Hello and welcome Dr. Benjamin Dress, Professor and Rosalynn Carter Chair in Mental Health at the Rollins School of Public Health at Emory University and health systems expert for SMI advisor. 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 one 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 June 19th. Slides from the presentation today are available in the handouts area down in the lower portion of your control panel. Select the link to download the PDF. 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 or 15 minutes at the end of the presentation for Q&A. Next slide. Now it's my pleasure to introduce you to the faculty for today's webinar, Dr. Judith Cook and Ms. Tina Peng. Dr. Cook is an internationally recognized authority on mental health services research, specifically the study of clinical and rehabilitation outcomes of children and adults receiving community-based care. She directs a federally funded research center along with numerous grants and contracts focusing on intervention science, psychiatric epidemiology, and outcomes research. Tina Lang, MSW NYCPS, has been employed at Baltic Street AEH Inc. since 2002 and was appointed as the CEO as of September 2020. Tina brings over 21 years of peer supervision, advocacy, and vocational services to individuals with mental health diagnoses. Thank you both for leading today's webinar. Thank you, Ben. I'd like to begin by acknowledging the funding we received from NIDILRR, SAMHSA, the New York State Office of Mental Health and Hygiene, and the New York City Department of Mental Health and Hygiene for the work we'll be reporting on today. The contents of our presentation don't represent the policies of any federal agency, and we have no conflicts of interest to report regarding today's presentation. Today's learning objectives include being able to differentiate generic supported employment services from the individual placement and support model, to apply work-specific health promotion to the delivery of supported employment, and to plan ways to integrate peer support into employment services. Today's agenda includes a brief review of the evidence base for IPS supported employment and for health education of people in recovery. Next, we'll discuss ways to integrate physical wellness and pursuit of career goals. We'll describe how you can adopt these new practices in your own work using freely available tools. Finally, we'll look at how this can help you achieve better recovery and engagement outcomes with the people you serve. Let's start by reviewing the practice of IPS and principles that underlie it. First, people are helped to find competitive employment, which is a job that anyone can hold, not one set aside. They find employment that meets their individual preferences, so this is not a cookie-cutter job placement approach. IPS follows a zero-exclusion policy. You don't have to be at a certain level of recovery to use IPS, and you can even be unsure about working. IPS also emphasizes rapid job placement so that people begin to work as soon as possible. They receive support for as long as they need it, so there are no arbitrary time limits in IPS. IPS services are integrated with the rest of the person's treatment by having regular meetings and ongoing coordination with other treatment providers. Finally, services include benefits and entitlements counseling so the person understands how working might affect their disability income and any other benefits they're receiving. IPS is an evidence-based practice supported by over 26 randomized controlled trials, and that's the strongest research design we can use to study a practice. These were conducted both within and outside the U.S. These studies followed people over a considerable period of time. In fact, two-thirds of the studies followed people for 18 months or more. They contrasted outcomes of IPS recipients versus those in the control group who received services as usual. Here's a graphic look at these studies' results with the black bars representing IPS and the red ones representing control participants. The height of the bars represents the proportion of people working competitively. Almost all of the black bars are longer, meaning that a higher percentage of IPS participants achieved competitive employment. In fact, in 25 of the 26 studies, people who received IPS did better. Across all studies, the competitive employment rate averaged 55% for IPS and only 23% for control participants. So for IPS, over half worked competitively, while less than a quarter did so in the control groups. IPS is the only model of employment services that has been definitively shown to work for people with psychiatric disabilities. You might think that with such a strong evidence base, IPS would be widely available, but this is not the case. There are challenges in implementing IPS due in large part to the need to blend funding streams. This typically means blending state vocational rehabilitation dollars, Medicaid funding, state general revenue or state tax dollars, and other sources. As a result of this and other challenges, IPS is not widely available to people with psychiatric disabilities. While 41 out of 50 states and the District of Columbia have one or more IPS programs, offering over 850 programs nationally, this service reaches less than 50,000 people a year with very low penetration rates. In a recent national survey of state administrators, IPS workforce issues was one of the top four implementation challenges to making IPS more widely available. With another survey of programs in rural areas, finding that lack of IPS providers was especially problematic in the rural