June 21, 2022
David Blacksmith, Executive Director, On the Road to Wellness and Ken Lewis, Executive Director, HEARTS Peer Support
Resources
Transcript
Good evening, my name is David Blacksmith. I am the executive director for on the Road to uh, Wellness in Manchester and Derry and we also, uh host, uh the um Step-Up Step-Down. And yeah, that’s who I am, that’s what I’m doing.
But did I just say that right because I’m trying to do two things.
There we go uh, okay. What happened? Anybody see the screen, yeah it just hasn’t popped to the presentation mode. I saw you hit from the beginning but we’re still asleep. There it is now, we’ve got the uh, presenter mode but that’s okay. David take it away.
It’s gotta be, it’s gotta be everywhere.
So, presenter view is checked if you look along the toolbar there under monitor it says automatic and then use presenter view. Well let’s see or maybe I’m messing that up.
Hold on a second, sorry it’s okay, we’re a patient crowd.
Let’s see here.
So, everybody can see everybody can see the screen correct? We can, okay. How about if I just play it safe and just do it this way. That’s fine work for us all right. So uh, we didn’t we didn’t pre-rehearse you know uh, uh, going back and forth and sharing slides. But uh, uh, So Ken you can feel free to jump in at any time, and pretty much I’m going to go through these slides tell you what our program is. These programs are, are, about and what they’re like, and uh, we’ll do the Q&A at the end if that’s all right with everybody. All right, that way um, yeah. So, what is Step Up-Step Down? It’s a um, it’s a new program, uh, it’s uh definitely in its pilot stage. Um it’s a three-bed recovery center. I’m going to do my best not to read these, but three bed recovery oriented uh program. Whether I like to stay up to 90 days it’s for individuals. You know who are uh, either coming out of, coming out of a higher level care. Something such as ah, New Hampshire Hospital or maybe they’re don’t want to get you know don’t need to, and it’s kind of instead of emergency room boarding. Uh the type of thing. So that, that would be the Step up, piece of the Step Up-Step Down is coming out of something like New Hampshire Hospital there are four of us in the state Keene, Manchester, Nashua and the Portsmouth areas. um all of these are non-clinical non-medical models. We very much are operated with the model of Intentional Peer Support, with leaning into uh WRAP, and other Symptom Management Core Competencies. Each of the programs are, are, staffed by Certified Peer Support Specialists. Um at least at a minimum of one most of us are moving towards having everyone that is on staff to be a Certified Peer Support Specialist. It is uh, it’s staffed 24-7 to be able to provide our guests with the support that they need throughout the day. Even at 2 a.m. if they just need someone to talk to you know sit in the living room watch Gilmore Girls and chit-chat type of thing. Get some support, um we are funded, um, by State Funding which comes from the General Fund, from, from the state, um benefits, it’s, it genuinely uh, provides as it says. It provides a more gradual and better planned return to the community, increasing chances of successful recovery and reducing the risk of readmission. As we’ll see at the end there is a video, at the end, that’s about three minutes long. That we put together and hopefully that shares some of that this little piece here. Um where our guests really have the opportunity to relax, really have the opportunity to connect with another peer. And that’s the probably the single greatest benefit that the guests receive is being able to work out that transition, from wherever they were to wherever they want to be. Back to independent living with supports 24-7. That’s non-clinical, it’s very relaxed it’s a home like environment. Each of us, so two of the four of us, have the Step Up-Step Down within the same physical facility as their peer support center. The other two that would be Portsmouth and ourselves. Our centers are separate. We have separate facilities for that, um but, we still provide access and encouragement for our guests to participate in our Peer Support Centers and get the support that they need. Uh, in a group in a group type setting, we don’t do any groups in Step up-Step down, we don’t do any of that that type of thing, but we do that at our Peer Centers. so, um the guests at both Monadnock and, and, Nashua have immediate access to that both of us. You know that type of thing. Yeah um, this is definitely a supportive environment. Um they all, everyone is very motivated by the, it’s, it’s, what’s the word I’m