Afiya Peer Respite

Afiya Peer Respite

Annual Report

FY ‘13

Summary: Afiya is a part of the Western Massachusetts Recovery Learning Community (RLC). It is a three-bedroom home situated in downtown Northampton at 256 Jackson Street. Afiya’s mission is to provide a safe space in which each person can find the balance and support needed to turn what is so often referred to as a ‘crisis’ into a learning and growth opportunity.

Afiya officially opened on Saturday, August 4th. (As such, all data included in this report is for 11 months, as opposed to a full 12.) Although we’d been told to expect that things would be “slow” for the first year, we had our first guest on the 4th and have had few “slow” days since. Although there were some ups and downs in activity in our first six months, our last five months have been steady. Overall, feedback both from people working at and staying at Afiya has been overwhelmingly positive.

Team Overview: The Afiya team is made up of eight permanent team members and several people working in per diem roles. Permanent team members include:

Jack Bonsignore, Director
Andy Beresky, Advocate
Wyatt Ferrera, Advocate
Kaylie Harriman, Advocate
Keely Malone, Advocate
Jess Norris, Advocate
Opeyemi Parham, Advocate
Dani Scott, Coordinator

We have not lost any team members since our opening date, and we have been able to add one new team member (Keely Malone) and increase the hours of others as a result of additional funds made available to us in January, 2013.

All permanent team members have been intensively trained in Intentional Peer Support including:

An initial five-day training in June, 2012 (with the exception of Keely, who had not yet been hired)
A two-day ‘co-supervision’ training in April, 2013
A two-day Crisis training in May, 2013

Most team members were also trained in Emotional CPR by Dan Fisher and Oryx Cohen in July of 2013, and four have attended the Certified Peer Specialist Training.

Total Contacts for the Year: People have come to stay at Afiya 131 times between August 4th, 2012 and June 30th, 2013. Of

those 131 stays, 83 (63%) of them were

with unique individuals, while 48 (36%) of

them represented return visits.

It’s also important to note that there have

Been 618 phone or in person contacts

between team members at Afiya and people

in the community. Many of those contacts

have not resulted in a stay at Afiya, and

the reasons are varied. However, the

most common reason by far is lack of

space available. As noted below, there were 240 calls where people would have come to stay, but were not able to because a room was not available.

Utilization Rate: As aforementioned, there have been some ups and downs in utilization of the peer respite during Afiya’s first year of existence. However, utilization rates have been over 80% in the last five months and over 90% in the last three. It’s important to note here that of the very few days where someone was not occupying all the rooms in the last five months, these brief lapses were often due to timing issues (e.g., tracking down people on the waiting

list and so on).

Demographic Breakdowns: Although the Afiya team continues to expand their outreach efforts in general and their capacity to support people who speak primarily Spanish or American Sign Language, people coming to stay at Afiya have been fairly diverse in a number of ways.

Age: People are able to stay at Afiya if they are

18 years of age or older. Ages of people who

have actually come to stay at Afiya have ranged

from 18 to the late 60’s, though the majority

of people are between 20 and 59.

Gender: For the first 6 months, people staying

at Afiya were predominately female. However,

in the last 5 months, the number of men

contacting the house has dramatically increased. By June 30th, a total of 35% of all separate individuals having stayed at the house were male identified.

Geography: By far, the highest

number of people have come to Afiya

from HampshireCounty. Hampden

Countywas the next mostrepresented

area withFranklinCounty close

behind. A small handfulof people

from the Berkshires have alsostayed at

the house, but only one person from

Central Massachusetts has taken

advantage of the offering. This may

reflect, in part, the Afiya team’s focus

on outreach in Western Massachusetts

during its first year.

DMH Services: We did not start inquiring about whether or not people staying at Afiya were using other services funded by the Department of Mental Health (DMH) until early in 2013. Some have declined to answer this question. However, of those who have answered, slightly less than half have acknowledged that they are connected to DMH in some way other than just their use of Afiya.

Fidelity to Structure: There are many

ways to examine fidelity to the values and

structure of peer respite in general, and

specifically for the structure of Afiya.

Generally speaking, values and standards

have included (among others):

Being run and facilitated by people

who personally identify as having been psychiatrically diagnosed, experienced trauma, hospitalization, etc.