United States. IPS has been around for several decades and numerous adaptations of the model have been proposed and tried. No model can do everything, but many in the field agree that more attention needs to be paid to integrating peer support into IPS service delivery. This has been done in a number of ways, including using peers to engage people in IPS services, providing peer support during the initial assessment process when people create what's called a vocational profile, using peers on IPS fidelity assessment teams, and we'll talk more later about what that involves, and using peers to train IPS staff. My center has developed a toolkit featuring different ways IPS programs have integrated peer support with examples of actual programs across the nation, and the link to that toolkit is provided in this slide. Another missing ingredient is directing specific attention to physical health issues that impact employment. Health is a major determinant of employment status in the general population, and it's linked to the amount and duration of labor force participation. While this is true for everyone, we also know that people with psychiatric disabilities have especially poor physical health, and many of those who are working must manage a number of chronic medical conditions, including obesity, cardiovascular disease, diabetes, and arthritis. All of this sets the stage for our project, which focused on the provision of IPS services by certified peer support specialists. A number of factors led us to propose this. All states now have behavioral health peer specialist certification programs. In fact, this is one of the few areas of workforce expansion in the behavioral health field, which is experiencing shortages of other providers, like psychiatrists and psychologists. Moreover, the latest data we have shows that one quarter of all U.S. mental health facilities now offer peer services. So this workforce is in place in many already operating traditional programs. In peer-run programs, employment services are a very popular offering, more so than in traditional programs. In addition, many states, 41 at last count, allow Medicaid billing for peer support services, which is one of the important funding streams in IPS. While many peer-run programs provide vocational services, their effectiveness is unknown, and this creates a need for evidence-based models that can be delivered at peer-operated agencies. One final argument for our project is the fact that historically, a major focus of peer-delivered recovery support has been the promotion of health and wellness. So the emphasis on health, plus the popularity of employment services in peer-operated programs, led support to what we were trying to accomplish. Next, I'll turn it over to Taina, who will describe Baltic Street, its membership, and its vocational programming. Thank you, Dr. Cook. Next slide. Well, this is our logo. We're based out in Brooklyn. Please, next slide. Baltic Street has been established as 1977. We've been providing peer-focused recovery services for over 45 years. Currently right now, we are the largest peer-run organization in New York State, which currently is about, I want to say, 93 individuals that are certified peer specialists with our organization. We have different programming that are offered throughout New York City, employment, housing advocacy, supported education, bridger services in state hospitals and in transitional living residences, self-help programs, and a barrage of other community-based integrations. Currently, once this project had taken away, we were able to actually employ some of the individuals that went through the IPA model. I want to say now it's been like seven years now, and they're still gainfully employed with Baltic Street as employment specialists, pardon me, as employment specialists and peer specialists. Next slide. Employment equals health, and health equals employment. At Baltic Street, all services or one-time serve or service delivery plans are developed with all participants utilizing SAMHSA's Eight Dimensions of Wellness model. Employment and health are closely linked, like Dr. Cook was just mentioning earlier. All of these significant bodies of evidence suggest that being employed has a positive effect on all individuals' physical, mental, and social health. Here are some examples that I'm going to give to you today regarding this. One, financial security. Having a job means having a stable income, which can reduce stress, anxiety related to financial insecurities. This in turn can turn positive impact on the person's physical and mental being by reducing the risk of chronic diseases such as heart disease, high blood pressure, and depression. Social connections. Being employed can provide opportunities for social interactions and a sense of belonging, both of which can positively impact mental health. It also provides an opportunity for individuals to develop social connections with colleagues, community members, other participants, and even clients that they may be serving within the communities, which can lead to improving social supports, lowering stress levels, and a better overall well-being. A sense of purpose. Employment can give individuals with psychiatric disabilities a sense of purpose and a meaning of life. It is particularly true that for individuals who find fulfillment in their work, leading to a positive impact on their mental health. Access to healthcare. And as we all know, states around are looking at the Medicaid dollars that are currently being spent in the psychiatric ERs. Many individuals that become employed, many of these employers offer healthcare