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Building Success Embedding Peers on Mobile Teams
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Hello and welcome. I'm Alexia Wolfe, Director of the Delaware Behavioral Health Consortium and SMI Social Determinants of Care Expert for SMI Advisor. I'm so pleased that you're joining us for today's SMI Advisor webinar, Building Success and Betting Peers on Mobile Teams. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Today's webinar has been designated for one AMA PRA Category 1 Credit for Physicians and one Continuing Education Credit for Psychologists. Credit for participating in today's webinar will be available until February 12, 2024. Slides from the presentation today are available to download in the webinar chat. Select the link to view. Captioning for today's presentation is available. Click Show Captions at the bottom of your screen to enable. Click the arrow and select Full Transcript to open captions in a side window. Please feel free to submit your questions throughout the presentation by typing them into the question area found in the lower portion of your control panel. We'll reserve 10 to 15 minutes at the end of the presentation for Q&A. And now I'd like to introduce you to the faculty for today's webinar, Steve Micchio and Maureen Bailey. Steve Micchio is inspired and driven by his personal lived experience. Steve spent over two decades creating, providing and promoting innovative crisis response services and systems level improvements across the U.S. and internationally that raise the bar on customer service, person centered communication, trauma informed care, empathy and positive expectations for people's recovery and wellness outcomes. Steve's unique models and approaches significantly reduce hospital utilization, incarceration rates and overall health spending. Maureen Bailey serves as a Recovery Support Services Section Manager at the Division of Behavioral Health and Recovery at Washington State Health Care Authority. Thank you for leading today's webinar. Great. Thank you. Hi, everyone. My name is Steve Micchio. It's nice to be here. I'm going to talk first about our disclosures. We have no relationships or conflicts of interest related to subject matter of this presentation. And the learning objectives that we'll be going over today are some strategies to train peer support specialists for inclusion on mobile crisis teams, the design mobile crisis teams response in a way that provides a more person centered approach through the years of peer supports. They bring a unique mutuality of lived experience that only peers can provide to an often intense service response and incorporate training curriculum and strategies developed by the presenters in their training for all staff on mobile crisis teams. So, again, I'm very happy to be here, let you know who I am a little bit and who we are. People USA is a peer run mental health nonprofit that creates, provides and promotes its own innovative crisis responses and wellness services. And we got into that not accidentally, but we got into it as an advocacy organization first is where we started from when I first started 25 years ago at People. Our role was to be advocates for the state and advocates for local communities on providing and asking for basic human rights and better health services and mental health services for people in our communities, especially those back then that were being released from psychiatric hospitals and kind of just, you know, let out of the hospital and into an apartment and good luck. And so we as an advocacy organization advocated strongly for better care for people that were, you know, coming out of hospitals that didn't have those basic skills, independent skills to living, weren't getting the appropriate follow-up treatment in the communities. So there were a lot of issues that really followed the closure of our psychiatric hospitals, not just in New York, but across the United States. And one day, you know, and just dealing with all these advocacy issues, I had an opportunity to create something that would start to go move us into services. And the first thing we did was supported housing. And that was one of our first programs that really focused on service delivery for people in our communities. The next thing I did was got approval to put my peer staff into hospital emergency rooms so that people could be treated with dignity and respect when they came in. And while I was infusing and moving people into the emergency rooms, I, through my own lived experience of being hospitalized, thought there would be, there could be a better alternative to people instead of going to a hospital in a crisis, rather than going to a respite house, which I didn't call respite houses at the time. When I created, I called it a hospital diversion house. And it was really designed around 24-hour peer support in helping people to come to a nicer environment, bed and breakfast kind of environment. And be, you know, heard by someone with mutual, a mutual experience and being offered education around recovery to kind of break the cycle of going home in crisis to hospital and giving them a better, less traumatic experience so that they could focus more on their wellness, their self determination, and maybe get a vision of hope for themselves. So that was my foray into services in the first two years that I started working at people. And then from there, it just escalated and evolved into a full service organization that is still 100% peer run, including my clinicians, including our other professional staff that are traditional, you know, in the behavioral health world, are people of lived experience who have disclosed. And it's become more than just a mental health organization, we've become a behavioral health, because we have a lot of folks that are in a dual diagnosis role of addiction and mental health issues. So we've become a substance use and mental