I'm Patrick Hoffman. I'm from Kalamazoo, Michigan, and I'm a peer support. I'm really excited about today's session. It's going to be awesome. It's called Building and Retaining an Effective CSC Peer Workforce Vision, the Reality, and Solution. Now I'd like to introduce everybody. We have Dr. Vanessa Kladnick, Abby Duke, and Nabelle Caruso. Moving right into that. Dr. Kladnick goes by her, she, hers, Director of Research and Innovation for Youth and Young Adult Services at Thresholds. She's been involved in a lot of research, furthering the peer support mentoring integration into youth and young adult pain and mental health services. So she's a heavy hitter for that. Abby Duke, she, her, hers, New York State Certified Peer Specialist with OnTrack New York. Abby is involved in training. She's developed materials at OnTrack, done a lot of webinars, conference presentations, and a lot to improve peer professional development and CSC integration. And Nabelle Caruso, she, her, hers, co-chair of the Early Assessment and Support Alliance, ESSA, Statewide Young Adult Leadership Council, and Coordinator of Peer Delivered Services at LifeWorks. Peer Specialist at LifeWorks NW, part of the Peer Support Program, Program Development and Expansion, lived experience, contributed to coronary special care and psychosis through co-authoring multiple journal manuscripts, and speaking at national and international conferences on early psychosis. So very exciting. Also, the speaker's report, No Relationships with Commercial Interests or Conflicts of Interest. Hi, everyone, and welcome to our transnational conference workshop on building and retaining an effective, coordinated specialty care peer workforce, the vision, the reality and the solution. When we were invited to speak on this topic, Abby, Nabelle, and myself met, we got to know each other a little better. And we immediately began talking about barriers and challenges and bonding over the frustrating it sometimes can be with supporting peer role integration into coordinated specialty care and other community mental health settings. And man, people can bond over shared challenges. But then we started talking about how incredibly promising this role is for so many reasons that we are definitely going to hit on today. It can transform providers, agencies, young people and families understanding of recovery. It also has real potential to improve how coordinated specialty care teams address cultural and developmental responsiveness to truly meet the needs of young people and their families. And so we thought, let's start today with the promise, the vision, and the theoretical implications for peer support. Let's move into some of the challenges that we've seen across the country, from the East Coast to the West Coast, and then down the middle. And also, let's really highlight some of the innovative solutions that we've either been involved in, heard about, and are learning. And I want to I want to throw this out there to folks. As we're generating solutions, please feel free to use the chat box to put ideas that you have to address some of the things that we're talking about today. I love the chat box at this conference. It has been incredible, literally on fire. Also, something that I want to do with the chat really quickly. So one of the things that's going to come up when we talk about solutions is our solutions have multiple intervention points. Some are system-level solutions. Some are more agency or program-level. Some are more team-level. And then some are individual role-specific, such as with supervisors or with non-peer roles on coordinated specialty care teams or with peers themselves. And so I wondered if folks who are participating today and welcome could share their role in the chat box. So if you could name, you know, your, you could say what your job title is, if you work for a coordinated specialty care program as a peer support, a clinician, maybe an OT, an employment or education specialist, a prescriber. Maybe you're an agency leadership. Maybe you're a state administrator. Maybe you're a researcher. Maybe you're a participant in coordinated specialty care or a former participant, a caregiver, or a community stakeholder, a trainer. Maybe someone that's just really interested in early psychosis and the state of the science. Share with us who you are, because this is really your opportunity to get to know one another in peer roles, right? So we all have peers and peer, we're not going to get into depth on what peer means today, because it's a lot. But we really want to cultivate a learning community today. And for this to be an interactive workshop, we will have some polls coming up. So get excited. And one last thing before I move it over to Abby to talk a little bit more about what peer support is, I do want to say, we are drawing from our own lived and living experiences and being part of what I think is a giant movement to really address some of the inequities in access care, access to quality care, among young people who are experiencing early signs and symptoms of psychosis across the country. And so as you heard, when Patrick introduced us, we're involved in a variety of efforts to understand this through trainings, conferences, webinars, advisory boards, work groups. And so we're really bringing all of that to this presentation today. All right, Abby, I'm tossing it over to you. Beautiful. Next slide, please. So today, we're here really to talk about not just peer specialists, but peer specialists on coordinated specialty care teams. And we are all deeply invested in this work. Some of us because we are actively doing it. I myself am a certified peer specialist and just feel so strongly about the value of the role and the way that peer specialist enhances the work of every single person they work alongside. So some of the things we wanted to highlight about the role and its understanding and its implementation on teams is that we're really seeing a lot of exciting new things coming up. It is a role that's being developed as it is being done. So we're seeing more and more peer specialists on CSE teams. At OnTrack New York, where I work, a peer specialist is a vital part of each and every team. We're also seeing more opportunities and higher quality training, more certifications across the country, different states offering different opportunities and pathways for those of us who have been labeled with a mental health diagnosis to then re-enter the system as staff to work as peer specialists. So there really are new and exciting opportunities for all of us who have been psychiatrically labeled. And lastly, just highlighting the pivotal piece of peer work, which is the influencing of culture, that innovative disruption that Dr. Pat Deegan talks about. Peer specialists are advocates, and our work is born out of our own experiences, and it aligns so beautifully with social justice work. So you will hear us talking a lot about how peer specialist work and the work of CSE really needs to be aligned with anti-racist and anti-oppressive practices. Next slide. When we're thinking about peer support, we acknowledge that it looks a little different for all the different initiatives and teams and programs that exist out there. But there are these foundational understandings that we hope all working as peer supporters will be bringing into their role. So a lot of them are born of our own experience that the wellness, healing, and each and every peer support specialist. Oh, we could go back. I'll keep talking. As we work through, is that we are