benefits, which lowers the spending on Medicare and Medicaid. And for individuals who now pay into their own health insurance plan, actually take better leads of health outcomes by increasing the likelihood of receiving preventative care and early treatments for health issues. Overall, employment has improved in to offer a range of benefits that promote good health, including financial security, social connections, and a sense of purpose and hope and improve access to all good healthcare. Next slide. Quality of life measures, Mary's story. Mary was diagnosed at the age of 22 with schizoaffective disorder and had been hospitalized for most of her early adult life. Her diagnosis was so severe that many years, she was unable to speak and would isolate herself within the inpatient units, not participating in group activities, and would often be told that she was noncompliant with her treatment. I remember this as a new employment specialist, and I was invited to host a group to discuss employment services that Baltic Street had to offer within the units of what would happen once they transitioned out of the state hospital. South Beach Center helped us host these variety of groups to really introduce what life would be in different work settings for all of these individuals that are within the inpatient. Mary had the opportunity to actually attend this first group. By the time Mary came to me and sat in our group, she had been there for 28 months and had not participated in any activities. This discussion led Mary to start her journey towards recovery. After meeting and participating in this group, she was then released from the inpatient unit seven months later and then joined our organization and started our work training program called the Baltic Bazaar, which was a retail store in Brooklyn and sold fabrics by the pound. We taught Mary how to work in a retail setting. We paired her with an employment specialist where she started working this training program at 12 hours a week as a sales clerk. She would develop and learn new employment skills and also would attend work development skill sets and resume development workshops every Monday with our organization. She then gradually increased her work time up to 20 hours a week within 10 months of working with us. During her progression, Mary worked closely with her employment specialist that would then support Mary in all areas within the eight dimensions of wellness. Mary was promoted to head cashier trainer, which was a great boost in confidence for her. She then was able to actually train other individuals that were coming into the program, which also gave her a sense of purpose. When it was time for Mary to graduate from the training program, her employment specialist started the conversation on where Mary wanted to work, choose which area, and how much she wanted to earn, which wasn't a question that many people would ask an individual that were receiving benefits. How much would you like to earn? That was motivating for Mary that she didn't have to stay at minimum wage. We let her dream, which was really a beautiful thing to see and flourish. Fast forward, Mary, with the help of the employment specialist team, was able to place her in the job that she wanted to work at and the location. We did a lot of mock interviews with Mary, which landed her the career dream that she wanted. And now, I'm proud to say, 18 years later, Mary now is a head manager at one of the largest retail stores in Manhattan and has been successfully employed now since then. Next slide. So, some of you may be familiar with the work of Dr. Peggy Swarbrick from Rutgers University and the peer-run statewide agency named the Collaborative Support Programs of New Jersey. Dr. Swarbrick has developed models of peer health and wellness coaching, which focus on what she calls the eight dimensions of wellness. This includes work as one of the eights. For our project, she and her colleagues created a model of peer health education and wellness support specifically focused on work. This model involves a structural set of activities that occurs during meetings with employment specialists. At these meetings, job seekers learn about linkages between work and getting adequate sleep and rest, being physically active, making time for stress management and relaxation, healthy eating, medical screening, and healthcare. People learn how to establish health routines that support and promote employment with the routine comprised of the individual's healthy habits, health habits. For example, someone out on the job interview might develop a routine of getting enough sleep the night before, having nutritious snack prior to the meeting, and then taking water, taking a walk after the interview to relieve some stress. This model is available in a manual called Physical Work for Wellness, which is available from Judith Center at the link on the slide. Next slide. Here's an example of part of the manual. And I thought it was important for us to take a look at this so that you can see firsthand how the assessment works. Physical wellness, all too many, when we discuss it, right, we can say, I wanna be more active. I would like to lose 10 pounds. I know I'm that person. Maybe I could lose 10 pounds, right, 15 pounds. But what does it take, right? So we start to really take a deeper dive in what does that mean? And with. And with that, you know, you start talking about what is your morning activities, your morning routines? What is your afternoon activities? What are your evening activities? Having a clear thought process and actually writing it down to making these things really real. And