Hello and welcome. I'm Alexia Wolf, Director of the Behavioral Health Consortium in Delaware and SMI Social Determinants of Care Expert for SMI Advisor. I'm pleased that you're joining us for today's SMI Advisor webinar, Serious Mental Illness in Older Adults, Certified Older Adult Peer Specialists as Advocates for Recovery. Next slide, please. 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. Next slide. Today's webinar has been designated for one AMA, PRA, Category 1 credit for physicians, one continuing education credit for psychologists, one continuing education credit for social workers. Credit for participating in today's webinar will be available until February 7, 2023. Next slide. Slides from the presentation today are available in the handouts area, found in the lower portion of your control panel. Select the link to download the PDF. Next slide. 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. Next slide. Now I'd like to introduce you to the faculty for today's webinar, Hilary Cantiello, Dr. Tori Creed, and James Klassen. Tori A. Creed, PhD, is an Assistant Professor and Licensed Clinical Psychologist at the University of Pennsylvania's Perlman School of Medicine. There she founded the Penn Collaborative for CBT and Implementation Science, which encompasses a large network of community partners, a program of training and implementation, and a rigorous complementary research agenda. Her research leverages this large natural laboratory of community partnerships to develop and evaluate strategies to support the implementation of CBT and other evidence-based practices, particularly in under-resourced communities. She has partnered with the Philadelphia Department of Behavioral Health and Intellectual Disability Services for almost 15 years to implement and sustain high-quality CBT across their public mental health system and has been the PI of a number of NIMH-funded studies examining strategies to improve access, treatment fidelity, and sustainability of EBPs in this and other community mental health care systems. As the Director of Clinical Implementation for LISN, she guides the integration of artificial intelligence-based supervision and competence evaluation tools into mental health training and routine care settings. Dr. Creed also serves as a Health Policy Advisor to Partners in Health with a focus on strategies to implement CBT and other EBPs in Haiti, Rwanda, and other low- and middle-income countries, and she serves on several scientific advisory boards to help improve the quality of public mental health care. In addition to an active program of research, she teaches, mentors students, and postdoctoral fellows and provides workshops and consultation. Hilary Cantiello is a Senior Research Coordinator and Project Manager for the Center for Mental Health, where she manages systems-level evaluation projects and leads the Certified Older Adult Peer Specialist Training Institute. Before joining the Center, she worked in prevention and intervention for a co-occurring program for women and their children in West Philadelphia. She holds a Master's of Liberal Arts from the University of Pennsylvania, where she focused on maternal and child health. She's interested in trauma-informed care, peer-delivered services, and community health services. Jim is a Certified Peer Specialist Facilitator, Advanced Level RAP Facilitator, and Certified Older Adult Peer Specialist Trainer. He brings over 40 years of experience in human services, including workforce development, mental and behavioral health. Jim has worked with youth, welfare recipients, persons returning home from prison, and persons impacted by trauma, mental health, and substance-related challenges. Jim is a CPS and brings lived experience, sharing his recovery journey openly as evidence that recovery and wellness are both possible and probable. Thank you all for leading today's webinar. Hi. Good morning, everybody. Thank you so much for joining us. It's very much an honor to be here. I'd like to start by just stating that none of the speakers today have any relationships or conflict of interest related to the information in the presentation today. In terms of learning objectives for the hour that we're going to spend together today, by the end of this hour, you should be able to identify the unique risks and needs faced by older adults who are experiencing or in recovery from serious mental illness, describe two ways in which the COAPS program provides tools to improve access to care for older adults in recovery, and discuss at least two benefits of recruiting COAPS to receive COAPS training. So I'd like to begin this morning by sort of setting the stage for the works that we've been doing with the Certified Older Adults Peer Specialist Program by talking about, to start with, the older adult population here in the U.S., which is very much growing. The number of older adults in the United States is rapidly growing, particularly as the baby boom generation ages. Looking at 2020 census data, which is the most recent data that we have, we found that 54 million Americans are age 65 and older. So that's one in seven Americans would be described as an older adult. And in the decade before the 2020 census, like since 2010, the number of older adults has increased by 14 million, and by the time we reach 2040, we're expecting the number of older adults to reach over 80 million Americans. So this is very much an important and growing population. When we think about mental illness and substance use among older adults, one in five adults who are age 50 or older, or 53 million people, experience a psychiatric disorder. And among people who are 65 or older, almost 6 million people report a substance use disorder. And while those numbers may seem large, in fact, they are probably underreported. Things like stigma and shame are common across folks who tend to underreport these kinds of challenges, but there is also a generational factor here. There are data to suggest that some of the pieces around stigma and shame are slowly decreasing, but among older adults, they grew up in a world and a culture where