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RBC Pathway to Peers Program: An innovative peer support partnership between Mount Sinai and Stella’s Place
A typical day for Yolanda Delmonte, the Peer Support Worker in the Pathway to Peers Program at the Mount Sinai Hospital Emergency Department (ED), starts with checking to see if there are any patients between the ages of 16 and 29. If there are, she checks their electronic chart to see why they came in and their medical history before consulting with the Emergency Department team; the social worker, doctor or nurse tending to that patient. With their approval, Yolanda introduces herself to the patient and asks how they’re doing. Sometimes they just chat for a couple of minutes, sometimes Yolanda grabs them a sandwich or a blanket, and sometimes, once she tells them that she has lived experience with mental health issues and substance use, the patient begins to open up to her about their own struggles.
A few months ago, Yolanda was approached by a doctor and was asked to connect with a patient who had presented with some physical health challenges. Yolanda introduced herself to this person and explained that she was a Peer Support Worker, which means that she has personal experiences of mental health and substance use challenges. She draws from those experiences and her Peer Support training to provide a listening ear, support, and coping strategies. The patient asked a few questions to better understand where Yolanda was coming from and Yolanda was able to describe some of the challenges that she’d faced, as well as some of the support and resources that had helped her manage her own mental health.
After hearing Yolanda’s story, the patient disclosed that they had been struggling for quite some time with feelings of depression and had been leaning on substances in order to cope. Yolanda commended this individual on their decision to come to the hospital to seek support. Yolanda accompanied the patient during their time in the emergency department and supported them in communicating with the healthcare team, ensuring they received the care they needed.
This anecdote is one of many that shows that the RBC Pathway to Peers Program at Mount Sinai is working, and working well. The premise of the program is simple: Peer Support Workers with lived experience of mental health and substance use challenges providing support and resources to young adults in the emergency department. Getting there, however, was not.
How it All Started
The idea for this program started to emerge in 2014. Sally Carver, the daughter of the founding Executive Director of Stella’s Place, Jenny Carver, was working as a research assistant for Dr. Bjug Borgundvaag, the Director of the Schwartz/Reisman Emergency Medicine Institute (SREMI) at Mount Sinai. Sally would often talk to Dr. Borgundvaag about the work her mother was doing at Stella’s Place, creating peer mentorship and training programs in consultation with young adults. Dr. Borgundvaag wondered how they could incorporate that work into the emergency department at Mount Sinai.
“The idea of Pathway to Peers was, how can we take the great stuff that’s being going on at Stella’s Place, that kind of peer support model—the intimate connection between the Peer Support Worker and the patient, the importance and value of shared lived experience—how can we take that and modify or adapt it to be able to provide something else for the folks who come to emerge?” shares Dr. Borgundvaag.
Nation-wide, the increase in young adults visiting emergency departments with mental health or substance use challenges has doubled over the past decade and Dr. Borgundvaag is the first to admit that emergency rooms are simply not equipped to provide the support young adults need. They assess whether someone needs to be admitted to the hospital but that is where their capacity ends and where peer support work begins.
Jenny Carver remembers the early days of Stella’s Place and how groups of young adults made it very clear that what they needed was to be able to talk to people their own age who knew what they were going through. Jenny also knew that Stella’s Place was going to have to find open and reliable partnerships within Toronto to start to address the gap of mental health care for young adults in the city:
“You can’t build in a vacuum in these times, it’s so important to have these relationships,” Jenny says. The reality is that young adults in crisis do end up in emergency departments, which are accessible but also intense experiences, but rarely get the support needed to access community resources afterward.
Early research showed there were no other programs like this, so Dr. Borgundvaag and Jenny decided to do it right, developing a rigorous and evidence-based research study designed to be replicable and accessible to other hospitals in the future. The peer support program needed to be an integral part of the emergency department and required specialized training to work in such a high-stress and sometimes triggering environment.
When Jenny and Dr. Borgundvaag talk about the obstacles they faced in getting a Peer Support Worker into a highly regulated and fine-tuned hospital setting, the list is daunting. Allison Dunning, Stella’s Place Peer Initiatives Manager was brought into the mix to support. Allison worked alongside the P2P Program Manager and MSH’s ED Social Worker, Christine Bradshaw, to address issues of confidentiality and privacy, develop standards of practice for the Peer Support Workers, write policies, craft job descriptions, get Peer Support Workers access to electronic medical records, and offer infectious disease control training, not to mention integrating these workers into a huge emergency department staff without ruffling feathers. Jenny remembers:
“You can get really frustrated with how long things take but you’ve just got to hang in there…It’s the story of persevering because of having the vision and knowing how important this is.”