working with young people with nothing but respect for their experience, for their understanding, for the path that has brought them to us and their path to their own future, whatever that might look like. So we create shared spaces, and we have joint responsibility with those we serve, that we are uplifting each other, that we're creating connections and community amongst all of us who have been psychiatrically labeled. Our work is earnest in mutuality, co-creation of plans, of tools, of pathways, co-caring, co-sharing, and co-healing. I get to bring my own challenges and struggles into my work, and I get to receive support from those I'm working alongside with, which is a really unique piece of peer work. We use our own experiences. We engage in mutual disclosure to share about the things that we've been through. And we are working to always be as authentic and transparent as possible. I just want to highlight a phrase that for those of you who are familiar with peer work, you've certainly heard before, which is the idea of nothing about us without us. And we use that to think about the larger peer movement, but also about each and every participant we're working alongside, that we are really honoring their agency and empowering them to make sure that they're a part of every conversation about their treatment and their life. And then lastly, we have this beautiful ability to continue growing, to continue learning about ourselves, about our work, about our communities, as we show up each day. So these are some of the common principles and practices that we're hoping each and every peer support specialist on a CSC team will bring. So these are some of the challenges that we have seen come up on CSC teams. And there's been research done about this to survey peers who are working on these teams. And I will say, as a person who supervises many peer roles, not just a CSC peer role, this is pretty universal. So on the job stigma and discrimination, which we'll talk a little bit about, about a little more. Low pay and no benefits. In my experience, I've seen this because a lot of positions are posted as halftime, because it's seen as, you know, peers can only handle halftime. Being isolated or being the only peer on your team, you know, not having other peers to connect and consult with. Unclear work roles, burnout, limited professional development and career advancement opportunities. There's usually not much of a career ladder or peer support is seen as a stepping stone to becoming a clinician. And high turnover rates. Next slide. I think there might be a poll popping up for everyone. So today, what we're really going to cover is this vision that we have for peer services on CSC teams, and how what the current challenges are and how we really work towards that. I think there's a couple more bullets that should be coming up. Thank you. So how do we integrate the peer role onto CSC teams? And how a part of that peer role is to influence team culture? And this idea of professionalism in the peer role on CSC teams? Yeah, we would love to do our poll now, if we could pull that up. And this poll is going to ask you, what is your primary interest in this workshop? Is it A, learning more about peer, the peer role in general and coordinate specialty care and really where to get started? Is your interest in proving integration of the peer role and better team member collaboration? Is it C, increasing lived experience perspective and coordinate specialty care and improving team cultural responsiveness to young people and family needs? Or D, is it better supporting the peer role in coordinate specialty care through professional development? And I am having a hard time seeing this specifically. As of right now, it seems like the most people are interested in increasing the lived experience perspective in CSC and improving the team cultural responsiveness. Yay. That is awesome. Thank you guys for participating. We're going to have some more as we go along. All right, next slide. Okay, so our vision for integrating peers onto CSC teams is that they are fully integrated. The peer is able to utilize their lived experience to contribute, you know, really have those mutual conversations as an equal member of the team. The peer is able to integrate those principles of peer support into their practice when they're working with individuals, you know, participants of the program. The peer perspective is seen as valuable by the rest of the team. And the inclusion of a peer on a CSC team leads to an overall improvement of the quality of care and the improved participant outcomes. So next slide. So right now, the reality is that a lot of times the peer role is not always well understood by the team members or the supervisor. Um, this can really vary. I have seen more supervisors really have a deeper understanding of the peer role. But then sometimes that might not be shared by the members of the team. You know, for whatever reason, there is a communication gap there. Or there are team members who really understand the peer role because maybe they worked with peers in the past on a different team, but the supervisor doesn't share that understanding. And I think there's kind of a spectrum of this where, um, you know, a lot of times I don't really see that there's an active resistance towards having peers. I don't really see much of that. It's more an indifference of like, oh, you're here. I don't really know why you're here, but you're here and I'll work with you. And, um, you know, like, um, just really that expectation that the peer will understand or conform to some of the more clinical models of the team, but not really that expectation that the team takes on the understanding of the peer role. And more often than not, you might be the only peer on a coordinated specialty care team. The unfortunate part of this is sometimes the way that our current funding streams work, they're only covering one peer. And I really think that, you know, especially in some of these bigger programs, it would be great to have two peers on the team because just think about like clinical staff, when you're able to turn to your fellow clinician and consult and how helpful that can be. And not every peer has that. And it's really unfortunate. Um, and this can put a lot of responsibility on the peer, like they have to educate the whole team about their role. And this can be really hard, especially if you have a program where you're hiring specifically youth peers or people who have graduated from the program, and this is their first peer role, they might not even, you know, it might be the expectation, this is my first job, shouldn't you be telling me what my job is? Like, shouldn't you know, why am I telling everyone else, so that can be really frustrating and can lead to burnout. And it also kind of can cause this clinical drift where it's easier to conform to the rest of the team around you. And, you know, instead of having to constantly reinforce, like, no, this is what I should be doing, this is what I should be doing. When you, when you get burnt out, it can be a lot easier to just kind of do what everybody else is doing. And also this idea that sometimes peers can be seen as an ex client or tokenized for their role. Not being seen as capable by the other team members. I've experienced this as a peer, especially because I started in my role very young. Being seen as like not having as much experience as clinicians on the team that I'm working with. Kind of like, oh, you know, this person, yeah, they're experiencing psychosis. And I know you're