there was really significant stigma and shame around these pieces. So we find that even among people who report feeling anxious or depressed and are older adults, only one in eight actually seek professional help for the challenges that they're experiencing, and less than 30% of older adults who have a substance use disorder seek treatment. So when we look at these numbers of folks, the prevalence numbers, in fact, they are very likely higher than this in terms of actual lived experience. The numbers that I'm reporting here, as I said, some of this is 2019-2020 data, so it was pre-pandemic. When we start to think about the multiplicative effect that COVID has been had broadly on mental health and particularly among older adults, almost 20% of older adults report that their mental health is significantly worse since the COVID-19 pandemic began. So if we then turn and think rather than broadly about mental health challenges and think about severe mental illness or SMI, the prevalence of SMI in older adults is estimated to be between about 1.4 and 4.8% overall. Of those, we have about 0.2% of older adults who report experiencing bipolar disorder, about 0.2 to 0.8% of older adults experience schizophrenia, and between 3 and 4.5% of older adults experience a major depressive disorder. Keep in mind that on average, most onset of SMI happens in the first half of the lifespan. So when we're thinking about older adults and their experiences of SMI, what we're really talking about is experiences that people have had for years and often decades of their lives. The experience of SMI and co-occurring disorders puts people at risk for a number of additional complications. So for example, compared to people who do not experience SMI, older adults with SMI have higher rates of a number of things that put them at risk. Higher rates of diabetes, lung disease, heart disease, obesity, and other things that are really lifespan-shortening diagnoses. In addition, older adults with SMI report higher rates of things like tobacco, alcohol, and other drug misuse. And that constellation of experiences and behaviors can contribute to earlier mortality. In addition, and I find these numbers to be particularly notable, incidence rates of dementia may be much higher in older adults with SMI. So when you look at people who have reached age 66, prevalence of dementia among those who have schizophrenia was 27.9% compared to only 1.3% of people who do not have SMI. And when we advance the timeline to reaching age 80, the dementia prevalence has risen to 70.2% in individuals with SMI as compared to only 11.3% among people who do not have SMI. An additional factor that's really important to think about is social isolation and loneliness. And those are connected ideas and experiences, but not the same thing, which I think is really important. When we're talking about social isolation, what we're thinking about is a lack of social connections versus loneliness, which is more of an experiential thing. So it's the feeling of being alone. These can occur together, but not always. Think about the fact that, for example, individuals can feel lonely, even while having social connections. I think that's an experience that many of us can connect to for at least moments or periods of our lives. And in addition, people can be socially isolated without actually feeling lonely. When we think about social isolation and loneliness among older adults, again, coming back to starting with data that is pre-pandemic, which is important to think about as context here. Pre-pandemic, we were hearing that nearly one in four older adults, so a quarter of older adults who were living in the community, were socially isolated. And among those folks, more than a million older adults were considered severely socially isolated. And again, these are folks who are living in the community. In addition, 43% of older adults, folks 60 and older, reported feeling lonely. And of those, 13% of people were reporting feeling lonely often. So there are reasons that older adults in particular are at risk for social isolation and loneliness. Particularly, older adults are more likely to live alone. Older adults are more likely, as we were talking a minute ago about, they are more likely to have chronic illnesses that can make it really hard to leave home or to interact with other people, physical limitations, vision loss, hearing loss, no longer driving. And in addition, as we age, we increasingly face the loss of our families and friends and the people who we have spent decades being connected to. So then, again, let's think about the additive effect that COVID-19 has then had on these experiences of isolation and loneliness, particularly among older adults who were identified as a group as being at particular risk for getting COVID and for having significant impacts. So lockdowns, the social distancing protocols that we all experienced, and the downstream then inability to interact with loved ones during COVID-19 really exacerbated this already present issue around both social isolation and loneliness in older adults. So those experiences increased even further as COVID-19 set in and remained with us and still remains with us. So we saw a lack of companionship and isolation and lack of social contacts further increasing during this period. When we looked just at the first three months of COVID, those really acute early days, what we saw was that a lack of companionship was more common among women, people who live alone, those who were unemployed or not working, and people who were disabled. And older adults are overrepresented in most or all of these categories. Now let's add back in the experience of SMI into this picture. So individuals with SMI and particularly individuals with a psychotic disorder experienced really notably high rates of loneliness. So in 2018, it was reported that almost 80% of people with schizophrenia reported experiences of loneliness. That's such a high number. And compared to people in the general population who have not experienced SMI, that's 2.3 times more likely for folks who have SMI to be reporting experiences