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Stepping Stone crisis respite program will offer compassionate alternative

By Shery Mead 

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Stepping Stone Peer Support Center, located in Claremont, New Hampshire, is in the process of developing, implementing and evaluating a model of crisis respite that is both consumer run and congruent with the center's philosophy of peer support and self help. Our hope is to create an opportunity for people to learn from and be supported in making the transition from crisis to wellness. We believe that within the context of a mutually responsible relationship, and with the help of consumer staff's experiential knowledge and training, those who sincerely wish to overcome their difficulties can greatly reduce the use of more restrictive hospital settings, including involuntary admissions.

The crisis respite program will be housed in the Stepping Stone Peer Support Center and is scheduled to open in October 1997. We will offer two private, single bedrooms, one full and one half bathroom, a kitchen and a TV room. Other rooms offer space for peer support groups and creative activities. Some of the current ongoing center activities available to respite guests, include t'ai chi and mediation, music, drumming, art, peer support skills, and groups focused on empowerment, recovery and wellness. Guests will be free to come and go from the center, cook their own food or participate in the cooking, and will have 24 hour peer support available to them. Training for staff includes a 12 to 15 hour peer support skills training seminar as well as forty additional hours in crisis skills, CPR and first aid. Crisis training includes a knowledge of relational theory, creative problem solving strategies, de-escalation techniques, and extensive role playing training.

Eligibility rests on having completed a pre-crisis interview with the respite staff and an ability to demonstrate adherence to both the center rules and the philosophy of peer support. The pre-crisis interview consists of both demographic information and collaborative brainstorming exercises with the goal being to develop a crisis plan. The interview will describe the expectations of the center, which will not include medical supervision, and establish the ground rules staff and guests will mutually observe. The staff will negotiate with the potential guest the details of how the crisis situation might be dealt with by incorporating experiences and needs of the guest and staff. Out of this exercise will come a document that will be followed if the guest enters respite. Guest may stay up to 5 days at one time.

Crisis, in our program, is not defined as a negative experience but, rather, as an opportunity for growth, even in the midst of overwhelming situations. People describe crisis as chaotic, scary, feeling powerless, having no where to turn, no one to turn to, or feeling they are losing their ability to deal with their lives. In times of crisis people feel alone with anxiety, panic, anger, frustrations, and depression. Our goal is to provide connections and relationships that diffuse the additional intensity of symptoms that comes from being alone, as well as offering a comfortable, non-judgmental environment in which one might be able to process the stresses and explore new options. We hope this will result in some fresh short-term solutions and a wider array of options for future crisis.

Our process allows and encourage the development of reciprocity and mutuality between the help givers and help receivers. It is our belief that this helps eliminated the traditional institutionalization effect that frequently results from hospitalization. Clearly, as people have an opportunity to stay connected with peers while moving through challenging thought/feelings/impulses, the need for external intervention is diminished. Over time, we believe that this alternative approach to handling crises will teach people healthier attitudes about themselves and others. Further, with increased skills, people's susceptibilities to the pressures that give rise to overwhelming emotional distress should be reduced.

The average cost of state hospitalization is approximately $500 per day which private hospital costs can be much higher. The cost of this respite program will be approximately $200 per day and will operate on an as needed basis. depending on how many long-term state hospital stays it prevents as well as decreased emergency service care, potential savings could be significant. This program is just one of the many New Hampshire consumer initiatives and clearly an amalgamation of ideas and values of the larger consumer movement. We are grateful to the work of the Crisis Hostel and owe a great deal to all the work that went into their program and their willingness to share with us. We are funded entirely through the Division of Behavioral Health and work collaboratively with the state to develop a new model of practice that truly reflects consumer values.

If you would like more information about the crisis respite program, contact Shery Mead at 603-543-1388 or 603-448-6941.