Good afternoon, everyone. I'm Dr. Terri Brister, Chief Program Officer at the National Alliance on Mental Illness, which is known as NAMI. I'm also a member of the SMI Advisor Clinical Expert Team. I'm pleased that you're joining us for today's SMI Advisor webinar, Implementation of Peer Support Specialist within a Mental Health Center. Next slide, please. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative that's 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 AMA PRA Category 1 credit for physicians, one continuing education credit for psychologists, and one continuing education credit for social workers. Credit for participating in today's webinar will be available until August 2nd of this year. Next slide. Slides from the presentation today are available in the handouts area found in the lower portion of your control panel. If you select that link, you will be able to download a PDF of the slides that are shared today. Next slide. Please feel free to submit your questions throughout the presentation by typing them into the Q&A area found in the lower portion of your control panel. We're going to reserve 10 to 15 minutes at the end of the presentation to go through your Q&A. We very much want to hear your questions. And I think you're going to find in this presentation that there's a lot of information that you'll probably want to know more about. Next slide. With that, I'd like to introduce you to today's speaker. And before I actually read her bio and her official introduction, I'm from Mississippi and had the great pleasure to meet Melody when I visited her mental health center in Oxford, Mississippi several months ago. And I got to observe firsthand what I have probably seen as the best example of thorough implementation of peer support throughout a mental health center. And as someone who worked for many years in the community mental health space, it was a pleasure to see. And I was thrilled, to say the least, when we were able to book Melody for this presentation today. And I look forward to all of you hearing from her about what it looks like and how they've made it work. So Melody Medeiros is an LCPC. She has over a decade of experience in co-occurring treatment, substance abuse prevention, and mental health advocacy. She's a licensed clinical professional counselor, a certified rehabilitation counselor, and also an EMDR and ART-trained clinician. She's currently pursuing a PhD from Enbridge University with a research focus on burnout and job satisfaction of peer support specialists in mental health treatment teams. So with that, I want to thank you for joining us today. And Melody, I'd like to hand it over to you. Thank you so much, Terri. I appreciate that. And welcome, everyone. This is one of the first, well, this is the first SMI training I've ever done. So I hope you guys do learn some stuff. And like she said, we really do appreciate questions. I'm used to training face-to-face. And so most of my training skills have to do with conversations. So this is a little outside my comfort zone. So please ask questions. And we will watch them as they come to make sure that we have plenty of time to answer all that we can. There are no, for disclosures, there's no relationships or conflicts of interest related to the subject matter of this presentation. And our learning objectives will be to identify the unique challenges associated with hiring peer support specialists, justify the successful integration of peer support specialists within a mental health team, and develop strategies to integrate the use of peer support specialists within a mental health team. So to start the conversation about peer support, I think it's really important for us to talk about the peer support history. A lot of people believe that peer support is this new idea and it's this new thing that's being pushed by SAMHSA to integrate peers throughout mental health treatment. But in fact, it has been here for a long time. Peer support has been widely used since the 18th century. And there they saw patients that were already institutionalized, asked to work directly with other individuals that were institutionalized within the same institution. They paired people that were more stable with individuals that were showing more severe symptoms. And so that went on, you know, since the 18th century and, you know, kind of has morphed into what we consider peer support today. The beginnings of community-based peer support is most notably associated with the beginnings of AA, of Alcoholics Anonymous. That was established in the 1930s. And part of the 12-step process, if you're not very familiar with it, is to act as a peer to others. The 12th step is basically to take what you've learned and give it back to other people that haven't come as far as you. So the whole basis of the AA program and of a 12-step program is to act as a peer. In the 1970s, along with many other civil rights movements, the mental health treatment became a focus of contention. Individuals with mental illness wanted the laws changed about compulsory treatment. And although we still have compulsory treatment laws, they have definitely come a long way. These individuals that were wanting laws changed pushed for a change in the hierarchical dynamic. And at the time, it was the psychiatrist who was the head of the treatment team. Everything was based on the psychiatrist's knowledge, beliefs, you know, objective opinions of symptomology, and the individual really had no say in their treatment. They went in and did what the psychiatrist told them to do. And if they didn't, then they were often put into institutions and forced into treatment. Sharing need is the brain of intentional peer support. And it is a fabulous way to do peer support. And it is something that we as an agency have been looking into having training brought in. But sharing need states that peer support is about social change. And I couldn't agree with that statement anymore. So through this social change that started in the 70s, we've kind of created this treatment model that ensures peers are an integral part of the treatment team, as well as the individual seeking treatment. And we call it the recovery-oriented system of care. And a recovery-oriented system of care promotes empowerment, hope, and healing, supporting that you can recover from a mental