Transformation Proposal

Transformation Funds

Peer recommendations for mental health system transformation

Prepared by Cassandra Nudel, in collaboration with Mary McQuown and David Mangano. Thanks for support and insight from Byron Stith, Will Gallik, Ann Benner, Brian Parrish, Beth Elliot, and consumers & consumer groups across the state. Planning and design of this proposal included consumers who serve as members, staff, and leaders from over 20 mental health programs. This proposal contains 4 sections: Consumer-Operated Programs, Consumer-Led System Transformation, Peer Provided Services and Office of Consumer Affairs.

Consumer-Operated Programs

Funding distributed directly to independent consumer-operated programs to support regional recovery-based services and conduct peer-led research and evaluation.

Impact on System Transformation:

Reach the goals in DMHMRSAS Integrated Strategic Plan: “Promote the establishment and expansion of peer-run programs throughout the state.”
Reach the goals in DMHMRSAS Integrated Strategic Plan: “Promote and support the establishment of peer-run programs in each CSB service area.” and “develop new and expand existing peer-run programs.”

Transformation Services:

Peer-run drop in centers and other community-based recovery-oriented programs.
Peer-run supported housing and independent housing. Both transitional and permanent housing, following a “housing first” model.
Peer-run crisis respite, based on successful models in other states such as “The Living Room” in Arizona and “Stepping Stones” and “Next Steps” in New Hampshire. Peer liaisons to consumers in psychiatric hospitals.
As a complement to CSB staff members who serve as hospital liaisons, staff an equal number of peer liaisons. On Our Own of Charlottesville is an example of a successful peer liaison program.
Developing a system for equitable pay for peer providers in Virginia, including possible accreditation for service development.
Peer-led recovery education, following the model of WRAP, WELL, META Peer Employment Training and other models of recovery education and wellness.
Peer outreach to traditionally underserved and hard-to-reach populations, including people not currently receiving services, and cultural and ethnic minorities.
Peer-led training, continuing education, and professional development to support the success of new consumer-operated programs and projects
Peer-run innovative programming and “exemplary practices” including consumer-developed training programs, consumer cooperatives, warm lines, media and creative arts programs, transportation programs, anti-stigma programs, and employment centers.
Anti-stigma and cultural diversity programs
Research projects demonstrating outcomes and effectiveness of peer-run programs in Virginia, and impact on system transformation and recovery/self-determination oriented measures. This research could be conducted in conjunction with universities and/or professional researchers.

Funding Recommendation:

A minimum of $500,000/year dedicated to development of new peer-operated programs offering services listed above.
A minimum of $375,000/year dedicated to expanding and enhancement of existing peer-run programs (those programs that currently receive DMH and/or CSB funding)
A minimum of $100,000/year to support peer-run recovery research activities and the development of recovery outcomes measurements for peer-run programs.
A minimum of $75,000/year to support peer-led training for consumer leaders and advocates working to create mental health system transformation.
A minimum of $50,000/year to support capacity building, professional development, and training in nonprofit management and leadership for staff and boards of consumer-run programs.
Equitable pay rates. Create peer positions that serve as meaningful career opportunities for consumers – full-time positions with equitable pay, benefits and continuing education and training on parity with non-consumer providers.
Offering regional funding directly and exclusively to peer-operated programs. (Programs where leadership, financial and staffing decisions are made by consumers; and where the Board of Directors is composed of a majority of mental health consumers). Experience in Virginia has shown that consumer-operated programs that receive funding in this way are far more likely to be successful.
Funds may be distributed through a competitive RFP. This would promote fairness in funding distribution, and quality of programs.

Consumer-Led System Transformation

Funding distributed directly to VOCAL, Inc to support consumer-led system transformation and create regional consumer coalitions.

Impact on System Transformation:

Reach the goal of President’s New Freedom Commission on Mental Health: "Consumers will play a significant role in shifting the current system to a recovery-oriented one by participating in planning, evaluation, research, training, and service delivery.”
Reach the goals in DMHMRSAS Integrated Strategic Plan: “Enhance and strengthen Virginia’s statewide network of peer organizations” and “Fund and support the operation of a statewide network of local peer organizations that increase the voice and representation of individuals receiving mental health services and supports”

Transformation Services:

Regional coalitions among consumer groups, as well as increased collaboration among consumers, consumer groups, and Regional Partnerships
Mutual support and education that enables consumers to play an active role in the mental health system, and in achieving their own recovery and independence
Collaboration with mental health advocacy organizations and the public mental health system to provide training, support, technology connection, leadership positions, and networking opportunities to consumers working on system transformation
Peer-to-peer training in program leadership and nonprofit management for leaders of consumer-operated programs.
A coalition of consumer-operated programs throughout Virginia, linked together for mentoring, support, and skill building
Publications, consultations, and technical assistance to support the success of consumer-operated programs in Virginia.
Recovery education workshops for stakeholders in Virginia, plus support to sustain programming in areas where recovery education has already been offered
Expanding REACH to include a statewide recovery-training center (Center for Excellence) that trains stakeholders in recovery principles and system transformation.
Training, technical assistance, and monitoring for recovery education facilitators. Trained facilitators leading WRAP, WELL, and other REACH recovery groups in all regions of the state
Partnerships with DMHMRSAS state hospitals, Community Service Boards, peer-run programs, and other mental health agencies that have an interest in establishing recovery-based education and service delivery systems