then realizing, are you being really inactive? Are you waking up and not really stretching, exercising? Are you having a healthy breakfast? What does that look like, right? Right? So we start to write it down and then we start to scale it. Excellent, good, fair, or poor. Then you circle. Next slide. Here we have habits and routines. Oftentimes, not too many people think about what are our habits and what are routines? So is your habit to get up in the morning, drink a glass of water, take medication, but not eat breakfast? Is it a routine for you to not, to get up in the morning? And oftentimes, people with psychiatric diagnoses are utilizing tobacco, nicotine in the morning once they wake up. What does that really look like? So here we have a simple scale. You know, what are your daily habits and routines? And you start to identify them. Next slide. Here we have the ideas for work habits and supports for work. Now we're gonna link work to this. So start to really write down, what are your strengths in your wellness habits? What are you gonna be your commitments? And what we can do to start working on the plans. Again, you can, next slide, you can see this with our, we will have, of course, this slide, with our, we will have, of course, this is gonna be attached to the slide so that way you can see firsthand. So IPS Research for Baltic. Okay, so with the IPS Research for Baltic Street, we were, we had trainings that were with the employment specialists. They were educated by Dr. Peggy Swarbrick and her team with the wellness work module. This was brand new to our team because although we had been providing assisted competitive employment, we hadn't really focused on works of wellness with that. So this brought, we married the two. The goal was to train the employment specialists on physical wellness and how to develop those roles. Next slide. So the IPS team, the gentleman's name was Steven, wonderful gentleman, would come down and assess the organization and see exactly the fidelity of the IPS model with the services that we were providing. And of course, in the beginning, we did score low because we weren't, again, you know, we weren't into the IPS model at that moment in time, right? So they provided in-person trainings biweekly with the staff and new staff that were hired would then be trained with the IPS model. Okay, the goal was to include monthly numbers of new employer contacts as well. So another piece to our employment was actually developing a job bank, which then showed that our employment specialists really had to do what? Cold calling. So cold calling had to become a practice for us, which became quite successful towards the end. The physical wellness for work, these individuals were trained by Peggy's team. And, you know, they modeled the wellness tools for participants and, you know, there was ongoing technical assistance and via in-persons and conference calls. This was before Zoom. And additionally, the experts worked with the managers in creating logs and notations and documentations of healthy promotion services and progressions towards the participants file. Next slide. So Baltic Street, again, when we started this project, it was with our then, the Assisted Competitive Employment, ACE, vocational program, which was called Network Plus. Baltic has had a long history of employment services and I spoke a little bit about our very first training program called Baltic Bazaar, which was entry-level retail job. It also was entry-level janitorial. And we had the Baltic Street Thrift, which was located on Staten Island, which was specifically a thrift store, and which was quite wonderful, which they handle much larger items there and individuals there were trained directly from the South Beach Psychiatric Center through their transitional living residence. We also had a convenience store called Little Things, which was off of Avenue I, which sold newspapers and handled food and worked with the community through the mental health clinic there. And of course, the ACE program, I'm proud to say that we use the Boston University Psychiatric Rehabilitation Center's Choose, Get, Keep model throughout the assessment process for the individuals. And currently now, our organization now, it's called, our employment services is called Baltic Works, which is linked with the American Dream Employment Network, ADEN. And this is our Ticket to Work program, which is located here in Brooklyn. And now we're actually throughout all the boroughs of New York City. Next slide. Dr. Cook. Thanks, Taina. So next I'm going to talk about the study that we collaborated with Baltic Street on, including Dr. Peggy Swarbrick and the expert from the IPS Employment Center, Steve Brown. We partnered with Baltic Street's existing vocational program to study its two highly similar supported employment teams that were providing assisted competitive employment. These teams, one was located in the borough of Brooklyn and the other was located in the Bronx. The teams had an identical staffing pattern, which was a team leader plus two to three full-time equivalent staff members. And they use the same supervision format. There was a different team leader for each team. While they were located at separate offices in these different areas of the city, the Bronx and Brooklyn at that time had similar geographic and job market features. Staff on each of the two teams were completely non-overlapping. Because we didn't have the resources to conduct a randomized study, and because it was really impractical to assign people randomly to the Bronx or to Brooklyn, we decided to convert one of the teams to IPS while the second