health disorder. And the peer support specialists are that poster child, if you will, that there is hope. There is an ability to have a mental health disorder and find recovery and, you know, still chase your dreams. So peer support is definitely a key tenet of the recovery-oriented systems of care. You can't have a true recovery-oriented system of care without peer support specialists. SAMHSA's peer support definition, which has changed often, the last one of 2017, it says that peer support encompasses a range of activities and interactions between people who share similar experiences of being diagnosed with mental health conditions, substance use disorders, or both. This mutuality, often called peerness, between a peer support worker and a person in or seeking recovery promotes connection and inspires hope. Peer support offers a level of acceptance, understanding, and validation not found in many other professional relationships. And this, like I said, this definition has changed, and every time it changes, it tries to ensure that the individual has hope, that the individual is empowered, and the individual has a say in their treatment, and through peer support, they're able to find that. So why is it so important, and why are you here today? So peer support is linked to reduced hospitalization rates, and recovery innovation in Arizona saw a 56% reduction in readmission rates after implementing peer support. And a study out of Yale New Haven Psychiatric Hospital showed double the time in outpatient treatment and engagement for individuals that had discharged. So that is a key, you know, point of peer support. Doubling the engagement in outpatient treatment is wonderful. We know that if somebody engages and stays in outpatient treatment, their chance of rehospitalization is going to diminish. So the more that we use the outpatient treatment programs that are available, the more the individual gets to remain in society, in their home, where they're comfortable, and they are capable of learning new skills to ensure that they integrate wherever they want to, whether that's going back to school, getting a job, doing some type of psychosocial rehab, whatever that may be, if they are engaged in outpatient treatment, that definitely helps. Peer support is also linked to reduced days in inpatient treatment. The Tennessee PeerLink program saw a decrease of 90% in the average number of acute inpatient days. I see more and more acute care facilities implementing peer support specialists in their treatment, and I've seen it really change the way individuals react and engage into acute care treatment. This is something that we are about to take over, a crisis stabilization unit, who has never had peer support associated with it, and our goal for the first year is to have a peer support specialist from 7 a.m. until 11 p.m., 7 days a week, so we can ensure that individuals engage in treatment, and we do believe we'll have the same type of results that the Tennessee PeerLink program did, with a reduction in how long the individual actually has to stay for acute care. Peer support is also linked to reduction of overall cost of services. The Pierce County, Washington reported a reduction in involuntary commitments after implementing peer support services, leading to an average savings of about $1.9 million in one year, and that is a lot of money. If we had $1.9 million that we could put back into intensive outpatient programs and other peer support programs, we really could continue to reduce the rates of people going into the hospital. There would be more access to treatment, especially in rural areas, and I can definitely talk about rural areas because that's where I am, and access to care is very difficult. Peer support is also linked to increased uses of outpatient services. Like we said earlier, increased use of outpatient services reduce rehospitalization rates. 90% of individuals enrolled in a crisis respite program in Orange County, New York, did not return to the hospital in the following two years due to the engagement in outpatient services, and two years is a long time for someone with a serious mental illness to stay out of the hospital. It shows amazing engagement within outpatient treatment and the ability to intervene prior to a serious mental illness becoming uncontrollable to a point where acute care treatment is necessary. Peer support is also linked to the increased quality of life outcomes. Veterans and peer support programs have significantly higher senses of empowerment and confidence, and this just quality of life. I mean, that's what life is about. It's about quality of life, and increased peer support definitely is connected to that increased quality of life. Peer support is also linked to increased engagement rates. A Mental Health America and Kaiser Permanente peer support pilot study showed participants that received peer support services reported an increased trust of the services and increased trust in team collaboration. So, you know, those of you that are therapists or psychiatrists, I'm sure that you've had the moment where a client looks at you and says, you don't know what it feels like. You have no idea what I'm going through. You've never been in this situation, so how can you help me? And, you know, partly, how wrong are they? You don't, you can empathize with them, but you truly don't know how they feel. A peer can, you know, tap into the level of empathy to really understand, you know, partially how that individual feels. They have been there. They have gone through that process. And the peer being able to connect to that individual and show trust in the treatment team just immediately increases that individual's trust with the rest of the professionals on the treatment team. When that increase in trust happens, then you start seeing the reduction in acute care days. You see the reduction in the rehospitalization rates because they're engaged with the rest of the treatment team. They're engaged with those therapists that are helping them with trauma-focused treatment to process some of the trauma they've been too scared to process in the past. They're engaged and trusting in the psychiatrist that is giving them medication to help them. And they've got the peer that is encouraging them to take their medication and trust the process and believe in