saying you've experienced psychosis, but I'm going to meet with them first. And then if it seems appropriate for peer support, I'll let you in. And then, you know, they forget to bring me in. And there can also be on the other side of this, overpraising or like, seeming surprised when a peer has expertise on something like, you know, one time somebody was sharing, like, you know, this person is showing these different signs when they just had a medication change. And they said the medications, and they were on medications that I take. And I was like, wow, that combination sounds like it could really cause, you know, this kind of thing to happen. And the room was like, oh, wow, that's so great that you thought of that, Nobel. And it's just like, I don't really think my fellow coworkers would have gotten that reaction. Next slide. So what are the solutions to these issues of integration? So I think sometimes we get kind of in a linear thinking or a tunnel vision of what getting that lived experience voice means. And so something that we do with ESA, which is the early intervention program in Oregon, is we have a young adult leadership council, which I'm a part of. And that council is made up of people who are either currently in ESA, or who have graduated ESA. And we meet once a month and have many opportunities to offer feedback to the different ESA programs. So they might approach us with, for example, a welcome packet of what new people new to the program get. And we're able to offer feedback on that and maybe how we would have felt when receiving this welcome packet. And we actually said, you know, there are some materials in here that look like they're meant for family. And so it might be more appropriate to give one packet to the family member, one packet to the person. And, you know, there's a lot of information here, it might be less overwhelming to just split it up. And that way, you know, we're not just thinking about like the professional peer and their lived experience, but also more of that informal lived experience piece where, you know, you're really hearing from people who have been through your program and are able to give honest feedback. And in fact, you might get more honest feedback than from a peer who's working on your team, because there's less of that conflict of like, not wanting to offend or like not wanting to disrupt your employment. And creating opportunities for your CSC peers to engage with other peers. So, for example, at LifeWorks Northwest, I help facilitate a two group supervisions with different peers across the agency. So our current CSC peer is able to have an opportunity to consult with other peers in different roles. And we always offer time, like, is there anything you'd like to bring to the table to consult about? And I think that really helps with remaining true to the peer role and having that opportunity to connect and consult from that view. And with that, I'm able to meet with people one on one for peer supervision and also offer that perspective. So considering if, like, you know, maybe you're not in a big organization, but there might be an agency that you can partner with where they have a peer supervisor and you could have external supervision set up for that peer. Or even thinking further, sometimes there are peer run organizations where they contract with different agencies. So you might be in a position where it's like, instead of the person being an employee of your organization, they are an employee of the peer run organization. And so they're working with your team, but then they go back to the peer supervisor as their primary supervisor. And that can cause a lot less role confusion. And, you know, some people might have concerns about triangulation with the clinical supervisor and the peer supervisor. But you can always do like co-supervision, you know, connect with that other peer supervisor, just really open up that communication and educating your program, your team, and the supervisor, don't assume that just because you've explained peer support once that people really understand what it means. Because this is a new field, right? This is really new. This idea of peer support in a professional role, like hasn't been around that long. Peer support has happened for a much longer time in an informal setting, you know, support groups or people meeting one on one, like more volunteer setting. So there's probably a lot of trainers out there who would love to come to your organization and do a presentation. Or, you know, see if there's somebody else in your organization who has been a peer for a while, and is willing to come to the team as an outside person, and talk about what that peer role means. Because again, you're more likely to get an honest overview of what peer support looks like. Because if you're relying on somebody who is hired on the team to do that, it's, there's just going to be so much influence and internal conflict of like, you know, not wanting to cause conflict with your coworkers. Or, you know, there might be pushback from the supervisor of like, no, this is what your job description says. So you know, ideally, even before you hire a peer, getting that foundation of what peer support means and what the role will ideally look like and being able to talk to those voices of experience. And just creating this environment where you are able to invite open and honest feedback. You know, part of the reason like I got burnt out at a previous peer job is I felt like I couldn't say anything. Or I felt like when I did say something about the challenges I was experiencing at the workplace, it was really downplayed. Or, you know, I was told like, cultural shifts take time. And the onus was kind of put more on me to remain patient rather than the accountability being shared as a team of like, we need to understand what the peer role means. And just really reinforcing this idea that peers are not better or worse than clinicians. I think sometimes when I've talked about peer support in the past, or I've gone to other trainings, there is this fear or this idea that peers sometimes or somehow see themselves as superior to clinicians or the peer model is better than the clinical model. And it's just that we're different. These are different viewpoints. And the reason we bring a peer onto these interdisciplinary teams is to have another perspective, and to bring in those different areas of expertise. And so if the peer ends up conforming to the clinical model, that's just more of the same, and you might as well not even have a peer. So that's all I'm going to say. And then I'm going to hand it back to Vanessa. Thanks, Nabelle. Next slide. That sets me up quite well. This notion of the role specifically influencing team or you could say program culture where a coordinated specialty care team is integrated through this notion. This is the vision, right? This vision that this, the role itself is going to influence the culture. And I think that's really interesting to think about because it's not just referring to a peer support provider and saying, Hey, peer, go engage that youth and do a good job with them. It's no, you're part of a process, right? So if you're in a peer role, you're on a team with all these different disciplines, and you have to figure out how to get your voice heard. You need to find out where what you to figure out what is your voice in the workplace. There definitely is training a lot of the work I've done in my so far in my career has been around training supervisors and young adults in peer roles and really focusing