Hello and welcome. I'm Amy Cohen, a member of the clinical expert team with SMI Advisor and an associate research professor in UCLA's Department of Psychiatry and Biobehavioral Science. I am pleased that you're joining us for today's webinar, Introducing Peer Support Into Your Organization, Expanding Peer Support in Behavioral Health. 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. Now I'm happy to introduce you to the faculty for today's webinar, Patrick Hendry. Patrick is Vice President of Peer Advocacy Supports and Services for Mental Health America. He provides national advocacy and develops new services and training for peers within the behavioral health system. Patrick has worked as an advocate and initiator of peer-run services for 27 years in a variety of leadership roles, including former director of NCSTAC as a consultant for National Council, the University of South Florida, SAMHSA, NASMHP, among many other agencies. Patrick, as always, thank you for leading today's webinar. Thank you, Amy. And I just want to start off by saying I have no conflicts of interest with this presentation today. So, what we want to talk about is trying to prepare an organization or an agency to introduce peer support when it hasn't been a part of your ongoing services. So why would a clinical behavioral health organization want to integrate peer support? Behavioral health providers, as we know, face a lot of difficulties in treating people with serious mental health disorders. It's difficult to activate people to self-manage and work in partnership with their clinicians. There's workforce shortages that everyone faces, difficulties in connecting people to community resources, lack of positive role models and mentors, and many other issues. So why introduce into your organization? On its most basic level, peer support provides a lot of benefits for people who receive it. The feeling that the individual is directly involved in making important treatment decisions, in other words, that they assume ownership of their own treatment plans and they work in partnership with the people who are providing them with services. Enhanced quality of life is perceived by the person receiving services. There's been a number of surveys done over the last 20 years about how people feel when they do receive ongoing peer support, and almost always people will rate their quality of life higher after they receive peer support than they did before. Peer support people and peer specialists are often role models for recovery because they've successfully moved into recovery on their own and they've learned a lot about navigating the system of behavioral health. We also see, for instance, in programs where people are being bridged from inpatient stays in a hospital or crisis unit and back into the community, that we see a dramatic reduction in re-hospitalization rates. And overall, there's a lower number of inpatient days or even crisis visits for people who, again, who have received that kind of bridge or service. And then finally, people who receive peer support say that they have a greater satisfaction overall with the services they receive, and that's something that we all try to achieve. So this translates into some benefits for the providers themselves. When people self-manage and have feelings of ownership in treatment, it leads to much greater commitment to follow treatment decisions. And that's so difficult, particularly when we work with people who have serious health disorders, that if they decide that the treatment plan is not their own, that they don't have the degree of control that they would like, then they're much more prone to deviate from the plan or never even buy into the plan. When people say they have an enhanced quality of life, it's an important marker for whole health. And, you know, as time goes by, each of us is beginning to look more at people in terms of their whole health, as opposed to just mental health, behavioral health, or any other particular specialized healthcare. Improved outcomes, such as reductions in re-hospitalization rates and inpatient stays, result in dramatically lower costs. This allows providers to provide services to more people. We see that when we can reduce someone's hospitalization stays by just even a few days, we've saved enough to pay for peer support for six months. Peer support also has a dramatic effect on other staff members in beginning to understand and really believe in a recovery model of care, because prior to introducing peer support, there's always a slightly different culture going on, and we're going to talk about that in some depth. Non-peer staff experience greater job satisfaction as service recipients' lives improve. And that's true. I mean, think about it. You know, why do people work in behavioral health? We all know we don't do it for the money, so there's other reasons that we do it, and it's primarily that we care, that we have some connection to what we're doing that makes it really important to us that we are able to make people's lives better. So when we see that the people we're working with feel like their life is getting better, then we have greater job satisfaction, and we're much happier to be in the role. So let's talk about the first three reasons, the primary reasons why peer support can play an important role in a recovery-centered system. First, prejudice and discrimination or stigma can cause individuals with behavioral health disorders to feel hopeless and helpless and despairing. Despite existing cultural backgrounds of misinformation and pessimistic prognoses and stigmatizing stereotypes, peer staff provide proof of the reality of recovery. You know, in society, it's not uncommon for people to believe that if somebody is diagnosed with a serious mental health disorder or if they spend time in a psychiatric hospital, that in essence, their life is over and that they will never be a full member of the community again. And the recovery experience of the last 30 years has shown us that it's quite the opposite. Second, for a wide variety of reasons, including those that we just talked about, many people with behavioral health conditions don't seek or access timely or effective treatment. And we know this, that many people living in this culture, because