the professionals that are trying to help them. And peer support is just linked to increase of whole health outcomes. Individuals receiving peer support services show a decrease in substance use. And we know that substance use is directly related to multiple physical health problems. So it is important to also know that although we do have research that shows this, although we do know that peer support is important and it's linked to positive outcomes, there truly is very little peer support research when you look at the breadth of research for all other types of mental health treatment interventions. So one thing that is important to me is the fact that there's virtually no research on how being a peer affects the peer. And that is challenging as an employer because I don't know how being a peer support specialist is truly affecting my peers' own mental health issues. And so that is something that we definitely need to continue to look in and research. So some of the challenges that we have seen associated with hiring peer support specialists and challenges that other people have seen because it's in the research is that people believe that the peer support is a newer role within a mental health treatment team. And although peer support has been here since the 18th century, it's not a newer model. It's really not a newer role. But what it is, is it's a newer recognized professional designation within a mental health treatment team. And still today, many people don't recognize peer support as being a professional within the mental health treatment team. Historically, treatment teams consisted of a psychiatrist, a therapist, a social worker, and possibly a case manager. And so the peer role in making it a professional really wasn't promoted until about 2007 when Medicaid started paying for peer support services. Another serious challenge is that there is no formal education needed to be a peer. And there is a lack of standardized training for peer support specialists, meaning often peers are completely thrown into this peer support role with no knowledge of how to do their job, no knowledge of the real expectations of their job, and unfortunately often their supervisors too lack the knowledge of what that role should look like and what the expectations of that role actually is. Other challenges that we've seen and of course has been seen through research is other treatment team members lack that understanding of the role, which means peers are often asked to do menial jobs that the therapist or other members of the treatment team just don't want to do. So it comes down to, hey, can you go scan the rest of this medical record into the electronic medical record system for our agency? And it often makes peers feel disrespected and isolated because instead of performing peer duties, and peer duties should be connection with clients, often they end up performing administrative duties or errand duties, and that is very disrespectful, and I can see where it also makes peers feel isolated. And there is a serious lack of pay that is provided to peers for their service. And peers are usually the lowest paid staff member on a treatment team. Often individuals that would be wonderful peer support specialists don't ever apply for the role because they can make money in different industries. So, you know, we do miss a large portion of individuals that could really help individuals benefit from treatment because they never have the opportunity to be a peer because of the pay. When I first started with Communicare, there were two full-time peers and they weren't treated as active members of the treatment team. They often, you could see as an outsider looking in that they felt less than the people they were working with. They were treated much more in lines of the client instead of a member of the team. And they didn't stay with the organization. It was years before we were able to make progress with our peer support program. And unfortunately, it took someone retiring to truly make a difference in our peer support program. And so with the retirement of that individual, I was actually able to take over the program and let it go in the direction I thought it needed to go in and in the direction that I kept reading this research showing how it should go and what great outcomes we would have if we were able to implement it that way. Recruitment of peers is absolutely a challenge. You need to make sure that they're stable enough to handle the pressure of the job. And how do you do that without committing some serious federal violations when you're interviewing somebody? We can't go into an interview for a job and say, so can you tell me what your mental illness is? And can you tell me what medications you're on? And do you take your medications as prescribed or do you just take them when you want to? You can't say, hey, when was the last time that you had a psychotic break? Or when was the last time that you were admitted into an acute care facility? All these things are off the, you can't ask them. You can't find this stuff out. Technically speaking, you shouldn't be even asking people that may know them. So recruiting peers definitely remains a challenge. At Communicare, we often use current clients that are in treatment or have been in treatment as peer support specialists. We often reach out to these individuals and say, hey, you're doing amazing. Have you ever thought about being a peer support specialist? Sometimes their therapist will get permission to refer them to the hiring director or the hiring manager and say, this person would be an amazing peer. And actually, I think probably 98% of the peers that we have employed were clients or are clients. The Mississippi Department of Mental Health offers a peer support certification training, and anyone can pretty much sign up for this through the Department of Mental Health website. You can't technically in the state of Mississippi be certified as a peer support specialist unless you're employed as a peer support specialist, but you can definitely go through the training. And so when they have the training, we have a very close relationship with the Department of Mental Health, and they share a list of all the individuals trained along with their contact information. And often we can go through that list and see who lives close and call