Peer Experience Certified Recovery Peer Specialist (PECRPS) Training Notes

Overview of Peer Experience Certified Recovery Peer Specialist (PECRPS) Training

• Development and Authorship: Developed by the Peer Experience National Technical Assistance Center (PENTAC), a program of the Peer Support Coalition of Florida (PSCFL), Inc.
  • Authors: Cheryl Molyneaux, EdD, CRPS (Executive Director) and Sherry Warner, B.Ed, NCPS (Education Director).
  • PENTAC is one of SAMHSA’s five Consumer Technical Assistance Centers.
• Purpose: To prepare individuals with lived experience in recovery (mental health and/or substance use) to support others in beginning, sustaining, and strengthening their recovery journeys.
• Role of a Certified Recovery Peer Specialist (CRPS): Individuals who have achieved significant progress in recovery, completed training ($40$ hours), and mastery of core competencies.
  • Settings: Behavioral health organizations, peer-run organizations, community agencies, criminal justice systems, and local/state/federal programs.
• Certification Requirements: Meets Florida Certification Board (FCB) requirements. Post-certification requires $10$ Continuing Education Units (CEUs) annually.

Defining and Understanding Recovery

• Evolution of Definitions:
  • Pat Deegan ($2001$): A transformative process of letting go of the old self and emerging as a new sense of self.
  • CSAT ($2005$): A process of change involving abstinence and improved health, wellness, and quality of life.
  • SAMHSA ($2011/2012$): A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
  • Kelly and Hoeppner ($2014$): A dynamic process characterized by increasingly stable remission, supported by increased recovery capital.
• SAMHSA’s 10 Guiding Principles of Recovery:
  • Hope: The essential belief that recovery is real and overcome challenges.
  • Person-Driven: Self-determination as the foundation; individuals lead their unique paths.
  • Many Pathways: Personalized recovery including clinical, non-clinical, and self-management pathways.
  • Holistic: Encompasses mind, body, spirit, and community (housing, job, clinical treatment).
  • Peer Support: Sharing experiential knowledge and skills; mutual aid playing an invaluable role.
  • Relational: Involvement of people who believe in the person’s ability to recover.
  • Culture: Background, values, and traditions as keys to the journey.
  • Addresses Trauma: Services should be trauma-informed to foster safety and trust.
  • Strengths/Responsibility: Individuals have personal responsibility for self-care; communities have social responsibilities.
  • Respect: Elimination of discrimination; protecting rights.
• Major Dimensions of Recovery: Health, Home, Community, and Purpose.

Person-Centered Principles and Self-Determination

• Medical Model vs. Person-Centered Model:
  • Medical Model: Focuses on diagnosis, disease, and deficits; the practitioner is the expert.
  • Person-Centered: Focuses on strengths and assets; the individual is the expert on themselves.
• Self-Determination Theory (Mancini, $2008$):
  • Autonomy: Ability to make choices for oneself.
  • Competence: Belief in ability to do something successfully.
  • Connection to Others: Positive relationships supporting goals.
• Recovery Pathways:
  • Clinical: Aided by healthcare providers/clinicians.
  • Non-Clinical: Often community-based utilizing peer support.
  • Self-Management: Sometimes referred to as "natural recovery."

Stages of Change and Stages of Recovery

• Stages of Change Model (Transtheoretical Model):
  • Precontemplation: Unaware of problems; task is to Raise Awareness.
  • Contemplation: On the fence; task is Resolving Ambivalence.
  • Preparation: Seeking solutions; task is Support Choosing Change Strategies.
  • Action: Implementing changes; task is Addressing Barriers.
  • Maintenance: Using coping skills with ease; task is Maintaining New Habits.
  • Return to Use/Onset: Normal part of nonlinear recovery; task is Addressing Consequences and Planning Forward.
• Five Stages of Mental Health Recovery (Fricks, $2011$):
  1. Impact of Illness: Overwhelmed by symptoms/disabling power.
  2. Life is Limited: Resigned to illness; role is to instill hope.
  3. Change is Possible: Questioning the illness; empower small steps.
  4. Commitment to Change: Identifying strengths and resources.
  5. Actions for Change: Moving beyond illness; using strengths.