of the stereotypes and stigma that exists so prevalently and because of the cultural attitudes among various groups around the country, many people are embarrassed or even afraid to reach out to get the help that they need. And then third, using their personal life experiences, peer support staff are able to provide people who are just beginning this journey of recovery with a positive role model and insight into the process. And the experiential knowledge, this experiential knowledge, complements the clinical and technical knowledge acquired by practitioners in their training. Recovery, the medical model, and cultural clash. So why do we talk about a culture clash? Avoiding an organizational culture clash is why it's so important to take some time up front to prepare an organization to introduce peer support. Peer staff, when they come into an organization that's never had that experience before, are frequently going into a system that's been traditionally grounded in a medical model of stabilization and symptom management, primarily. Assessment and service planning in a recovery model of treatment focuses more on the multiple domains of an individual's life in order to foster meaningful change. So for instance, when we talk about people in a recovery model of service, we're not only looking at symptoms and symptom reduction or crisis stabilization, but we're also looking at the full scale of the problems that they face in their life. And peer support as transcending kind of the normal boundaries between provider and patient and creating a different type of relationship, and we'll talk in a few minutes about what is different about it and why it's different. But when they do this, when people are able to transcend that and create that different way of looking at it, then it's much more easy for people to begin to move into recovery if they don't have to worry about their basic living needs or being ostracized from their communities so that they can build supports in the community, natural type supports. I like this quote, transformation is nothing short of revolutionary. And it's true. We've been talking about transformation in behavioral health for 25 years, I'd say now, and it's really happening across the country, but it's an ongoing process. And I don't think we'll ever be able to say we're fully there. Organizational culture plays an influential role in almost all healthcare organizations. It's got a pronounced effect on organizational values and staff and leaders' attitudes, as well as the normal policies and procedures of an organization. Historically, practitioners using a medical model have focused, as I said before, on stabilization and symptom management in a recovery-oriented model, and the recovery-oriented models really began taking place in two places. One, they started with the peer movement as people started coming out of the hospitals during the years of deinstitutionalization, late 60s all through the 70s and into the early 80s. And maybe that's where it kind of began, but where it really took hold was in the community mental health system. And so many community mental health centers were early employers of peer support, and as they did that, they began to see how their entire outlook and system of care began to change. In a recovery-oriented model, providers try to understand people with behavioral issues in the larger context of the effect their mental health issues have on their entire lives. So, for instance, we know that it's not just that when someone is living with bipolar disorder that they're going to be prone to maybe irresponsible acts, through mania, danger-seeking behavior, or that they're going to have these extremely low periods where they're unable to participate in day-to-day life, and this has effects on families and friends and employment and really all parts of a person's life. But also that we're looking at the things that can set those into motion. So, for instance, when somebody first begins to show some symptoms of a mood disorder, for instance, and the people in their employment pick up on this and begin to kind of shy away from that person or push them away from the group, that exacerbates anybody's condition. One of the primary things that we know that is a trigger for almost everyone and pushes people deeper into their disabilities is isolation. So when peer support providers, so peer specialists is what we're generally talking about, and in 46 states we're talking about certified peer specialists primarily, so when they join a mental health service team, they help the entire team to become more patient-centered. Now, we've all talked about patient-centered everything. For many, many years, but we really haven't achieved it until the individual who's receiving the services begins to feel that they are truly a partner in the planning and the carrying forward of their own treatment plan. So when peers begin to work in a system, people start to really think more from the point of view of somebody who lives with the disorder because they're seeing it modeled right in front of them by a peer specialist, and it becomes more recovery-oriented, and they promote a better and more empathetic understanding about the people they provide services to. Some really early adopters in the Philadelphia area, a group called Northeast Treatment Center and Horizon House, for instance, have constantly demonstrated, and they've been doing this for many, many years now, have constantly demonstrated that successfully integrating peer-to-peer staff improves overall staff retention and morale, and most importantly, improves outcomes for the people we are all there to provide services for. So what do we mean by patient-centered and recovery-oriented? In a recovery-oriented approach, the power shifts from the service provider to the person receiving services, and decision-making becomes collaborative, and that's not always easy for traditionally trained staff, people who've worked in their job for many, many years and have worked in a certain fashion. It's not always easy to accept that, but they first began to talk about this idea of moving toward, shifting the power to the patient, to the person receiving services, and becoming more provider-patient collaborative type who are working in