of loneliness. And thinking about the things that are connected to those experiences of loneliness and SMI, we are also seeing increased experiences of internalized stigma, lower self-esteem, paranoia, depression, anxiety. Adding all of these pieces then together as a cluster of experiences, we see that social isolation and loneliness are associated, again, with comorbidities and increased risk factors. So isolation and loneliness, with those experiences, we see an increased risk of death across the board from all causes. That increased risk rivals that of smoking, obesity, lack of physical activity. And I find that really notable because I think as a society, we are hearing discussion of the risks of smoking, obesity, lack of physical activity. And there's much less discussion of the very similar, very significant risks of loneliness and social isolation. We see, for example, people at a 50% increased risk of developing dementia and almost 30% increased risk of developing coronary artery disease, a 32% increased risk of stroke, as well as increased risk of other mental health issues like depression, anxiety, risk of suicide. And in a study of heart failure patients, loneliness was associated with a nearly four-time increased risk of death, 68% increased risk of hospitalization, and 57% increased risk of emergency department visits. So we are really talking about a situation that is a basic threat to health and wellness. One more thing I want to say before I hand the slides over to my colleague, Hilary Cantiello, is as we're thinking about these risks that are then building, I think we have a picture of that. And all of this is happening at this increased level in the presence of COVID, but also as a timing issue is happening at a time where our mental health system here in the United States is on fire. Burnout and turnover rates in mental health are incredibly high at this point, and so access to mental health care, which has often for years been an issue, is even more of an issue at this point. And with that, I would like to hand things to Hilary to talk to you about how we've been thinking about those pieces. Thank you, Tori. Actually, if you could keep the slide. Thank you. Yes, so sort of in light of discussing some heavy things like loneliness and social isolation, we want to talk a little bit about peer support and how that can be a helpful tool in wellness and recovery for individuals. So peer support is not new. The peer support movement started in the 1970s, but just in the last few decades, we've seen it become more of a seriously used and understood practice. It's now considered an EBP or an evidence-based practice, which really just means that there's rigorous research behind this, proving and showing that it works and that people use it and want to use it. And it's particularly useful for individuals with mental health conditions or challenges. What we do is we look at both the quantitative and qualitative data to show that peer support really improves a lot of different aspects of mental health services, including lowering the overall cost. I know that's usually a big deal. How can we save money? How can we make services more affordable for individuals who need them? Peer services are one of the greatest ways to reduce rehospitalization rates and inpatient services. We know that using peers also increases the use of outpatient services. It engages people more in community, in their community services and in their communities in general. We know that peers, that there is a bidirectional benefit to peer support. So not only the consumer who is receiving peer services, do they have improved quality of life, but the peer who is providing services also. We also know that peers increase the engagement with services generally, both clinically and also in community. And there is an increase in whole health and self-management when peer servicers are used. We'll get to the next slide. So increasing the peer workforce is really important, especially like Dr. Creed mentioned, that right now when there is a lot of need for mental health care, increasing and expanding this workforce is going to be really, really important. Peer specialists can advocate for those they work with. They have a shared understanding and respect because of their lived experience that helps them connect people to services and helps them to remain engaged in their recovery process. Helping with goal setting and reaching goals is another thing that peers are really, really wonderful at. These are all things that normally would happen in a clinic or within health care settings and can be expensive. It takes time and training and having peers come along and do that work with individuals can be cost-saving and really benefit people. They can work with individuals and their treatment goals. Beyond that clinical setting, a lot of times clinicians and health care services are done in a silo and people can't be seen after being in the clinic. So peers have a really wonderful role in that they can sort of connect these services together. They can work with someone to make sure that they're getting to the different appointments that they have. They can help set up appointments, things like this. So it takes some of the burden off of the health care side and really helps people to stay engaged. So what we want to talk to you today about is the Certified Older Adult Peer Specialist Program or COAPS. This is a program that is here at the University of Pennsylvania. It started in around 2008 in partnership with the Pennsylvania Department of Aging and OMSAS. This program trains already certified peer specialists as older adult behavioral health specialists and wellness coaches. So it's an additional training on top of that original like 75-hour training. The COAPS training is three days, it's 18 hours, and it goes into a lot of information sort of like what Dr. Creed already talked about, sort of things that we see as people age, you know, issues that people might be coming up against, and then different resources that are available. COAPS support older adults in recovery in many different