through which people who share common experiences or face similar challenges come together as equals to give and receive [and move towards] based on knowledge from shared experience. …It not only benefits the person receiving support, it makes the helper feel valued and needed (Riessman)

Peer — an equal, someone with whom one shares demographic or social similarities. (Penney)

Peer — any individual supporting an individual or a family member who has similar life experience, either as a current or former recipient of substance use or mental health services, or as a family member of an individual who is a current or former recipient of substance use or mental health services. (OAR 309-019-0105 (70)).

Support — expression of deeply felt empathy, encouragement, and assistance people with shared experiences can offer one another within reciprocal relationships. (Penney).

Peer-Developed Peer Support — a non-hierarchical approach with origins in informal self-help and consciousness-raising …closely intertwined with …activism promoting human and civil rights and alternatives to the medical model …influenced by the human and civil rights movements …in the 1960s and ’70s, …and the Independent Living (IL) movement of people with physical, sensory, and cognitive disabilities. …[Peer support] is also an interpersonal process with the goal of promoting inner healing and growth in the context of community …led by people [with lived experience] using mental health services. (Penney, 2018)

Peer Staff Employed in Traditional Mental Health Programs — expansion of peer staff in traditional programs was accelerated when the federal Centers for Medicare and Medicaid Services (CMS) issued a State Medicaid Directors’ letter in 2007 clarifying the conditions under which “peer support services” could be reimbursed by Medicaid. [E]mployees with psychiatric histories working in paraprofessional roles in traditional mental health programs, whose roles and job descriptions can vary broadly. Relationships between peer staff and service users are usually hierarchical, similar to staff-service user relationships generally within the mental health system, in contrast to the horizontal relationships that characterize peer-developed peer support. (Penney, 2018)

Sources:

Disability Rights Oregon. (2012). Mental Health Law in Oregon, 4th Edition.  Portland, OR: Disability Rights Oregon.  Last viewed online 2020 Jun 01 at: http://droregon.org/wp-content/uploads/Mental-Health-Law-in-Oregon-Fourth-Edition.pdf

Oregon Secretary of State. (2020). OAR (Oregon Administrative Rules) Chapter 309 Health Systems Division Behavioral Health Services, Division 19 Outpatient Behavioral Health Services, Section 0105 Definitions, Items 44 and 70. 309-019-0105 (44), (70).  Salem, OR.  Last viewed online 2020 Jun 01 at: https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=242798.

ORS (Oregon Revised Statutes). Forthcoming.

Penney, Darby.  (2018 Feb 10). Who gets to define peer support?  Foundation for Excellence in Mental Health.  Last viewed online 2020 Jun 01 at: https://www.mentalhealthexcellence.org/gets-define-peer-support/

Penney, Darby. (2018). Defining “Peer Support”: Implications for Policy, Practice, and Research. Advocates for Human Potential, Inc.  Last viewed online 2020 Jun 01 at: https://www.ahpnet.com/AHPNet/media/AHPNetMediaLibrary/White%20Papers/DPenney_Defining_peer_support_2018_Final.pdf

Riessman, F. (1965). The “helper” therapy principle. Social Work, 10(2), 27–32

Riessman, F. (1989). Restructuring help: A human services paradigm for the 1990’s. New York, NY: National Self-help Clearinghouse.

VIDEO LINKS:

Peer Support Services in Crisis & Recovery (2019). Washington County Mental Health.  Last viewed online 2020 Jun 15 at: https://www.youtube.com/watch?v=bm1jQd5Nydg

What is Peer Support?  (2017). UK: Mind, The Mental Health Charityhttps://www.mind.org.uk/  Last viewed online 2020 Jun 15 at: https://www.youtube.com/watch?v=iUS4CYM_V2A

Youth Peer Support 101.  (2018). Ontario, Canada: Ontario Centre of Excellence for Children and Youth Mental Healthhttps://www.cymh.ca/en/index.aspx.  Last viewed 2020 Jun 15 at: https://www.youtube.com/watch?v=n0d4dvrkp9c

The Role of the Family Peer Support Specialist. (2017). USA: Midwestern Public Health Training Centerhttps://iowapeersupporttraining.org/  Last viewed on 2020 Jun 15 at: https://www.youtube.com/watch?v=HjiAaHp8xE0

Peer Support Specialist — an individual providing peer delivered services to an individual or family member with similar life experience under the supervision of a qualified clinical supervisor and a qualified peer delivered services supervisor as resources are made available. A peer support specialist shall be certified by the [Oregon Health] Authority’s Office of Equity and Inclusion as required by OAR 410-180-0300 to 0380 and be:

(a) A self-identified individual currently or formerly receiving mental health or substance use services;

(b) A self-identified individual in recovery from a substance use disorder who meets the abstinence requirements for recovering staff in substance use disorders treatment and recovery programs;

(c) A self-identified individual in recovery from problem gambling; or

(d) A person who has experience parenting a child who:

(A) Is a current or former recipient of mental health or substance use treatment; or

(B) Is facing or has faced difficulties in accessing education and health and wellness services due to a mental health or behavioral health barrier.