looking for? It’s a very self-driven program where as it’s not, um even us as peers you know. Coming alongside making suggestions that type of thing. it’s, it’s, really driven by the individual themselves and what they want to accomplish in that 90 days. Obviously, the housing piece is important, um and I guess it would be. It’s not in these any of these slides, but I’ll say it that the truth is these Step-up Step-Down Programs are not necessarily a housing program. It is really more of a wellness program, with the housing component. So, we really emphasize individuals being able to find the support that they need while they’re looking for housing. So that’s, um that’s, that’s what we like, to what we like to say. Um yeah, we, we absolutely support connections and out, you know not only just allow but encourage access to community-based clinical treatments. You know providers, we don’t, we, you know, we, we are in a place where individuals can still connect with their, their providers. Whether that’s in person we provide uh each of our sites have computers. We have, um with, with privacy type of thing. We also have, an iPad so individuals can engage with their providers, uh in a in a privacy type of thing. Virtually if necessary or that’s what they want to do. So those things take place regularly. The overall program support again it’s a very much of a home-like environment, um, you’ll see at the end when we when, we show this video of ours. Um, ours is different we ours is very much a home it’s a house, um each of these of the four of us we all look a little bit different and feel a little bit different, but the, the internals of each one is very much cozy home like. Independent private rooms, kitchen, that type of thing. All the amenities that would, somebody would have there in their own home and again that’s a providing that home-like environment, where someone can step-down from an inpatient stay or step-up, uh to it. Um, if instead of if they require a higher level of support maybe by means of diversion, so they don’t necessarily have to be there and do that. Who is it for? Adults 18 or over who are experiencing mental health or occurring challenges individuals who experience mental health crisis that’s worsening. Even in the current’s events, with their current supports and services. So, we’re there for them or individuals who are hospitalized can benefit from an immediate step between inpatient and return. It’s not like I’ve repeated myself on that, so what can each of our guests or anybody that’s referring to our guests, what can they expect everyone has their own private bedroom? There are shared common areas such as the kitchen, bathrooms, living room, things of that nature. Not a locked down facility, so guests can come and go as they please. Uh the guests are encouraged to engage in the peer support program, as I mentioned earlier. And they are also encouraged to you know they get the support and making community connections as well. Community connections could be just even family friends or as well as their um, clinical supports that they might need or want. I already mentioned that earlier, but the connections with the, the Portsmouth site is actually located in Northwood, um parks are right in in Nashua. Monadnock is in Keene and, and, Manchester as well. So, we’re very much located in the southern part of the state. And how does somebody make a referral? That’s a common question it’s a really just a phone call, and, uh, sending the standard referral form. All four of us use the same form. We, we spent a lot of time on the front end. When I’m setting this up to, um to develop a relatively comprehensive, a uh referral form, so that can be found in I believe all of our websites. We’ve done our best to distribute it around so that people can have it on their servers and have easy access to, to make that referral. Then after the referrals are done, you know someone from the clinical world might make that referral out. It doesn’t necessarily have to be a clinical one. Even, truth be told even a Peer Support Agency could make that referral out, but once that referral is done, then it’s 100 engaged with our staff. With the individual, with the guests themselves, and having that conversation, a little bit of screening takes place. And yeah, trying to make that determination if it’s a good fit, so, I think this would be an appropriate time for the video hopefully this you can all see and hear the sound.
At Step-Up Step-Down we give people that place to heal while they can still be part of their, I’m going to pause did anybody hear that.
Yes, we can, yes okay so all right good deal, all right.