team would continue to deliver assisted competitive employment. So we trained the staff and team leader of one of the teams to provide IPS services while the other continued to offer the programming that had existed before based on the choose, get, keep model. Then ongoing supervision of the IPS team occurred, which involved biweekly check-ins, sometimes by telephone, and sometimes Steve actually traveled to Baltic Street with the IPS expert who had trained them. And Taina talked a little bit about the training that they received. They took the employment center's introduction to IPS course. They had readings about the delivery of IPS. They modeled going out on employer visits and also modeled how to meet with clients as an employment specialist and develop the vocational profile, which talks about, as Taina said, the person's dreams. What kind of job they'd like to get and what kind of industry or field, how much they'd like to work, how much or how far they would want to travel to work. All of that goes into the creation of the vocational profile. And then based on that, the employment specialist helps the person land a job that matches their preferences. There was refresher training. Two staff were hired. They received the full complement of training. And also we did IPS fidelity assessment using the scale, the fidelity scale developed by the IPS Employment Center, which is the international IPS training and education organization. Okay, let's see if I can advance this. Here we go. The study period was two years, beginning in July, 2015 and ending in July, 2017. The outcomes on which we compared the two teams, one IPS and one generic supported employment, included the percentage of service recipients ever achieving competitive employment, which again is a job that anyone could compete for and hold. We also looked at the team's monthly average number of clients working in competitive employment. We looked at how much money people made, their average hourly wage. We looked at the number of hours each month that they worked in competitive employment. We looked at the job tenure of jobs that had ended. How long did they hold their jobs? And we looked at the monthly number of job starts, which is one of the benchmarks that the employment specialists were aiming for. For the analysis, because we weren't able to randomize people, we used a random effects logistic regression model with group assignment propensity score adjustment. The propensity scores adjust for the bias that might be introduced by variables that are known to influence employment, like age, gender, race, education, ethnicity, and the number of months receiving vocational services. So we used propensity score adjustment to control for those things since we weren't able to do random assignment. We compared the rates of competitive employment over the two year period among 184 IPS participants and 164 recipients of assisted competitive employment. The competitive employment rate for the IPS team was lower than the generic team at the start of the study. But by month five, as you can see in this graph, the IPS team's rate exceeded the rate of the generic supported employment team and continued to rise throughout the period of the study ending in July, 2017. The rate of competitive employment for the assisted competitive employment team plateaued basically until May, 2017, when it declined sharply through the studies and in July, 2017. Over the entire study period, 43% of IPS participants achieved competitive employment compared with 21% of generic supported employment participants. On average, 38% of IPS participants were working in competitive employment each month compared with only 18% of recipients of the generic supported employment services. The IPS group had a significantly higher number of job starts per month and a significantly longer mean job tenure than the control team. So for jobs that ended, they lasted longer than those that received generic supported employment. But two things the teams did not differ on was average hourly wage, how much money they made or average hours worked per week. There might not have been a long enough follow-up period for wages to increase. And it's possible that the fact that people were receiving SSI or DI kept their labor force participation at around 20 hours per week. Now we've talked a lot about fidelity. I think one of the reasons the IPS supported employment model works so well is that the extent to which the program adheres to the principles and practices of IPS is measured regularly. So fidelity assessment in our study was conducted by an external expert from the IPS Employment Center and a trained partner. And these fidelity visits involved in-person visits to the program where interviews were conducted with Baltic Street's chief executive officer. So the people at the management team at the top of the entire agency, the vocational program director who oversaw all of the things Tyina talked about earlier, the IPS team leader, the IPS employment specialists and a sample of IPS service recipient. So all of those met with the fidelity assessors. 