(OAR 309-019-0105 (81))

Sources:

Oregon Secretary of State. (2019). Oregon Administrative Rules (OAR), Chapter 309 Health Systems Division Behavioral Health Services, Division 019 Outpatient Behavioral Health Services, Section 0105 Definitions, Item 81.  Portland, OR.  Last viewed online 2020 Jun 01 at: https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=242798

See also: Peer Support

Peer Telehealth –the use of electronic information and telecommunications technologies for individual and/or group peer support delivery and related services via videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.  (HealthIT.gov)

Telehealth means healing at a distance, and offers accessibility for individuals who may otherwise have barriers accessing peer support.  (HIMSS)

Sources:

Fortuna, Karen et al. (2019). Peer Support: a Human Factor to Enhance Engagement in Digital Health Behavior Change Interventions Journal of Technology in Behavioral Science. Last viewed online 2020 Jun 01 at: https://img1.wsimg.com/blobby/go/44e6f477-442a-4f9e-8877-b6b551de7a23/downloads/Peer%20support_human%20factor%20in%20engagement%20.pdf?ver=1578089018677

Fortuna KL, Naslund JA, LaCroix JM, Bianco CL, Brooks JM, Zisman-Ilani Y, Muralidharan A, Deegan P. (2020). Digital Peer Support Mental Health Interventions for People With a Lived Experience of a Serious Mental Illness: Systematic Review.  JMIR Ment Health 7(3). Last viewed online 2020 Jun 01 at: https://secureservercdn.net/198.71.233.51/g97.672.myftpupload.com/wp-content/uploads/2020/03/FINAL1Digital-Peer-Support-Mental-Health-Interventions-for-People-With-a-Lived-Experience-of-a-Serious-Mental-Illness-Systematic-Review.pdf

HealthIT.gov.  (2020). What is Telehealth? Last viewed online 2020 Jun 01 at: https://www.healthit.gov/faq/what-telehealth-how-telehealth-different-telemedicine

Montana Healthcare Foundation. (2020 Apr 03).  Peer Support Telehealth Webinar Materials [incl. Examples of Success].  Last viewed online 2020 Jun 01 at: https://mthcf.org/wp-content/uploads/2020/04/Peer-Support-Telehealth-Webinar-Materials.pdf. Video link: https://vimeo.com/407712623.

Tennessee HIMSS. (2020). How does telemedicine and telehealth work for mental health and substance abuse?  Last viewed online 2020 Jun 01 at: http://www.tnhimss.org/how-does-telemedicine-telehealth-work-for-mental-health-and-substance-abuse/

Recovery — a process of healing and transformation for an individual to achieve full human potential and personhood in leading a meaningful life in communities of their choice.  (OAR 309-019-0105 (98))

Sources:

Oregon Secretary of State. (2019). Oregon Administrative Rules (OAR), Chapter 309 Health Systems Division Behavioral Health Services, Division 019 Outpatient Behavioral Health Services, Section 0105 Definitions, Item 98.  Portland, OR.  Last viewed online 2020 Jun 01 at: https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=242798

Support GroupA group of people with common experiences or concerns who may provide each other with encouragement, comfort, and feedback. (Oxford University)

Support Groups may or may not:

  1. follow a specific sequence (e.g. meeting format / agenda).  
  2. have group agreements, guidelines or rules. 
  3. have a designated facilitator or co-facilitators.
  4. have a specific number of sessions
  5. be “open” or “closed” to new members, to family or natural supports.
  6. be “drop-in” or have specific start dates
  7. require registration / eligibility / pre-approval to join

NOTE: If you are not sure whether a support group is “open” or “closed”, check with the facilitators and/or contact person(s) ahead of time.