ways. Some of the big ticket items that we see are crisis support, developing community roles and natural supports, also just finding those communities and natural supports. They can advocate for the individuals that they work with. They can talk to them about self-help and self-improvement, and they can help navigate health care and social service agencies. A lot of times with the lived experience, these are things that they've had to navigate themselves, and so that knowledge is something that they bring to the table when they start working as a peer. Next slide. So some of the main goals of the COAPS program is to prepare a peer workforce to meet the health and wellness needs of older adults with behavioral health challenges and SUDs. This is a very broad and big goal, but we really hope that in training people to have specialized knowledge in aging and in, you know, special mental health disorders and substance use disorders, that the treatment and help that they can offer is more specialized, more personal, and more focused on whole health, and we hope to strengthen the capacity of the workforce to meet the health and wellness needs of people with SMI who are aging but whose health are often neglected. Sometimes, as Dr. Creed mentioned, there's a lot of stigma or shame around getting help, and so having a peer working alongside someone can really help in these parts of life that are sometimes neglected. And most importantly, we just hope that COAPS can help improve the quality of life of older adults. We know that peers work. We know that it does improve the quality of life, and so expanding this workforce, we find to be very important. We have quite a few different partners that we've worked with. This is just a small list of agencies and organizations that have, you know, understood the importance of peer work and of older adult peer specialists. Obviously, the University of Pennsylvania, which is where the COAPS program lives, but like I mentioned, the Pennsylvania Department of Aging has been huge in helping to develop the curriculum. They've been supportive since the beginning to get things going, and OMSAS as well. We work in many different states. This is mostly just our Pennsylvania partners. So how can organizations or healthcare settings utilize COAPS and peer support workers? We truly believe that COAPS are key members of the healthcare workforce that can advocate for older adults experiencing mental illness or SUDs. We believe this because they are trained specifically to work with this population, especially those who are, you know, dealing with loneliness and social isolation. We've seen, like Dr. Creed said, with COVID that these numbers have really gone up, and sometimes just having someone that you can call, that you can talk to or see to help you through some of these difficult times can be really life-changing. We train people to spot, not diagnose, but spot mental health disorders, SUDs, social isolation and loneliness, and give resources and knowledge to connect older adults with these supports and needed services. So part of the training really is just getting exposure to different resources that are available to individuals. So when a peer starts working with someone, they might not be an expert necessarily, but they can say, I know who we can call, I know a resource, or even from their own life, I know something that worked for myself. COPEs work in a lot of different settings. They're very useful in many different ways. We've seen them be very successful in health clinics, hospitals, long-term care centers, senior centers, recovery organizations, and senior housing. Really anywhere that older adults are is a good place for COPEs to be working. We've trained well over 300 people across the United States, primarily in Pennsylvania and Massachusetts, but we've also reached out to New Jersey, New Mexico, Virginia, and we're going to be doing trainings in North Carolina this upcoming year. Next slide. So expanding access to COPEs training and to peer services in general is crucial in this moment because of the needs in the mental health system. After many years of stress, isolation, and loneliness, we know that we need more people who can work with these individuals and who have knowledge and ability to reach into their lives and help. The mental health care staffing crisis means there are fewer available services to access and fewer people to do the work. Peers come to work and come to the job with a lot of knowledge and resources, like I said, that can really be beneficial and save a lot of money in terms of not having to train clinicians or other health care providers to provide some of this help. So they can really hit the ground running. Peers offer a way to scale up available services because they can deliver their services through the lens of someone with shared experience. Engagement really stays high when a peer is involved, not just in older adults, but just in peer services in general. I would be remiss to not mention that pay is so important for peers. When we say that peer services are cost-saving, it's not because they should be paid less. It's because those expensive, high-end, high-utilization rates and services don't have to be used as much when peers are being used, but they should be getting a living wage and they should be getting paid. And so we're excited that there is currently a bill in Congress, the Peers Act, which would make peer services reimbursable through Medicare funds. And this is just one more step towards making sure that people are getting a living wage, that they can stay in the field and do the work that we know that they're good at. I'm hoping that Jim will mention this when he speaks with us in a little bit. Next slide. So we do collect a lot of data after our trainings. Obviously with COVID, our trainings paused for a little while. So this data is from 2019, but I wanted to highlight a few things that people have said in these evaluations. So we know that peer work is not only wonderful for the people who are receiving it, but for the peers themselves. 