August 13, 2018 | | SAMHSA's GAINS Center By Ayorkor Gaba, David Smelson, Debra A. Pinals, Kelsey Clary, & Idella Sanders-Jones Joe* smiles ear to ear as he receives his graduation certificate from his treatment court team, which includes his MISSION Peer Support Specialist and Case Manager. He humbly explains to the group in attendance that this was his first time graduating anything in his life. Joe has had a long history of addiction, mental health problems, and incarceration; he started in the mental health court about 1 year ago. He was quickly referred to MISSION-CJ (Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking—Criminal Justice) as part of an alternative to incarceration program to address the unique and complex needs of justice-involved individuals with co-occurring mental illness and substance use disorders. MISSION-CJ is an evidence-based intervention developed in 2008 by David Smelson, Psy.D. and Debra Pinals, M.D. to meet the mental health, substance misuse, and other needs of justice-involved individuals with co-occurring mental health and substance use disorders (CODs). Theoretically rooted in the Health Belief Model (HBM), MISSION-CJ combines several evidence-based practices (EBPs) into a comprehensive system of care in order to explore and address population-specific factors (e.g., criminogenic factors in criminal justice populations), provide treatment for CODs, and link participants to community-based supports to sustain recovery. In MISSION-CJ, Joe received trauma-informed dual recovery treatment, case management, peer support, vocational support, and linkages to long-term recovery supports. As he speaks at graduation, he focuses on the critical support he received from his Peer Support Specialist. He talks about the early stages of treatment when he experienced strong cravings to use. He would find himself picking up the phone to call his Peer Support Specialist to talk him “off the ledge.” He knew she would understand and “get it” without judgment. He explains that his Peer Support Specialist “has been in my shoes, and that’s what I like and that’s why I trust her. When I told her my story, she’s lived it and worse, so I trust her for advice and I can learn from her.” He continues to share how she linked him to his sponsor and recovery coach, and he mentions the trust he was able to build with her as she connected him to community supports: “She did what she said she would do, and she kept her word, so it built trust and a relationship, and it gave me hope.” He even jokes that he was very reluctant to get involved with the recovery community, but when his Peer Support Specialist shared that this community saved her life and that she still goes to meetings, he gave it a chance when she invited him. As Joe speaks about his experience and accomplishments in MISSION-CJ with pride, one is left struck by the important role of his Peer Support Specialist who served as a guide and role model to help him through his journey. Peer support involves individuals with histories of mental illness and/or addictions and/or criminal justice involvement who help those with similar histories (Davidson & Rowe, 2008). In MISSION-CJ, peer support is provided alongside specially focused case management to help clients maintain their mental health and sobriety, to engage in healthy and non-criminal lifestyles, and to offer the client assistance to participate in needed supports, thus bolstering the effectiveness of the other interventions. Many states have certification for mental health peer specialists, and MISSION-CJ provides special training to help Peer Support Specialists learn about criminal justice peer support work. Peer Support Specialists offer inspiration, the understanding of one who has “been there,” and they aid in the client’s adjustment to new routines, such as attending 12-step programs. In addition, Peer Support Specialists in MISSION-CJ offer practical strategies and exercises to promote engagement in prosocial attitudes and behaviors; skills to help the client navigate complex systems, including navigating legal mandates related to their criminal cases, advocating for their clients across these systems, and helping clients learn how to advocate for themselves as well. Although Peer Support Specialists have existed in other settings (such as mental health settings), the emergence of this type of support in criminal justice settings and with criminal justice populations is a newer and evolving role. Anecdotal evidence suggests that individuals with criminal justice involvement who have a mental and/or substance use disorders are very satisfied with being able to have access to a Peer Support Specialist. Some research has found that those who receive peer support are more likely than those who do not to avoid returning to jail or prison, improve their community living standards or general level of functioning scores, to work, to live independently, to re-establish family relationships, or to develop new social connections to people in their communities (Baron, 2011). MISSION-CJ’s findings support this research. To meet the needs of alternatives to incarceration programs and criminal justice-involved populations, states have started to use Peer Support Specialists in a variety of criminal justice settings and at various potential intercept points. The Commonwealth of Massachusetts has been a leader in these efforts and has embedded Peer Support Specialists via MISSION teams in various adult drug, mental health, Veteran, and family drug courts. The model has also been used in re-entry programs in Massachusetts in collaboration with the state’s Public Health and Mental Health agencies and the Executive Office of the Trial Court. The court sees the added value of having case managers and peer support teams provide critical intervention and wraparound support to help individuals with CODs achieve and maintain long-term recovery and reduce risk for criminal recidivism. Peer Support Specialists in specialty court programs across Massachusetts bring a unique perspective to treatment planning and provide much needed supports that scaffold individuals who are navigating complex systems and issues on their road to recovery. Peer Support Specialists can often reach and engage clients in ways that others cannot and have been a critical part of teams serving Massachusetts diversion and other alternative to incarceration programs. The work of Peer Support Specialists changes courts, systems, and clients’ lives in positive ways. As the research unfolds, data shows the impact that serving as a peer has on Peer Specialists themselves (Baron, 2011). From informal discussions and focus group interviews with MISSION-CJ peers, peers are positively impacted by their work. Maggie*, who has been in her MISSION-CJ peer role for 2 years, shares that her time as a Peer Support Specialist has been one of the most rewarding experiences. She takes tremendous pride in helping program participants by letting them know that she too has been where they are, understands how difficult and traumatizing the transition back into society can be, and is there to support them along the way. As is true in her own life, she champions that there is life after recovery and leads by example. There is a well-known quote in the recovery community that says, “You have to give it away in order to keep it.” The underlying principle is that service in recovery can help the giver as much as the receiver. Numerous studies have supported that helping others in recovery provides great benefit to the helper. MISSION-CJ Peer Support Specialists have talked about how their work has helped strengthen their commitment to serving as mentors in the recovery community, being advocates for recovery-informed treatment systems that integrate consumer perspectives, and developing better materials, such as parts of its peer group session materials and MISSION-CJ workbook. Peer Support Specialists are a critical part of jail diversion and other alternative to incarceration efforts. Continued support and research of their work is needed. Learn more about the MISSION-CJ model. References Davidson, L., & Rowe, M. (2008). Peer support within criminal justice settings: The role of forensic peer specialists. Delmar, NY: CMHS National GAINS Center. Barron, R. (2011). Forensic Peer Specialists: An Emerging Workforce. New Brunswick, NJ: Center for Behavioral Health Services and Criminal Justice Research, Institute for Health, Health Care policy, and Aging Research. *Names have been changed to protect client anonymity.