Being in a completely residential location with no clinical supports
Not using forced treatment or coercion
Operating from a values-driven (rather than rules) driven place with no mandatory bed times, curfews, groups, meetings, and so on
Approaching each person with genuine curiosity and learning about how they have made meaning of their experiences
Not inquiring about diagnosis, psychiatric history, medications, etc.
Not speaking for people, even when other providers call seeking information

We are pleased to report that we have held close to the fidelity of our approach. All people who work at Afiya openly identify as having personal experience with extreme emotional distress and a variety of other experiences and life challenges. Afiya has successfully operated in a residential location, without any clinical supports. Team members have never called for crisis services or other involuntary treatments. There are no rules about bed times or mandatory meetings, although it is commonplace to talk about the importance of taking care of basic needs (like eating and sleeping) and conversations about a number of topics are frequent. Discussion of someone’s psychiatric history only occurs when an individual wishes to share. Providers who call to find out information about someone are routinely directed to speak to that person, and team members are only involved at that person’s request and in their presence.

Additionally, Afiya was structured around the idea that response time would be quick and minimal red tape would exist between a person wanting to come stay at Afiya and them actually beginning their stay. Although measurement of time between a first contact and the start of a stay only began being tracked in early 2013, Afiya has also had great success in this area. Excepting situations where space is not actually available, the vast majority of people are able to begin their stay less than 12 hours from the point of first contact, and never more than 24 hours after. The actual process to talk to someone and make a decision about whether or not they are a fit for the house actually only takes about an hour and any delays beyond that are typically due either to when a room is actually becoming vacant and/or when someone is actually able to get transportation over to the house to begin their stay

(or for some other reason at

that person’s own request).

Additionally, Afiya was based

around the idea that stays would

generally be one to seven days

in length. Although the Afiya

team does have the discretion to offer

extensions, the vast majority of

stays (116) have been equal to

or less than seven days in length.

Of the 15 stays during which extensions were granted, about two thirds of them were for only one or two additional days.

Outcomes: Outcomes have been measuredboth by general tracking in the house, and

through the use of a post-stay survey. Some outcomes have been tracked since opening, while others represent newer areasof focus.

Post-Respite Destination: One of the outcomes we’ve been most interested to track has been whether or not people have been helped enough by their stay at Afiya to return home or to another non-treatment-oriented location such as a friend’s house. We are pleased to report that of 131 stays, 97 have ended with a person returning to their home and 23 to a friend or family member’s house. Five people left to unknown destinations, and only six of 131 stays ended in someone leaving to a treatment facility of any kind. However, it is worth noting that one of those six was to a medical hospitalization. * Also worth noting, of the two psychiatric hospitalizations that have occurred directly following a stay at Afiya, one was at the choice of someone staying at Afiya who then decided to return to the house after she stayed briefly at the hospital. In the other situation, a woman ended up being taken to the hospital after a negative interaction while in town on her own and not while actually at the house. Of the three people who went to traditional respite following their stay at Afiya, two were dealing with housing issues that required more time to address than Afiya could offer.

Meeting Goals: In early 2013, the Afiya team also began tracking whether or not people staying at Afiya had met at least one goal they had identified during their time there. This is tracked through conversation with the individual staying and when they complete their ‘Hopes for Stay’ form at the end of their visit. Of the people who were included in the tracking of this outcome, 66 people reported meeting at least one of their goals. *Of the 6 who did not, it is important to note that, for at least two of them, their stays ended abruptly and unexpectedly due to medical or other issues.

Survey Feedback: Toward the end of this year, the Afiya team developed a survey to further assess their impact on the community. This survey was distributed by Facebook (the Afiya Facebook page has over 90 community members, and the RLC Facebook page has over 420) and our newsletter (both the paper and electronic versions which go out to around 1500 people between them every month). The survey was also mailed to people who had stayed at Afiya and left us with sufficient and current contact information in order to send it to them. Surveys were able to be completed on-line through Survey Monkey or in paper form.

We have received 22 surveys back. (We expect higher numbers in future years when the survey will be more readily available.)

Prior Service Usage: Of the 22 people who

completed the survey,15 had had prior

psychiatric hospitalizations,14 had stayed at

a traditional crisis respitehouse, 10 had

received or were currentlyreceiving other

DMH-funded supports (clubhouses,

supported housing, etc.) and onereported no

other connections with DMHor crisis

services.