96.5% of the respondents said that their work was extremely or somewhat important. They are extremely satisfied with their work as peers and that their quality of life was good and improves. There was a study or survey that we did after a group session was led by COAPS. It was a multi-week whole health workshop sort of done in a senior high rise. And afterwards, individuals reported that their quality of life improved and that their health improved just by working with the COAPS. You can see that there's that bi-directional benefit again, the importance of working with peers. You know, they say it's extremely important or somewhat important in their own recovery. So it's beneficial for them as well. Some of the wonderful quotes that we got when asked what area of your recovery has been impacted by working with others, maintaining my own hope and optimism by seeing their progress in helping our callers. I am continually reminded of what I need to do to maintain my own wellness. I have a sense of purpose and meaning. I get to be in a supportive role I'm very good at. It helps me to give back to others in recovery, gives me support as I support others. So just some wonderful quotes there. We can see that it's beneficial for everybody who's involved. Next slide. So if anyone is ever interested in hosting a COAPS training, we are always excited to talk about how to make this happen. COAPS can be used in so many different settings, as I mentioned, and they can benefit a multitude of groups, state peer networks, youth COAPS, local mental health and SUD recovery organizations, hospitals, nursing homes, assisted living facilities, just to name a few. Because of COVID, we did figure out how to do our trainings virtually. So we now offer them virtually or in person. Like I said, it is an 18 hour training. We usually cap our trainings at about 20 people because we found that that's a nice number to keep the group discussions going and there's a lot of interactive parts of our training. If you are ever interested in talking about how to host a training and getting maybe your peer staff trained in the COAPS, you can reach out to myself or Ann Futterer. She's another colleague of ours who helps run the COAPS program. We'd love to talk to you about it more. We did include a lot of resources for you to see just from our slides, which I think you have in your handout. I won't go through this. And now I'm going to pass it over to Jim. Jim is a COAPS facilitator. He's been with us for a number of years. He and I have trained together for I think around eight years at this point. Jim is wonderful. He's one of the best facilitators that we have and a really great advocate for our peers and peer work. So Jim, take it away. Thank you, Hilary. Thank you, Tori and Hilary. I think I can check all of those boxes. I am your resident baby boomer here. I'm 73 years old. So hello, everybody. My name is Jim Klassen and I am an older adult, as you can see, with serious mental illness and with, I was going to say, an unhealthy dose of substance use to go along with it. And so as was just shared with us, what I didn't know along the way, and this goes to that feeling alone kind of thing, is that it turns out I'm one of five older adults with a serious mental illness and one of, what, six million of us older adults with substance use issues. Again, consistent with what was shared, I did know early on that something was not right, that something was going on with me. Early 20s really probably started around the time that I was starting college, which I think is, those of you who do this work probably would agree, that's kind of a common time when issues really start to flare. And I did seek, I mean, I did seek help, I have to say, and I got some, but I still seemed to be on a trajectory that was going to continue. Even though there were good things, there were benchmarks along the way, it seemed like I was destined for depression. My diagnosis is bipolar substance use disorder. I was ashamed, I was confused, and I was not very nice to myself. And that went on for decades, I think is, you know, kind of shared here, right? Something that started early on, but certainly continued to vex me, affected my life, my families, plural, and I was very, very fortunate that somehow, don't ask me how, maintained a career was able to continue to work. And like what, it was interesting, that slide that Hilary just shared, selfishly so grateful for the work that I'm doing now, if for no other reason than how it benefits my recovery and wellness. So it was a long stretch for me, a number of hospitalizations, intensive outpatient, I may hold a record for the number of rehab after works one can go, can experience. Good therapists, psychiatrists, even electroconvulsive therapy at one point, and finally, and I was an older adult by then, started to make some headway. And when we work with, when training with certified peer specialist supervisors, so I had the gall to do that training too, but I always feel a little embarrassed at first and obligated to say, first of all, thank you, because professional help was necessary. However, it wasn't sufficient. And that's where the peer support piece comes in. When I was introduced to that, then I think my recovery really did start to take off. My one liner about my own recovery is that, oh Lordy, I'm a slow learner and a late bloomer, but peer support did help me. And that was about 12 years ago. So with some recovery under my belt, I learned about peer support, became a certified peer specialist here in Pennsylvania, and shortly thereafter, a COPS, a Certified Older Adult Peer Specialist, and then became a COPS trainer. So I know I've benefited others, but selfishly, I have to say doing this work, and I think it's a vocation really. I'll just text back to what Hilary was saying too. Yes, Hilary, that's my experience training CPSs, and over 500 in Pennsylvania I've trained, and we know that a lesser number, but a significant number in COPS. Those that do this and do it well see it more as a vocation than a job, and has incredible benefits both for the folks we serve and us as well. Risks and needs, one of the learning