health and healthcare organization as we've gone forward. And from this graphic, you can see that there's a whole host of services that we now provide from care coordination, which is case management for some of you, supported housing, crisis stabilization centers, we've now created and operate core services, our psych rehab services and wellness services, mobile teams, employment services, and integrating peers into all different facets of behavioral health in our communities, to not only advocate, but also provide a nicer place to engage or first engage. When you're going into such as a clinic or a partial hospitalization program, or some other kind of programs that what's the whole process of getting a community to embrace and work on these kinds of programs that are coming to the community? And what we had to do is we mapped the assets. And this is not even the sequential intercept mapping. This is just mapping assets of the community, figuring out what was in the community, and not just in criminal justice, but overall, and what was needed in the community, and then building relationships. So a lot of this work, even before the mobile teams start, are those of us going to the community and meeting all the different providers and meeting all of the different funding systems and county governments and people that were important, even up to Chambers of Commerce and getting to know who the people were in the community that were going to help us be successful in the services that we provide. And we used a process or a couple of processes. But we used appreciative inquiry in one of our processes that was very powerful and worked really well. Appreciative inquiry is getting a large group of people into the room from different disciplines. And like I said, we would have faith-based, we'd have community leaders, we had Chambers of Commerce, we had provider agencies, police departments, any aspect of the community that we can invite to this, we invite it. And you have a facilitator that runs the meeting and asks a series of questions and breaks the teams up into smaller groups. And from those answers, you start to see the gaps in your community, the gaps in services, the gaps in quality care. It's all discussed. And in addition, we have people with lived experience in this process as well. So we have people that are living out in the streets and we have people that are in services and wherever in the community. And we bring them together asking the questions. By the time we were done with it, after a couple of days, we had a roadmap of what needed to happen to fill gaps, what needed to happen to change attitudes and change policy and change the way we flow, the way the system flows. And the community continued to meet and work on these issues until we had a clear roadmap on how we could develop a collaborative system of care, which was much different from the provider meetings that we would always go to. And people would say, as a bunch of providers in a room, don't we work well together? And I was the one saying, no, we don't work well together because I don't know what your organization does. We try to collaborate, we have trouble, we have all these issues. This kind of brought it to the next level of really putting an implementation plan in place to design and deliver a better system of care. And of course, the mobile team was a big important component of that. But the other part of it was, it's great to have a mobile team, but then what? so the team could engage, they could maybe refer people to a service or whatever. But what if the service was over capacity and they couldn't take that individual for weeks on end? Well, mobile teams are designed to get people to services immediately so that they are avoiding either criminal justice or hospitalization or worse for an individual. So you had to raise the bar on the accountability and the expectations of your fellow providers and your fellow community so that when you do engage someone that needs a service, they can get into that service immediately. And that is an ongoing task that we have to do in our process. So this is just building up to, you know, how having peers on your teams can be such a value, but then how do you have those peers working on your teams? So here, I just wanna go back to the GAINS Center and the sequential intercept mapping. This was the criminal justice side of it, where you look at your system and you look at the intercepts and where you are. So again, breaking down your community services, your court systems, your police systems, your jail systems, probation systems, and seeing where are the gaps? How come people can continuously recidivate back into our programs? How come they keep, you know, kind of dropping the ball? And when I say they, I don't mean the individuals served, I mean the system itself, how it drops the ball on the individuals and where we can pick up and fill those gaps. So between the community mapping and the intercept mapping, we got a real good picture of our community on what was needed and how it, you know, how we should go forward with a workflow that's gonna work for the community. So it's really building the business plan around behavior health. So with all that, when I, about 2000, and I think it was 12, New York City got a parachute program grant for the city. And it was a 12 million, I think, grant that came. It was a five-year grant that would help them do a couple of things. They were gonna build respites in the city. They were gonna build mobile teams in the city. And then they were gonna put peers also into hospitals, similar to what I had done. So that they can engage folks when they were, you know, in crisis and have a better experience even in the hospital emergency rooms too. So we started designing the respites and they were, you know, designed and doing pretty well after a year or two. But we kept getting calls around the mobile teams. They were having some challenges on the