For Colleen Vaughan, the path to be a nationally recognized mental health peer support specialist at the Veterans Administration (VA) has not been easy, but her story illustrates the power that peer support can have on both supporter and supportee. After dealing with mental health issues from childhood on through multiple hospitalizations and even homelessness, Colleen has empowered many veterans and non-veterans, including herself, to become more than their diagnoses.
Working as a peer supporter helped launched her career in mental health as she went on to earn a Masters in Psychology and certification as a Psychiatric Rehabilitation Practitioner. Colleen’s experience in peer support is rich with insights and inspiration, reminding us that for many, peer support is more than a job, it’s a calling.
Getting Started with Peer Support
“Wow, I came here to help someone else and this is pretty awesome because I can use it too”
While Colleen was in day treatment for schizophrenia affective disorder 13 years ago, her case manager heard about a part-time opportunity to be a peer bridger, the first of its kind in North Carolina, and suggested Colleen go for it. She joined five others in providing peer support to individuals as they transitioned from a psychiatric hospital back to their communities.
Colleen remembers that the training they received was “life-changing. For the first time, someone told me that there was something I could do to impact how this illness does or doesn’t control me. No one had ever told me that. I was always at the mercy of people telling me what to do.” With pivotal support from the other five peer supporters, she flourished in this role; within six months she was a full time peer supporter, and within one year, she was the director of the program. Colleen went on to supervise between 15 and 20 mental health peer specialists in this program.
The Mental Shift from Patient to Person
“It’s like flipping a switch”
From Colleen’s own experience undergoing her first training and throughout the course of training peer supporters since, there is a profound mental shift that happens for each peer supporter. She describes the first half of trainings as learning about oneself and telling one’s recovery story, and the other half as how to use what was learned to inspire and role model for others.
However, between those two halves of the training is what she calls “absolute vulnerability. Where you’re telling your recovery story from a different perspective… how do I describe my pain, how do I describe the challenges in a way that will inspire hope.” This, she has found, is the time when a mental shift occurs from patient to person, when individuals realize that they do not need to be defined by their diagnoses. That is one reason why, after making the transition to the Psychosocial Rehabilitation and Recovery Center (PRRC) at the VA, she is still asked to do the orientation for veterans who are becoming peer supporters.
After telling her story, she says that even after 7 years she continues to hear, “Really? You hear voices? Wait, wait, and you have a job?… I thought I was the only one.” Providing that little bit of hope inspires others to make that mental shift in themselves.
Colleen related one story about witnessing that mental shift that exemplifies the unique and individualized nature of peer support. In working as a peer supporter, she has noticed that having mental illness is “kind of like a horse with blinders. We live, breathe our illness and we forget the importance of having fun and doing things just for the sheer enjoyment.”
So when she was working with one man, she asked him what he would like to do if everything was perfect, and he responded: I would like a girlfriend. After digging a bit deeper, she learned that he felt he couldn’t have a girlfriend because he was afraid of going to the movies, and girlfriends liked going to the movies. Armed with that knowledge, over the course of 6 months, they took baby steps. Driving into the parking lot and sitting there; role playing buying a ticket; buying a ticket but not going inside; and so on and so forth until the momentous day he was able to sit inside for a whole movie during the day. Followed by almost the same procedure to watch a movie at night.
While this was not something a doctor could have prescribed, the man “ultimately graduated from the [peer support] program, because he got a girlfriend, got engaged, and they got married.”
Advocating for the Discipline of Peer Support
“It’s not better than, it doesn’t replace. It adds to and enhances an already great system”
In her 13 years in the field of peer support, Colleen has worked tirelessly to advance the discipline of peer support locally and nationally. She has collaborated with the University of North Carolina School of Social Work to create the peer support certification process for North Carolina as well as with the VA headquarters in Washington, DC to create the peer support position description, requirements, and core competencies.
With the recent mandate to hire hundreds of new peer supporters at the VA, she has been providing mentorship to the veterans now becoming peer supporters as they navigate the challenging road ahead. When asked the most important piece of advice she could give to a new peer support specialist, she shared two: 1) not to neglect personal wellness, and 2) “learn how to speak up in a way that you’re heard rather than dismissed.”
Colleen Vaughan’s passion for peer support is contagious, and invaluable to promoting peer support as part of the conventional mental health care system. Peer support, in her words, is “that missing piece in a jigsaw puzzle that just pulls the entire picture into place.”
Targeted ACA enrollment efforts to reach uninsured Latinos
March 31, 2014 marked the end of the first open enrollment period in the Health Insurance Marketplace. It also marked the beginning of National Minority Health Month, an effort by the Office of Minority Health to raise awareness about the disparities that affect racial and ethnic minorities. As the ACA takes full effect, it is critical to understand how the law is impacting minority groups in particular.
Over the last month, the Obama administration made a concerted effort to reach out to Latinos and other minority groups with high rates of uninsurance through targeted marketing efforts on Spanish-language media, town hall gatherings, and celebrity endorsements.
Why the interest in reaching Latinos in particular? Latinos make up the largest group of uninsured adults in the United States. 31% of non-elderly Latinos are uninsured, compared to 21% of African-Americans and 13% of whites (Kaiser Family Foundation, 2013). Not all uninsured Latinos are eligible for coverage under the ACA because of immigration status and other legal restrictions. Nevertheless, the goal is to encourage eligible Latinos to sign up for coverage.