on those. But there's so much more that we can do to improve programs and organizations. That's where I'm going to focus today for my part of this. One thing I want to mention that just having a peer role is so incredibly important. So although Nabelle, we're referencing this notion that it's isolating, right? There can be a lot of issues with power and privilege and how it plays out in the team. But just by having someone who is someone who is employed, is an active member of a multidisciplinary treatment team, who has the lived in living experience, and is a model of recovery, just that alone shifts how team members who are non peers, have families, how young people and arguably how the community understands what it is to be well, how folks who get a diagnosis can achieve their hopes and dreams and give back and become peer support providers. You know, this desire to give back and to support others who've gone through similar things. Something I wanted to mention these, these four little bullet points down here. One of the things I think is so interesting is this idea of introducing alternative and creative narratives and co-creating how a young person is making meaning of their experiences with psychosis and achieving wellness, right? That this is this vision that peers are going to support this process, that peers are going to advocate and bring the young person's perspective to the team. What's so interesting about this is I do feel like the peers on coordinated specialty care teams and employment and education specialists, they get the real story. They know what's going on. Also, this notion of bringing more recovery oriented strengths based, non stigmatizing language to the work. You're going to hear us avoid words like consumer. I've heard that a few times in this conference. We don't use that word. I don't like the word diagnose or excuse me disorder. I don't like diagnosis really either. But I don't want those words. I don't think they're helpful for helping young people become empowered and, you know, make progress on their recovery journeys. But this notion of this nothing about us without us just so critical and that the peer on the team in theory is embodying that, right? And bringing that lived experience perspective to team meetings and a team communication and collaboration at all times. And also using creative engagement strategies, getting out of that office, doing things that maybe other team members are like, I don't know if that's allowed. And peers really thinking like, no, like this is the thing that's going to get this youth excited about working with us and trying things. And so I think, on the whole, the peer role just has so much like promise for influencing team culture through these four bullet points. Next slide, please. So the reality as I've kind of nodded to and as you can imagine where I'm going, if you're familiar with this role, is that as Nabil had said, just lower paid primarily in part time, we do have a little bit of research. We know that many folks in coordinated specialty care who occupy peer roles are in part time positions. Typically, they're the only one on the team. And they're on a team that by default, because of the narrative of how these programs have developed over time, and the way that they weave evidence based practice come from a medical model or more clinical perspective. Also, many of these professionals, Nabil nodded to this too, are younger, this might be their first entree into a professional job, especially if you're a program graduate coming in. And I do think that's the hardest to do is to transition in real time from client, participant, patient into peer support provider. There's a lot and we could talk later about that in the discussion if folks want to. But this notion also of young people in these roles being individuals of color too. Also, as we heard a little bit from Nabil, young people are subject to microaggression. So tiny little slights that happen, being ignored, not being heard someone's opinion being dismissed over and over and over. It might not bother someone one time, but when it becomes something that you can tell, is like a thing. This is the reality of the peer view or the lived experience view, maybe not being as, I'm going to say privileged as other viewpoints on this multidisciplinary care model. Something I'm very, very interested in and am just I think part of my future research is going to be digging into the feeling of needing to share and feeling like I'm oversharing, or I'm undersharing, or I'm not. I'm sharing something in a way that now is changing how my team members see me and their own biases, their own beliefs and ableist views or racist views are influencing how they now see me. And it's adding on to they know I have a mental health condition. They know I'm younger, I'm a young person in this role. But now they're also seeing me with this other piece of information I now gave them, which could be in relation to maybe justice system involvement, substance use. These are examples that many of the young people I've worked with in peer roles have talked to me about like, God, I wish I didn't. I wish my team didn't know that about me, but I can't take it back. They know now. And also something that's really fascinating about this role is the kind of educator piece of the role, having to educate your fellow colleagues about the role, but also about when your colleagues use language that feels uncomfortable, that feels offensive, and feeling like because it's part of the role to really shape the culture of the team of speaking up and saying, Hey, you know, what you said really feels uncomfortable. It's hurtful. And figuring out how to do that is really hard because we are all subject to experiencing shame when someone calls us out for something we do. And the way that that happens, it can happen in a bunch of different ways. And maybe it has, maybe you're on a team and someone on your team called you out for a view that you had that maybe was well intentioned. But the way that it was heard by a teammate or multiple teammates was one that didn't feel good. It felt uncomfortable, and it felt discriminatory. And when this is pointed out, it can feel really bad and staff can react with a very defensive like, wait a minute, no, no, no, no, no, like, that's not what I mean. And it's like, okay, well, how do we create safe and brave spaces for teams to collaborate with one another in ways where we value diversity of thought, and alternative narratives of explaining and understanding healing and wellness. It's really, really tricky. And so this is the reality. And I want to move into solutions, because I think you guys are seeing where I'm getting at. And I think we'll get a little bit of this in a minute. So next slide, please. Okay, so to start out, from an organizational perspective, and arguably, a national effort needs to be embarked upon to examine pay rates, so we can increase equity and pay across folks who are in peer roles. One thing that's come to my attention pretty recently is just the amount of people in part-time roles. If you're in a part-time role, that can impact your capacity to have paid time off for vacation, sick time and personal time, and also time for professional development. Making sure that there's equitable opportunity for time to do training and professional development across your roles on coordinating specialty care teams is really critical. Also creating that career ladder that Nabelle talked about, we have to figure out ways to help the folks in peer roles grow with