mobile teams with the peers. And so what I did is I asked the questions is what is the problem? Well, we don't know how to supervise them. And we don't know exactly what their role is. We don't know exactly when they should engage. So there were a lot of questions around putting peers on mobile teams and how do you do that? And what's that gonna look like for people? So I went down to the city for, you know, a series of meetings and I asked for their policies, policies and procedures. And they had very little written on the teams themselves as far as the makeup of the teams and the roles of the people on the teams. So there wasn't much, you know, really thought about or written on policies and procedures of those teams. The other question I asked them was who are the policies written for on the teams? Is it written for everybody or are we singling out the peers to have different policies? And I found out that that was happening. And so we corrected that and we put everyone under the same policies and procedures because it's all about performance. It's all about outcomes and what you're trying to do. It shouldn't be individualized into positions. The next thing I did was I looked at the roles of each of the members of the team. And on those teams, we had a nurse, a social worker, a psychiatrist, a mental health technician, an addiction specialist and a peer counselor. Well, the peer counselor was the one that seemed to be the issue for the team on how to address it and how to deal with it. So one of the things we got, you know, out of the way was the supervisory piece of it. I said, it shouldn't be a supervisory piece based on behavior of an individual who has disclosed with lived experience. It should be supervised based on the, not only the experience of the individual but the performance of the individual. So everything and everyone on the team should be performance-based supervised. And it didn't matter if it was a peer supervising a peer or a professional supervising a peer. It was a clear model and indication that supervision is performance-based back to how are we serving the community? What are the challenges we're facing? What are the successes? And what are the plans of correction we can do to maintain our team and make sure that our team is successful in what they do? So that was a big part. The role clarification was a big part of getting those teams to work together well. Once we did that in year three, four and five, those teams had gelled and there was clarity on the roles of everyone on those teams. And there was clarity on who would engage first based on what they were walking into. If they felt it needed a little more of a clinical component, it would be the clinician or psychiatrist. If they felt that it was just somebody that was experienced a generalized crisis, we had a whole kind of criteria around it, it was the peer that would first engage. And I have to say that 90% of the engagement was usually done by the peers after we had gone through this training and role clarification and policies and procedures redevelopment. And it was extremely successful in engaging, but also getting people to talk about their issues and what's going on. And the one thing we all noticed, and I've noticed since I'm a peer on an organization, is that people will often tell a peer something they would not tell their therapist or psychiatrist or other clinician or whoever. And the reason was the trust. And we still have stigma, discrimination and trust issues in our behavioral health world. And so the peer would hear this comment from somebody they were serving, maybe suicidality, maybe self-injury or whatever it is, and say, that's really important, have you told the psychiatrist? Well, no, I haven't, because I know if I do, they're gonna put me in the hospital. And the peer will say, well, not necessarily, I can work with you on how you can tell your therapist, your psychiatrist or whatever, and tell them in a way that is more empowering for you to trust them that you're not going to be immediately assessed and put into more of a restricted environment. And so we had to do quite a bit of work around that because we were taking a traditional system of care that is very fear-based and very aversive to almost, I guess, a parental aversion to taking care of the individual rather than giving the individual the power to make different decisions for themselves. And that would involve more communication, more conversation, motivational interviewing is a big part of what we do on our teams and many other teams that I've worked with throughout the country. So it's just looking at the different perspective on a mobile team, and when you have a peer, you have some value on that team that is gonna engage in a different way, doesn't only have to be a better way, but in a different way, so that you can get better information from the person you're serving, and you can make a better decision with that person on what the next step would be, in going forward. So that's, I just wanted to give you that overview to start this conversation. And there's a lot that goes in behind it, but I can tell you that mobile teams are one of our favorite services now, and working with other organizations on developing their mobile teams is great because it's such an added value to our communities with all the other services that we provide. And now I will give it to Maureen. Hi everyone, I am Mo Bailey and I use she, her pronouns, and I am the Recovery Support Services Section Manager here at the Healthcare Authority Division of Behavioral Health and Recovery. I am also a person with lived experience with behavioral health recovery that includes criminal legal involvement. I think it's important that I share this information so that people see that folks like me can and do recover and can live full and amazing lives. I know the power and impact of peer services as a recipient of peer services and as a person who has provided