partnership. That first started being talked about in the 1950s, and there was an article, I believe, in 1955 that referred, that was called The Modern Doctor, and in order to be a modern doctor, and it was talking primarily about, well, all types of health, primary care, I think, mainly at the time, but in order to be a modern doctor, you had to work directly in partnership with the people you were serving, and you had to work as equals, and you had to try to diminish that inherent power imbalance that exists between the doctor and the patient. For many of us as we grew up, doctors were God. You went to the doctor, the doctor said, do this, and we did it, and if it didn't work, we went back to the doctor and did the next thing they said. Very rarely did people question doctors' opinions, and particularly in behavioral health at that time, because if you had a serious mental health disorder in the 1950s and early 60s, chances were that you'd go through long-term hospitalization or institutionalization. When peer support providers join a service team, they help the whole team not only shift to this idea of being patient-centered and recovery-oriented, but they promote a better understanding about the people that everyone provides services to. We have people coming in, and everybody has their own set of circumstances, and we know that when a person shows up in an emergency room with a psychiatric crisis, or they show up in a standalone crisis unit for admission, they're brought in by the police, we know that the whole story is way more than the symptoms that they're showing when they walk in the door. They may be unable to make sense of the environment around them at the time. They may have difficulty because they're having some type of hallucinatory experience, but we know that there's way more to their story, and that's where we can begin to actually learn what's going on. We have successfully across the country in many places been able to place peers into crisis services and then directly into emergency rooms. What we found is that when the peer kind of enters in and starts to build a trusting relationship, because they can come to the person and they can honestly say, you know, I've kind of been here too. I've experienced similar things. I've been working in peer support, as Amy said, for 27, almost 28 years now, and I've gone through the experience of being taken to a crisis unit in a police car with my hands handcuffed behind my back, and I was very fortunate that one of my very first hospitalizations I met someone who was providing peer support. We didn't call it peer support at the time, but we didn't even use the word peer back then. We used to refer to ourselves as consumers, but because of that experience, my experience in the system was so much easier and so much more palatable and so much less terrifying. Some early adopters, I think, as I said before, have really demonstrated dramatically improved outcomes. So formalized peer support is rapidly expanding throughout behavioral health. A lot of progress has been made in including peers in areas that have traditionally been clinical, and one of the things that's really important is peer support is not a clinical service, and peer support workers should never be placed in a position of trying to take on a clinical role, but we can work in clinical environments, and we work in a different way, but it's complementary for the two sides. Peer support is proving to be actually a primary change agent in transforming the system to recovery orientation. We've talked about transformation, as I said, for 25 or more years, and the number one change agent has been the introduction of peer support into what traditionally was a very clinical and medical type model. So the transition from patient to staff or provider, a number of studies have shown that peer support staff can find that transition to go from being a patient to being a person who's providing services to be challenging. That's particularly true in small towns, rural communities, where there may be only one community behavioral health center in the town. So in all likelihood, a person will find themselves being hired to provide peer support at the same facility where they've been receiving services, and that has been very controversial, but we have found that there are certainly ways to work it out, and probably the best way is for everyone to communicate clearly. Peers can find themselves working alongside staff that they've received services from, so these dual relationships, they're not uncommon in any small community for anybody because we, in a small community, many people know each other. Somebody who provides therapy, for instance, may know somebody because they are their cashier at the grocery store, or they may volunteer to do some kind of service where the other person is. So these dual relationships exist, and we know that they're not violations of boundaries. They're just another way that has to be carefully managed, and the exact same thing is true for peer support people. For instance, a peer who is providing peer support should not be receiving services of any kind, say, outside of the community health milieu, but should not be receiving it. For instance, you shouldn't be providing peer support to somebody that you, who is your attorney, for instance, because when it doesn't, it upsets the power balance, and in peer support, balance is everything. There needs to be a feeling that we're coming together as equals and that you're not more important or more powerful than I am. As I said, these kind of circumstances call for really frank discussions about the issues with your supervisor and with the individuals involved. So for instance, if I, and I did, I provided services at a place where I had received services, and I had to make sure that if I was even, you know, tried to stay away from people that I had a very close personal relationship with, I did not provide services for them. And that was something that we discussed when I was first hired, and continue to discuss as each opportunity from some kind of relationship like that came up with my supervisor and with other staff members, and particularly with other peer support people. But we also had the conversation with the person who was gonna