10 randomly selected client files also were reviewed along with the vocational outcome data of the jobs that the team was helping people work at. This information was then used to complete the fidelity scale items that were divided into three sections. There's a section on staffing, one on organization, how the team is organized and run and then one on services. At the study baseline, as Tyina mentioned, the IPS team received a score of 71. And that indicates that services didn't meet minimum standards for IPS. And that was expected. We had just started working with that team to train them to do IPS. By the study's midpoint, the score had risen to 99 and that indicates fair fidelity to IPS. And then by the study's end, the fidelity score was 110, which indicates that the team was showing good fidelity to IPS. In other studies of IPS, teams are considered to be delivering acceptable IPS services when they're at the fair to the good level. In a previous study that trained peers to provide IPS, the highest level of fidelity they were able to achieve was fair. So our study is the first to show that it's possible to train peers to deliver high quality IPS with good fidelity if people are receiving ongoing supervision and training. To me, the most interesting part of this study was observing the ways in which Tyina's program encountered both obstacles and facilitators when implementing IPS. I'm gonna talk about some of the obstacles and then I'll turn it back to Tyina to talk about some of the facilitators, the things that made it easy to implement IPS. One obstacle was the need to shift the relationship between service providers and recipients. In peer support in general, recipients take the lead and the service provider partners with them. So the recipient takes the lead in setting goals and taking action in traditional peer support. But in IPS, the employment specialist guides the job seeker through a predetermined sequence of service delivery stages. The employment specialists in our study needed additional training and support to assume this leadership role and it was uncomfortable for them a little bit at first but eventually they learned to guide people and lead people through the stages of IPS while they were also fully honoring peer support principles of mutuality, trust building, promoting choice, and building a good relationship. Another obstacle was that there wasn't a larger clinical team with which the IPS providers could coordinate. Generally IPS is delivered at a traditional agency and the employment specialists meet on a regular basis with the psychiatrists, case managers, and counselors and directly coordinate IPS services. Baltic Street didn't have those things. It was delivering peer services. They didn't have psychiatrists or psychologists on staff. So this led to the need for employment specialists to coordinate with off-site treatment providers and they did this through emails and phone calls with the service recipients permission and they would talk with the off-site providers about issues such as medication regimens, did a person need a medication adjustment for example, service coordination, how can we better coordinate, how I'm helping Robert with his eating issues so that he has a healthier diet at work, and how are you as his case manager coordinating with him to help him learn new recipes for healthy cooking for example. And other needed employment supports were discussed with the traditional treatment providers. Another challenge was the use of benchmarks to evaluate the job performance of the employment specialists which they were not used to and this caused some concern because they felt that having performance demands, initially they viewed these performance demands as unrealistic. They thought we were asking too much. And one of the sticky wicket issues was the number of cold calls they were supposed to aim for for new employers. So pretty standard level would be 16 new employer contacts per month and that was just something that initially they didn't think they could do. And they also had a benchmark that was the number of job starts per month and this was set at five for them initially. And so there was some resistance, there was a feeling that just wasn't doable, but what they saw was that if they aimed for these benchmarks it improved their participants work outcomes and their team's competitive employment rate. So over time they were able to accommodate these benchmarks. Another problem was high vocational staff turnover. The employment specialists made less money than the peer service providers in other parts of Baltic Street. And I might say that the peer service providers didn't make as much money as people outside of Baltic Street who were delivering other types of mental health services. So what was happening was employment specialists were being hired and trained and then lured away to other parts of Baltic Street or outside of Baltic Street to other positions, usually in the clinical realm. And Baltic Street dealt with this by eventually raising the salary level of its vocational staff and this really needed to happen to address this problem. So what I'd like to do now is turn it back to Taina who is going to describe some ways in which the way peer-run programs operate actually facilitated the adoption of IPS. Taina? Thank you so much, Dr. Cook. So in addition to the challenges we faced, there were ways that Baltic Street's peer-run philosophy and staff made adopting IPS easier. First, Baltic Street was already doing supported employment so we were invested in many features of IPS such as securing competitive jobs, not having service time limits, and client's choice guiding job development. The integration of the new health component into the work of the agency's employment specialist was aided by the fact that all employment staff were comfortable in the role of health educator and participants were open to its importance in the recovery process. Another facilitator was that the services recipient's trust was higher in a peer-run program, making engagement in IPS services much easier. Finally, the ability of peer employment specialists to role model for participants that