An episode of Changing the Conversation
Sarah Saint Laurent and Judy Fox share strategies the state of Rhode Island has used to build and maintain the infrastructure to support peer recovery services with host Livia Davis.
May 16, 2022
Livia Davis, Host (00:05): Hello, and welcome to Changing the Conversation. I’m your host, Livia Davis. Our topic today is integrating positions in government to support peer-based recovery support services. My guests today are Sarah Saint Laurent, calling in from Westerly in Rhode Island, and Judy Fox calling in from Cranston, Rhode Island. Sarah Saint Laurent is the lead on peer-based recovery support services for the Rhode Island Department of Behavior Healthcare, Developmental Disabilities, and Hospitals. Welcome, Sarah.
Sarah Saint Laurent, Guest (00:41): Thank you, Livia. Great to be here.
Livia (00:43): And Judy is a peer workforce development specialist at C4 Innovations, and she’s also a former Rhode Island state employee. Welcome, Judy.
Judy Fox, Guest (00:53): Thanks for having me here.
Livia (00:55): Judy, I know that you’ve had a key role in creating the peer-based recovery support position in Rhode Island. Could you talk a little bit about why Rhode Island decided to add this position?
Judy (01:08): Sure. After Rhode Island received Medicaid approval for peer-based recovery services in 2018, and the state of Rhode Island agreed to pay 50% of the services, which is what required, it was clear that Rhode Island needed to focus on documentation of what was needed for the service and how to operationalize and oversee this service. And this included three major components. One was establishing and monitoring standards for agencies who would be reimbursed. The second was educating community agencies and consumers about this new service and how it relates to traditional behavioral health services. And the third is implementing and monitoring a workforce plan to ensure quality peer recovery services, which included uniform training for peers and quality supervision.
Livia (02:13): So, talk a little bit more about the context for these positions, if you would, for just a moment in terms of the expansion of recovery support services in Rhode Island. Why was it important for Rhode Island to do that now?
Judy (02:27): Because it wasn’t possible to implement Medicaid reimbursement without someone within state government overseeing what needed to be done and ensuring it happened. It involves a lot of time and energy and resources. And as it existed at the time, Rhode Island did not have the ability to just add these additional tasks onto other existing jobs. They were too specialized and too time consuming to add onto anyone’s existing job duties.
Livia (03:10): So really, the context is we need to have somebody who is doing this work and this position needs to be created and that’s why we did it and also because, of course, the funding.
Judy (03:22): Yeah. One addition is that it’s a very different type of Medicaid service than ever existed in Rhode Island in that it was looking at behavioral health from a nonclinical perspective and that required looking at all the components from a slightly different lens than they had been looked at before.
Livia (03:48): No, I think that’s exactly right. The addition of this peer workforce being nonclinical in nature really has prompted states to look at what is the infrastructure, what are the roles, what are the positions we need to put in place in order to support this workforce? So, thank you, Judy, very much. Sarah, you are the lead for peer-based recovery support services in Rhode Island now. Can you tell us about your day-to-day work?
Sarah (04:17): Yes, I’ll start big picture and then I will give more detail. Big picture, I assist in planning, administration, and oversight of recovery support services funded by my department, BHDDH. There are many different tasks and responsibilities that fall under this big picture. And before I get into detail about them, I want to note that I’m not always doing everything that I’m about to discuss. In the six years that I have been with the state, I’ve found that work ebbs and flows. An example of that is some weeks, my calendar is packed with meetings and engagements, and I’m interacting in big groups all week. And other weeks, I’m shut in my office for days deep in an independent project that I’m working on. So, what I do each day can vary quite a bit, depending on the needs of the department and the recovery support provider community at the time.
Sarah (05:14): That being said, meeting participation is always an important part of my job. I participate in many meetings, meetings with other BHDDH staff, meetings with other state departments, and meetings with community agencies and stakeholders. My purpose in participating in all of those different meetings is to coordinate the work that our department does and that our department funds with the work that other state departments and community agencies are doing so that we’re all on the same page and working together towards the same set of goals or the same vision, rather than accidentally doing things that work against each other. Another sizable piece of my job is contract monitoring and oversight. I manage multiple contracts. One is a peer recovery specialist training contract, another pays for peer recovery specialist certification and re-certification fees, and a third contract I manage is brand new, and it will be providing leadership training just for participants with lived experience of a behavioral health condition.
