The Revolution of Emerging Transformation Recovery Leadership: The Renewing of the Mind, Heart and Soul

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1 The Revolution of Emerging Transformation Recovery Leadership: The Renewing of the Mind, Heart and Soul A Performance Domain Analysis of the NCPRP Credential Compiled and written by Trudi L. Griffin, MS, LPC-I Researcher/Curriculum Developer, PARfessionals Abstract Peer provided recovery services are integral to recovery oriented systems of care in behavioral health. The National Certified Peer Recovery Professional (NCPRP) credential standardizes the knowledge, skills, and abilities (KSA s) required of Peer Recovery Professionals. This paper provides an overview of the research used to create the NCPRP credential exam. The NCPRP credential paves the way for legitimization and professionalization of a global Peer Recovery workforce. Peer support Important to Recovery When someone is going through something difficult, the best motivation to succeed is a vision of hope. Mark Sanders, an addiction treatment veteran, may have said it best when he spoke of his early experiences working in a detox center for African American men. He said, People needed to have a reflection of themselves as part of their own recovery experience (White, 2013). People who have lived recovery serve as an example of hope for others. In their literature review of the principles and values of the Substance Abuse and Mental Health Services Administration (SAMHSA) definition and guiding principles of recovery focused on recovery oriented systems of care, Sheedy and Whitter found multiple studies that showed the use of peer support to be helpful to others in recovery (Sheedy and Whitter, 2009). This success was present for people recovering from substance use disorders as well as from chronic health conditions. More current research of programs providing peer support services to clients showed an increase in reaching underserved populations, a positive impact on families and communities understanding and roles in recovery, a positive impact on organizations and workforce development, and larger system improvements (SAMHSA, 2012). Peer Support Stigmatized by Other Provider Professionals Despite the positive impact of peers on clients, organizations, communities and systems, challenges remain. Traditional peer support services were distinguished by their first-hand knowledge of recovery and by their informal, friendship-type relationship with clients (White, 2009). By moving peers into a clinical model of treatment, many licensed treatment providers still fear that peers will be viewed by clients as more qualified, thereby devaluing the services provided by social workers and counselors (SAMHSA, 2012). Unfortunately, those who provide peer support services report low or no pay, lack of career advancement, and discrimination due to their background (CMHS and CSAT, 2012). Recommendations for the Future of Peer Support Organizations within the treatment system have noted challenges encountered when implementing peer support programs. As a result, SAMHSA called together a consortium of professionals and organizations to promote recovery oriented systems of care (CMHS and CSAT, 2012). This consortium evaluated challenges experienced by treatment providers and by those who provide peer support. Recommendations for overcoming those challenges included developing best practices for organizations implementing peer recovery support services and strengthening training and certification programs for those providing such services. Peer Recovery Professionals In an effort to professionalize and legitimize an underused workforce and to meet the recommendations of the aforementioned research, PARfessionals created affordable, accessible training based on best practices recognized throughout behavioral health treatment systems and on 1