their skills and move into different positions. One of the things that's tricky about this role is that, especially if it's a young adult peer role specifically, and that's really more of an area that I like spend a lot of time thinking about is people grow out of being young adults, and people arguably can move out of peer roles. And how do you keep pieces of who you are and what you have done, right, as a peer as part of you as, you know, that that's important and also move into a role that maybe isn't a peer role? Do you let go of that part of you? Or do you keep it? Like, how do you integrate those? And my argument to that is that we, as an organization, have to really examine our mission, our practices, our policies. So agencies really have to take a look. Ideally, if you had a multidisciplinary, multi-department committee that gets together across your organization to examine to what extent does the agency or the system, maybe we'll take this to a state level, does the system have policies and practices that are truly aligned with peer support principles and practices? How did the principles and practices and policies support disclosure? Another word I don't love, right, this notion of strategic use of self and how do people do it and how are relationships built and supported when different disciplines on these coordinated specialty care teams are taught about disclosure and how you shouldn't do it and taught about how relationships have boundaries and you shouldn't cross them. In peer support, there's so much more and Abby's going to get into this about mutuality and its value. So I don't want to steal your thunder, Abby, sorry. One big thing that I think is important to mention is increasing supervisor competency. So Nobel definitely nodded to this, having a supervisor who's an expert in peer support and is a peer support is ideal. It'd be amazing if one day if across the country coordinated specialty care team team leaders are all peer support providers, right? But the reality is that's probably not going to happen soon. But to think about training supervisors, not just to know peer support, but to be better in multidisciplinary team facilitation and collaboration. Typically, team leaders and program managers come from clinical positions and are promoted. And they have to learn how to facilitate these teams and bring all these disciplines together and to figure out how to create equity and the different disciplines and it is tricky. And I think we need to invest as a field in our aura, I'll say a part of the field of coordinated specialty care stakeholders in that team leader, program manager, facilitation of diversity in experience, diversity in how we think about mental illness and healing, and really coming creating common ground for folks. I don't think we get enough training in that we definitely could use more. I also think and this is in this last year focusing on what is stigma, we can't just train organizations on here's what the peer role is. We have to teach people about what is stigma, what are micro aggressor, excuse me, microaggressions, what is privilege, right? We need to teach people what they can and can't ask their colleagues, right? That's one piece of it. But it's so much beyond that it is truly taking a step back and thinking, okay, what is the purpose of our work? And are we empowering our young people, our clients, our families? And are we using language because we're clinically trained and where we are using our clinical evidence based practice models? And what are the what's that language doing? And so we need to take a step back and together look at that language. And consider I would say reframing some of the language and maybe losing things like psychoeducation. One of those words that I just I really don't like just using education. Why does it have to be psychoeducation? And finally, this notion of having the peer role be a culture carrier be solely responsible, and we'll get into this in a little bit too. But this, the notion that the young person in there or the individual in the peer role is responsible for calling out colleagues for their use of language that feels uncomfortable is just not fair. This we have to change that it needs to be not just the young person or the individual in the peer role has to be the whole team's responsibility and arguably the program and agency and perhaps systems responsibility. To make sure that we are using language that is inclusive, equitable, and responsive to our communities. I'm going to stop there and turn this over to Abby. Thank you. And we'll move on to the next slide. So now we're going to talk a little bit about professionalism, which I think of as a pretty loaded word. And you'll learn more about that in a moment. So this vision of what a peer professional is, is that we are non-clinical professionals embedded on a clinical team. Our work is really truly centered around mutuality and reciprocity. That is the hope that that we have for all peer specialists on all teams, that we are able to transparently manage our own wellness, that we can talk about the things that are going on for us, that we're able to share about our current challenges as well as our past experiences in our work, supporting others, that we're able to really bring that authenticity and transparency into our relationships with participants, family members, colleagues, team members, that we're able to hold this perspective and approach of mutuality and building reciprocal relationships with participants of all intersecting identities. And we're going to talk later on why that's a vision, not a reality at this point. And lastly, that we're able to really capture these interactions in a way that honor the values of our work, collaboratively, role-based documentation. So let's move on to the reality, because this is how we would love to see it. Next slide, please. So the reality is that when people hear professionalism, it truly, it does not, it means something different to each and every person, and it really doesn't have a clear definition. So professionalism is regularly sort of considered being able to have a clinical approach. To be a professional is something that I think was really born out of white supremacy culture, with this idea that a professional, you know, wears their jacket and has very strong boundaries and doesn't feel about things. Whereas the true peer practices, which are mutuality and reciprocity, dismantling that hierarchy, the power struggles, that's not what people think of when they think of professionalism. So peers are, in general, by their clinical colleagues, by their supervisors and agencies, they're encouraged to really depersonalize their work, and to only bring our best selves, which means that if I'm having a hard day, and I tell a colleague about it, they're likely to consider that it's a symptom of my mental health versus just a human who's struggling in this world. And if you laugh, I mean, it's true. It's something I think we've all experienced. This idea about being able to connect, that peer specialists can connect with every person they work with. It's challenging. When we talk about intersecting identities, and the many, many things that each one of us are, for me, having been labeled as someone with a mental health diagnosis is a small piece of that. But that doesn't mean that every person that I'm working with shares intersecting identities, whether it be gender, race, all of these things make us who we are, and can really be challenging to have this pressure to be able to connect and be peer with