receive services. Peer staff should not be receiving services from a clinician that they work with in their peer support capacity. So in other words, if I'm gonna work alongside a case manager, and we're gonna work with the same people, and we have to cooperate together, that should not be my case manager if I have one. It's unlikely if I'm doing peer support that I might still have a case manager, but I may still be receiving therapy or management or something. And so we try to keep that degree of separation. In some rural communities, even that's difficult because the provider agencies are so small and so underfunded. And so it becomes even more important that these be very open and frank discussions each time this kind of conflict begins to arise. So the city of Philadelphia, Department of Behavioral Health and Intellectual Disability Services, has put out this peer support toolkit. And it's available online, and you'll be able to download these slides and you can use the link, but you can also get it by searching on peer support toolkit and just use the word Philadelphia with it, and I think it'll come up for you. It's probably the best document that's been put together that actually helps an organization go through a step-by-step process of deciding whether they're gonna use peer support, what are the rationales for it, what are the potential problems, how do you prepare your organization, how do you go about in the hiring process and every step of the way. So I really recommend this. There's a number of other great assets out there that go through the same thing, and a lot of them will be cited in the references at the end of this PowerPoint. The toolkit, as I said, does a step-by-step plan. So for instance, step one, if an organization is thinking that they're going to perhaps add peer support, senior leadership has to really communicate the organization's commitment to the staff and the commitment to shifting to recovery orientation. In order to shift the focus and the nature of services, it requires changes in policies and budgets, evaluation practices, and all kinds of other administrative aspects. So it has to really begin with senior leadership. Fundamental changes in an organization requires the efforts and support, not only the leadership, but of the entire staff, but it needs the leadership to be a champion in order to articulate a clear vision of where the organization is going. For culture change to occur, a prerequisite is for someone in a position of significant authority and leadership in the agency to announce that a recovery-focused transformation process is an agency-wide priority. If you don't have that degree of buy-in, the chances of it succeeding are almost nil because if leadership doesn't want it to happen, it's not going to happen. So for instance, you may put together a change management team to look at this and begin to develop your plan. And so who might be some of the members of a change management team? So in a larger organization, for instance, a fairly medium-sized or large community health organization of some type, you might want to have a board member, a top organizational leader like the CEO or executive director or whatever of your organization. You might want to bring in a strategic planning or change expert. So that may be someone from your staff or it may be that, for instance, when your organization does its strategic planning, and we all do that as nonprofits, we usually have somebody that we call on to kind of lead us through that process. And they can be a staff member or they can be an outside consultant. The medical director should be involved in the discussion. The clinical director should be involved in the discussion. And clinical supervisors should be involved. If you have a peer advisory council, and many, many places do, sometimes called consumer advisory council, at least a member or members from that organization should participate. If you already have some certified peer support staff, but maybe just one or two people and you haven't really shifted the focus of the organization, they should participate in the discussion. As I said, organizational change experts can be really, really effective as can be strategic planning experts. Somebody from human resources, because you're gonna have a whole different set of criteria in both promoting the plan, but also in developing job descriptions and advertising positions in the interview process and reasonable accommodation if necessary. So human resources can play a very important part. And then performance improvement staff, whoever that might be that's in charge of quality improvement within your organization. Step two, solicit the perspectives of people in recovery and family members and staff. So you're trying to get ideas about this from each stakeholder, each group of stakeholders. One way to really give a sense of urgency about the process is to gather input from all of these people, because this gives us a kind of an overview of what we have to deal with from the beginning. Initially, it's really good to have, for instance, you can set up these focus groups. Initially, it's good if the focus groups are the distinctive groups of people. So for instance, a focus group for people receiving services, a focus group for traditional staff, a focus group for family members, and maybe administrative. And the reason to do that in that part is because you will hear more of people's real views when they're among their colleagues and they're not worried about saying something that might upset somebody else in the room. Once you've had these groups come together and you've gained all of that information and people had a chance to talk through perceived problems or the things that they see as barriers going forward, then these groups can be mixed and start to meet together and begin to share ideas. And what happens in a group like that is it becomes almost a question and answer or posing a problem and a solution type of a discussion. And it can be really, really dynamic. And generally, again, if you're really looking to make a major change in your organization, this can be an ongoing process for a significant period of time. So you might have a meeting once every few weeks of the staff, the clinical staff, maybe somebody