objectives we talked about, just to kind of highlight what's already been shared, certainly the stigma, the self-stigma, loneliness. I was so grateful to see that. I thought maybe I was alone in saying, I think loneliness should be a diagnosis. It's incredibly painful. I know for me, it was related to the substance use. I've always said, if anybody thought it was partying, I was not having a party, it became a job, and really, it was maladaptive. It wasn't the right way to go about it, but I was trying to treat that loneliness. A lack of connection, I think the word connection comes up for me in peer support over and over again. It's not always our biological family, maybe more a logical family, a network of support that we develop where we can share these secret lives, the concerns that we have, the behaviors that we're not sure about, that aren't easy to share at any age. This has been especially important to me as I learn more, so even today, I continue to learn from the ongoing research and data that the University of Penn collects, and practical ways to deal with challenges and change, change in others and myself, so some of the practical things that we train about, like motivational interviewing, which I'm sure you're all familiar with, knowledge, developing a knowledge base, and practice. In our trainings, we do a lot of pair work and group work, so we practice. And maybe, well, I don't know if I want to say best of all, but certainly a great outcome is developing, continuing to develop and increase the network of those who are doing similar work and have had similar challenges. So yeah, so I trained, for the last, I've worked in the mental health field now for over 10 years. Before that, I worked in, well, I guess you know from my bio, in employment and training, always with disadvantaged folks, so to speak, hate those labels, but I guess that's what it was, but not mental health, specifically. My mental health adventures and misadventures were part of my secret lives, but over the past 10 years, I've worked with 500 would be a minimum number of persons of all ages have been in our classes as CPSs, and then a number of them go on to become COPS, a Certified Older Adult Peer Specialists. And out of a class of 20, which is a usual class size, there's always one, two, or three people that when we talk about older adults are specifically interested in pursuing COPS training. So I'm hoping that we can really start to do more and more of it now as, I don't know how to describe the pandemic, but I guess we're certainly not post-pandemic, but as things start to open up that we can do more and more classes for the folks who want to learn this and want to work with older adults. I know from a recent conference I was at with area agencies on aging, the providers are waiting for us as well. So there's definitely a need to build a workforce, to support a workforce, and to increasingly work with the increasing number of older adults like myself that are coming into senior centers and nursing homes and home, wherever it is that we might be. I think Tori reminded me, I should mention that last May, Older Adult Mental Health Awareness Month, or May 20th, I think it's Older Adult Mental Health Awareness Day. I was asked, Hillary was there. We went to Washington and spoke before the special committee on older adults and mental health. So that was, like today, was a real honor for me. I wanna thank you for allowing me to be part of this event today. And with that, I'm hoping that there'll be a dialogue, that there's some questions that we can try to take on. Thanks, Jim. We have one more slide, Alexia, I'll go over quickly. Thank you everyone for being here today. It's been really exciting for us to speak with you all. If you do wanna reach out to us, we have different ways you can get in touch with us. You can visit our website, which is www.olderadultpeerspecialists.org. On that site, you can join our mailing list and receive a monthly newsletter that has topics relating to older adults and aging and substance use and mental health. You can email us directly through the website as well to get more information. Like I said, if you wanted to host a training or join a training. We also have a lot of resources, applications, and additional information on that site. Please visit our website and let us know. Thank you for such an interesting presentation. And before we shift into the Q&A, I wanna take a moment and let you know that SMI Advisor is accessible from your mobile device. Use the SMI Advisor app to access resources, education, and upcoming events, complete mental health reading scales, and even submit questions directly to our team of SMI experts. Download the app now at smiadvisor.org backslash app. I know we've had a lot of questions coming into the chat. And as the participants continue to add questions, one thing that really struck me in your presentation is that you work with such a broad range of partners. And I can imagine some of them were new to peer support when you started. Could you talk a little about how you integrated peer support into this variety of settings with such success? Sure, I'm happy to talk about that quickly. I think having such robust data to support peer work has been really important for us, especially coming from an academic institution. And truly, once people hear about and learn just a little bit about peer support and see that the data really does support it as being beneficial and that it works, it doesn't take a lot to get people on board, honestly. There's really not very many downsides to incorporating peers into the healthcare setting. And so it's been pretty easy. Once people are open to the conversation, I don't think it's a hard lift to get them on board long-term. If I could weigh in, I think historically peer support, not just COAPS, but peer support, right, going back in Pennsylvania to around 2006. Yes, it was training folks who were interested in being peer specialists, but it was also preparing the environment, talking to the provider community about what peer support was. Yes, Hilary, a lot of folks wanna know, what's