peer services. I've been professionally involved in peer services for over 12 years and have been working at the Healthcare Authority since 2019. I was hired here on as the Enhanced Peer Services Program Administrator to create a continuing education training in collaboration with the DSHS Office of Forensic Mental Health Services. The training that I first created here at the Healthcare Authority is intended for peer counselors who support people involved in our forensic mental health system. I am passionate about creating opportunities for peer counselors to grow and provide effective services. I'm gonna talk a little bit about the section I oversee. The Recovery Support Services Section consists of three different teams. That we have the Foundational Community Supports Team that works under our 1115 waiver, doing work around supported housing and supported employment and implementing new housing programs and so much more. We also have our Recovery and Community Team that oversees outreach programs, including Housing First, Community Recovery Supports, our clubhouses, recovery cafes and peer-run orgs in the state and a Housing Stabilization Team. Last but not least is the Peer Support Program Team who certifies and supports the development of peer specialists in the state of Washington. So I'm here today to talk to you about the crisis training for four certified peer specialists in Washington State. And this training is intended for peers who work in crisis settings. Before I start talking about the TTI project that led into our 40-hour crisis training for certified peer counselors, I would first like to start with a brief history of peer support in Washington State. Washington State began offering certified peer counselor training in 2005 and prides itself on one of the first 11 states in the country to deliver peer services using Medicaid funding. Mental health peer support services were added to our state plan in 2005 and that's when we began offering those trainings using what we now refer to as our standard CPC curriculum. This meant that people with lived experience with mental health and our co-occurring recovery or parents or guardians of children who receive mental health services could become certified peer counselors. In 2015, we added a youth and family CPC training and this training has a focus on preparing youth partners and family partners who will be working in wraparound teams known as WISE and WISE stands for Wraparound with Intensive Services. Exciting news in 2019, substance use peer services were added to our state plan and opened up the ability for somebody to become a certified peer counselor who's solely identified as a person with lived experience in substance use recovery. When that happened, the interest in becoming a certified peer counselor in the state of Washington exploded. We also created a gap training because we noticed the need that we had some folks who are C-CAR recovery coach trained wanted to be certified peer counselors and there was a gap in the training between a C-CAR training and our CPC training. So we developed this bridge training which is a shortened version for folks to become certified. When we began training in 2005, we had about five trainings a year certifying approximately 100 certified peer counselors. Gradually, this grew to a maximum number of trainings of 34 in 2019. And that's when we had the addition of SUD peer services in our state plan. This current fiscal year, we have 105 trainings scheduled. In the last calendar year, we received over 3000 applications. At the end of fiscal year 2023, we had trained approximately 7,200 certified peer counselors in Washington State since 2005 and 1200 of those folks were trained in fiscal year 23. Certified peer counselors in Washington State provide peer services in a variety of settings to include but not limited to peer run organizations, licensed community behavioral health agencies, on outreach teams, teams providing supported housing and supported employment. We have peers in emergency rooms as peer pathfinders, as peer bridgers working at our state hospitals. We have substance use disorder facilities and juvenile rehabilitation facilities. We have peers at peer respites, we have peers on PAC teams, and of course, peers working in crisis settings or on crisis teams. And this brings us to the importance of the development and timing of both the TTI grant project and the 40 hour training for peer specialists working in crisis settings. Next slide, please. So concurrent opportunities spark the expansion of peer support services in crisis care across Washington State. With Governor Jay Inslee's announcement of a five-year plan to dramatically reshape how and where people experiencing symptoms of acute mental health conditions are treated, Washington State's Health Care Authority Division of Behavioral Health and Recovery worked and continues to work with the community agencies to develop capacity and treatment services that deflect crisis response from law enforcement to behavioral health agencies. Also in 2019, the Trueblood Settlement was reached. This was a case challenging lengthy delays in competency restoration services. And to reduce delays, HCA continues to enhance our crisis triage and stabilization and mobile crisis services to improve response times, increase collaboration, and provide law enforcement with opportunities to connect individuals to treatment instead of taking them home. And to provide law enforcement with opportunities to connect individuals to treatment instead of taking them to jail and entering into our court system. As part of these enhancement efforts, new programs were developed that include certified peer counselors. With these enhanced efforts, certified peer counselors are being added in additional settings. Lastly, the Health Care Authority is planning for a dramatic rise in referrals to care from implementation of 988 in 2022. They will use a