and say, hey, are you looking for a peer support job? Because we may have one. We found that the successful integration of peers and implementing this program has to absolutely be a top-down approach. Without this top-down approach, you are going to have that isolation of peers and you're going to have peers doing just very meaningless jobs that no one else wants to do. So the leaders within the organization must understand peer support. They must ensure that the supervisors under them have a clear understanding of peer support. They must understand what the role entails and what the expectations of that role should be. And they must let everyone in the agency understand that as well. Without this, the peers are going to always feel disconnected and they're going to not ever feel as part of a treatment team. They should absolutely be an active member of the treatment team, meaning that they should go to clinical staffing. And not only should they go and sit in a clinical staffing, if they aren't speaking, somebody, a supervisor or the therapist should say, what do you think? How has your interactions with this individual been lately? Where do you think they are in terms of treatment? And ask them for their feedback. And it's the leadership's responsibility to provide the training to their supervisors and their other professional staff to ensure that they are being asked for feedback in clinical staffings, that they are being treated as though they are an active member of the treatment team. And training, training is huge. And I talk with my executive director frequently that we offer training. We are an organization that believes training is essential in maintaining employment throughout the agency, whether it's peers or therapists or people in between. But I can tell you that I'm the one that typically does the contracts for training. I'm the one that typically goes out and schedules the training. When I email my peers and I say, hey, we have this training opportunity. This is when it is, this is what's gonna be expected of you. They're responding within 30 minutes. Often I will let our therapists know that, hey, we've got this amazing clinical training. This is when it is, this is how you sign up for it. And when it gets close to this training that we've paid a lot of money for, we're having to call therapists and volunteer them to go to the training. And I say that just so you can see the difference in the enthusiasm in treatment and how this enthusiasm from the peers is contagious. And it's contagious to the client, which is wonderful. We offer very specific trainings devoted just to our peers. Sometimes our peers are out of their office and out of their duties for an entire 40 hour week. And leadership ensures that their direct supervision knows that they're going to be in training. Nothing should be asked of them. No one should make them feel guilty because their notes aren't done. And the supervisor needs to make sure that treatment is provided even without the peer. They're people with lived experience and their job revolves around the fact that they have a mental health disorder. So the organization has gotta be flexible. Flexibility is very, very key. But it must be done in a way that it doesn't look like you're giving peers special privileges. But you definitely need to make sure that your peers are taking mental health days when necessary that your supervisors are keyed in to the behaviors of their peers and that they're reaching out to their peers to say, hey, what about a mental health day? Not in a negative way, but hey, you've worked so hard. You've done so much amazing stuff. Why don't you take a day for yourself? And don't make them take annual leave for that. Let them use some sick time. And the other thing is getting the families involved in peer support services. Families need peers almost as much as the individual receiving treatment does. A peer is stable and a peer can go and connect to that family and give that family hope that their loved one can recover. And peers often find so much job satisfaction in working with families because they remember when their family was hopeless and their family was scared and sad and didn't know what else to do. And it's personally very rewarding for a peer support to work with a family and see that hope come back in that individual. All of our peer support supervisors have completed a peer support training through the Mississippi Department of Mental Health. Actually, it's part of the Department of Mental Health Standards that anyone that supervises a peer go through this training. And the training is great, but I can tell you the training is not something that's going to make your peer support supervisor a great supervisor. It should, they need some, you know, just honest communication from their supervisor. And I always try to give this experience. I had a brand new supervisor and she had a peer support specialist under her. This was the first time she had ever had a peer as a co-worker, much less somebody that they supervised. And she completed her peer support training through the Department of Mental Health. And she thought that she was good to go. She called me one day and she was very upset because the peer had come into the office, very distraught, had been crying, didn't have lots of makeup on, didn't look like herself, but confided in the supervisor about just mass chaos that was going on in her family, including, you know, CPS being called to intervene because of some allegations of drug use. She was a participant in a drug court program. So we knew she wasn't using drugs, drug court, you know, drug screened her consistently. And so the peers or the supervisor's response to that was to call me and say that she needed guidance, how to have a conversation with this individual to talk about the fact that those types of conversation were not appropriate in a workplace and that her supervisor was not somebody that she needed to confide in and give that much personal information to. And that right there is the key to where the integration of peer support specialists start to splinter. Because so many professionals feel that at this position or in this role, I need to have this hard shell and not open up to my coworkers or to the people that work for me. And the fact of the matter is that is absolutely the