Funding Recommendations:

$260,000/year for expanding and enhancing VOCAL – Virginia’s statewide consumer organization, including funds for VOCAL’s programs, a full-time Executive Director position, financial management, and office staff allowing VOCAL to support the goals of system transformation.
Regional and statewide funding for VOCAL Network to assist consumers in creating regional consumer groups that will work for system transformation, in partnership with regional entities.
Regional and statewide funding for VOCAL CO-OP trainings in leadership and nonprofit management for leaders of consumer-operated programs, to support the long-term success of peer-operated programs in Virginia.
Regional and statewide funding for VOCAL’s REACH program to continue to provide and expand recovery education to all stakeholders and training for a peer provider career path.

Peer-Provided Services

Funding distributed directly to Community Services Boards (CSBs) to support regional peer-provided services and consumer-driven care.

Impact on System Transformation:

Reach the goals in the Virginia DMHMRSAS vision of future service system: “a consumer-driven system of services that promotes self-determination, empowerment, recovery, resilience, health and the highest possible level of individual participation in all aspects of community life, including work, school, family and other meaningful relationships ”

Transformation Services:

Peer-to-provider training and education. Programs where peer educators provide training for providers in recovery philosophy, approach, and orientation.
Peer provider services within the CSB offering counseling, one-to-one mentoring, and recovery coaching services.
Peer outreach to traditionally underserved and hard-to-reach populations, including people not currently receiving services, and cultural and ethnic minorities.
CSB demonstration projects in recovery, such as “cash & counseling” and “self-directed care” models
Developing a system for equitable pay for peer providers in Virginia, including possible accreditation for service development.
Peer-led program development which encourages empowerment, self-determination and peer-defined community building and integration rather than provider defined community integration leading to life long dependence on the mental health system.

Funding recommendation:

$1,000,000/year dedicated to development of peer-provided transformation services listed above, within the CSB.
All staff hired with Transformation Initiative Funds are people who identify as mental health consumers (particularly management and leadership positions).
Equitable pay rates. Create peer positions that serve as meaningful career opportunities for consumers – full-time positions with equitable pay, benefits and continuing education and training on parity with non-consumer providers.
Funding for peer-provided services serve as a complement to (and not a replacement for) funding for consumer-operated programs.
Funded programs are developed in accordance with the Center for Mental Health Services Draft Principals of Consumer-Driven Care: “Consumers are the primary authors and decision makers in developing policies affecting local, state, and national mental health service delivery.”

Re-establishing the Office of Consumer Affairs

Funding dedicated to an independent Office of Consumer Affairs to support collaboration between consumers, providers, and policymakers in creating system transformation.

Impact on System Transformation:

Reach the goals of President's New Freedom Commission on Mental Health's final report of recommendations for "Involving consumers and families fully in orienting the mental health system toward recovery."
The Transformation Services listed below are from the national best practices model, "Offices of Consumer Affairs: A Pathway to Effective Public Mental Health Services", from the National Association of State Mental Health Program Directors.

Transformation Services:

Policy and regulation development
Program planning
Evaluation
Educating/training consumers/family members/professionals/public
Input into the funding and advocacy involvement in contract management of agencies
Addressing complaints and grievances
Promoting the expansion of self-help and consumer-operated programs

Funding Recommendations:

$175,000/year to fund staffing and operational expenses to establish an Office of Consumer Affairs
A staff position for a Director who is a self-identified consumer/survivor

About this Proposal

Planning and design of this proposal included consumers who serve as members, staff, and leaders from: Richmond Mental Wellness Mentors, On Our Own of Charlottesville, Laurie Mitchell Employment Center, Chesterfield CSB, Chesterhouse Clubhouse, Mental Wellness Support Group, Our Place of Fairfax, VOCAL Network, REACH, VOCAL CO-OP (Consumer Owned & Operated Programs), CELT, Family Mental Health Advocacy, Arlington CSB, Mental Health Association of Virginia, PAAMI Council, Olmstead Oversight Committee, Coalition for People with Mental Disabilities, Northern Virginia Mental Health Consumers Association (NVMHCA) and the Virginia Mental Health Planning Council.

The consumers involved in planning this initiative represent a wide array of experience and expertise – including Directors of community-based mental health programs; providers in both CSB and peer-run settings; licensed clinical social workers; university faculty; recovery educators; consumer advocates; and graduates and faculty of Consumer Empowerment & Leadership Training (CELT), Recovery Education and Creative Healing (REACH) and Virginia Human Services Training (VHST).

Consumers were meaningfully and comprehensively involved in all aspects of the development of the transformation initiatives in this proposal. Peers were not just participants, but active leaders in all areas of planning. Many of the consumers involved in this planning process also identify as family members. The ongoing planning process for these services truly meets the President's New Freedom Commission on Mental Health's final vision of "Involving consumers and families fully in orienting the mental health system toward recovery."

The Full Proposal

The above excerpt is an overview. If you'd like to read the complete proposal, click here