2 recommendations noted in the literature. By receiving education and training by medical and healthcare professionals and by licensed addiction and mental health counselors, the meaning of the term peer will be strengthened and standardized in congruence with the needs of recovery oriented systems of care. Keys to a Successful and Sustainable Global Recovery Workforce Accountability. Peer Recovery Professionals (PRPs) play an important role in a client s recovery and are responsible for obtaining the necessary knowledge, skills, and abilities (KSAs) to perform their duties in a professional and effective manner, thereby reducing the cost of risk for their team members and employer (Kelley-Hardison, in press). Transparency. Recovery Support Professionals withhold bias and supply clients current, unbiased information on all available recovery support methods. This empowers the client by providing them with information to make their own decisions, assisting them in their recovery. Recovery Support Professionals accept the role that other professionals (doctors, social workers, case managers, legal professionals, prevention specialists, treatment counselors) and experts contribute and remain open-minded about recommendations for education and work experience. Innovation. Those in professions supporting recovery create jobs for those with scarred backgrounds, allowing them to be positive role models of recovery not only to clients, but to their family, friends, and community. Through gainful employment, those in recovery contribute positively to the economy, are able to meet financial obligations, and assist with the shortage of professionals in the behavioral health field. Authenticity. Recovery Support Professionals allow clients to be who they are and respect the values, beliefs, and cultures of others without bias, supporting the recovery process led by the client. The priority for recovery support, is guiding the client on their path to long term recovery within the client s cultural context. The practice of allowing clients to be true to themselves promotes a client centered profession. Global Order of Recovery Leadership In the United States, credentials for providers of peer recovery support are inconsistent and require different education and work requirements. This inconsistency makes the recovery support profession seem less credible to other healthcare providers and third party payers thereby devaluing the profession. The recovery support profession needs discipline and international guidelines on KSAs to create consistency and establish value for providers of recovery support. PARfessionals created the National Certified Peer Recovery Professional credential to provide an international standard of practice for recovery support professionals to be recognized globally, and includes other titles within the profession such as peer specialist, peer recovery coach, or peer supporter. National Certified Peer Recovery Professional Credential The National Certified Peer Recovery Professional credential serves as the standard for those with lived experience providing recovery services in a variety of roles. As our treatment providers work toward the integration of behavioral health and substance use disorder treatment, Peer Recovery Professionals will be trained to provide support in both environments. Performance domains and learning objectives for the NCPRP were based on a review of the literature regarding best practices and recommended core competencies. Knowledge Recovery occurs via many pathways (SAMHSA, 2012). In order to understand one s purpose and function within a larger system, one must understand the evolution, organization and direction of that system as well as the fundamental concepts that support it. The fear that Peer Recovery Professionals will work outside of their scope of practice and render licensed professionals positions obsolete (CMHS and CSAT, 2012) is mitigated by providing peers with tools and resources to explain to clients and communities the role they play within the treatment system. Education regarding ethical standards of practice helps peers to feel empowered to maintain the integrity of the system. Addiction and other behavioral health problems are complex conditions. One s journey to freedom from them is just as complex. Basic understanding of the science that drives treatment and recovery helps Recovery Professionals explain the many pathways of recovery and reduce the stigma involved in pursuing treatment options. 2

3 Creating Partnership Recovery is person-driven, emerges from hope, and based on respect (SAMHSA, 2012). Research is consistent about therapeutic alliances being instrumental to a client s success in recovery (Sheedy and Whitter, 2009). Working in collaboration with a treatment team means being able to speak the language of providers who use evidence based practice. A peer needs to be able to support a client through explaining their needs and being able, when needed, to interpret the recommendations of providers in a way the client understands. Instructing recovery support professionals in the skills necessary to form therapeutic relationships of partner-collaborator is essential to their legitimization in treatment communities, and it is the goal of the NCPRP credential to achieve the delicate balance between peer-based and professional services (White, 2009). Communication skills, client centered relationships, and motivational enhancements are skills congruent with those recommended for establishing quality helping relationships at any level of care (CSAT, 2009; White, 2009). Creating therapeutic relationships is not just for counselors and social workers. Creating relationships built on honesty, integrity, empathy, and compassion yet holding clients accountable for their choices and actions in a nonjudgmental way has been deemed the most effective for helping clients make lasting change in their lives (SAMHSA, 2009). Active listening, direct communication, and encouraging clients to make their own decisions are among the basic core competencies of helping professionals (ICF, 2013; ICandRC, 2013; inaps, 2013; RCI, 2013). Research on motivation and the process of change shows that people are more likely to make the lifestyle adjustments needed for lasting recovery when they choose to make changes (CSAT, 1999). Motivational interviewing is the evidence-based practice used to inspire client centered change in behavioral health and substance use disorder treatment settings. As an integral member of treatment teams, Peer Recovery Professionals trained in motivational interviewing as well as the stages of change model are able to provide services consistent with other providers. Assessment is an ongoing component of treatment, especially in determining levels of care and needs for support services in the community. Peer Recovery Professionals work with clients and families in a less formal manner and, likely, more often than a social worker or counselor. Peers trained in the basics of assessment can provide valuable support to clinicians and clients. Recovery Planning Recovery is holistic and supported by peers and allies through relationships and social networks (SAMHSA, 2012). While there are many forms of recovery planning, accepted best practice is to guide clients to create their own recovery plan (Sheedy and Whitter, 2009). Due to the nature of the peer relationship, Peer Recovery Professionals are in a unique position to assist clients with motivation enhancement and recovery capital identification. Working within the treatment team, peers trained in recovery planning are able to work with clients on goal setting, specifics of writing a plan and consistent plan evaluation and revision, allowing licensed providers more time to work with clients therapeutically. Frequent contact not only helps a client stay on track, but allows them to measure progress, and learn valuable life skills such as empowerment and selfadvocacy. Supporting Activities Recovery involves families and communities, is culturallybased and influenced and supported by addressing trauma (SAMHSA, 2012). Just as those in recovery need a reflection of themselves to feel hope (White, 2013), families and communities need examples of successful recovery to build communities supportive of recovery. Not only does a peer provider s knowledge and respect of a client s cultural background facilitate recovery, but communities continue to play a vital role in the success of peer delivered services and in the sustained recovery of individuals (Sheedy and Whitter, 2009). Effective professional peer workforces are culturally competent and an effective advocate for recovery in their communities. Trauma plays a large role in the lives of those in recovery, and peers need to be educated in trauma informed communication skills and basic assessment strategies to give client empowering choices about their recovery (SAMHSA, 2014). Since peers tend to have more frequent contact with clients, they may be able to detect indications of a trauma history in clients who are not comfortable disclosing trauma to a clinician. Summary Recovery-oriented systems are like complex puzzles, and in order to support the many pathways of recovery, treatment organizations need to be prepared to provide clients with options for obtaining that treatment. Every level of help is needed, and with standardization of training and certification, expectations are clear for the valuable role Peer Recovery Professionals play in recovery systems. 3