Sources:

Oxford University. (2019). Lexico: Support Groups. Last viewed online 2020 Jun 01 at: https://www.lexico.com/definition/support_group

See also “Open Meetings” and “Closed Meetings”

Telehealth — the use of electronic information and telecommunications technologies to support long-distance health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.  Telehealth is broader than telemedicine and can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services. (HealthIT.gov)

Sources:

HealthIT.gov.  (2020). What is Telehealth? Last viewed online 2020 Jun 01 at: https://www.healthit.gov/faq/what-telehealth-how-telehealth-different-telemedicine

Traditional Health Worker (THW)

  • community health workers
  • personal health navigators
  • peer wellness specialists
  • peer support specialists, and/or
  • birth doulas not otherwise regulated or certified

          –  Oregon Revised Statutes (ORS) 

           – Oregon Administrative Rules (OARs))

Sources:

Oregon Administrative Rules.  (2018).  Traditional Health Workers.  Chapter 410-180-0300. Last viewed online 2020 Jun 01 at: https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1741.

Oregon Statutes.  Traditional Health Workers.  ORS Chapter 414.025 Definitions for ORS chapters 411, 413 and 414 and 414.665 Traditional Health Workers Commission.  Last viewed online 2020 Jun 01 at: https://www.oregonlaws.org/ors/414.665 and https://www.oregonlaws.org/ors/413.600.

Trauma — a deeply distressing or disturbing experience; a physical or psychological injury; the emotional shock following a stressful event or a physical injury which sometimes leads to long-term effects. (Oxford)

Trauma — the result of witnessing and/or experiencing violence, abuse, neglect, loss, disaster, war and other [emotionally, mentally, physically, and/or spiritually] harmful experiences.  It has no boundaries with regards to age, gender, socioeconomic status, race, ethnicity, geography, or sexual orientation.  If not addressed, trauma can increase the risk of chronic pain, physical, mental and/or addictions challenges and is almost a universal experience for persons. (SAMHSA)

Toxic Stress — can occur when a child or young adult experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate healthy adult support.  This kind of prolonged activation of the stress response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.

Sources:

Oxford University.  (2019). Lexico: Trauma.  Last viewed online 2020 Jun 01 at: https://www.lexico.com/en/definition/trauma

Substance Abuse and Mental Health Services Administration (SAMHSA). 2014. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, Last viewed online 2020 Jun 01 at: https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf

Harvard University.  Toxic Stress.  Boston, MA: Harvard University.  Last viewed online 2020 Jun 01 at: https://developingchild.harvard.edu/science/key-concepts/toxic-stress/

Trauma Informed Services — services that are reflective of the consideration and evaluation of the role that trauma plays in the lives of people seeking mental health, substance use, or problem gambling services, including recognition of the traumatic effect of misdiagnosis and coercive treatment. Services are responsive to the vulnerabilities of trauma survivors and are delivered in a way that avoids inadvertent re-traumatization and facilitates individual direction of services.  (OAR 309-019-0105 (118))

Six (6) Trauma Informed Care (TIC) Principles issued by SAMHSA (US DHHS Substance Abuse and Mental Health Services Administration) to guide service agencies in recognizing and responding to trauma:

  1. Safety
  2. Trustworthiness and transparency
  3. Peer support
  4. Collaboration and mutuality
  5. Empowerment, voice, and choice
  6. Cultural, historical, and gender issues

Sources:

Oregon Secretary of State. (2019). Oregon Administrative Rules (OAR), Chapter 309 Health Systems Division Behavioral Health Services, Division 019 Outpatient Behavioral Health Services, Section 0105 Definitions, Item 118.  Portland, OR.  Last viewed online 2020 Jun 01 at: https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=242798

University of Wisconsin Milwaukie. Translating Trauma-Informed Principles into Trauma-Responsive Practices: SAMHSA 6 TIC Principles.  Last viewed online 2020 Jun 01 at: https://uwm.edu/icfw/translating-trauma-informed-principles-into-trauma-responsive-practices/

Trauma Informed Oregon.  Module 1: What is Trauma Informed Care? Portland, Oregon: Portland State University. Last viewed online 2020 Jun 01 at: https://traumainformedoregon.org/tic-intro-training-modules/module-1/

Trauma Responsive Services — a comprehensive approach to reviewing and (re)designing all aspects of an organization’s programming, environment, language, and values while involving all staff in better serving clients who have experienced trauma.