Fundamentals of Relationship-Based Practice

• Building Rapport: Forming a harmonious connection based on mutual attentiveness, positivity, and coordination.
• Connecting Questions: Does the person feel I care for them? Can I help? Can they trust me?
• The PACE of MI (Spirit of Motivational Interviewing):
  • Partnership: Collaboration between experts.
  • Acceptance: Affirming worth, autonomy, and accurate empathy.
  • Compassion: Deliberate promotion of the other's well-being.
  • Evocation: Drawing out motivation already within the person.
• Active Listening Principles:
  • Be Attentive; Stay Engaged; Remain Authentically Curious; Embody Tolerance.
  • Barriers: Judging, using jargon, avoiding concerns, giving unsolicited advice.
• S.O.L.E.R. Framework:
  • S: Squaring (Sit or stand squarely facing the person).
  • O: Open posture (No crossed arms).
  • L: Lean forward (Show interest).
  • E: Eye contact (Maintain good, culturally informed contact).
  • R: Relaxed body language (Natural pace).

Mental Health and Brain Basics

• Neural Foundations: "Neurons that fire together wire together."
• Neuroplasticity: The brain’s ability to change based on experience, physiology, and intention.
• Categories of Neurotransmitters:
  • Excitatory: Glutamate, Epinephrine, Norepinephrine (Cause the neuron to fire).
  • Inhibitory: GABA, Glycine, Serotonin (Block chemical messages).
  • Modulatory: Acetylcholine, Dopamine, Serotonin, Histamine, Cannabinoids (Tweak communication at synapses).
• Major Neurotransmitters and Functions:
  • Dopamine: Pleasure, reward, addictions, and movements.
  • Serotonin: Mood, well-being, sleep, and digestion.
  • GABA: Calming, focus; low levels cause anxiety.
  • Endorphins: Euphoria, self-esteem, pain reduction.
  • Norepinephrine: Alertness, actions, concentration.
  • Glutamate: Memory, most common transmitter.
• Medication Overview:
  • Antidepressants: SSRIs (e.g., Prozac), SNRIs (e.g., Effexor), NDRIs (e.g., Wellbutrin).
  • Mood Stabilizers/Antipsychotics: Lithium, Olanzapine (Zyprexa), Quetiapine (Seroquel).
  • Anti-Anxiety: Benzodiazepines (e.g., Valium, Xanax), Buspirone.
• Post-Acute Withdrawal Syndrome (PAWS): Six major symptoms occurring within the first $2$ years: Sleep disturbances, Memory problems, Inability to think clearly, Emotional patterns (overreactions), Physical coordination difficulties, and Stress sensitivity.

Substance Use Disorder (SUD) and Medication-Assisted Treatment

• MOUD (Medication for Opioid Use Disorder):
  • Methadone: Full agonist; occupies and activates receptors; only via federally licensed Opioid Treatment Providers (OTPs).
  • Buprenorphine: Partial agonist; has a "ceiling effect" for safety; lowers potential for misuse.
  • Naltrexone (Vivitrol): Antagonist; blocks receptors so opioids have no impact; non-addictive; requires $7-14$ days drug-free before start.
• Harm Reduction: A philosophy of meeting people where they are to reduce the negative consequences of substance use.

Cultural Humility, Diversity, Equity, and Inclusion (DEI)

• Components of Culture:
  • Aware: Understanding other groups.
  • Knowledgeable: Knowing beliefs and traditions.
  • Sensitive: Aware of differences without assigning values.
  • Humble: The ability to suspend what you think you know and be open to the individual's personal culture.
• Implicit Bias: Attitudes or stereotypes affecting understanding in an unconscious manner.
• Bilingual vs. Bicultural:
  • Bilingual: Speaking two languages.
  • Bicultural: Living seamlessly in two different cultures, combining their norms.
• CLAS Standards: National standards for Culturally and Linguistically Appropriate Services to improve health outcomes.

Trauma-Informed Care (TIC)

• SAMHSA’s Definition: Results from an event/circumstances experienced as harmful or life-threatening with lasting adverse effects ($the\,3\,Rs$ of Trauma: Realize, Recognize, Respond).
• ACEs (Adverse Childhood Experiences): Occur before age $18$; include abuse, neglect, and household dysfunction. High ACE scores correlate with SUD, depression, and physical disease.
• Trauma Responses: Fight, Flight, Freeze, and Fawn (People-pleasing or appeasing to avoid conflict).
• 6 Key Principles of TIC:
  1. Safety
  2. Trustworthiness and Transparency
  3. Peer Support
  4. Collaboration and Mutuality
  5. Empowerment
  6. Cultural, Historical, and Gender Issues

Ethics, Boundaries, and Professionalism

• Mandatory Reporting: Disclosure is required in cases of child abuse, elder abuse, or threats of harm to self/others.
• Confidentiality Regulations:
  • 42 C.F.R. Part 2: Stringent federal rules for substance use treatment records.
  • HIPAA: Health Insurance Portability and Accountability Act.
• CRPS Boundaries: A CRPS is NOT a sponsor, nurse/physician, priest/clergy, or therapist/counselor. Moving beyond these roles breaches professional integrity.
• Documentation (DORP): Describe, Observe, Response, Plan. Collaborative documentation is preferred.

