C4 Innovations

Community & Behavioral Health | Recovery | Social Change

Growing Peer Support in Alabama

An episode of “Changing the Conversation” podcast

Pamela Butler and host Steven Samra discuss the process of building and expanding the number of mental health and substance use peer support workers in Alabama.

August 2, 2021

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Steven Samra, Host: [00:05] Hi, everyone. Welcome to Changing the Conversation. I’m your host today, Steven Samra, Senior Associate with C4 Innovations, and our topic today is growing peer support across the state. It’s my pleasure to introduce a colleague, friend and fellow peer, Pamela Butler who’s the Coordinator of Recovery Resources with the single state agency in Alabama, the Alabama Department of Mental Health. Hi, Pam.

Pam Butler, Guest: [00:34] Hi, Steven. How are you? It’s so good to see you.

Steven: [00:37] You too, Pam.

Pam: [00:38] Glad to be here.

Steven: [00:39] Pam, how did you end up with a job at the state?

Pam: [00:44] They hired me to help change our system of care to a more recovery-oriented system of care, which means that services was going to be centralized, individualized and inclusive of peer support services. But when I got there, there was no peers certified in the state and nobody really knew how to get peers certified and working and all of that. For me, it was a grounds up, no anything except a good team to work with.

Steven: [00:15] And now five years later, what does the peer landscape look like in Alabama today?

Pam: [1:02] Well, today we went from two to four recovery community centers. I have certified almost 500 peers that are with about 85% of them working. We have a 24/7 helpline that’s available for families as well as individuals in need of the services. There are 50 peers on the ground in 50 of our 67 counties. We have a program where we are getting people out of jail, going to treatment. We have peers inside our parole day reporting centers and we just changed, we got two special women peers who are being doula trained, which means they’ll be able to go in the delivery room as well as work postpartum. And we’re inside three hospitals. It’s very bright in Alabama based on where we started at.

Steven: [2:17] Wow, that’s a tremendous amount of work, Pam. And honestly, it’s really amazing.

Pam: [2:23] I researched and found a lot of stuff because Alabama was behind in this area so it was a lot of information out there. And I ran up on a grant that afforded me to connect with C4. And C4 came down, several visits, walked us right through how to develop it, how to promote it, as well as how to implement it in our state. And what you’re seeing right now in Alabama, all derived from the intervention, the education, the information, all of that was just because I had a lot information but I didn’t know what to do with it, but they definitely helped me with that.

Steven: [3:03] I know you were extraordinarily busy in those early years. Can you talk a little bit about how the development of peer services occurred? I know you mentioned that C4 Innovations played a fairly large role, but you were the advocate. You made this happen. Can you talk about how you made the use of peers a mainstream issue in Alabama?

Pam: [3:27] Well again, I have to revert back to C4 for that because not only did they teach us and give us the information we needed to create the certification. They also helped us to already look at challenges that were going to be coming as well as implementation and how to promote this. Even after I got a team of peers and providers across the state and we finally got the manual on that and we decided what the training was going to look like, then I was left with the job of going out, selling it to our providers and other stakeholders and that was the hard part.

Pam: [4:03] It really was because even though we had plenty recovery in Alabama, people knew about recovering people, whether it was 12-Steps, faith based or whatever. Nobody really understood the peers’ role in our system of care. That’s the part — and my agency, the Department of Mental Health, was very helpful in creating a billing code for the provider. And that was an incentive to help them to get on board too, as well as them providing funding for our peer run organizations and peer type services throughout the state. And I just want people to know it is a big ordeal, especially when you are army of one.

Steven: [4:44] Absolutely, Pam. And in the time that I’ve known you, I’ve watched you use your advocacy skills, your peer status, everything that you could bring to bear to really increase the awareness of peer support in the state of Alabama. And you’ve been this super powerful advocate for peer support services since the first time I met you. And so can you talk a little bit about how you see the peer role expanding? And just as an example, I know that you work for the Department of Mental Health, but much of your focus in at least in the recent past has been around substance use disorders. How is it that you were able to expand the availability and essentially breadth and depth of peer support in the state?

Pam: [5:39] I believe the Department of Mental Health was supportive of peer services for substance use disorder. They didn’t know how. They didn’t know what to do and they didn’t know how. And I think upon them hiring me to be completely focused on that, the support that I received from them. And that’s why I always tell people, “When you build a team, make sure you build a team of those who have like mindedness.” Having the Associate Commissioner and the Director of Treatment Services on that team made a huge difference too. You still have to do the work.