At Step-Up Step-Down we give people that place to heal while they can still be part of their community. We’re kind of a transitional program for people who are either coming out of a psychiatric hospitalization. That would be like the Step-Down part, or they might be trying to avoid going to a psychiatric hospital. And that would be like coming from the community and stepping up to a program that offers more support. We’re meant to look like real life we’re very much a home. I’m somebody that has been in hospitals and it was a really really challenging experience. There are definitely limits to how much you can heal and discover yourself in an environment like that. So by having a true home in the community with peers running it, I’d like to think that we set people up to really heal in a way that can then translate to the rest of their life. People also before this didn’t really identify how hard it can be from leaving the hospital, like cool you feel better but, you’re just going back to your normal life. It can be a bridge between the hospital and going back home. The program is 100% free for individuals coming in as a guest. There’s no insurance requirement, there’s no co-payments. We do our level best to remove as many barriers as possible for an individual to find the supports and to help them succeed. Here people have the opportunity to stay with us for up to 90 days at a time. Our peers are here 24 hours a day. So, no matter what time of day it is, if somebody needs support they have access to it. Some things that people might not have told someone else or felt that it was okay to talk about you can talk about it here. Everything that we’ve tried to do here including the space itself, we wanted to feel hopeful, comfortable, peaceful and a place to move forward. We’re really trying to create the space for the thing we needed. When it wasn’t there for us, and we want to make our community stronger because this exists now. I love getting to remind myself and my peers every day that we get to choose who we are. We get to choose what we want our lives to be. I’m just so incredibly happy that we have this home and the space to provide people a place where they can begin that journey.
Well, thank you.
Thank you, David.
And Ken, do you want to share now and give us your, your piece of this presentation. David, uh presented well, and that’s such a great video. I just, uh kudos, on the way most of us, uh, took advantage of the agency’s video, and put it all on our website. So, thank you for the hard work, David. Um yeah, it’s something that we’ve been working on for, uh quite a few years and finally, you know. Ayla Kendall credit to her DHHS and BMHS to really, uh take a, a healthy risk on creating this, community, uh service. That was well needed as you know there’s, there’s not many residential or transitional programs in the state. Now they’re, they’re starting to open and, um the mental health centers are, are opening um community beds. Which is great but this was kind of difficult for us and we were given this opportunity in the middle of a pandemic. So, I know that we opened in mid-May and a lot of us followed after that. So, we had a challenge but, we were very dedicated in ensuring this piece was given to the community. And us as peers to have this opportunity of an alternative program and a transitional program. It’s a little more goal orientated, so we it’s voluntary it’s totally voluntary program. That’s why we meet with them, and talk to them, and kind of like a proactive conversation with them, to ensure that they’re, you know, since we only have three beds. We want to make sure that they’re we can be a good success for them or be a part of their success while they’re staying with us. So, we, we tend to have in Nashua, uh a challenge and David spoke on the housing challenge. We, we have a big challenge with housing in Nashua. Even in the middle of a pandemic. Where you know housing is like lower than one percent per capita. That we were finding that a lot of folks needed either to Step-Up or Step-Down into an apartment or finding apartment. There was a lot of vouchers given out uh during the pandemic and still now. Theres just a soft place to land for folks, to help them transition to finding a permanent residence. This was crucial for us I mean. we most of the folks that come through our program have transitioned into housing either by themselves or with a roommate. So, we’re you know we were lucky and we’re blessed to be in a community in that in the greater Nashua area. To be connected with our mental health center you know. And some of the hospitals and some of the emergency services around here. So, we all kind of work together and we were all growing and developing and during this Step-Up Step-Down pilot program. We were kind of growing together. Mobile Crisis was setting up a new location with their beds, and so, we kind of worked hand in hand uh together to make us a better uh success story for our community. Anyway I know that for sure.
Thank you, Ken. Now how about questions for Ken and David.
Yeah, sure about there, Hi it’s Adele again, I had a question. Um, you, you said I gotta say. I love the presentation, I love this program. Like all of it, it’s, it’s um, it’s beautiful and i’m really glad to see that it’s funded with general fund dollars. If nothing else so the funding is coming from somewhere. Um, but I was curious you kept saying co-occurring. So, it was mental health and or co-op? So, I just didn’t know what role substance misuse and substance treatment might have in this or not. Yeah, that’s a legit question. Um everybody still hears me okay? Yeah, yeah. Only because I’m wrestling with my stuff today. Like I’m doing great my computer crashed will be three days ago so I’m working with, with new, new tools. Anyway um, yes. So, when I, when we say co-occurring it means that primarily and we do mean primarily. if like, like 85% of the individuals, uh stuff that they’re working with is mental health, but if they have some substance use things going on in their life that does not, that’s not going to exclude them. Right, but we are not primarily, that’s a great distinction.
