Peer Bridger Project
The NYAPRS Peer Bridger program, under contract with the New York State Office of Mental Health and through collaborations with local community mental health agencies and selected state psychiatric centers, has been charged to "help ease the transition into community life for individuals being discharged from New York State Psychiatric Centers and help to significantly decrease their need for readmission by offering an array of both intensive individual and group peer support services."
At a time when New York has prioritized the development of innovative initiatives that provide enhanced services and supports for "individuals with high service needs," particularly those individuals who require more intensive attention during the critical transition period following release from the hospital, there is a critical need for innovative and effective new approaches like the Peer Bridger model.
In 1994, the NYS Office of Mental Health approved Commissioner's Performance Pool funding for NYAPRS to implement a demonstration project assessing the effectiveness of peer operated bridger services and supports aimed at helping individuals with long or repeat state hospital stays to make successful transitions back into their home communities.
A project design team, comprised of Drs. Edward Knight and Cheryl MacNeil and NYAPRS Executive Director Harvey Rosenthal, with input from local county mental health departments, state facility discharge staff and local community rehabilitation and peer-operated agencies, developed a model for this new Peer Bridger Project that trained and supported individuals with successful management of their mental health recovery to offer candidates for hospital discharge four primary service interventions:
engagement in a uniquely personal, positive supportive relationship with a peer
involvement in an array of Peer Support Meetings located both in the hospital, and
following discharge, in the community
linkage to a broad range of community-based service and natural supports
teaching community adjustment and wellness self-management skills
Since 1995, NYAPRS has delivered these services to individuals and state hospitals in 5 counties, in collaboration with the following local community mental health agencies:
Albany Capital District Psychiatric Center
Community Living Associates Program
Ulster Hudson River Psychiatric Center
Mental Health Association in Ulster County
Broome Binghamton Psychiatric Center
Catholic Charities of Broome County
Queens Creedmoor Psychiatric Center
Builders for Family and Youth
Suffolk Pilgrim Psychiatric Center
Clubhouse of Suffolk
Westchester Rockland Psychiatric Center
Westchester Empowerment Center
In 1996, OMH approved additional funds to the Project to allow for the addition of a Peer Support Specialist to each team to both expand the number of peer support meetings in each area and 2 to provide ongoing training to state hospital and community staff to raise their awareness and support for peer-supported recovery and bridger services.
Today, our Peer Bridger teams play critical roles in those facilities and in their surrounding communities. In the last eight years, we have engaged hundreds of state hospital residents in powerful personally supportive relationships with our peer bridgers that have helped many to successfully leave the hospital and make a successful and stable adjustment to the community. Moreover, we have offered thousands of people with the opportunity to participate in weekly peer support meetings in state hospitals and in a variety of community-based settings. Finally, we have provided training in peer-supported recovery to thousands of state hospital and community staff, raising their awareness as to what is possible and their willingness to collaborate with projects like ours. In the future, as state hospitals in the areas we operate bridger teams come to substantially reduce their censuses, peer bridger services could be transitioned into local hospitals, adult homes and correctional settings in those counties.
In the several evaluation studies we have commissioned since 1996, the Project has consistently received high marks from both service recipients and facility staff for its unique ability to effectively engage and support people to leave and successfully stay out of hospital.
Our experience in developing the Peer Bridger model here in New York State has demonstrated that this uniquely personal level of support and service adds a crucial new element to each state/local mental health system's joint efforts to effectively engage and provide consistent, uninterrupted quality care to those individuals during the key period of transition back into the community from long or frequent hospital stays.
For more information about the Peer Bridger Project, contact Denise Ranaghan, Director of Peer Services at email@example.com.
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Overview of the Peer Bridger Model
Since 1995, the NYAPRS Peer Bridger Project has helped ease the transition into community life for individuals being discharged from New York State Psychiatric Centers and has helped to significantly decrease their need for readmission. The Peer Bridger Project accomplishes these goals through the use of Peer Bridgers-persons who have been successfully managing their own recovery from a psychiatric disability and have completed the requisite Peer Bridger Training Program offered by NYAPRS.
Referral and Initial Matching
The project is intended to serve those individuals who are willing to consider discharge and to voluntarily participate in the project. Trained peer bridgers engage in a peer matching process with hospital residents who have been identified by facility inpatient or discharge staff. Increasingly, we have been matching with individuals who have self-referred themselves, having learned of the program through our facility postings or presentations or by dropping in on one of our hospital-based peer support meetings. The project has prioritized serving those individuals who have been hospitalized for long periods of time or who have had high rates of return.
Typically, these residents and our teams of peer bridgers meet either at regular social get together hosted by the project at the State psychiatric centers, or at peer support meetings held at those centers. A mutual selection process then takes place, resulting in the development of a "match" with one of our team members, the completion of a "peer agreement" specifying respective goals, roles and responsibilities and the identification of needs derived from the completion of a "skills and support inventory." Upon consent, the facility also provides a completed history form, identifying particular areas of difficulty and the typical signs of distress for each individual.