supervisor's role is to be there to listen when chaos happens. It's to be there and not act as their therapist, but act as somebody who truly cares about them and help them find therapy if they've stopped going to therapy. Remind them of their treatment. Hey, have you done this or have you done that? But cutting that off and explaining to a peer that this is not appropriate, it's gonna stop that peer's ability to trust. And if they don't trust, then they can't help the people we are serving trust. So beyond this training and beyond working with peers, a supervisor has got to connect with the peers. They have to have an open door policy. They've gotta be observant and notice behavioral changes. They must be authentic. It can't be something that is created and is made up. And they've gotta be able to provide both professional resources and personal resources when someone is struggling. So you've gotta be real with your peers. I have actually, you know, we had a peer one time that an old drug charge caught up to them. They didn't even realize that this charge was still pending three states away. And I rode in the police car with the individual to the police station and kind of just hung out with her while she was booked into jail. She was mortified. She was scared. She had been in recovery for a long time. And that is how you make peers trust you is you're there for them when they need you. And that's what we do. All of our supervisors, it's not just me, all of our peer support supervisors, we're there for our peers when they need us. Depending on the level of care, the treatment team meetings or staffings need to be held within the office with all the treatment team members. And I can't preface that enough that the peer support specialist is a professional role within the treatment team and they should be heard. They should be invited. They should be encouraged to discuss their viewpoints. And when their viewpoints differ from those that are the historical professionals, so the psychiatrist, the social workers, the therapist, they should be asked to elaborate. They shouldn't just be discounted because this peer has a different viewpoint. They should be encouraged to tell us their different viewpoints because they may be coming from a place that none of us have thought about and it may completely change the course of treatment for this individual. Peers are used to help bridge that gap between services and help build rapport. And with resistant clients, this couldn't work better. We have so many positive outcomes when we have resistant clients. When we honestly just send our peers in first, we look at the quality of life, we look at risks. And if the risk is not very high that they are gonna harm themselves or others, then lessen the period. They don't trust us. They don't believe we're gonna be able to help. So the peer can create that relationship and help them start becoming engaged. And they need to be valued. They need to feel their value. They need to be told how valued they are. Everybody, whether you're a peer or you own a company, everybody wants to feel valued. That's just human nature. And when, as supervisors, when we make sure our peers are told they're valued and they are shown that they're valued, then their loyalty remains with you and the organization, even though, again, they're the lowest paid member on the treatment team. So speaking of money, how do you pay for them? Although they're the lowest paid member of the treatment team, it still costs money to have peer support specialists. In 2007, Medicaid began paying for peer support services across the board. And they use the CPT code H0038. In Mississippi, the reimbursement rate is $7.83 per 15-minute unit, with a max of six units billed per day and a max of 200 units billed a year. On the surface, it sounds like a lot, but it's really not enough and it's not a whole lot of peer support services. And those individuals that don't have Medicaid, you can hang it up. Most commercial insurances don't pay for it at all. Other states have modifiers you can add to the CPT code based on credentialing and based on where you're located and it will increase the billing rate. Many other states have the H0038 at a reimbursement rate much higher than Mississippi. But again, Mississippi is the poorest state in the country and access to mental health care is one of the lowest. So it's not surprising that we are one of the lower reimbursement rates for peer support specialists. Some commercial insurances have read the fact that, hey, peer support will save us money in the long run because if they are engaged in outpatient treatment, they won't have to go to acute care hospitalization. And that means that I don't have to pay for this really expensive hospitalization if I pay for peer support specialty. So Cigna, or I'm sorry, Aetna has began to cover peer support services. And we believe that across the country, more and more commercial insurance companies are gonna start this process. Some commercial insurance companies will allow health and wellbeing coaching, which is CPT code 0591T and 0592T. But health and wellbeing coaching doesn't always have to be provided by a peer. And it does require different certifications. So the reimbursement rates for the CPT codes are higher, but Medicaid doesn't reimburse for the CPT codes. So paying for peer support specialists is one of the bigger challenges that we see. Peer support certification is necessary in our organization, is necessary within the state of Mississippi, but it's not necessary across the country. So in order to bill Medicaid in the state of Mississippi, you have to have a certification as a peer support specialist. That certification is done through our Department of Mental Health. But this training, although wonderful, doesn't teach them how to do their job. It doesn't teach them what their expectations should be. It also doesn't teach them basic information about other mental health disorders. A peer may be the specialist in the mental health disorder that they face, but that doesn't mean that they understand all the other mental health disorders out there. And peers aren't always connected to the individuals with just their diagnosis. As a peer support specialist, you really need to be able to connect and provide services to individuals no matter what their mental