Pam: [6:15] It was my job not only to promote because we knew peers was valuable. We’ve been watching a recovering people help other recovering people for the last 67 years. We knew that it worked, we needed to figure out a way to implement those services, to turn what’s happening in the community into an actual professional service. And that’s where the work came in of having to write all this up, job descriptions. What would that consist of? How are we going to utilize the peers? Because how we utilize the peers in the treatment center is totally different than how we utilize peers inside our peer run organizations. And so all of that had to be written up and explained and as well as the funding piece was so important for it because you can’t run these services without funding.

Steven: [7:08] Pam, can you say a little bit more about that funding piece because I know how critical that is. Can you talk a little bit about that?

Pam: [7:16] Yes. In the beginning, it was just about getting some peer run organizations in Alabama and that wasn’t an expensive funding source. We created, at the time, two recovery community organizations. And so we have both of them and we were able to fund their community centers. We started out with two community centers and two peer run organizations. And from that, things just kept going and we started needing more from our peers. That’s how we developed our 24/7 helpline. That’s how we ended up with peers, boots on the ground physically in 50 of our 67 counties right now. There is a peer located in those counties that physically gets up every day and search out people in need a recovery support services, get relationships with stakeholders and anywhere a person with a substance use disorder show up like jails and for us, our Department of Human Resources is our Child Protective Services.

Pam: [8:21] Those individuals had to develop those relationships and those people had to be trained on how to do that too. And so nobody really knew how to do any of this. It’s just a matter of you finding that funding and being able to sustain that funding because what I didn’t want for them to be funded under some grant. They’re funded through the Block Grant in Alabama. Again, another plus for the Alabama Department of Mental Health, they’re funded through the Block Grant because that’s the most secure funding any state has.

Pam: [8:56] And so now that we have our outreach peers, our 24/7 helpline, we have four recovering community centers. They’re open 12 hours a day and that’s a big deal because there are many pathways to recovery. And so a lot of people that don’t do 12 steps, they need somewhere to go hang out. They need to go to have somewhere to go be like them. And having that peer either on their telephone, 24/7 or in those community centers 12 hours a day has made a huge difference in those four communities. But the funding, they have to be fully funded because they’re not billable. Their services are not billable like our treatment providers. We at the Department of Mental Health have to pay any expense that they have. We have to cover it.

Steven: [9:47] Pam, thank you for that. It’s really an incredible journey that I think Alabama has taken really as a direct result of your advocacy and your impact. The other thing that comes to mind for me is that as you were convincing the community essentially that this peer support thing is it works, at the same time I think folks might’ve been able to watch you model recovery and there’s a tremendous amount of power in being able to help shift the paradigm and maybe at least reduce some of the biases and stigma that we see towards people who have substance use disorders. And speaking of that, we know stigma and bias is a huge issue in behavioral health. And we know it’s one of the main reasons that people don’t come for treatment. Can you share how you see the impact of stigma on your peers and your services? And if you’ve got any strategies that you’ve used to reduce or eliminate it, I suspect a whole lot of people would love to hear that.

Pam: [11:01] Well, a lot of people don’t understand it, but the hardest group of people to me to stop the stigma was the language of recovering individuals. And I’m just as guilty as anybody for using language like “dope fiend” and “crackhead.” And we do that kind of stuff, and so we have to change the language, and we have to get people to understand. We say it’s a disease but then we don’t act like it’s a disease. I always try to remember educate, educate. Educate everybody from, whether it is the funding source or judges, police, I’m always somewhere. And I just don’t ever think the education piece is going to stop. Everything that I put out promotion wise is going to help. Addiction is a disease, not a moral failing. People can get that. They can hear that one line and they understand that but you have to get in front of people.

Pam: [11:58] And part of it is be willing to share your own story. It’s kind of difficult to sell that without selling your own story. It’s difficult, but one thing I can preach all the time is language, language, language. And the peers have come around to that language and hearing them talk differently and understanding that we are the people that’s going to be promoting this in the public. We got to say the right language so others will use it too and have a better perspective that we do recover.

Steven: [12:31] Wow. That was just beautifully stated, Pam. For states that might not have such a strong peer presence or such a strong peer advocate, do you have any advice you’d like to share to them?