Currently, many individuals wanting to begin intensive work with a bridger frequently must go on a waiting list, since our bridgers are typically at their full capacity serving between 3-6 individuals in the 15 hours a week we can provide at current funding levels.
In the meantime, all interested individuals are encouraged to immediately begin attending the Project's Peer Support meetings, which do not require either a referral process or waiting period.
The Peer Bridger Relationship and Role
The primary role of a bridger is to offer peer support to persons in state psychiatric facilitiesboth prior and subsequent to discharge. The bridger seeks to develop a trusting relationship with the person in the facility, serving as a role model, mentor, teacher, a connector, an advocate, a supporter, an ally and a source of encouragement and hope. The bridger is not expected to be a member of the treatment team , or take on the roles of case managers or crisis workers. However, peer bridgers can closely complement the work of case managers, helping to support a more comprehensive, coordinated approach.
Bridgers perform a variety of functions in their unique peer relationships: skill teaching, social and emotional support, recreation companionship, advocacy, and mutual peer support through one-on one peer support and participation at weekly peer support meetings.
The time allotted for the development of a trusting relationship between the Bridger and the person to be discharged is to be defined by that person's desires and needs. As a general rule of thumb, Bridgers will work intensively with three to six individuals at a time, typically beginning their involvement at about 2-3 months prior to planned discharge.
The typical bridger relationship develops according to the following pattern:
Personal relationship building emphasizing the development of trust, mutual respect, encouragement and emotional support.
As the above becomes solidified, the encouragement of deeper involvement in peer support
groups, exposure to community resources, attention to skills inventory (and working on
mastering identified desired skills)
Following discharge, intensified peer supports are paramount. Deeper involvement in skills
teaching, learning wellness self-management skills, increased connections to community
supports and resources, and regular, honest communication is emphasized. Peer bridgers may
encourage more frequent contact to promote increased involvement, support and social contact.
Setting the stage and laying the ground work for independence. Again, revisiting the skill inventory and addressing those skills not yet quite developed are worked on. Meetings in the community are emphasized. Support for the establishment of a wider circle of friendships, and enhanced social activities in the community. Positive risk-taking and greater independence are supported.
Therefore, peer bridgers typically move from spending the majority of their time providing social support and companionship to teaching coping and community adjustment skills and linking their 'matches' with important community resources. Some examples of these include:
helping to open up and use a checking account at a local bank
assistance with budgeting
help in following through with medical needs
help with menu-planning, shopping (sometimes cooking)
getting comfortable frequenting local movie theaters, art galleries, libraries, malls, YMCAs,
churches and other social centers
learning bus routes
help cleaning apartment
assistance in following through with getting/keeping necessary entitlements
regular visits to talk, have coffee and learn techniques for staying out of the hospital
Since our inception, the project has struggled with the challenge posed by the difficulty hospital residents have in getting permission (passes) to leave the unit or the hospital to prepare and practice for their lives in the community following discharge. The trainings and 'public relations' work of our Peer Support Specialists has provided some help here in getting the facility to overcome unnecessary barriers like these.
Peer Support Meetings
These meetings are held weekly at the psychiatric centers and are attended by one or more bridgers and by any individuals residing in the hospitals who are interested in receiving peer support from the project. The peer support meetings provide a continuing safe forum for individuals in recovery to receive support and encouragement, hope and assistance from their peers.
To reassure participants that the same, identical level of support will be there for them following discharge, participants are regularly reminded that our teams have established identical peer support meetings led by the same individuals at a variety of community settings that include area clubhouses, community residences, adult homes and churches.
The goal of the project is to provide hospital residents with a "match" with a peer bridger for intensive personal support services in preparing for discharge and during the initial period of community adjustment. While the typical period of time for the match has been anticipated to last for an average of 12 months, it can last longer. Sometimes it is longer, because hospital residents have either struggled in their recovery and in their readiness to leave..or because community housing and other key resources do not become available. Sometimes it has been shorter, typically when individuals require and/or ask for less post-discharge support.
It is important to note that participation in our various peer support meetings is available both at the first point of interest in the program (no referral needed for them)...and for as long as the person desires it (reminiscent of the "membership for life" component of clubhouse services). Developing immediate contact with the person who comes to be your peer bridger through your immediate participation in peer support meetings..and retaining contact with your bridger in peer support meetings after you move out of the intensive "matched" phase allows the project to offer substantial advantages in "continuity of care" to individuals who use our services.
In 2008, the Peer Bridger Project worked with 229 individuals and 176 of those consented to the release of their hospitalization data. After initial review of this data, 125 of these individuals were not re-hospitalized in the state psychiatric center in 2009.
That means that approximately 71% percent of the people we worked with were able to stay out of the hospital in 2009.