Building upon research and responding to the need of “felt safety”, redefine what safety is and how someone can identify it within themselves. Assist persons with trauma experience in feeling safe in unpredictable situations, identifying Vagus Nerve responses and calming techniques, education surrounding the Limbic System and its purpose, and rebuilding their lives. With validation and support from the appropriate people, healing can be a reality. (Compass Point Counseling)

More forthcoming.  Co-Regulation.

Sources:

Bloom, Sandra. The Sanctuary Model: Trauma-Informed, Trauma Responsive Culture.  Last viewed online 2020 Jun 01 at: http://sanctuaryweb.com/PublicHealth/Trauma-ResponsivePrograms/TheSanctuaryModelTrauma-Informed,Trauma-ResponsiveCulture.aspx.

Compass Point Counseling.  What is Trauma Responsive Care Exactly?.  Last viewed on 2020 Jun 01 at: https://www.compasspointcounseling.net/blog/what-is-trauma-responsive-care-exactly

University of Wisconsin Milwaukie. Translating Trauma-Informed Principles into Trauma-Responsive Practices: SAMHSA 6 TIC Principles.  Last viewed online 2020 Jun 01 at: https://uwm.edu/icfw/translating-trauma-informed-principles-into-trauma-responsive-practices/

Virtual Online Meeting — an event where two or more people to connect in real-time by video and/or audio usually over an internet connection, usually using an app (software) on a device with a camera, microphone and speakers via a web link or login for a meeting platform service (e.g. Zoom, GoToMeeting, Facetime, Support Groups Central, HeyPeers, RecoveryLink, etc.)

Warmline — a telephone service (call line) staffed with people (peers) having lived experience — coping with trauma, mental health and/or addictions challenges, and/or being labeled with such, and/or seeking recovery, healing, and wellness — who are open to listening and sharing. (Hope and Healing Center, text added)

Unlike crisis lines, warmlines often operate less than 24 hours per day, 7 days per week.  The hours of service may increase or decrease depending on capacity, funding, and special circumstance.  For example, during the pandemic, hours have been extended for some warmlines on a temporary basis.  Some warmlines have an option to leave a recorded voice message (voicemail) asking for a return phone call.

A warm line is an alternative to a crisis line that is run by “peers,” generally those who have had their own experiences of trauma that they are willing to speak of and acknowledge. Unlike a crisis line, a warm line operator is unlikely to call the police or have someone locked up if they talk about suicidal or self-harming thoughts or behaviors. Most warm line operators have been through extreme challenges themselves and are there primarily to listen. A warm line has the purpose of reducing hospitalization and forced treatment, being a cost effective and non-intrusive, voluntary intervention. (Grossberg)

Examples include but are not limited to:

Sources:

Grossberg, Chaya. (2014 Jun 22). What is a Warm Line and What Should I Expect When I Call One?  Mad in America.  Last viewed online 2020 Jun 01 at: https://www.madinamerica.com/2014/06/warm-line-expect-call-one/

Hope and Healing Center. (2020). What is a Warmline?  Last viewed online 2020 Jun 01 at: https://hopeandhealingcenter.org/what-is-a-warmline/

SEE ALSO: Peers, Lived Experience, Peer Support, Crisis Line, Crisis Services

Wellness — an approach to healthcare that emphasizes good physical and mental health, preventing illness, and prolonging life. (OAR 309-019-0105 (126))

Sources:

Oregon Secretary of State. (2019). Oregon Administrative Rules (OAR), Chapter 309 Health Systems Division Behavioral Health Services, Division 019 Outpatient Behavioral Health Services, Section 0105 Definitions, Item 126.  Portland, OR.  Last viewed online 2020 Jun 01 at: https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=242798

SEE Wellness.

Wellness Activities — Actions that produce outcomes which maintain or improve an individual’s health and well-being (social, emotional, mental, intellectual, occupational, environmental, physical, spiritual and other aspects). 

Example of virtual online wellness activities can include but are not limited to: 

  • Social Connection: Community Building, Community Service, Getting Involved, Conversations, etc.
  • Breathwork: Deep breathing
  • Movement / Fitness / Flexibility: Dancing, Stretching, Walking, Massage, Promoting Circulation, Yoga, Tai Chi, etc.
  • Diet / Nutrition: Meal planning, Meal Preparation, Food selection, Food cleaning, Food growth, Label reading, etc.
  • Stress Management / Healing Arts: Art, Music, Journaling, Meditation, Relaxation, Releasing, Discharge, Nature Connection, etc.
  • Rest and Sleep Enhancement: Sleep Hygiene, etc.
wordart for peer telehealth