And then you may have said this, but I, I, kind of was jotting down questions. And a couple you answered along the way. Is there, um, I hate to say it like this, but a time limit for the house the bedroom availability for a person. Well yeah um, we will I’ll say it this way, um if you’re saying the availability is so obviously. You’re asking, your kind of asking what do people do when they call? If we’re full is there a waiting list type of thing. Oh no I’m sorry I literally meant if once enrolled, is it like you have 90 days to move through the program. Then you’re out or oh is it 90 days. I was just grabbing that out of the sky. Okay it is up to 90 days. We’ve had people leaving, thank you, 65 days about 90 days. Yes, that’s it similar to uh respite. We have a couple of our programs have respite and in fact we invented it in the state of New Hampshire but and it’s national now, but it’s something that we could ask the state for. Oh, this is the situation they need a little more time. We might need a waiver. So, there is a process that could. I think we’ve done it once or twice, so okay, great, thank you. Possibility to extend past 90 days. Okay I appreciate that, thank you Pam.
Your muted Pam. I’m sorry um, this is a question with both the um, Step-Up and Step-Down with only three beds, um and community you know living, living space. I would think that, um somebody that needed the Step-Up part would be a little different. Hopefully somebody that was doing the Step-Down, um so I’m wondering if that creates a
An environment that might be more difficult to handle. If you had two Step-Ups and one Step-Down. Does it um, raise the anxiety and Step-Down, too, to be cohabitating with those who are in Step-Up? If that makes any sense. but that’s, that’s my thought process at the moment. Well, that’s, you’re the first person to ask a question like that. That’s actually pretty good. Um, we have not found that to be a challenge. Uh I think that at least, I can speak on behalf of On The Road. This is, that at least my co-directors do an exceptional job of, uh of the interview piece of trying to find out, you know discovering who the individual is. What are they like? You know how is this going to be. Is it going to be a good fit? Is the program itself going to be a good fit? Will it be a good fit with the other let’s say other two individuals that are in the house? Uh, we have as a matter of fact, truth be told. Um at least in our experience, at all times, with the with the exception of once in the very beginning. For ever since, you know over there. At this time of a year, or about a year. All of the guests that are there, they’re ,they’re, they’ve become a close-knit group. They support each other amazingly regardless if they’re stepping up or stepping down. They just, you know, they, they just discovered that they’re all in the same boat. Looking for the same thing, you know moving in different directions obviously, but we have, we have not found it to be a challenge. Now that you mention it that will be a challenge next week. So, thank you it speaks to the power of the peer experience. I think yeah, for sure, yeah, thank you David. Karen, did you have a question?
I did, but I didn’t raise my hand or anything, so you have ESP.
Um my question was, is a comment and a question. When I first heard about the Step-Up Step- Down plan you know and that it was going to be 12 beds around the state. Um I was unimpressed. I couldn’t figure out how 12 beds were going to make much of a difference.
However, I guess my question is, is how, how often are you full? All the time? yeah so, yeah so, yeah. Ken, I don’t want to cut you short. You were talking, oh go ahead. No um, so let’s go back to the topic. Let’s go back to the first your comment about the 12 beds, and it does seem like, it does seem small. Even when we were talking to our city, city officials and that type of thing. And talking about the program. What it is? And everybody says you know what what’s the deal? Three beds really gonna make a difference. With three beds, well it does make a difference to the individuals that are getting that support. Without a doubt I mean, we already have testimonials that are just amazing but it was very strategic in terms of the three bed limit. It is because as soon as you hit four beds or more licensure issues start to kick in. We don’t, we’re not in that world right now. Also, the truth is when you hit four beds or more with you know with unrelated people. When they’re under the same building and all of a sudden you have to have sprinkler systems and things of that nature. so, it was very strategic in terms of making it as easy as possible to raise up facilities and be able to provide supports for these 12 individuals.