If Not Afiya: The majority of people who

responded (56%) said they would have

gone to the hospital had Afiya not been available. An additional 18% said they would have ended up at a traditional respite, while 9% said they would have stayed with a family member or friend. 14% said they would have just stayed home, and an additional 9% said they would have had no other options and left comments stating that they may have killed themselves had Afiya not been available.

Comparisons with Other Settings: Respondents also compared Afiya to hospital and traditional respite settings, they were asked to circle any environment in which they experienced the following:

Felt welcomed when entered setting
Was given clear explanations and information about the space and supports available
People working there consistently used respectful, recovery-oriented language
People working there treated them non-judgmentally
People working there were genuinely interested in learning about the person and their perspectives, fears, challenges, homes, wants and dreams
There was opportunity to connect with and engage in mutual support with others who were staying in the space, not just those working there
Stay had long lasting, positive impact

Respondents were able to circle as many environments as they wanted for each item or they could circle ‘none.’ 100% of respondents reported that Afiya was welcoming, offered clear information, used respectful language and offered opportunities to connect with others staying in the space. 95% of respondents also reported Afiya to offer supports that were non-judgmental and reflected genuine interest, and 82% said their stay had lasting positive impact. Of those people who had previously also stayed at hospitals or respites, scores were dramatically lower and generally under 20%.

Respondents were also asked to rank the following statements based on how true they were for each environment:

Overall, I was treated with great dignity and respect while in this space.
Overall, I had a lot of freedom to make choices and really be myself.
Overall, my stay here was helpful, and I left feeling better than I arrived.

The scale ranged from 1 to 5, with 1 being “Not True at All” and 5 being “Completely true.” Afiya consistently ranked above 4.5 and was scored an average of at least two points higher then hospitals or traditional respites in all areas. Not a single respondent ranked Afiya lower than a ‘5’ as to whether they had freedom to make choices and “really be [themselves].

Areas of Change: Respondents were also asked to mark in what areas of their lives they’ve noticed change since their stay. These areas included:

Housing
Eating habits
Physical health
Sleeping habits
Coping skills/tools
Less contact with police
Employment
Mental/emotional/spiritual health
Recovery from substance use
Relationships
Setting personal goals
Self-advocacy
Fewer hospital or crisis visits
Greater connection to community supports

Although there were positive responses in all categories, 86% of people responding to the survey reported an improvement in overall emotional health, 67% of the total group reported a reduction in use of the hospital (93% of the group that had actually reported using the hospital previously), and 50% reported a stronger ability to self-advocate. Most importantly, of those citing improvements, 90% stated that they felt the improvements were related – at least in part – to their stay at Afiya.

What Helps the Most: Respondents were also asked what about their stay was most helpful. They were able to select from the following list:

Just being around others
Having privacy
Feeling understood
Feeling heard
Not feeling judged
Freedom to stay connected to work/school/friends/etc. while getting extra support
Connection to someone else staying at Afiya
Connection to someone working at Afiya
Learning new tools / coping strategies
Ability to accomplish specific goals
Ability to catch up on sleep/eating/taking care of self
Other (to be specified by the respondent)

Feeling not judged and connecting with someone who was working at Afiya ranked highest, with 15 people ranking them as core to their experience. Catching up on self-care (eating, sleeping, etc.), accomplishing a specific goal, feeling heard, feeling understood, having privacy and just being around others all ranked next in line with 14 responses. It was particularly interesting to see ‘accomplishing a specific goal,’ ranking so high because there is intentionally very little pressure to set and meet goals in the space. However, this does speak to the community’s generally belief and experience that creating space for choice and personal discovery often leads to more powerful results than pressure and regimented processes. (Specifically for people who had indicated that their stay at Afiya helped them reduce their use of hospital and/or crisis services, the ability to accomplish particular goals was the most frequently marked ‘helpful’ aspect of the stay above all others.) Also of note, of the people who marked ‘other,’ diversity of the Afiya team and the ability to talk to someone 24-hours per day were noted as meaningful.

100% of individuals completing the survey said that they would choose a stay at Afiya again, if in distress and needing additional support.