Pam: [12:45] I would definitely advise them as we did, to contact C4 Innovations. Contact them, allow them to come in because what they helped me to understand is all the research and the work I had done, I still needed somebody to help me to put all that together. And I really wasn’t even thinking about the marketing, the peer support. I wasn’t thinking about the challenges and things like that. By working with them, I was already ready for a lot of challenges before they even came. As I always say, build that team based on the motive. If you’re working with something criminal justice, then you got to have criminal justice people. If you need funding, then you got to have somebody on the team who can provide that funding for you. That’s why I always advise people, look at your team and make sure people on your team have the same motive as well as can help you accomplish the project that you’re working on.

Steven: [13:44] Pam, that’s amazing. And thank you. Is there any recommendations or advice or lessons learned that you might be able to share for other peers? Do you have some words of wisdom for other peers out there, Pam?

Pam: [14:01] Well, I always tell people about building a team and I have some non-recovering coworkers that this was not part of their job to help me build this stuff up but they did. Even in my certification training, I got a coworker she always come and teach about our system of care because she’s an LPC [Licensed Professional Counselor]. That’s what she does. And so she teaches them ongoing ever since I started the training. I got someone from our advocacy office that comes and talk about, you got to build a team of people with like minds and want to accomplish the same thing and you need someone on there who can be decision makers. That’s why the Associate Commissioner — and I needed her approval, but I needed the budget of the Director of Treatment Services. That’s who budget I come out of. You got to build that team and make sure.

Pam: [14:57] Another thing that I’ve learned over the years is that having those expectations, just because peers are in recovery, that doesn’t mean they ready for the professional world. Peers need to be trained. We need to make sure we’re taking care of their mental health. Making sure we’re giving them the resources so they can take care of their mental health. Compassion fatigue is real and stigma and all of those things. You have to just, if I wanted to say, I will continue to say, educate, educate, and don’t just take anything for granted that it’s going to be right. You got to make sure you put the education out there. When you’re putting projects out there, one of the hardest things we’re working on now is trying to get inside the emergency rooms.

Pam: [15:45] We are in about three hospitals in Alabama and that’s where the overdoses are showing up at. And so it’s a matter of trying to convince these hospitals to understand that if I can connect that person with a peer, there’s a high probability they won’t overdose and come back in two nights from now. And so what I would tell people is, strap on your boots and get ready for a long, hard ride. There will be rejection but you just have to keep pushing forward. Know what you want and be willing to do the work. If I were to sit back and waited on somebody else at the department to write the stuff, yes, I had to write the manual. Yes, I had to train all 40 hours but today I got five trainers. You see? And so you have to be willing to do the hard work because my goal was exactly what we have in Alabama right now.

Pam: [16:43] And I just see the future as being bright. The Department of Mental Health, that support, we don’t put out anything with funding that don’t include peer support. I haven’t saw us put anything out in the last four years that don’t include peer support services and the funding to make that happen. And we fund them differently than we do. We don’t fund them at a minimum. We fund them because we know what they’re doing works. Our community centers are seeing 2,000 people and they cost what? A $100,000 a year. We don’t have any other service in the state of Alabama that’s seeing 2,000 people a month for that amount of money. They get a big return on the money that we put out.

Steven: [17:28] Wow Pam, I know how much you have advocated. I know the blood, sweat and tears of Pamela Butler is all over Alabama’s peer workforce. I think there’s a lot of folks, very grateful for the work and for your presence. Where do you see the future of peer support in Alabama? Do you have some thoughts about that?

Pam: [17:54] My thoughts is sustaining what we got and continuing to grow. We still got a lot of areas to get in. We got to do something about housing. One of our larger peer run organizations, ROSS [Recovery Organization of Support Specialists], they just entered a contract agreement with the Alabama Department of Commerce, where we’re going to have peers physically working with people to get them back employed. Being their transportation. See, that’s one of our biggest barriers in Alabama to recovery, to employment, to medical, mental, all that. By us putting that transportation, taking away that barrier made a huge difference. I see and I believe the work that we’re going to do inside these hospitals, I see more and more hospitals are having a willingness to let people in and just finding ways. My thought is everywhere somebody with a substance use disorder show up at, we need a peer there. And that’s my goal.

Steven: [18:54] Pam, I think you’re well on your way to achieving that goal. I want to thank you so much for joining me today. I know how busy you are. I’m just really grateful that we were able to spend a little time together today.

Pam: [19:05] Thank you for having me, Steven.

Steven: [19:07] Our work is not finished and I will see you again very soon. That’s for sure. And for our listeners, join us next time on Changing the Conversation.

Erika Simon, Producer: [19:18] Visit c4innovates.com and follow us on Twitter, Facebook, LinkedIn and YouTube for more resources to grow your impact. Thank you for joining us. This episode was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Join us next time on Changing the Conversation.

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