4 APPENDIX A National Certified Peer Recovery Professional Credential Summary of Learning Objectives KNOWLEDGE Recovery Talk Understand the importance of lived experience as a recovery resource Identify personal attributes that make a good peer support professional Identify qualities of a supportive, effective recovery community Addiction Science Basics Understand how addiction changes the brain Understand how the physical nature of addiction affects recovery History of Recovery Movement and Basics of Addiction Recovery Models Identify key figures of the recovery movement and their contribution to the field Explain the development of the recovery movement Understand the different addiction recovery models, how they are similar, and how they differ History of Addiction Treatment -- What We Know about Addiction Science and Treatment Outcomes, Introduction of SAMHSA Definition of Recovery and ROSC, Systems of Recovery, Integrated Care Understand the evolution of addiction treatment Know how research supports recovery oriented systems of care and peer support Definition of Peer Support and How It Fits into Current Treatment Models, Including an Overview of Core Competencies Become familiar with the history of the recovery movement and how peer recovery services fit into current systems Define the role of a peer recovery support specialist and a peer recovery coach Identify the types of recovery coaches; give examples of the duties of each Understand the core competencies and basic knowledge required for recovery coaches and peer support recovery specialists Ethics Boundaries, Professional Limitations, Confidentiality, Fair Housing and Civil Rights Law, Documentation Understand professional ethics and how they relate to the peer support specialist and recovery coach relationship Define confidentiality and how it relates to the recovery and treatment community Demonstrate the key components of documentation Importance of continued ethics education CREATING PARTNERSHIP Phases of Peer Support and Basic Skills - Communication and Effective Listening, Introduction to Stages of Change, Motivational Interviewing (MI), and Cognitive Distortions Identify the phases of the peer support process Understand basic skills needed to facilitate relationships such as questioning and active listening Understand and apply stages of change Understand and learn the basic skills of motivational interviewing Learn to identify and reframe cognitive distortions Basic Group Facilitation Learn basic group facilitation skills 4

5 First Meeting and Assessment, Assessment Basics and Purpose, Ethics of Assessment, Suggested Assessments Examine the initial stage of contact as it relates to the recovery community Understand basic ethical use of assessments and their purpose Acquire knowledge about assessment methods and instruments used in the substance abuse recovery field Create protocol for assessing clients Identify ways in which a client s personal narrative can help a client resolve their issues Co-occurring Disorders, Medication Assisted Treatment (MAT), Suicide/Self-Harm Assessment Identify when and how to refer a client for counseling for co-occurring disorders Understand the benefits, barriers, and basics of medication assisted treatment Learn basic suicide and self-harm screening Whole-Health Recovery Understand and describe what whole-health recovery means Understand what role peer support can play in integrated healthcare Compassion Fatigue, Self-Care and Self- Assessment, Integrating Your Recovery Story into Peer Support, Serving as a Recovery Example Understand the importance of self-care and create self-care plans in advance Understand how one s recovery is integrated into peer support and using one s recovery as an example to clients Recovery Capital Identify how recovery capital can be developed and rebuilt Identify models to help develop the recovery plan SUPPORTING ACTIVITIES Self-Advocacy Describe how self-advocacy is beneficial in recovery and how it can be used with clients Understand clients rights during the coaching process Accessing Programs Identify how to access social service programs Cultural Competency and Special Populations, Including Gerontology, Youth and Families Increase awareness and understanding of one s cultural perceptions Increase knowledge about the existence of diversity and its influence on recovery Finding a Job, Guidelines for Licensing and Certification Examine current growth trends in the field Taking care after training Trauma-Informed Care Understand what trauma-informed care is Be able to recognize a client s need for traumainformed care and direct clients to appropriate services RECOVERY PLANNING Basics of the Recovery Plan, Stages of Change, and Using Motivational Interviewing Apply the stages of change and motivational interviewing techniques to create the recovery plan 5