With the exception of when we have gone through, you know some uh, um workforce issues. When we didn’t have enough staff that type of thing. We had to close for a little bit. We’ve always been full from day one there’s never been a bed empty. you know and so, If, if anybody asks us the question is the supply. You know enough for the demand. The demand is much, much, much higher than the supply is so. You know we do get a lot of referrals, um not all the referrals are necessarily received, because they’re looking for something different than what we offer. But we always have at least a handful of individuals that are on the waiting list. Of course that waiting list doesn’t last long. Because they probably have found something different or more than what they’re looking for. From the time that they called and the bed becomes available. but anyway, hopefully that adequately answers your question. That was great, thank you David. Joanne Malloy did chime in, becomes as an institution if you get too big and there’s plans to expand three more beds in the state so another site location to be determined. Yes, yeah, it’s all part of the RFA process and we’re not allowed to talk about that yet okay. Your lips are sealed until we get it up, until the governor signs up on stuff. We’ll wait and Melissa asked how do you get referrals? How do people know about you? It’s a great question, um, yeah mostly at this particular juncture, it’s really word of mouth, but getting the word out, that’s how we receive the referrals. How do people even know that we exist? Is us participating in groups like this and getting the word out. Um, again each of our websites has the referral form and the information necessary. As well as the videos. So, somebody can view a quick three minute video and see what this thing about. Not just the referrer like the clinician who may want to make the referral, but also the individuals like, oh this is this some place that i actually want to go. Uh, that type of thing. So, we do, uh those things are available to anybody in this room, in this virtual room. If you want, um our referral form and our information packet please let me know. Send an email, you know even put it in the chat box. I’ll try to write that down and you can copy that in some fashion, because then I’ll just email you that packet. You can put it on your even, on your own computer or whatever agency you work for and can have it on your server. Easier access immediate access to that. So, um yeah, we want to we want to get that information in people’s hands.
And chase did ask about age, Liz answered it’s 18 and over. Correct? David and Ken? That’s correct, yep, no limit at the top. Um people loved the video. Which makes me teary, I’ve seen it a handful of times now and it’s just an amazing video. So well done, uh and David you talked about how you were fortunate to find, uh an industrial zone. A house in an industrial zone. Which meant you didn’t have to deal with people saying I don’t want that in my backyard. North of the Portsmouth area Northwood issue. People, people probably know that housing in Portsmouth is outrageously expensive. So, our friends at Connections in Portsmouth were unable to find anything locally and had to keep moving out, and the housing market was atrocious. A year plus ago so that’s why they ended up in Northwood. There’s the disconnect between the day programming at Connections Peer Support and the folks being out in Northwood. Yeah, I know, I don’t necessarily need to speak on their behalf, but they did part of that was strategic on their part. They had to try to be a little bit more centralized for their region, because enforcement. It’s kind of on the outside edge of their region. So, they also did that as well and they wound up in a very nice old bar. A very old farmhouse type of thing and, uh yeah, so they are very accessible that one’s right on route 4. It’s right next to Hannaford so it’s a very convenient location and a very lovely home. Nancy Fennell, you have your hand up. Yeah, one question that I have for you all is, um the guests that are in your facilities, do they come from the local area, or have you had people come from other areas of the state? Just curious if you do have them from other areas of the state, how do you manage with, if they do? I know you talked about having access to telehealth and things like that, but does that happen frequently? Yeah, it has at least for us I can speak with, you know with intelligence for us that yes, we have had people from outside of our region. Uh none of us work within a catchment area. So, someone can come from Berlin and can call us, hey I want somebody to come down type of thing. So, we can do, we, we can do that. We have and we work that out. We, we work out the logistics and we have that conversation with the guests. Like okay, you’re in an area, you know that’s a way for instance. We had somebody that was eligible to go to Keene, but they were full, but they really needed someplace. With this they came to us and so they maintained their clinical relationships with telehealth. Fortunately, this individual also, his, his goal was I need to get back to school. He wanted to get back to the school and in the 90 days he was actually to get back into a role in the school. He wound up being a Resident, in a school with you know type of thing. So, uh it didn’t matter where he was at that particular point. So yes, that does happen. We don’t operate in the catchment area, and we do our best to ensure that’s part of the negotiating pieces. Like do you actually want to be here in Manchester? but you’re coming from this particular region, you know? How are we going to work that out? Because yeah that’s what we do. I’m just going to add this little piece because I see the, the question coming up on the chat about transportation. Um we do, we do provide transportation, um I’m not sure about I can speak again with intelligence about all four of us. I think all four do or at least we do our best. Um, yeah, we do, we do provide, we try to do our best as I kind of said that. In the in the video presentation that we do our very best to get rid of as many barriers as possible. So, you know, provide transportation. So, they can get to where they need to be. You know, but if somebody has a clinician that’s in Berlin, we’re not going to drive them to Berlin once a week.