people in recovery can hold competitive jobs, build careers, was quite powerful in itself. A final advantage was that the ability of peer vocational staff to demonstrate how health routines positively impacted their own work at Baltic Street. So we always say what's for us is for us and we're going to share it with the world. Next slide. So if you're thinking about adopting some of what you've learned today's webinar, here are some resources that you can take advantage of. First, SAMHSA offers a free supported employment toolkit that describes the IPS model. Research that support and to adopt it and train your staff in ways to evaluate your success. Second, there is a free comprehensive web portal hosted by Judith Center, which webinars and podcasts on different features of IPS delivery. These include how to engage people into the IPS service, assessing IPS fidelity, cultural competency in IPS delivery, and providing vocational peer support. The web portal also has separate section for employers and one with tools for families for other supporters for people receiving IPS. Third, the peer health coaching model we use is available in the manual I described earlier called Physical Wellness for Work. Fourth, the toolkit Judith mentioned on a different ways to involve peers in IPS is available online with descriptions and examples from different programs. Finally, the different sources of all things IPS is the IPS Employment Center. There is website includes courses, research studies, supported employment policy development, and updates on the national IPS learning community. Next slide. So here we have the future direction for peer supports in IPS. So I'll give you a little rundown of what's been going on here at Baltic Street after we ended our IPS study with Dr. Judith Cook and team. So we've developed a ticket to work program, which is working absolutely phenomenal, called the Baltic Works program that I mentioned earlier. We have a steady job bang, I'm proud to say over 900 employers, a wide variety of competitive jobs that are that are just not the five F's, which we all know as food, filing, factories, flowers, and filth. We have individuals from all different levels and capacities of different types of employment. We have some professors that are working out of some universities that have come through our doors and sought support. And we also have individuals that are entering the job market. We have varieties of different levels of education seeking job advancements and job satisfaction, and ways that IPS has enhanced our organization. In 2019, we're proud to say that we did receive the SAMHSA Wellness Award. We partnered with the American Dreams Employment Network, which in creating our own employment network, which is our ticket to work program, increased job satisfaction from hiring peer specialists that went through IPS, and longer employment tenures as I made an example earlier. Next slide. So the future direction for peer support in IPS, the workforce development will be maximizing the peer works in delivering a higher quality IPS supported employment, integrate peer providers, and natural support. So working with families and friends, and other community members, explore different ways for peer specialists that they can support employment and health together. Because like I said, health and employment are one. And develop national and state capacity to disseminate support of use of IPS peer run programs. The knowledge and creations in the translations is of course to further this study because it is important in the impacts of IPS delivered by peer services. And study how adding the health components within IPS to improve work outcomes. And develop initiatives or approaches by using peer working run by non-peer programs. So I'll turn it over to Dr. Cook now. So this slide contains the references to the literature that we cited in today's presentation. And finally, here is Taina's and my contact information, if anyone wants to follow up with us later. Thank you for your attention, and I'll turn it back to Ben. Thank you, both Taina and Judith. Really wonderful presentation and intervention. So just a reminder to participants that you can submit your questions by typing them into the question area, which is in the lower portion of your control panel. We have a few minutes if you have them. But before we do that, I do want to take a moment, 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 rating scales, and even submit questions directly to our team of SMI experts. Download the app now at smiadvisor.org forward slash app. So let me start with a question. So one thing that I really loved about the presentation is that you provided tools for clinicians or peers who might want to implement the program. My question is, you know, looking through the tools, how do you think about who the kind of the audience is for clinicians or peers who are listening in today? Are these things that that kind of frontline clinicians can implement? Or is it more something for them to point their say their clinic directors or their organizations to adopt the whole program? So I'll take a stab at that, Ben, and then Taina can chime in too. The tools that we talked about today can be used by all the people you mentioned. If you're a manager of a clinic or a program, or even a whole system, you'll want to take a look at the IPS toolkit, because that's designed for managers that want to bring this practice into their program. Maybe you're a peer who's wondering, how can I get involved in IPS service delivery? Maybe I don't want to be an employment specialist, but hey, I thought it sounded interesting