every single person served by our team. And that leads to some of the things that Nabil was sharing about with burnout, with really sort of making this a role that isn't sustainable, because it's you're giving so much of yourself, and it can feel really hard and really challenging. And I know it's something that's experienced by peer specialists throughout CSE programs. And then lastly, thinking about documentation, specifically, we are documenting based on a clinical treatment plan. The goals came out of a clinical assessment and evaluation process. And all of our notes need to feed back into that. So without having specific training on the role of peer specialist and peer focused documentation, I know for myself, I learned to write notes by reading the notes of my clinical colleagues. And that's how we figure it out, because there's no other opportunity for us to learn. So we tend to take on some of that language that we might have seen our colleagues use, or even the structure of thinking about maybe how someone appeared, having occasional assumptions and judgments within our notes, all of that moves very far away from our intention in doing this work. So let's move on to the next slide, because we got some some ideas for how we can address some of this. And the first one in thinking about professionalism, we need to all shift our values. And this should not be the onus of the peer specialist, but it is on each and every one of us to acknowledge the role that this white supremacy culture has played in our definitions of what it means to be a professional to show up at work every day. And we need to actively work to dismantle these values. And that's as a collective, not as an individual, we need to come together and feel really comfortable calling things out and feeling safe in our positions and that we're not risking our job to do it. And honoring youth culture, especially thinking about working on CSC teams, we're working with young adults, it's a very specific time in life. And being able to, to hold that in our work and to shift expectations of what staff should be. So I think that a couple of really concrete examples of this are dress code. If you have to be in a suit to be a professional, like that's not what a peer specialist should be. Like we wanna look like people who you could connect with. So I, for one, am pro jeans at work. Feeling comfortable wearing like street clothes as a part of your job. Social media and access to technology. The fact that there are CSC teams out there that can't even text is such a huge barrier to this. I'm really looking over the policies around social media access. That is how young people connect and communicate and having the ability as a peer support specialist or as any member of a CSC team to utilize that as yet another engagement tool. We really need to look at every single policy and guideline within our agencies, programs, teams and say like, where is this coming from? Is this coming from what it should be or is this coming from what's actually going to best serve the young people and their families? Because that's what it should be about. Thinking about training and access to work. No, not even to work. To show up in the world as a person who has been labeled with a mental health diagnosis. To show up in the world as a young person in an adult world as a person of color. Like there's so much challenging just to walk through this world. Let alone to be expected to bring that to your work. So we really wanna highlight the importance of training and not just cultural competency. We wanna go beyond competency and really look at humility. Look at each and every staff person and if they're able to think about their intersecting identities and to bring those pieces to work. So it's not just the peer specialist that's talking about who we are. And then identifying that we cannot be peer with all and that that's okay. It's not on us to connect with each and every person but really to think about what are the resources are in my community? If I don't identify as an LGBTQIA person then I wanna make sure that I know what centers are available in the neighborhoods that my participants live in so that we can connect them. Faith communities, neighborhood associations all of these places that can also be peer. So it's not just on the peer specialist to expect that they're gonna be able to connect with each and every person. And then lastly, thinking about documentation. I just all, I'm such a huge fan of collaborative documentation. I personally think it is the only way any person should document their interactions with someone. I know for myself as someone who has served like the medical record about me, like that ain't me. That's someone's interpretation of me. And so to be able to demystify that process for participants and partner with them to say, we just spent an hour talking about some major stuff. Like how do we wanna summarize what we did together so that the rest of the team knows? And to really factor that into the way that we're planning does every team member have access to technology? So if we are out doing a community visit we're able to collaboratively document. Do all of our participants know about the documentation process? As peer specialists, are we making it crystal clear that we're a part of a team and that we're going to be documenting our interactions? There's so many different ways that we need to ponder this and to really make sure that we are supporting peer specialists in writing notes about peer specialist work. And then also thinking about the assessment, evaluation, treatment planning process with the hopes that peer, if your team has a peer support specialist that they're involved from the very beginning, that it is not just being done by the clinical staff, that all people, that the entire team, that every stakeholder, the young person, their family members, their friends, their coaches, their teachers are all engaged in this process. And that those treatment plans are capturing those experiences. We don't live in a bubble in our therapist's office. That's such a small part of who we are. We wanna make sure that we're capturing each person's whole selves. So those are some of the solutions we have, but I'm sure you all have found solutions as well. So I'm gonna pass it back to Vanessa. I love that. Please, as you're listening to us, this chat is so great. Keep adding your solutions. It's fantastic. Next slide. So we've talked about things, solutions on a bunch of levels, and we wanted to end with two big takeaways. One is what you can do on an organizational level. And then what we'll finish with before we get to questions is what you can do as an individual, as a coordinated specialty care stakeholder. No matter what your role is in this community, we've got some ideas for you of what you could change your behavior, your attitudes, your belief system, and it will have a huge impact on the peer workforce. So first off at the organizational level, I've been using this word a lot, squeeze. We need to stop squeezing peers and peer providers into preexisting contexts that have belief systems and practices that run totally counter to peer support practices and principles. We can't keep squeezing in these roles and expecting these folks to change the system miraculously. And as the chat is going, I feel very much this is resonating with people. We also have to invest resources. This is the call to action. Leaders on this call, state people, high-level administrators at agencies. Listen, we need you guys not just to put money, but