Motivational Interviewing (MI) Skills

• OARS:
  • O: Open-ended questions (cannot be answered with yes/no).
  • A: Affirmations (Shining a light on strengths).
  • R: Reflections (Mirroring back content or emotion to clarify meaning).
  • S: Summaries (Drawing together multiple points).
• Change Talk vs. Sustain Talk:
  • Sustain Talk: Language favoring the status quo.
  • Change Talk: Language for making a change (DARN CAT: Desire, Ability, Reason, Need; Commitment, Activation, Taking Steps).
• The Righting Reflex: The urge to fix others' problems, which can take away their autonomy.

Recovery Planning and Recovery Capital

• Recovery Capital (RC): Internal and external resources drawn upon to sustain recovery.
  • Social RC: Connections and sense of belonging.
  • Physical RC: Financial, transportation, and housing assets.
  • Human RC: Values, purpose, and self-efficacy.
  • Community RC: Policies, role models, and local institutions.
• SMART Goals: Specific, Measurable, Achievable, Relevant, and Time-based.
• The 8-Step Planning Process:
  1. Assessing Recovery Capital
  2. Setting Recovery Goals
  3. Determining Strategies
  4. Mobilizing Strengths
  5. Identifying Skills & Resources
  6. Anticipating Challenges & Stressors
  7. Identifying Allies & Supports
  8. Reflecting on Progress

Stigma, Advocacy, and Social Injustice

• Three Forms of Stigma:
  • Structural/Institutional: Laws or policies resulting in discrimination.
  • Public: Attitudes and beliefs of groups portray stereotypes.
  • Self-Stigma: Internalized negative stereotypes resulting in shame.
• Types of Advocacy:
  • Self-advocacy; Group advocacy; Peer advocacy; Citizen advocacy; Professional advocacy.
• Key Laws:
  • ADA ($1990$): Americans with Disabilities Act.
  • MHPAEA ($2008$): Mental Health Parity and Addiction Equity Act.
  • ACA: Affordable Care Act.

Group Facilitation and Crisis Support

• Facilitator vs. Trainer: Facilitators lead the group to learn from each other; trainers deliver expert instruction.
• Challenging Behaviors: The Quiet/Shy, The Know-It-All, The Dominator, The Unfocused, The Center-of-Attention, The Complainer, The Superachiever, The Joker, The Devil's Advocate, The Argumentative, The Verbose, and The Resistant.
• CALM A.C.T.S. Framework for Crisis:
  • C: Center Yourself
  • A: Acknowledge & Attune
  • L: Listen & Learn
  • M: Measure Safety
  • A: Anchor the Moment
  • C: Connect to Support
  • T: Transition Forward
  • S: Strengthen & Support
• Types of Crisis: Developmental (identity), Situational (job loss), Acute (panic attack), Chronic (long-term illness), and Existential (meaning).

Whole Health and Flourishing

• Dual Continuum Model (Dr. Corey Keyes): Mental Health (wellbeing) and Mental Illness (symptoms) are two separate continua.
• Domains of Flourishing: Happiness/Life Satisfaction, Health (Mental/Physical), Meaning/Purpose, Character/Virtue, and Close Social Relationships.
• SAMHSA’s 8 Dimensions of Wellness: Emotional, Financial, Social, Spiritual, Occupational, Physical, Intellectual, and Environmental.
• Power Statements: Declarative, present-focused sentences that shift a person from reacting to choosing. Includes: State the problem, Tell what you want, and Tell why.
• Evidence-Based Wellness Systems:
  • WRAP: Wellness Recovery Action Plan.
  • WHAM: Whole Health Action Management ($11$ weeks).
  • Personal Medicine: Self-initiated, non-pharmaceutical activities used to stay well.

Problem-Solving and Legal Systems

• ADAPT Problem-Solving Model:
  • A: Attitude (Positive orientation).
  • D: Define the problem.
  • A: Alternatives (Brainstorming solutions).
  • P: Predict (Cost-benefit analysis).
  • T: Try Out (Implementing and monitoring).
• Legal Protections in Florida:
  • Baker Act (FS $394$): Emergency mental health services/$72$-hour hold.
  • Marchman Act (FS $397$): Involuntary assessment and treatment for substance use.
  • Chapter 39: Mandatory reporting of child abuse/neglect.
  • Managing Entities (MEs): Regional systems of care (divided into $6$ regions in Florida) that contract behavioral health services.