There are a number of barriers this population faces including limited English proficiency, lack of internet or computer access to sign up online, lack of familiarity with the health care system and how it can benefit them, and fears about the legal implications of being from a mixed immigration status family. Given these challenges, levels of Latino enrollment were slow in the early phases of implementation. In contrast to the resource intensive mass media marketing efforts, another approach to boosting Latino enrollment was through the use of navigators.
Role of navigators beyond the open enrollment period
By law, all marketplaces are required to set up two navigator programs, one of which is required to be in a non-profit setting. Navigators are trained according to a standardized federal training curriculum. They perform a number of functions, including distributing information about qualified health plans, providing impartial information about enrollment options, assisting with enrollments, providing referrals to individuals with more complex questions, and ensuring information is provided in a culturally and linguistically appropriate manner to diverse populations (Families USA, 2011).
Navigators were essential in reaching Latinos and hard-to-reach populations during the open enrollment period (Gamboa, 2014). Working out of familiar community organizations which were already trusted sources of information, navigators were highly effective in reaching these populations.
Although the initial enrollment period has ended, the work of navigators continues on. According to the Kaiser Family Foundation, half of all uninsured individuals have been uninsured for more than three years. Chronically uninsured individuals may lack knowledge about the benefits covered by their insurance, the meaning of fundamental concepts of the health insurance system such as copayments and deductibles, or how to find an in-network provider. Having insurance is only the first step in ensuring access to health care services for underserved populations. Navigators can help ensure that people know how to take advantage of their benefits and actually access health care resources, with an emphasis on preventative health care services.
Unfortunately, many states have taken steps to restrict even the most basic functions of navigators, such as providing comparisons of plans offered in the marketplaces (Zomorrodian et al., 2013). 25 states have restricted the role of navigators to solely providing information. While it is important to ensure navigators are offering impartial information to all consumers, delimiting their role strips their ability to help underserved populations effectively navigate the complexities of the healthcare system.
Increasing health care coverage is one of many challenges that navigators can address in the mission to eliminate health disparities among minorities. As we observe Minority Health Month, let us remember the important role that navigators have played in helping Latinos enroll for health insurance and their ongoing work to improve access to health care.
Gamboa, S. (2014, March 31). Hours before deadline, Latinos line up to enroll. NBC News. Retrieved from http://www.nbcnews.com/news/latino/hours-deadline-latinos-line-enroll-n67256.
Families USA. (2011). Navigators need not be licensed as insurance brokers or agents. Retrieved April 7, 2014 from http://familiesusa.org/product/navigators-need-not-be-licensed-insurance-brokers-or-agents.
Kaiser Family Foundation. (2013). The uninsured: A primer. Retrieved April 7, 2014 from http://kaiserfamilyfoundation.files.wordpress.com/2013/10/7451-09-the-uninsured-a-primer-key-facts-about-health-insurance.pdf.
Zomorrodian, P., Grace, A., & Rosenbaum, S. (2013). Navigating state exchange laws: An overview of state approaches to navigator regulation. National Association of Community Health Centers. http://www.nachc.com/client/documents/Navigating%20State%20Exchange%20Laws.pdf.
Patrick Tang, MPH
Chronic disease patients spend most of their time away from clinic, and they can often get caught unprepared or puzzled with managing their conditions. Instead of going to the emergency room when that happens, reaching out to a nearby peer can relieve potentially stressful situations and provide answers when healthcare professionals aren’t available.
Organized peer support in the form of one-on-one coaching, group meetings, and telephone calls aren’t available to many people, especially in rural areas. Moreover, when patients struggle with everyday issues regarding their condition, they can’t wait until the next peer support meeting or doctor’s appointment. Now that 58% of the American adult population owns a smartphone, mobile apps are quickly filling this need, improving opportunities for connectivity and responsiveness in peer support.
In the Android and Apple marketplaces, there are thousands of apps to help people manage their chronic diseases. In recent years, the growth of diabetes apps has been especially strong. According to one study, 76% of mobile health app publishers see diabetes as the therapeutic area with the highest business potential for mobile health. Currently, 1.2% of Americans with diabetes that own a smartphone or tablet use apps to manage their conditions. By 2018, the study predicts that that proportion will grow to 7.8%, or 24 million people.
While the majority of diabetes apps help users monitor their glucose and maintain healthy behaviors, some, like HelpAround, take a different approach and are built around peer support. Described as a mobile safety net for people with chronic conditions, HelpAround enables users to find peers around them wherever and whenever they need help or advice. Currently, the app supports communities around diabetes (type 1 and 2), parents of children with diabetes, and food allergies.
HelpAround works by linking “help seekers” with “helpers” in its Diabetes Safety Net. The app identifies the people with the highest likelihood of being able to help, notifies them of the request, and invites them to respond. Using a phone’s GPS, the app can link peers in close proximity to each other when the need arises. The built-in scalability means that user requests aren’t drowned out in a sea of messages. No matter how many people are using the app, only the people most likely to respond will receive requests. Users looking to chat with others that share their conditions can join one of many virtual support groups in the HelpAround community.
Mobile apps like HelpAround can assist healthcare providers build local patient communities that can mutually support each other when providers aren’t available. When patients can help each other before situations turn into emergencies, they are less likely to use urgent care or need hospitalization. Furthermore, healthcare providers can attract new patients, identify dissatisfied or distressed patients, help transition them to at-home care, and lower the risk of hospital readmissions.