the data, what do we know? Anecdotally, I can say that nothing succeeds like success. So when early on we were able to make good placements of people and providers where they can demonstrate their worth, then they get more and more bought in. Thank you for that. And the data that you shared on the job satisfaction among peers, 95%, is quite striking. And I'm sure that's something that a lot of people in our audience would wanna emulate given the well-documented workforce challenges right now in behavioral health. Could you tell us how you achieved that and do a bit of a deeper dive into the elements that people found most rewarding and that are driving that incredible satisfaction level? So on that survey specifically, we don't dive into the details of what is satisfactory for them, but just in conversations and anecdotally, and maybe Jim, you can talk a little bit about this. I think the main aspects that come out are the finding support and supporting others, if that's really beneficial for everyone. And now that peers are seen more as professionals in the workplace, I think that was a big hurdle to get over early on in your movement. I think just having a professional aspect to their recovery is really wonderful. Yeah, I don't know if you have more to say about that, Jim, but... I think giving meaning to a really difficult thing in life has been a really great part of peer work, for sure. I know I've heard that a lot from people that being able to turn something that's a really hard time and a really dark time in life or something that's been very difficult to work through, to be able to give that meaning and to help others through that is something so satisfactory. Yeah, I do hear that a lot from people. Excellent, thank you. And could you describe the ideal candidate to become an older adult peer? What is it, the ideal candidate to be? Yes. Wow, I love it. So I was an older adult. All right, I said I was a late bloomer, right? So primarily we're looking for older adults that can relate to other older adults or who have some recovery under their belt, some wellness under their belt, demonstrate an ability to connect with others, to engage with others in a way that's nonjudgmental, really meeting people where they're at and an ability and a willingness, a vulnerability to share their story, their experience, not with telling people what to do. We're not about fixing or curing people or telling them what to do, but really being with another in a difficult time and just joining them in their journey, learning together, a lot of mutuality. So I think that's a lot of people. I will say, though I do want to add, sometimes we find, it's interesting, some older adults don't want to work with older adults, they want to work with younger people. So that's okay, that's their niche. And sometimes there's young people that just love older adults. Maybe it's because they're experienced with their grandparents or whatever, and they can be good too. So I would not want to discriminate. That's a wonderful point. And a related question is, what is the age range for older adult peer support? So what would the starting point be to be considered eligible to become an older adult peer? So we loosely say 55 and older, but like Jim said, if someone's really dedicated their life to working with older adults and they are 30 years old, we wouldn't turn them down. The other main thing, though, is that they have to be certified as a peer specialist or a recovery specialist before they can do the COAPS training. So we really expect that everyone who comes into this training has that baseline knowledge and baseline certificate because they go through so much information to become a peer specialist, and we don't have the time to overview any of that stuff. So everyone has to be certified before they can become a COAPS. And if I can, I'd love to go back and connect two pieces for a second around the piece that you were highlighting about the satisfaction that comes from this work and who an ideal candidate might be. I think that those two things are connected. I think that there are many people, but not everyone who finds deep meaning in doing this work. And so I think another key, and there's some self-selection then in who is really successful in being a COAPS and decides to pursue this training. So I think people who are driven by having an increased sense of connection and an increased sense of service and opportunities, as Hilary was saying, to make meaning of the experiences that they've had, I think that makes someone an ideal COAPS, and I think that that feeds directly into those high rates of satisfaction for people who decide to pursue this training. Those are wonderful points. There were a couple of comments that came in with the questions about the data you shared at the beginning of the presentation on the prevalence of serious mental illness, substance use, loneliness among this population. And a related question came in, do you feel based on the data that older adults with substance use disorders are likely to also have co-occurring mental health concerns? Oh, go ahead, Jim. I don't have data. I can only speak from my lived experience is that those two things were so connected and really needed to be dealt with. I needed to be dealt with as one human being, one organism. And you can imagine, as someone who was born in 1949, my early experiences with treatment were to try to knock one thing down at a time. So I would think, and I seek to speak to it probably from the data, that certainly that was my experience, is that this was all interconnected. I think that absolutely, that your experience aligns with what the data say as well. And there's also this complicated piece in many of our systems that are serving people, depending on which system you're looking at, people sometimes get rooted into substance abuse treatment or they get rooted into mental health treatment in ways that don't honor what Jim was just saying, that in fact, this is a whole person with one set of experiences and strengths and challenges. And so sometimes the prevalence rates can be a little bit