we need resources and people at the top of organizations to pull together different departments within an organization, your human resources, your IAS, your operations, all your people, get them together and talk about what we're doing to best support recovery and this peer support role. We have to be more, if we're gonna be recovery focused, that's the way at the top. We've really got to do that. It's not just money saying, hey, peers go to trainings. Trainings are great. Let me just say they're wonderful, but they're not the answer. And then finally, we have to figure out how to better value and centralize peer support practices as much as the other modalities that have longer histories, have more research, have big names behind them to really privilege peer support as an equal person at the table. And I think from hearing what we talked about today, all of our solutions that we put forth are ways to do this, but really it's an organizational approach to where do you list peer support in your list of coordinated specialty care service lines? Is it the last one? Is it the first one? What's most important? Think about it. So it's really thinking, examining how your team functions, what's on your website, how you talk about your team and what y'all do. Where do peers fit in that? Think about that when you go back out to where you are. Actually, no, you're probably right where you are. And think about it and then maybe change something. Next slide. So these are really important. And although they might seem simple, they're more of things that you can do over time, but they're things you can do as an individual that will help to support the peer workforce within coordinated specialty care. First, you can self-reflect, gain awareness of your own perspective, learning how do I know what I know? Who created the knowledge that was taught to me? Were peers involved in that? Were people with lived and living experience? How do I know what healing looks like or what a successful outcome is? How do I define that? Why do I think that way? What does treatment look like? It's only when we take a step back and start self-reflecting and if you can do this, if you're on coordinated specialty care teams, do this in supervision. Take a step back and ask that with your supervisor. Supervisors, do it with your supervisor. Really examine where your knowledge and privilege comes from. It's really, really important. Also, this notion of embracing alternative ideas. Take a step back before you dismiss someone's idea. Reflective supervision is such a powerful tool. If you don't know what that is, Google it after this. But this notion of not trying to solve a problem immediately and tell someone what to do and just taking a step back and being like, huh, tell me more. How's that? Why is that? So simple. My God, so simple, but so tricky. And so we hear sometimes people on our teams or our young people say something we might think is ridiculous. Hold that, that's your bias. And listen and learn, right? Who knew? TikTok, go learn what TikTok is. You might learn something. Don't rely on the peer person on your team to explain what TikTok is. It can be a very healing thing to be part of a community through TikTok. And finally, you have to speak up. You have to, if you're working in community mental health and you really wanna make change, we have to adopt, we as individuals, again, I'm talking about your self-work in this community of coordinated specialty care stakeholders adopting an anti-racist, anti-ableist, anti-ageist approach that you use. You have to speak up when you hear things that upset you that you know are hurtful to yourself and to other people on your team. And I know this is hard. I referenced shame earlier. It can be really hard, but it's really, really important we do this even more so arguably for the young people and families we work with, but also because of our peer workforce, we wanna create safe, brave spaces for everyone to bring their ideas and their perspectives and their lived and living experience and themselves to the workplace. Because if we can do that for ourselves and create spaces that feel healing, even for staff and stakeholders and for wellness for our families, we will change this work. It will be more equitable and accessible and more inclusive and more diverse. And so I'm gonna stop with that and open this up. There's a bunch of questions. I looked at some earlier and I just wanna say everyone for your participation in this chat, thank you, thank you, thank you. This was more than we could ever have hoped for and it brings us great, great joy. And so Patrick, I wasn't sure if you'd synthesized a few questions that would be fun for us to take a stab at. Great presentation, by the way, that was awesome. Looking forward to the questions. So I have a couple that stood out. One of them, we're gonna start with Abby and then Nabelle and then of course you, Vanessa as well, if you wanna chime in. One of the questions was about the advancement for peer support. What ideas do y'all have about what those next steps could be? Like what are those new positions? What are those opportunities for advancement? What more can we do as peers to build on what we do? I think when we're thinking about career advancement and options for those of us who identify as peers in our work and want to continue this work, I consider my career to be peer work, but I feel tremendously privileged because there's not that many opportunities currently. So I think that is when we really need to lean into the advocacy element of our work. And this is when we are calling on supervisors, team leaders, agency staff, program staff. We need y'all to step in too and to really say this is important. And we need to have peer specialists, A, as we've already said, be full-time, be equitably paid, have access to all the benefits they need. But then we also need to say who's supervising our peer specialists and creating opportunities for development and growth. And so if you have an amazing peer specialist and they've worked with your team for a couple of years, it's time to think about opening up the next option and creating that next level, that supervisory position, which not only allows that person to thrive and to keep them from leaving their job, is to give them that promotion, which opens up a position for another peer specialist to join the crew, to get that same level of supervision from a peer. But that will not happen without loud, consistent advocacy. So we need to advocate and we need to say if we have another line on our team, if we increase our care load and are able to get more funding that we're not just necessarily hiring another clinician, that we're really strongly considering the value of peer roles and to highlight the tremendous work being done by those of us with lived experience, to research with Dr. Nev Jones or learning from Dr. Pat Deegan and her training, and to see all of those of us who identify and who have moved up in their career, but then to look into our own neighborhoods, into our own backyards, our own agencies, and say, what can we do to make sure that for our team, we're creating this? Nabelle also brought up having a second role of peer specialist, making sure that they're not the only person speaking, bringing them on to work groups and planning boards and advisory boards and paying them for it, paying them for every single thing they do. Okay, that is all Nabelle's on. Thanks, Abby. And just to add to what you said, I kind of saw in the chat like, oh, I hope peers are getting paid if they're