Sarah (06:17): And in managing those contracts, I’m responsible for the administrative pieces of those, specifically of those three contracts and that entails things like initiating and managing a procurement process to get a contract written and signed. I track the progress of tasks and deliverables within those contracts. I process monthly invoices. I do all the other fiscal paperwork and things like that. That administrative work is just for those three contracts. Then outside of those, I have programmatic responsibility to every single recovery support service contract that our department has and that means that I work with the other contract monitors to monitor the quality of services provided by the contract. I write scopes of work that details exactly what our contractors are supposed to be doing and how they’re supposed to accomplish that and on what timeframes. And I provide support and assistance to the provider that we contract with if there’s a piece of the work that they are struggling with.
Sarah (07:26): Sometimes the support that a contractor needs is more than I can provide as one person and then it’s my role to identify what does the contractor need and how do I get them… who can provide the training and support that they need and how do I bring that in? How do I facilitate the relationship between the TA provider, the technical assistance provider, and the contractor and how do I monitor that process to make sure that everyone gets what they need? An example of a technical assistance need that I recently supported is training our recovery community centers on how to use a specific evidence-based life skills curriculum. So, I went in and taught the staff in a recovery community center how to use a life skills curriculum with members of their center, how to facilitate the curriculum and the process. And it took me about a week’s worth of effort to do that, to plan the training and deliver the training and make sure that facilitators felt comfortable versus a TA need that was too great for me to meet, and I’m working on outsourcing right now is support on curriculum development for our peer recovery specialist training provider.
Sarah (08:45): The need there is too great for me as one staff person to meet on my own, so, as I mentioned earlier, my role in that space is to identify a provider who can help and facilitate that help and support.
Livia (08:58): Thank you, Sarah. That was a lot that you covered, and you certainly do a lot of different things in your role. If you could talk a little bit about how the recovery support providers respond to this position. How do they feel about this position? Do you have any sense of that?
Sarah (09:19): I think the community of recovery support providers overall has responded positively to my position. People feel for the first time that people in recovery are being valued because I’m a certified peer recovery specialist, and I’m a person in recovery. And it was very important when my department hired for this position, they wanted someone with those qualifications to give that message to the community that their voices are important and their experience matters and they should be at the table, and so the community is overall very excited to have someone at the table advocating for them and bringing their perspective to the work that we do.
Livia (10:05): Thank you, Sarah. So, there’s a lot that has happened since this position was started by you, Judy, and it certainly sounds like, Sarah, you are taking it to the next level. Judy, I’m wondering if you could share for a few minutes any hopes that you have for the future, as it relates to peer services.
Judy (10:26): My hope is that peer recovery services are embedded as part of all the behavioral health services and is seen as one additional avenue to provide help for consumers. Also, it’s important to me that this is recognized as a standalone service that’s consumer-driven so that people who are in recovery, but might not feel comfortable or be interested in traditional behavioral health services, will have another path to follow on their recovery journey.
Livia (11:17): Thank you. Thank you, Judy. Sarah, as a followup to what you just shared about what you’re currently doing, can you tell me about the future of peer services in Rhode Island as you see it?
Sarah (11:31): I’m with Judy as far as having peer services be just another piece of behavioral healthcare treatment that people can receive, including having it be a standalone service. I agree with her. There are a lot of people that have very valid reasons to mistrust our medical and behavioral healthcare treatment systems, and they deserve care and support and a peer can provide that for a lot of people in a way that feels safe rather than unsafe in the way that many people have been made to feel by treatment. On the other side, I think to have that become a reality where peer services is just another piece of treatment that people can get or support that people can get while they’re in treatment or not, we need to have more infrastructure for it at the state level. Right now, I’m the only person working on recovery support services full-time for the state.
Sarah (12:28): So, while it’s definitely groundbreaking that the state prioritized hiring a person with lived experience to do this work, there’s only one of me, and there’s so much work that I would love to do, and I just don’t have the time in my day. So, I would love to have a division of recovery support services within BHDDH that I lead with multiple staff under me, and I would love to bring a lot of the infrastructure work that supports peer recovery services in-house, so that would be things like peer recovery specialists, initial training, and ongoing training for those who are seasoned in the field. I want to bring that in-house. I would love to bring recovery housing certification and support in-house as well. And that’s just off the top of my head, but I would love to see BHDDH have a stronger presence and a more robust group of staff focusing on this so that we can integrate peers into other behavioral health services in the right way.
Sarah (13:35): Because as Judy said, this is a specialized service, it’s very different from other behavioral healthcare treatment services, and there’s a lot of risk if you do it wrong.
Livia (13:47): Yeah. No, that’s so critically important. Do you have any lessons learned that other states might like to hear about as they start their journey to create recovery-focused positions within their departments?