Transformation Transfer Initiative Grant B to create a continuing education training of four certified peer counselors working in crisis settings. And this training ended up being called the Power of Peer Support and Crisis Services. So in fiscal year 22, HCA was tasked to create a 40-hour in-person training for peer support counselors. So we utilize the TTI grant project, this online training we developed that came at the right time as a foundation for that 40-hour crisis training. We now require all people who apply for a 40-hour in-person crisis training to complete our LMS training, this TTI grant training called the Power of Peer Support as a prerequisite to our 40-hour. These continuing education training support Washington's current efforts to expand opportunities for certified peer specialists to provide services within crisis programs, such as emergency departments, evaluation and treatment facilities, and mobile crisis teams. The training creates career pathways while providing information and education for CPCs to be successful in these expanded environments. Next slide, please. The creation of a training was a collaborative effort. So the Peer Support Services team at HCA, we pride ourselves in bringing in the voices of people with lived experience to the table whenever we create new curriculum. A work group was established and made of certified peer counselors and crisis service providers to create a curriculum that serves the behavioral health provider's needs, as well as build upon the lived experience of those uniquely qualified to provide those peer services. We exceeded our set goal of having at least 51% of the people with lived experience in the work group. Instead, we had well over 75% of people with lived experience to include people who represented managed care organizations, behavioral health administrative organizations, law enforcement, and crisis service providers. A lived experience perspective was integrated throughout the curriculum for both the TTI grant project and the 40-hour crisis training. The Healthcare Authority partnered with the Washington State Health, Washington State University's Peer Workforce Alliance in the development of the power of Peer Support and Crisis Services. And we continued with that same group in the development of the 40-hour training. Although that training was transitioned over to an organization called Peer Washington, who has a Peer Workforce Alliance, a Peer Workforce Development Team, and Peer Washington is a consumer-run organization that provides peer emotional support and peer workforce development. One exciting thing about our TTI grant project was Dr. Peggy Swarbrick was one of the main curriculum writers, and we were able to incorporate the eight dimensions of wellness into our training. So as I mentioned earlier, the training has helped to create career pathways while providing information and education for certified peer counselors. The training promotes coordination and collaboration between crisis service providers and certified peer counselors. This training is available to all certified peer counselors to enhance the unique qualifications that they bring to the table in the behavioral health system. However, you don't need to be a CPC to take our training. This training is also available to anyone who wants to access it online. The training has seven different modules, and like I mentioned earlier, is now being used as a prerequisite training for a 40-hour. This training is available at no cost on HCA's Talent LMS website, along with other continuing education trainings developed by the Washington State Healthcare Authority. This training went live in January of 22, and as of yesterday, we had about 1,660 people that had registered and completed the training. Next slide, please. The power of peer support training. We wanted to address some of the key messages conveyed from SAMHSA around peer support and crisis care. These key messages include how peer support services are an integral component of the behavioral health continuum of care, from prevention and early intervention to treatment, recovery, and crisis services. Crisis care services are available to anyone, anywhere, at any time. This can be through crisis lines, mobile crisis teams, and crisis stabilization facilities. We also wanted to provide information on the benefits of including peers in crisis care, including strengthening engagement and treatment and improving outcomes for people experiencing crisis who receive these services. Peers share their lived experience and living experience working in crisis care settings. They embody recovery and can provide hope and encouragement that recovery is possible and that they can be successful every day. We also address the challenges related to the work and include self-care so that peer counselors can retain wellness and be sustainable in their employment. This is great and rewarding work, and it's also really hard work. We hope that this training provides a foundation to build upon in supporting certified peer counselors to provide effective services in crisis settings. And we continue that work in our 40-hour training. I'm gonna briefly go over some of the topics that we cover in our LMS training. These modules provide exercise opportunities for the participants to write down some of their thoughts in the training and also include a quiz at the end of each module. Module one covers how crisis relates to wellness and really sets the stage for the remaining six modules. This module goes over what is crisis, the definition of crisis, and emphasizes that crisis is temporary. Module two covers the roles of CPCs in crisis services. And you might hear me say certified peer counselors as well as certified peer specialists. Right now, Washington State is in a transition. We have historically called our certified peers as certified peer counselors. We are transitioning over to a new title, certified peer specialists in 