health diagnosis is. It's more peer support specialty is more about the connection and empathy that you can have based on the fact that I too deal with a mental health disorder. It doesn't matter which disorder it is. It's not about the connections of symptoms. It's about the connection of empathy, of being in the same kind of dark hole that the individual seeking treatment may be. But in order to make sure that our peers do have some understanding about other mental health disorders and about suicide, we have all of our peers go through mental health first aid. We also have all of our peers go through QPR, question, persuade, and refer as a suicide intervention training. Because the first time somebody says, hey, I'm suicidal, peers do not know what to do. This gives them some confidence in knowing what to do and knowing how to reach out to the treatment team and making it a very warm handoff to a higher level of the treatment team. We have also offered forensic peer support certification training. Most of our peers are certified forensic peer support specialists. A lot of the individuals we work with in a community mental health center are involved in a criminal justice system. So this forensic peer support training helped our peers understand more about the legal process and the criminal justice process that many individuals face. We have offered recovery coach training through the CCAR and other trainings offered through CCAR as well as wellness action recovery planning training for our peers. And so prior to doing these slides, I sent an email to our peer support specialist and I said, hey, if you could tell somebody, if I could bring you to this training and you could tell individuals what it's like to work for Communicare and why you're a peer support specialist and why you choose to be a peer for us, what would you tell them? And I promised them I wouldn't associate their names because many of them are very shy and they don't really want to stand up in front of a lot of people and talk. But these are some of the things that they said. I took a job at Communicare because I wanted to give back to the people that saved my life. Although as an agency, we remind every person that comes through our doors that we don't really save any lives. All we do is provide some guidance and we provide a road and try to clear it off for them to save their own lives. But, you know, this individual truly believes that without us, that they wouldn't have been able to come to the place that they are. Another peer said Communicare supports my personal and professional journey to become a licensed clinical social worker. Many of our peers, he is not the first one, nor will he be the last one, but many of our peers start out as a peer support specialist and they're like, hey, this is wonderful work. I love this. How can I continue to grow and do more work? And many of them seek education. As Communicare, we try our best to help them pay for education. We are a member of the HRSA program, so we have, you know, the loan repayment program for our staff members if they sign the contract with HRSA. And although as an administrator, that process is not the easiest process and it does require a lot of time to provide documentation and to go into their website. It is absolutely worth every millisecond we spend making sure we stay in good with HRSA because it has encouraged so many of our staff members to go back to school and then serve in higher levels of the treatment team. Other peers said, I appreciate that I'm viewed as part of the team and not just a person with mental illness. And this, I think this statement alone shows how we have been successful in integrating peer support specialists. Another one said, I know that my supervisors will always be there for me and will never judge me. They will always help me. And you find this when you talk to other peers outside of our organization. They're often scared to go to their supervisor and say, hey, I'm struggling. This has happened and it set me back a little bit and I'm having these symptoms because they're so scared they're going to be judged. They're going to, their supervisor is going to believe that they're not capable of doing that job. We have made it very clear to our peers that we are not going to judge them. If you come to me today, if you call me at 3 a.m. and you tell me, hey, I'm struggling, I'm going to be there for you and I'm going to help you. And it's not going to have, it's not going to change your job. We have actually had to intervene on one of our peers who was suicidal. And we have great relationship with our law enforcement. I couldn't begin to tell you what an amazing relationship that we have with them. But he disappeared from work one day and about two hours after he left, we got a phone call from a client that said, hey, my peer isn't here. They always come and pick me up for my med clinic appointment and they never showed up. And we immediately knew something was wrong. So we started trying to find them. Phone was turned off. The family didn't know where they were. They weren't at home. And so with great relationships with law enforcement and the criminal justice system, we had some strings pulled and we got his phone pinged real quickly. We found him probably about a hundred miles away. He wouldn't answer his phone. And so with different law enforcement agencies working together, his supervisors, we got in a car headed that way and the law enforcement agencies in that area found him in a motel. When they found him, he had already completed a suicide note. He had a gun and one bullet and he had drank that evening. So there was an empty pint of alcohol in that hotel room. And I truly believe if our supervisors didn't notice the fact that, hey, he's gone, this isn't normal for him. We didn't have these great relationships within our community and we didn't care that he wouldn't be with us today. And we didn't judge. We helped him get into treatment. He got into treatment. Nobody asked questions when he was released. We had a quick meeting with him. How are you feeling? Do you, what do you need from us? And he told us, I need, you know, a reduction in my caseload and I need to do these things. Not a problem. This is where the flexibility comes in. We are going to do whatever we can to support you because you are