Sarah (14:03): For states that are considering adding a position of this type, I would encourage them to talk to the community first before they have a firm set idea in their mind of what this position or position should be. They need to talk to the community because every community is different, and the people who are providing direct peer services know what their consumers need, and they know what they need because a big piece of this position is being a liaison to the recovery support community and hearing their needs and bringing those back to the table, to planning tables at the department, to represent their perspective and make sure that they get their needs met. So, talk to the community and see what do they need? What skills do they think this person should have? What would they look to this person to do as the recovery liaison to the community? Involve the community from the very beginning, and I would keep them involved throughout the process. As states are writing their job descriptions and identifying tasks and responsibilities for the staff, keep the community involved.
Sarah (15:15): I would even go so far as to ask them for recommendations for people to interview. I would ask them to do some of the advertising and marketing for you so that they feel like they’re truly a part of the process. Because if the community doesn’t feel like they have been involved enough, then they’re not going to want to engage with that person and that’s one of the most important things I do in my job is engaging with the community in an authentic way. The other thing that I would say, the other lesson that I would pass on is that this person needs to have lived experience of a behavioral healthcare condition. That’s a non-negotiable. You have to understand what it’s like to try and use the system as a consumer to be able to operate effectively inside of the system and really remove barriers for people that use the system.
Sarah (16:09): I have one more lesson. If at all possible, hire more than one person at the same time. It’s very hard to be the only person who openly has lived experience in a department. It’s very hard to be the only person who is thinking about the human impact of decisions at the table. And having a mentor or a partner that really gets it and understands your perspective and why the things you’re fighting for are important is so essential to not burning out in this role.
Livia (16:42): Thank you so much, Sarah. That was very poignant and well said. Thank you. Judy?
Judy (16:47): One thing I found towards the end of the process is that our department and people working within state government did not really have an understanding of what peer recovery services were. So, we then went and developed a training, internal training to train people internally about peer recovery services. I think that’s really helpful. Even though people give lip service to it, they didn’t really understand the depth and the breadth of the service and how it relates to traditional services, and I think that’s also true in the provider world to the extent you can go out and do some education early on and keep it up. That is really helpful to lay a foundation. And the other thing we did in Rhode Island that I think in the long run is going to save us a lot of time and energy is we were able to integrate substance use disorder and mental health peer services into one certification and one training process so that everybody was on the same page, and we didn’t have really parallel tracks that overlapped. So, if you can do that from the beginning, that will really save time down the road.
Livia (18:21): Thank you so much. One final question before we wrap up today. Sarah, what inspires you to keep going?
Sarah (18:30): I’m inspired to keep going by the difference I can see that peer services makes for people. It’s hard for me to put into words how much a peer can really improve someone’s life, especially an individual who has never connected with a peer recovery specialist before, who’s only connected with helping professionals who can’t share their own experiences. To watch someone connect with a peer for the first time and to tell the peer what they’re going through and for the peer to say, “Yeah, I know what that’s like. I woke up in the hospital bed right down there when I overdosed. I know what it’s like, and I’m here to hold your hand through this process, whatever you want it to be,” it’s so transformational for people, and I’ve seen so many people who just were hopeless find hope again.
Sarah (19:23): And I’ve seen people be motivated to get better and to try to get better in a way that other helping professionals haven’t been able to inspire within them. I’ve seen peers inspire that desire and that hope to really get better and live life differently in people and that’s what inspires me to keep going. When I’m climbing out under mountains of paperwork and bureaucracy, that’s what really inspires me to keep climbing is those people that get helped.
Livia (19:54): Thank you, Sarah. And Judy?
Judy (19:57): What inspires me is that peer recovery services really are able to help people who traditionally have not engaged in behavioral health treatment because of their own personal distrust of the system or fear of being labeled crazy or unable to really manage their lives. They’re willing to engage with peers because it’s nonthreatening, and they’re met at their own level. They’re asked really what they need to move ahead, and there’s not a set formula that’s imposed on about what they need to do. So, I worked for 17 years with women leaving prison and saw their fears of the behavioral health system and the stigma. And some of it is cultural of engaging with traditional services, and some of it is access issues, but peers really break down all those barriers and allow for an entree into really behavioral health without all the labels that are associated with it.
Livia (21:23): Well, thank you both. You are both supporting what someone has coined “the business of hope.” You’re in the business of hope, and you’re supporting all the folks who are on the front lines providing hope to so many people. Thank you so much, and I hope that there’s some valuable nuggets here to our listeners. Sarah, thank you so much for joining us today.
Sarah (21:47): Thank you for having me, Livia. It was wonderful to be here.
Livia (21:50): And Judy, thank you so much for joining us today on our talk.
Judy (21:54): Thank you for having me here.
Livia (21:56): And to our listeners, join us next time on Changing the Conversation.
Erika Simon, Producer (22:01): 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.
Access additional “Changing the Conversation” podcast episodes.