2025. So in module two, the role of peer counselors in crisis services discuss the systems and that people serve in crisis. Specifically, we go over SAMHSA's core crisis, core crisis care services, such as services in call centers, mobile crisis teams, and crisis stabilization facilities. We go over crisis care principles and best practices. It also covers where peer support workers may work with and whom. In module three, it covers the unique strengths and needs in crisis and examines the impact of culture and wellness, recovery, and crisis services topics included in this module include unique strengths in crisis, cultural responsiveness in crisis services, culturally sensitive approach, multiculturalism. And the module also goes over youth experiencing crisis, older adults in crisis, houselessness in crisis, and many more topics. And each one of our modules wraps up with a self-care activity. This brings us to module four, the stages of crisis intervention for peers. This module covers the simple steps for writing crisis support as a certified peer counselor, intervention strategies, such as listening, planning, communicating, and teamwork. Next slide, please. Module six is all about trauma and the trauma-informed perspectives. It's jam-packed with great information that covers how practicing trauma-informed care pervades everything we do as certified peer counselors and takes a deeper dive in some of the ways trauma-informed care prepares CPCs to be effective in crisis services. Module seven is our after crisis planning and self-care practices. It includes post-crisis debriefing, and post-crisis work reflection. Next slide, please. Sorry about that, I got a little mixed up there. So the Health Care Authority was funded through legislative proviso in fiscal year 22 to create that 40-hour training. And we call that training, it's our 40-hour crisis training. It's called a Crisis Awareness and Communication in Peer Support. We actually did this in a few stages. We did a curriculum writing group, we did a train the trainer, we did a first pilot project, which gave us the opportunity to go back, reread the curriculum, incorporate the input that we received from the first pilot. And then we went on to do a second train the trainer and a second pilot. What was really exciting about this work is we were able to reach a real diverse group of folks. We reached youth and family. We had many folks that identified as living in marginalized communities. And so we trained over 19 trainers for this program. And we plan on training about 350 CPCs in our crisis training this year. And I'm just gonna go through and I'm just gonna go briefly over, I'm running out of time. So I'm gonna go briefly over what our training is. So Crisis Awareness and Communication in Peer Support. We launched that in May of 22. We officially launched the entire training in July of 2023. As I mentioned earlier, this training builds upon the power of peer support and crisis services. Because this training, this 40 hour training is in person, there are many activities and skill building throughout the training that could not be incorporated into that LMS training. Some of the topics of this training can cause many feelings. So we wanted to require our contractors to provide an onsite training coordinator that would also be a certified peer counselor that could provide support to participants throughout the training. So our training has nine different modules. Module one covers crisis and self-care with a focus on what crisis looks like, partnering skills and the seven pillars of self-care. Module two takes a deeper dive into trauma-informed approaches in crisis to include the principles of trauma-informed approaches and wraps up with post-traumatic growth, one of my favorite topics. Module three covers communication in crisis and focuses on conversations during a crisis, covers language and the skills and the skill of following what's alive. Module four goes over the crisis system in Washington State, including mobile crisis evaluation and treatment centers, designated crisis responders and includes the Involuntary Treatment Act and goes over the sequential intercept model. Module five is all about self-advocacy in crisis and includes a wellness recovery action plan and advanced directives. That leads us into module six, which is interventions and this includes crisis de-escalation skills, prevention and intervention and post-crisis staff support and documentation. Module seven is all about conflict in crisis and learning about conflict styles. Module eight covers suicide prevention and using traditional prevention tools such as zero suicide, applied suicide intervention skills training or assist and alternatives to suicide. And module nine wraps up with prevention and post-crisis support. Next slide, please. I did include a slide here that has a bunch of our online training opportunities. And again, these are all free. I'm not gonna go over them all. They're all on this PowerPoint. You can find them at the links provided. Our trainings are on our Talent LMS site as well as our peer support site for HCA. Next slide, please. And this has my contact information. If you want any information about any of our trainings, including our crisis training, if you'd like to take a peek at our curriculum, I can get that to you as well. Well, thank you for such an interesting presentation, Steve and Mo. And next slide. And before we shift into Q&A, I want to take a moment and let you know that SMI Advisor is accessible from your mobile device. You can use the SMI Advisor app to access resources, education, and upcoming events, complete mental health rating scales, and even submit questions directly to our team of SMI experts. And you can download the app now at smiadvisor.org backslash app. And I know we had some great questions coming in during the presentation. The first one is referencing a presentation at NatCon this year regarding peer