a valued member of our treatment team. And just because you had a setback in your own mental illness absolutely does not mean you're not amazing at your job and that you can't do this job anymore. It just means you had a setback. And we truly believed that. He knew we believed that. And today he is still one of the best peer support specialists we have ever had. And I don't know what we would do without him. He has helped save people's lives that I think our therapists could have never touched. And he's stable. That's all it took is just some, some true compassion and non-judgment and he's stable again. And he's been stable for a long time now. Another peer said that being able to watch people find recovery is one of the best parts of my jobs. And when you talk to peers, they'll tell you that it reminds me of where I was and how far I've come. And it honestly helps me stay in recovery. It reminds me that, hey, I need to take my medication. I don't want to go back. And watching these people find recovery reminds me how joyful recovery actually is. And a couple of other ones is I continue to work at Community Care because my supervisors understand that our mental health is more than just a diagnosis and that recovery looks different from everyone. And we believe that with our clients too. Mental health is more than just a diagnosis. Mental health is your entire being. And it's finding a way to, to deal with whatever's going on with your life and have a good quality of life. And how can we help you do that from our clients to our, our staff? And the last one is as a peer support, we're able to take the suggestions that therapists give the clients and show them how it works. And this is where, this is why it works so well. This is why you have such amazing positive outcomes is because what this peer just said, they hear the therapist, they go to the treatment team. They know what the therapist is telling this client. And the client may not understand how to implement this, or they may think it's bogus. Like this therapist doesn't know what she's talking about, but the peers able to take that. And because they're an active member of that treatment team, they're able to go to that home and say, Hey, your therapist said we need to be doing this. Let me show you how to do it. Let me talk to you about how this helped me or how I've seen this help other people. And let's do it together so you can learn how to do this on your own. And that right there is, you know, it's how it works. It's why it looks like such a holistic treatment program is because it is. We are trying to reach our clients in every place we possibly can, and we use every tool we have. And our peers are one of our strongest tools, and they are truly one of the strongest assets we have on our treatment team. So my final thought is that when you ensure your peers know and feel they are part of something bigger, you can retain their employment. And the longer your peers are employed with you, the better they get at being a peer. The more they learn themselves through, you know, on-job training. And we all have learned things through, you know, baptism by fire. And unfortunately, sometimes that happens, but they learn. So, you know, if you don't have peers employed with you, I implore you to do that, to reach out. People have my contact information. I'm happy to help anybody try to implement peers within their practice, because I can assure you that the clients you serve are going to benefit greatly from it. So with that said, here is some of the research information. And I have to admit, I took some of this from the literature review that I had for my dissertation. And I want to say thank you so much for listening to me. I hope I did not bore anyone. And if you have any questions, please don't hesitate to ask. Melody, thank you so much. I think everybody on the call probably understands real clearly why I was so impressed when I saw your services in action and why we invited you today. So thank you for being here. Before we do move into Q&A, if you'll click to the next slide, please. I'd like to take a minute just to let you know that SMI Advisor is accessible from your mobile device. And you can use the SMI Advisor app to access resources, education, upcoming events, webinars, such as the one you've just participated in, and also complete mental health rating scales. You can even submit questions directly to our team of SMI experts. So again, encourage you to download the app at smiadvisor.org backslash app. And now if you'll go to the next slide. And we only have about a little over five minutes left. And I would encourage people to enter your questions into the chat, the question box, if you will. And Ben, I'm going to apologize because I'm having a problem reading them for some reason. Let's see. Oh, will the recording be available for download? Absolutely. All of these webinars are recorded and they're posted on the SMI Advisor website. Again, SMI Advisor and that's eradvisor.org. And you'll be able to find this and other recordings of webinars on the same topic with peer support specialist. Melody, one of the things, there are a couple of things that I wanted to ask you about specifically, because what you've just talked about sounds too good to be true for many mental health centers or professionals who aren't there yet, who haven't gotten to the point that community care has. What I'd like to hear from you are suggestions on how to get started. If you're a community mental health center, if you're a social worker, if you're whether you're a psychiatrist, a nurse, a social worker, but you want to either increase the number of peer support specialists you have at your organization or get it started, how do people get started? Can anybody do this? Anybody can absolutely do this. And I would say that the best way to get started is to make sure that your leaders are on board. And if you need somebody super passionate to talk to your leaders, I'm always available, but there's plenty of people throughout the country that is very passionate about peer support. And another suggestion is to find a peer in your area that has been successful. Ask them to come and meet with your leadership and tell your leadership what you do and how it's changed clients' lives. I mean, we can look at statistics all day long, and I am a