And I agree with David. I think we all provide that transportation service, but we do have that conversation. Around what’s that going to look like and what your support’s going to look like our first
guest that came through our program. In early May they transitioned in June to Concord and we, we assisted them and supported them in transitioning services to Concord from Nashua. and to transition to an apartment safely there as well. So, then we all kind of work together. Since we’re limited to only 12 beds in the state, we cover the state, we kind of, we talk with the individual to see if, you want to try to see. Like in David’s case where if you were wanting to go to Keene but would you settle on Manchester would that be okay for you? Would that be a good fit? We all kind of re-refer the referrals back to each other internally. So speaking of that referral form, David I did google, actually David and I just typed, Step-Up Step-Down and On The Road to Wellness pops up first. When I clicked on that I saw your referral form and your packet at the bottom of that website. David, so Ken is the same. True to yours I didn’t have enough time to go looking for more. I took the first one and yours is the same. What was the question again? The referral form is on the website. Yes, we all use the same one David mentioned. We worked hard to make sure that it was a proper referral form, because some of it is clinical information, and we wanted to make sure that it was legal for the state. If they got the lawyer in the state to okay it, but more importantly was it going to be user friendly for us and for peers? Yeah, so on right? On the websites all people have to do is google Step-Up Step-Down. It’s going to pop up, that forum is on the first page of the On the Road To Wellness website. I assume it is for Hearts as well clinical referral form for providers is the same but some of us have unique referral forms that we use for Hearts Manchester’s. It’s a little different and so, I think Keane and the other program is as well. They kind of tailored it for their logos and some of the information that they want. That’s kind of universal, but those will be different. So most of them have two referral forms. Okay David, yeah essentially there’s a universal referral form that everybody uses the same one but then each of our agencies have a different personality. You know, type of thing to it. So, there’s kind of like a referral form plus an additional information form, so that’s pretty much what it’s like. Okay that’s what you’re finding our informational packet all that stuff is one piece. Any other questions as we come to the end of our time with David and Ken? If you send that referral form say from On The Road, we’ll take it and that’s fine with us. If that, you know personality form is a from then we will use it. Good to know and Kim Murdock says, would love to share the video on NAMI New Hampshire’s communication platforms. Are you able to send a link to that video? Yeah, absolutely. Right, it doesn’t even have to be from our site, it’s on YouTube. It’s on uh it’s on several places for easy access. I do see a number of individuals that are asking for the referral forms. So, I’ll do my best to garnish, I’ll call these and send them out. I’ll make sure that I don’t close my chat so I can get all these. Excellent, thank you very much, this was wonderful. Yes, I see we’ve got some, some praise going on here. Thank you so very much I know there are folks tonight who were completely unaware of Step-Up Step-Down and now have a lot of really good information to go share with other folks. Thank you all for having us tonight, and so we’re, we really love the program that we’re doing and i can tell you firsthand that some of our guests have really, really, really done exceptionally well. Right, so good to know you’re a worthwhile investment. Yes, you are part of the solution and we appreciate it.