supervision and peers being supervised by peers. And I love this phrase that was used, not training the peer aspect out of the role and the risk that's posed by having peers supervised by clinical staff. Could you please share your thoughts on that? There's a couple of ways of looking at it. Absolutely, yes, it is. And when we first started doing this, it was very preferential to having peers supervise peers. But then we wanted to take a holistic approach to care and train other clinical staff on supervising peers, again, based on performance. And so we're a peer group that has kind of tried to really integrate our understanding of peers, integrate how important supervision is. So there's several types of supervision that we could be talking about. One could be just a peer-to-peer support, which I don't necessarily think is supervision, but it's more of a wellness approach when somebody is working in those critical settings and needs that kind of support. The other is the supervision that could be done and we feel and we do from a traditional clinical. So you're not really trying to get the peer out of the individual, you're trying to look at the performance of the individual based on criteria of the role. And as long as the clinician or the supervisor that is maybe not a peer is trained and adheres to and embraces the philosophy of peer-to-peer or peer support, there's no reason why they can't be able to support somebody. But that's really more of, I think, an individual issue that an organization might wanna address themselves, but knowing that there's different aspects of support, but then there's also maybe different aspects of supervision. And you would want to probably work within your team and work with your peer groups to see what they would prefer and what would be best for them. So it's a process. And for us, again, it's an evolution of understanding and moving forward and really having a well-rounded supervision for everybody. Excellent. And Mo, would you like to add to that? I know you have extensive experience in this as well. So we do provide a training for our providers called Operationalizing Peer Support because these topics do come up quite often about supervising peers. In Washington State, like I mentioned in my presentation, we are going through a bit of a transition. Our peers who are providing Medicaid services currently need to be supervised by a mental health professional. We have new legislation that we're implementing in 2025 and we are going to be training peers to supervise peers. So that is a transition that we are going through in Washington State. I am really excited about that transition. And so if you wanna connect with me in a couple of years, I'll let you know how it's going. Well, thank you for that. We look forward to the update. Another question is asking if the mobile services that are provided are more successful than other services or maybe other traditional services. Good question. Yes and yes. I mean, basically, yes, they are not better. They are a compliment to providing better service for the people in the community is the way I look at it. And so if you have a good engaging mobile team that can then bring someone to another service that's going to also provide that quality care of service now that individual is having a better experience. So it really comes down to the individual's experience of moving forward in their path to recovery. And so with the thing I love about mobile teams is that we get to meet people at that stage in community and see that crisis kind of deescalate and move forward into a more of a wellness approach. So it's not better, it's just a compliment to providing better service in your community. That's terrific. Thank you. There's a question asking about your experience with peers and youth mental health. If you could speak to that. We can. We are seeing a rise in youth that are in need of mental health, even with our police related teams or not. And so we have to serve. I mean, it just makes sense to serve. And so we're seeing a rise in it and we're working now with the school systems because they're also having some great challenges and difficulties in designing and preparing to upgrade the service delivery for youth because it is a different kind of approach in some ways. And we have hired staff that are reflective of the community and understanding of youth services. So it's been for us another evolving process of working with the youth in our communities. Thank you. And Mo, is there anything you'd like to speak to on that topic? I can touch on the training components. Like I mentioned in my presentation, we do have a youth and family CPC training that really focuses on the parent partner aspect as well as the youth partner aspect. And these folks not only can work on WISE teams, which is the wraparound with intensive services, but they can work in any provider providing those services. And our youth peers are generally between 18 and 25. In Washington State, we don't certify folks under 18. But like Steve said, in schools, there is a huge need now. And so we are not in my section, but in other sections at DBHR, they're working on youth services. That's great news. We have another question about the composition of the mobile response team in terms of the number of people and great practical question about how many people are in the SUV. Yeah, we have two-person teams. So it's a peer and a clinician or it's a peer-to-peer or it could be clinician-clinician depending on who's on call or on duty at that time. And we have another question about billing in Minnesota that for mobile crisis response, there's a requirement for a mental health practitioner with certain level of education, bachelor's degree in supervision to respond. And then if the peer doesn't meet the requirements, another staff person would be needed. And so they're paying the same rate for both, but they have to bill at a lower rate for peer support. So