6 APPENDIX B Recommended Knowledge, Skills and Abilities for Peer Recovery Professionals Referenced in Literature CSAT/ SAMHSA ATTC ICF RCI IC&RC inaps Knowledge Recovery orientation x x x x Process of addiction x x Core knowledge, stages of recovery, communities of x x recovery, treatment communities Ecology of recovery (understanding of systems) x x x x Documentation x x Ethics of service delivery x x x x x Co-occurring disorders Medication Assisted Treatment Compassion fatigue and self-care x x x Using your story / servicing as a recovery example x x x x Creating Partnership Client engagement / therapeutic relationships x x x x x x Motivational Enhancement x x x Active listening / communication skills x x x x x Coaching skills x x x x Focus on present, next steps, near future rather than x x x x past Hope based motivational strategies x x x x Personalized services/client driven x x x x Stages of change Basic group facilitation x Assessment basics and ethics Basic suicide assessment Recovery Planning Recovery planning x x Strengths-based x x x x x x Resource development (recovery capital) x x x x x x Whole health recovery x x x Lapse and relapse intervention x Crisis planning 6

7 CSAT/ SAMHSA ATTC ICF RCI IC&RC inaps Supporting Activities Advocacy x x x Empowerment at all levels of treatment both on the x x x x client side and treatment provider side High degree of personal involvement x x x x x Fidelity and endurance: long term contact x x x Community education and development x x x x Building relationships in the community x x x x x Cultural competence x x x x Special populations (gerontology, youth and families) Finding a job, licensing, certification Trauma-Informed Care x x CSAT Center for Substance Abuse Treatment SAMHSA-Substance Abuse and Mental Health Services Administration ATTC-Addiction Technology Transfer Center ICF-International Coaching Federation RCI-Recovery Coaches International inaps-international Association of Peer Supporters 7

8 REFERENCES Center for Mental Health Services (CMHS) and the Center for Substance Abuse Treatment (CSAT) (2012). Equipping behavioral health systems and authorities to promote peer specialist/peer recovery coaching services. Rockville, MD: Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Treatment (1999). Enhancing Motivation for Change in Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 35. HHS Publication No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Treatment (2009). What are Peer Recovery Support Services? HHS Publication No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration. International Association of Peer Supporters (inaps) (2013). National Ethical Guidelines and Practice Standards: National Practice Guidelines for Peer Supporters. Sparta, MI: International Association of Peer Supporters (inaps). International Coach Federation. (2013). Core Competencies. ICF: International Coach Federation. Retrieved from Kelley-Hardison, J. (in press). National Certified Peer Recovery Professional Candidate Handbook. Columbus, GA: PARfessionals, LLC. Recovery Coaches International (2013). Core competencies. Recovery Coaches International: The voice of choice for recovery and beyond. Retrieved from Sheedy C. K. and Whitter M. (2009) Guiding Principles and Elements of Recovery-Oriented Systems of Care: What Do We Know From the Research? HHS Publication No. (SMA) Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. (2012). Perspectives on the Evolution and Future of Peer Recovery Support Services. Rockville, MD: Substance Abuse and Mental Health Services Administration. Substance Abuse and Mental Health Services Administration. (2012). SAMHSA s Working Definition of Recovery (Recovery Support Initiative PEP12-RECDEF). Washington, DC: U.S. Government Printing Office. Retrieved from Substance Abuse and Mental Health Services Administration (2014). Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration. Wang, Z.G. (2013). Peer recovery credential job analysis report Harrisburg, PA: International Credentialing & Reciprocity Consortium. White, W. L. (2008). Recovery management and recovery-oriented systems of care: Scientific rationale and promising practices. Philadelphia, PA: Northeast Addiction Technology Transfer Center, the Great Lakes Addiction Technology Transfer Center, and the Philadelphia Department of Behavioral Health and Mental Retardation Services. White, W. L. (2009). Peer-based addiction recovery support: History, theory, practice, and scientific evaluation. Philadelphia, PA: Great Lakes Addiction Technology Transfer Center & Philadelphia Department of Behavioral Health and Mental Retardation Services. White, W. L. (2013). ROSC from an African American community perspective: An interview with Mark Sanders. Posted at 8