that maybe I could train IPS employment specialists or be part of the fidelity team that goes out to rate teams that are providing IPS. So there you'd want to look at our IPS peers and IPS toolkit that I mentioned. If you are a case manager, or providing frontline support to people, and maybe they don't even have a supported employment program, you can still work with them on increasing their physical health so that they can get ready to look for a job and continue to hold it once they're hired by using physical wellness for work. So there are three resources that can be used by different levels and types of people. Taina, did you have anything you wanted to add? I was just gonna say, you know, exactly what you said, you know, there, everyone can use this, the work for wellness is absolutely an amazing tool, and it's free. You know, you can go on to the site, you can download it. And it's so simple to give to the person and work with the person. So at any, you know, given moment of time, the moment that a person expresses an interest for work, you can start with that, you know, in the conversation, you know, with peers, you know, if you if you want to know more, definitely go through those tool sets, you know, at any given level, you know, it can, you can start the process. Thank you so much. We have a question about funding, I guess, perhaps, either for your clinic or more general, you know, are the typical payment models that you're seeing for these, be for service or case rate? And what do you see as kind of the most promising approaches to allow these models and providers to succeed? What's been successful for Baltic Street is the ticket to work. So we've been adopting the model, where we put in our tickets, you know, for the fee for service. So that's what's been successful for us. You know, unfortunately, our ACE program did end at the end of 2017. The contract was terminated. So we then switched over to the tickets work model, which is what's been successful for our organization. But again, starting that if your organization is is not a, an EN, which is an employment network, you're going to see it's going to be a slow process of of tickets coming in for billing, you know, for the fee. So you won't really see a good like amount of tickets coming in, I want to say for towards the organization for payment till the third or fourth year. Thank you for that. And maybe just one more question. I in the when you were talking about the kind of the, the challenges and the things that worked well, you were talking a little bit about what it was like implementing this within a, a peer, a peer organization. Have you had any experience or thought in implementing this sort of program in a community mental health provider that might have a mixture of peers and other clinicians? So, I mean, that's an interesting question, Ben. It wasn't the focus of our work, because we did work with a peer run program. But the tools we talk about and some of the lessons we learned can be adopted and used by traditional programs that don't have any peers working as employment specialists and say to themselves, you know, wow, I'm, I'm not sure I'm going to have any peers working as employment specialists and say to themselves, you know, wow, this might be a good workforce from which to recruit and train employment specialists. Many states have certified peer specialists and the thought that they could become IPS providers and would be willing to and would probably make more money as IPS providers than they can make as peer specialists, I think lends itself to the adoption of peer provision of IPS by traditional supported employment agencies and mental health agencies doing vocational services. Thanks so much. Well, we're just about at time. So I do want to, we'll have to wrap up Q&A. But I do want to let folks know that if there are any topics covered in the webinar that you'd like to discuss with colleagues in the mental health field, you can post a question or comment on SMI Advisor's webinar roundtable topics discussion board. This is an easy way to network and share ideas with other clinicians who participate in the webinar. If you have questions about the webinar or any other topic related to evidence-based care for SMI, you can get an answer within one business day from SMI Advisor's 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's a completely free and confidential service. SMI Advisor offers more evidence-based guidance on peer support as windows of wisdom. Shape your own journey with insights from experienced peers. The video talks about different systems of care, navigating relationships, and establishing boundaries. Access the video by clicking on the link in the chat or by downloading the slides. SMI Advisor will transition to a new online learning portal in May. Your login credits and claimed CME or CE course history will not be affected. In-progress courses will not carry over. You must complete any in-progress courses and claim credit by April 30th. You will not have access to our courses or your account during the transition period from 1150 p.m. on April 29th to 8 a.m. on May 8th. 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 on May 18th as Dr. Benjamin Buck presents Using Digital Health to Connect Young Adults with Early Psychosis to Treatment. Again, this free webinar will be May 18th from 4 to 5 p.m. Eastern Time on Thursday. Thank you so much for joining us. Until next time, take care.

IPS model

supported employment

peer support

physical health promotion

Baltic Street

study results

implementation resources

funding options

Ticket to Work program

peer support in IPS