nerd through and through, and I love statistics, but statistics only give us some numbers, and it only gives us like a snapshot. You need some real stories, real stories that are personal and can paint a picture of what peer support looks like and how it's helped someone can truly be the change that you need within the upper level of management. If you can't get your managers on board, it is going to be a struggle, but I still think you can do it. You know, if you have a line item that you can put a peer in, find a peer support specialist, hire them, train them, and spend a lot of time kind of with them under your wing and help them develop that role to where you want it to be, it is going to be successful. And the more successful your peers are, the more leadership is going to start saying, hey, we're saving money, we see better outcomes, and they're going to want to know why, and it's going to be directly related to that peer, and at that point, you can start bringing them on board to add your peer support specialist. Those are great suggestions, and what I'm hearing you say, just to drill it down, is you need champions. It can be one or two people that work at the mental health center already, ideally then identifying a peer who can, but just champions to help get the program started, and then it proves itself once you get going. Yeah, absolutely. I mean, you know, that's what mental health has been from the beginning. It's been people standing up and saying, hey, we got to do something different, this isn't working right, how do we do this different, how do we do this better, and it's just another step. I heard you, and you touched on this when you were going through some of your slides, but it's something I remember about your center, that you talk as much as you're doing and as integrated as you have peer support specialists in your organization, and they are at every level in the organization. I remember you talking about, or your executive director talking about, when you hire new staff, especially new supervisors, you have to do onboarding with them about your organizational culture, correct? Absolutely. Every person from the receptionist to our human resources director we hired a year ago, to every therapist, they have to be onboarded. We have a two-week orientation process, and the first week of that process, everyone, therapist, peer, CSS, anybody, they're all together. After that, we break the clinical people off a little bit, and they have to leave that orientation with a clear understanding of our cultural beliefs and the culture of our organization, and that culture is that peers are part of the treatment team, and we expect everybody to treat them just like they would another colleague, and at the end of it, I tell people all the time, it doesn't matter all the degrees I have or the certifications I have, I'm a good therapist because I connect to people, and I truly love human beings, and people feel that, and so I remind therapists that, you know, you're just, you're not as good as your degrees, you're as good as the way you treat human beings, and I expect them to treat all the peers just like they would anyone else, no matter what the letters behind their name may be. That's such, such words of wisdom. I've just been in a leadership training, and one of the things that kept being repeated was people don't care how much you know until they know how much you care, and so many of the things that you mentioned in suggestions for supervising peer specialists, I would argue, go for being a good supervisor, period, just being in tune with your employees. I totally agree, and you know, when you start looking at a lot of statistics, you know, a lot of your professionals also could qualify as peers. There's very, there's a lot of therapists and psychiatrists and social workers that also have a mental health diagnosis themselves, and so even if they don't hold that role, being able to connect and be flexible with your staff, it doesn't matter. It makes the job much more tolerable, and people truly love working with you. It makes us more genuine, too, right, when we can be ourselves. Yes. Melody, thank you. We are, I need to close us up with business now, but I just appreciate so much you doing the presentation, and encourage those of you on the call, if you have additional questions, go to smiadvisor.org, and you can submit a consult. You can share your questions there, and if it's something that one of us can't answer, we can reach out to Melody and to other experts on this topic. Any mental health clinician can submit a question and receive a response from one of the SMI experts within 24 hours, 24 hours business day. If you do it on a Friday, you probably won't hear from us until Monday, but the consultations are free and confidential. If you'll go to the next slide. 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 also the Suicide Prevention Resource Center. These initiatives cover a broad range of topics from school-based mental health through the opioid epidemic. If you'll go to the next slide. Thank you. 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 can take up to five minutes, and you'll then be able to select Next to advance and complete the program evaluation before claiming your credit. And we hope that you'll join us for future SMI Advisor webinars, and the next one coming up is on June 9th, and it is Nanette Larson who's going to be presenting the Protective and Healing Role of Spirituality and Mental Health Recovery, Utilizing a Spiritual Health Framework to Improve Patient Engagement. Again, this free webinar will be June 9th from 3 to 4 Eastern time. So, thank you again for joining us, and Melody, I can't thank you enough for sharing the information, but mostly for sharing your enthusiasm and passion for this vital component of treatment for people with serious mental illness. Well, I truly appreciate the invitation. I've really enjoyed it, and if anyone on this call, or Terri, if you ever need anything, don't hesitate to call me. Terrific. Thank you so much, and I hope that you all have a wonderful afternoon. Thank you.

Dr. Terri Brister

Chief Program Officer

National Alliance on Mental Illness

NAMI

webinar

peer support specialists

mental health center

SMI Advisor initiative

evidence-based care

Continuing Education credits