from peer support staff, if you have it, or somebody from peer community, some of the family members and people receiving services, some of the actual people receiving services. And each group can talk about what they're concerned about. And then other groups can propose ways that those kinds of issues can be dealt with. And this produces change at the individual level and at the agency level. It's an excellent way to begin the process. Another thing that's really important is that we provide ongoing training, resources, and opportunities to orient the current staff. We're really good, organizations I have seen, when they hire peer staff, they're really good about giving them the kind of introductory training that people need when they come into a new organization and helping the peers be trained into the specifics of the job they're gonna face. Where we've not been so good is providing this training to existing staff and ongoing training to existing staff. And the reason why that's necessary is because, again, we're shifting totally the way we're looking at what we do. In other words, we are going from that medical concept or that clinical concept of we bring people in and we hope to reduce the symptoms that are disturbing to them so that they can exist more comfortably in the community. Recovery is trying to move people to where it's not that symptoms are done away with, it's that people find a new way to frame their life so that the symptoms are not the major part of their life or their experiences with their disorder or even hospitalizations are not the way they define themselves and allow other people to define themselves. When staff is provided with training and resources, they're way more likely to increase their understanding of recovery and then begin to come up with their own ideas about how it can be brought into day-to-day services. All the best ideas in recovery didn't necessarily always come from peers. A lot of it has come from the academic world, some of it came out of SAMHSA research projects, but much of it has come directly out of staff who came up in a system that didn't really believe in peer-supported recovery. But as they began to see people recover, because people do recover, sometimes even without peer support or without even recovery orientation, we know that some people do recover and go on to live out their life in a way they choose. Early training is really critical to explore needed changes and how we're gonna go about doing that. Another step is, as you begin this change, is to do an agency walkthrough. After you've oriented the staff to talk about this idea of a recovery model, now this change team does a walkthrough of the agency and they can provide a way, this provides a way to gain a sense of how the agency and its services are experienced by the people who actually receive the services. And now, because you've done a walkthrough, and now because you've begun to talk about it and people have received some training in the concepts of recovery and flourishing, now they're better able to really understand what the experience of treatment is like for the person receiving it. So, if you have a group, select someone from your group to play the role of a person seeking services. You can role-play within your group. What would it be like if you walked in the door and you were having distressing symptoms in your life, you didn't fully understand it and you were seeking services? What would it be like? How would you be greeted? How would you be treated? How would you be brought into services? How would you build trust with the people that you're working with? It's especially helpful to have somebody who has done that be a part of that group so that they can help the person who has been on the other end of the system really see it from the eyes of the service recipient. And ultimately, that's the most important thing is the experience that people receiving services have. Another very important thing, and we're gonna do some more work with this within SMI Advisor, but language really matters. And it's not always good language that we see people modeling within behavioral health. Part of changing an orientation is making sure that the references that we use about people receiving services, about conditions and programs, reflects that recovery orientation. Many organizations now use person-first language, which is basically where you acknowledge that a person is not their diagnosis. So we don't say that a person is a schizophrenic. We don't say they're a bipolar, because that's not what they are, that's not who they are. They may have schizophrenia, but they're a person who has schizophrenia. You would not say someone is a cancer, or is an asthma, or even, I mean, you might hear somebody say an asthmatic, and that gets by, but we really should not refer to people in terms of what their problems are they're dealing with. It's who they are as an individual, and when all else fails, you refer to them by name. So you may say, for instance, if you're talking about me, you can say, Patrick has bipolar disorder, and that's why it's really important that he controls his sleep schedule. And that would be totally proper, but if you were talking about me going to work at, let's say, a construction job, Patrick's gonna be joining our team, and did you know he's a bipolar? Now you're putting a label on the person, and everybody within that group that heard that has their own way of interpreting it, and deciding if they're gonna really get along with this guy Patrick, because he's already messed up. So language really does matter. Some people think that person-first language is really just political correctness, and you can make that argument, but it's way more than that, because it completely, when we label each other, and we use negative language like crazy, and loons, and all of the things that we hear every day in society, and we frequently hear from people who are actually receiving a lot of help, who are actually receiving treatment, and part of the reason for that goes way back to the civil rights movement, and to, for instance, the civil rights movement, where people began to come out of the institution, civil rights for people with mental health disorders. One of the first organizations that was