they're curious about how other people may have tackled this issue. It's different in many states. It depends on the state plan amendment that the state makes with Medicaid, Medicare services. And then there's also deficit-funded programs out there too that are funded by the state exclusively without billing. So what we do in New York is it's a two-person team and we can bill with a clinician and a peer. They are different rates, but they are affordable. They're sustainable. If we have two peers go out, that would be under our deficit-funded program. So that's how we've been able to deal with it. And I think Minnesota has gotten the state plan amendment for Medicaid expansion. So there may be a possibility of the state renegotiating that. And in our last couple of minutes of questions, we've had some questions come in about supervising peers on a team that has integrated peers relatively recently and resistance that is encountered with clinicians and role confusion, how you've gotten through that. Of course, we know that preparing the organizational culture is really critical. So I think people would really appreciate your wisdom on this. Yeah, absolutely it is. And I mean, they're doing it in Washington, a great job with it and infusing, kind of trying to prevent the resistance before you hit it, but you're gonna hit resistance with traditional clinicians possibly. And in going forward, it again comes down to the role clarification, the understanding of what each member of that team it was hired for and what's the expectation of that individual on the team. But you do need the leadership to embrace the concept of having peers on the team. Otherwise it's gonna kind of fall apart on you. So there's a lot of back work that is done or had been done, especially on our level, because we were just introducing it in our area. And it took a while for the integrity to build to where it was embraced by everybody. So it just, it does take time, but you can get through it. And when people realize how good it is and how powerful it is, they embrace it. And Mo, we'll give you the final word on this before we move into the housekeeping. Oh, so we do have an operationalizing peer support training and I know we don't have much time. My contact information is at the end of the slide deck. Please feel free to reach out and I can share some information on what we do and what we offer. And we'd love to share that with you. Well, thank you both. And thank you to the participants for such terrific questions. Next slide. Two. If there are any topics covered in this webinar that you'd like to discuss with colleagues in the mental health field, post a question or comment on SMI Advisors Discussion Board. This is an easy way to network and share ideas with other clinicians who participate in this webinar. And if you have questions about this webinar or any other topic related to evidence-based care for SMI, you can get an answer within one business day from one of SMI Advisors National Experts on SMI. This service is available to all mental health clinicians, peer support specialists, administrators, and anyone else in the mental health field who works with individuals who have SMI. It is a completely free and confidential service. SMI Advisor offers more evidence-based guidance on peer support, such as the webinar, Peer Support in Transitioning from Crisis Care, Variations on the NYAPRS Peer Bridger Model. This examines the core principles of the Bridger Model and its use in transitioning levels of care and supporting people in their journeys to recovery. You can access the webinar by clicking the link in the chat or by downloading the slides. To claim credit for participating in today's webinar, you need to meet the requisite attendance threshold for your profession. After the webinar ends, please click Continue to complete the program evaluation. The system then verifies your attendance for credit claim. This may take up to one hour and can vary based on local, regional, and national web traffic and usage of the Zoom platform. Please join us tomorrow on December 15th as Dr. Deb Pinals and Dr. Charles Scott present Explaining the Relationship Between Stimulant Use and SMI. Again, this free webinar will be December 15th from 12 to 1 p.m. on Friday. Thank you for joining us. Until next time.
Video Summary
In this webinar, Steve Michaud and Maureen Bailey discuss the importance of peer support in mobile crisis teams and the training needed to implement this model effectively. They emphasize the need for role clarification, supervision based on performance, and a person-centered approach in crisis response. They also highlight the value of peers in engaging individuals in crisis and creating a trusting and supportive environment. They discuss the process of mapping community assets and building relationships to develop a coordinated system of care. The presenters share their experiences of integrating peers into various settings, including emergency rooms, respite houses, and mobile teams, and the positive impact it has had on individuals' recovery. They also touch on the training and certification process for peer specialists in Washington State, as well as the specific training for peers working in crisis settings. The webinar concludes with a discussion on the composition of mobile response teams and the challenges of billing for peer support services. The presenters stress the importance of organizational culture in supporting the integration of peers and addressing resistance from clinicians. Overall, the webinar provides insights into the role of peer support in mobile crisis teams and the steps needed to ensure effective implementation.
Keywords
webinar
peer support
mobile crisis teams
training
role clarification
supervision
person-centered approach
crisis response
community assets
coordinated system of care
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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