taking on supervisor roles. Yes, absolutely. Do not give your peers supervisor responsibilities and not change their job description or pay them more. That is absolutely unethical. My role in the agency is a program coordinator because our agency has about 30 peers or peer roles. And I share that with another person. I'm not supervising 30 people, but it's just like, right now we only have, at our whole agency, we only have one peer supervisor position and I'm hoping eventually that can change. There are also issues with like, if you're a really small organization, you might not be able to justify having a peer supervisor if there's only a couple of peer support specialists. However, having something like a peer support one or peer support two or whatever the job title is, because for example, right now at our agency, we have service coordinator one and two, but our peers don't have that or we don't have team leads. So anything you can do to create some kind of career ladder within whatever you're working with in your organization. And this can also be one of the benefits of contracting with a peer run organization because often they already have those structures set up. So it can make it a lot easier because then the person is able to move up within that organization and it's not necessarily relying on your organization for that. Anything else to add, Vanessa? Oh, I have thoughts, but I think I'll stop. I think you guys made really, really good points. Like, well, I'll say one thing. We don't wanna just turn the peer workforce into a bunch of clinicians. And that, so I'm looking at the chat and I feel like that's one route, right? Like helping connect to graduate programs and get that master's that you need to go be in that role. In doing supervision with young people in peer roles, I always am career focused, but that should arguably be part of every role supervision is career focused and thinking about what is your next step and how am I helping you as your supervisor and how I'm helping you get there. And so I do think there's that, there are those routes that are, they're just gonna be more clinical. But my big push is I think that those social work and counseling routes need to embrace, they need to have coursework on peer support and they need to value peer support. And it should be more part of the work that we do in all of these roles to really enhance engagement of this, we'll say vulnerable and hard to engage population. Stop. There was another question about sort of related to that. One person was saying they had, they were paying a peer the same as everybody else. And then they were finding it hard to hire more peers because the cost relationship with what the peers are reimbursed for and what they're being paid. And I also wanna add to that, what can be done on that higher level so that we're reimbursed more? Because that seems like where the problem originates, but how do we manage that being paid more, maybe through more roles that bring in more funding, not that everything's about money, but we all know how that works. So who wants to take a stab at that first? Abby. Let's get started. I do believe that the certification of peer specialists is something that is moving us in the right direction. I live and work in New York State and I'm a New York State certified peer specialist, which does allow us to bill under Medicaid for New York State. So I think that's an important piece. But whenever I'm talking about the work and the value of peer specialists, I think that much of the money, for we're talking finances, much of the money we earn is actually the money saved by working with a peer specialist, support someone in staying out of the hospital, in not needing a higher level of care. And that's really, in my opinion, working for OnTrack New York, that's what those teams were developed for, is to keep young people out of the adult mental health system as lifelong service recipients. So if we're able to invest in this earlier part of their life to keep someone from needing more expensive services later on in their life, then that is the true value of peer specialists. And so it's not a dollar that you make, but it's a dollar that you save. And it's so crucial because it's not just hospital bills and insurance, but it's supporting someone in creating a life as a citizen of the world where we are able to work and contribute and to be a part of our communities, our neighborhoods, our families. And that is a value which cannot be assigned a dollar amount. Vanessa, I'm gonna call you Dr. Kladnik now because we're switching hats. From a research perspective, is there a lot of research to support what Abigail's saying? I believe I just saw some in part of your information that there's research that actually is showing that we could present to those upper level people to say, like, we're saving money that justifies reimbursement. Do you have more to say about that? Yeah, I mean, what you have to do is have a group of people at your state level who are deeply invested in this work and who are gonna create legislation and then beyond legislation are gonna negotiate a rate for reimbursement for Medicaid and commercial insurance. And I know there's a talk about this later. So go to the financial sustainability talk later on, definitely check that out because they're gonna touch on this. There are creative, there's a lot of creative ways to fund these multidisciplinary care services and also cover roles that aren't typically reimbursed like supported education, for instance. However, one way in the short term beyond that kind of high level reimbursement, we've gone after some small foundation grants. And sometimes just to get started, if you're like, gosh, our state doesn't have a certification or if it does and it reimburses at a really, really low rate, you can still pick up that money by using that mechanism. But looking for different, we've got like small banks. It's so interesting who wants to give money, but there's places out there that do. And that's just the start. The bigger thing is as states, Illinois, you'll learn about this later. New York has done a good job at this. I think as we see more and more states having financial models that we can say, oh, that state did it. You'll see it go across the country a little bit quicker. We're still, I mean, it's just those reimbursement rates are still in Medicaid so low. That's an issue. Thank you. We have just a couple of minutes left. If one of you happen to look at questions and had something stand out, jump out with that. I'm gonna look at what else we have, whoever's fastest, I guess. I've seen a lot of comments about language, which I think is so important and so crucial. So my thoughts on language is not that there's a list. It changes every single day. Just to be really truly person-centered and to value the human in front of you and to use the language that they use to refer to themselves. And to always be thoughtful that our language is not making assumptions. It is not labeling. It is not judging. It is just connecting. So I'm sorry that we don't have a simpler answer, but we each know our own path and we know our own truth and we know what feels respectful and good to us. And to make sure our language captures that. Thanks so much, everybody. It's been great information. Thank you, Abby, Nabel, and Vanessa. We so much appreciate it.

coordinated specialty care

peer workforce

integrating peer support

organizational values

funding

training

career advancement opportunities

self-reflection

mutuality

inclusive spaces