formed, it was in Portland, Oregon, I believe it was in 1971, and it was called the Insane Liberation Front. They chose that language because they wanted to take away the power that other people had by using it, and if you look at, for instance, the gay rights movement, you look at racial civil rights movement, people have done the same things. They choose some of the more pejorative terms to refer to themselves, because they want to take ownership. The problem with that is there's always gonna be somebody else who's gonna hear you using that term, and they're gonna think that means that that's kind of insider talk, and that if they use that talk, it'll prove to the world that they get it, and unfortunately, that's not true. It's modeling bad language, and bad language controls how people think. The perception we have of someone who is labeled as crazy is completely different than the perception we would have if we say Patrick has bipolar disorder. When referred to a group like as the mentally ill or the homeless, we are separating them from the mainstream of society and the communities in which they live. People want to be included, and that's part of recovery. Again, as I said, language matters, because language can help people in feeling included and equal members of their communities, or it can be used to push them to the margins of society. We know one of the biggest problems in mental health has been that people with serious diagnoses have been pushed traditionally to the margins of society, frequently to live in poverty and kind of in an outcast way, and we know that when people are isolated and looked down upon, that their outcomes are gonna be far worse than they would be if they were accepted and supported. When people are diminished by the way they're referred to by providers, by implying that they're totally taken over by their disorder, we risk the people becoming to believe it themselves, and it's not really unusual. I go into a lot of community health centers, and it's not unusual to hear the staff in a staff meeting referring to somebody as a frequent flyer, or particularly if we're talking about people with a diagnosis that might be more difficult to treat and more challenging, so we might look at some people with a lot of mixed states and bipolar disorder, or somebody with borderline personality disorder. Very frequently, staff will use pejoratives when they talk about these people, and so what they're doing is they're setting up their own feelings about the person, and they're setting up the feelings of everybody within hearing distance, and eventually, it's setting up the way the person thinks about themself. We need to anticipate and address concerns of the staff. Staff frequently have concerns and questions when faced with prospects working with peer staff, so these kind of questions are not unusual, and they need to be answered, and so if you're part of the team that's gonna make this changeover, anticipate the questions and be prepared to answer them. Help staff understand how peer support will function and be of great benefit. Typical questions, and we won't go through them all, but for instance, are peer staff likely to relapse, a very typical question. Relapse among people who have been trained as peer specialists, who have gone into recovery on their own is rare, and this is because the people who are hired in these positions and trained and certified have demonstrated that they can handle job stress. In order to get some of the certifications in the country, you have to have hundreds, even thousands of hours of experience before you even get to be a peer specialist, so even if they do have a relapse, they should be treated like any employee who has a serious illness that interferes with job performance. We all have times when we need to step back from our jobs. Now, and again, some of the other questions is an individual who receives services from a clinic that they now work for more likely to not be trusted by the staff, and that's when people get to know each other and work closely together, that's where bonds and respect are formed. It's not because of a label. So just as an agency, self-assessment is important. You know, in preparing a strategic plan, you always do a self-assessment. It's important in developing new services, and it's particularly important so that we see the unconscious biases that affect service delivery, and that goes back, again, to the kind of language we use and the way we think about certain types of people, like people who come in and out of crisis units. You know, we label them as frequent flyers, and that immediately sets up kind of an image in our head of who they are and what they are. An agency that fosters cultural diversity in areas of race and ethnicity and sexual orientation is well-suited to also begin to have the diversity of people in recovery, and there's many, many tools that people can use, one for self-assessment. The Recovery Self-Assessment Tool by the Yale Program for Recovery and Community Health is an excellent tool and is available online. So these basic steps are critical in preparing for change, but they're not the only answer, and so we need to continue to look into this. We need to look at things like ethics and boundaries because there are differences. We have to talk about policy changes, all of these things that you do when you radically change the focus and mission of an organization. It's also critical that people have a clear understanding of what you're asking them to do and that they're well-supervised. Supervision and peer support is particularly important, and we're gonna do a separate learning module on that subject. So, you know, as it's clear, introducing peer support into behavioral health that is not fully prepared can easily result in failure, and conversely, with proper preparation, it can succeed tremendously. Peer support can improve agencies, and it can make the work of other staff more effective and successful, and more importantly, it can actually change people's lives for the better. So thank you very much, and I'm gonna turn it back over to Andy.

peer support

behavioral health organizations

patient involvement

recovery-oriented approach

inclusivity

training for staff

cultural shift

job satisfaction