It took many years of advocacy before multi-year funding from RBC Foundation and two private donors was secured and allowed Mount Sinai to hire Christine Bradshaw, an emergency department Social Worker to develop and manage the program, and their first Peer Support Worker in January of 2020.
(Above) Peer Support Worker Mahalia Dixon (middle) celebrates the 100th young adult served through the Pathway to Peers Program with colleagues in August, 2020.
One Year Later
After a year of operation the program is exceeding expectations. Not only are the Peer Support Workers helping young adults who walk into the emergency department, but they’re also helping the hospital staff do their jobs better. Yolanda says that the staff often come to her seeking her support with a patient or to offer her input or recommendations for a case. She says she knows her work is valued and that she feels good knowing she’s an asset to the medical team.
Dr. Borgundvaag speaks highly of Yolanda’s performance and contributions and how seamlessly the Peers have integrated into the department. “This is the first program in Canada where we’ve really taken Peer Support Workers and fully integrated them into the emergency department and that’s, frankly, the most noteworthy accomplishment of all.” Allison, who is responsible for the customized training and ongoing mentorship of the Mount Sinai Peer Support Workers, confirms how important it is to have them working as a part of the hospital staff team:
“Having a hospital staff member who is able to connect with a young adult over a mutually shared experience really helps people to feel less alone, and more capable, during a time that can often be some of the hardest days in these young peoples’ lives.”
This program also offers valuable professional experience for the Peer Support Workers. While there was some concern initially about Peer Support Workers being in such a traumatic environment, it is clear that they are thriving, finding meaning and value in their work and embodying recovery for the young adults they are helping. Yolanda is filled with such joy when talking about her experiences at Mount Sinai:
“It’s amazing, it’s really, really rewarding, and it’s super fulfilling. People seem very grateful to have me there, especially now when young people are coming into the emergency room without their parents or family members and very nervous. They always say ‘thank you for just spending some time with me.’”
Yolanda also says she’s able to work through difficult moments and set boundaries with the help, support, and supervision of both Allison and Christine, which has been key to her success.
And not only is Yolanda able to support patients in their moments of crisis, but she is also able to help them when they leave the emergency room: “Having them confide in me builds a trust, not just with me, but even a little bit more with the health care system.” Yolanda is able to help patients identify community resources, offer lived experience about what it looks like to go to an inpatient unit or into treatment, and always offers to follow up with patients on the phone after they leave, which many take her up on.
Dr. Borgundvaag is pleased that early feedback indicates increased adherence to recommendations and follow-up with meaningful connections in the community. Allison agrees, adding:
“We also know that making sure that young folks get connected to community support after discharge from hospital is essential to well-being, and having a fellow young adult talk about these resources often makes them feel more accessible and creates more buy-in. This program is really increasing young folks’ chances for success, and I can’t wait for the evaluation to show that.”
When asked how she knows the program is working, Yolanda said: “It’s being with a patient and when I explain that I have lived experience, it’s seeing their comfort and seeing their walls break down a little bit more and they open up to me and tell me things they haven’t told the social workers or the doctor.”
Dr. Borgundvaag hopes that this research project will lead to similar programs at other hospitals and in other communities. Yolanda is excited to soon be joined by two new Peer Support Workers so that they can help more young adults. Allison says that “it’s been a tremendous privilege to support the growth of this program.” Stella’s Place Executive Director, Wangari Muriuki, adds that “Stella’s Place is well positioned to scale our highly effective and customized Peer Support Training to other hospitals that express interest.” Dr. Borgundvaag is also beaming with pride:
“I really feel like the Pathway to Peers program has been a fantastic new development, I’m so proud of it honestly. I’ve been doing this a long time and I think it’s one of the things I’m most proud of in my career…In a really horrible year where there’s been nothing to look forward to, it’s something that I look back on with intense pride and it’s given all of us such happiness…It’s been a really successful program so far.”
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