different and can be a little bit biased one way or another, depending on which systems someone originally entered through. And whatever someone has experienced gets labeled in one bucket or another. But I strongly suspect that the reality that Jim was just describing is also the reality that many people experience is that these are very much connected pieces. But yeah, the rooting piece of that, I think influences what the data looks like. Those are great points. Thank you for that. And there are a number of questions that came in related to Medicare. So I'll fold those together. Are the peer support services billable under Medicare? And there's also interest in the audience in learning more about House Bill 2627, if that's been passed and if not, if you have any sense of what the issues might be. So I am not an expert in Medicare, but I know that there are like some loopholes that people can get peer services reimbursed. I don't know what those loopholes are. I'd be happy to try and figure it out and I could send that information out after the webinar. I have not heard that the bill has been passed. I don't know if you've heard, Jim. I think it's just been passed I have not heard that the bill has been passed. I don't know if you've heard, Jim. I think it's just a slow moving ship. And a lot of times these things go very slowly. And so we're hoping that in this next year, this new administration seems to be a little bit more interested in moving these things along quicker than they were in the last administration. So we're hoping to see it, but it has been something that's been on the table for quite a number of years. I'd say at least since I started working with peers, you know, eight or nine years ago, I know that the discussion was happening then as well. So I think it's just slow going. Correct me if I'm wrong, Tori or Jim. I think that's absolutely right. And that really was what the May event in Washington, that was sort of the underlying thing there is that anybody that, you know, can advocate for the Medicare Peer Support Connection should be doing so. I think literally advocacy is the word that was in my head for each of your responses. The peer support broadly is such a valuable service tool component of health and wellness, as we've said, with a bidirectional influence and particularly so for older adults. And it is so undervalued financially in our mental health system. I mean, here we are, we have the three of us dedicated large components of our careers to this work. And even we are a little bit at a loss as we talk about how do we get people well compensated for this incredibly important work? So I think like to the extent that folks who are here in the virtual room with us today can find ways to advocate for the importance of this work and valuing the importance of this work in ways that gets it reimbursed and respects this work. I think that that is an incredibly important direction for us to move in. And I see there's a lot of interest in the questions on how people could implement this locally in their community, what the cost might be. Could you touch on that please? So I think first, the first step is just getting people trained, recognizing groups that would benefit in having older adult peer specialists and then getting them trained. It's such a niche training. There's no one else that's doing it. So you would have to come to us. But yeah, getting your workforce built up, truly getting them involved in the work is not the hard part. It's getting people trained and ready to work. But once they're trained, I mean, it's pretty easy to incorporate them into most settings. They're passionate about the work. They are willing to do the work. It's a really fabulous group of workers. And I will also just add to that. Sorry, for folks who are interested, reach out to us. We do this both in person and virtually. And so there are, in terms of the specifics around costs, we have different models of delivering this. We also do a train-the-trainer component to our COAPS training. And so we are happy to connect with anybody through the contact information we've shared to talk about specifics of how to put this in place in other systems. Excellent. And as we start to wrap, I see notes of appreciation for you in particular, Jim, in the question box for representing the peer support field and for sharing your story. So thank you for that. And thank you again for such a wonderful presentation. I will move into some of our housekeeping as we're at the top of the hour. If you have, 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 Webinar Roundtable Topics 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 is just one of many SAMHSA initiatives that are designed to help clinicians implement evidence-based care. We'd encourage you to explore the resources available on the Mental Health Addiction and Prevention TTCs, as well as the National Center of Excellence for Eating Disorders and the Suicide Prevention Resource Center. These initiatives cover a broad range of topics from school-based mental health through the opioid epidemic. And to claim credit for participating in today's webinar, you'll need to have met the requisite attendance threshold for your profession. Verification of attendance may take up to five minutes. You'll then be able to select Next to advance and complete the program evaluation before claiming your credit. Please join us next week on December 15th as Judge Charles Auslander, Laura McCoy, and Tony Sanchez present How Treatment Court Professionals Can Effectively Build Relationships and Interact with Behavioral Health and Court Treatment Teams to Better Serve Justice-Involved Clients. Again, this free webinar will be on December 15th from 3 to 4 p.m. That's a Thursday. Thank you all so much for joining us. And until next time, take care.

certified older adult peer specialists

advocating for recovery

older adults with serious mental illness

Certified Older Adult Peer Specialist Program

training peer specialists

peer support

improving quality of life

peer support services

billable under Medicare

unique needs of older adults