So good morning, everybody. I wanted to welcome you to today's webinar on peer specialists with OnTrack New York. I am Judith Doberman, Program Manager with the Center for Youth, Mental Health, and Wellbeing at Stanford University, and also the Program Manager for PepNet. Also with us today is Dr. Kate Hardy, who is a Clinical Licensed Psychologist and Clinical Associate Professor at Stanford. Dr. Hardy will be facilitating your questions through the chat. So today's webinar is in partnership with the Clinical Support System Serious Mental Illness Initiative, which is a SAMHSA-funded initiative implemented by the American Psychiatric Association. Okay, and to introduce today's presenters, Danny Sosa is a peer specialist in the OnTrack setting. After being part of the OnTrack program himself, Mr. Sosa decided to contribute the same support and dedication that was shown to him back into the community. He is looking to learn as much as possible from both the present and the approaching future. And we have Abigail Duke with us today, who is a New York State Certified Peer Specialist and the Recovery Specialist and Trainer for the OnTrack New York Initiative through the Center for Practice Innovations. In her role, she offers training and support for OnTrack peer specialists statewide and works as part of the OnTrack central team. So thank you, Danny and Abby, and I turn it over to you. Beautiful. Welcome, everyone. My name is Abigail Duke. We're thrilled to be with you today and just to talk a little bit about the role of peer specialist on a CSE team, specifically the OnTrack New York teams. Today, we are leaving you with sort of three objectives that we're really hopeful for everyone to grasp, which is just understanding what the role of a peer specialist is on OnTrack New York teams, what their focus is and some of the tasks that come along with it. And we're going to learn about Danny's journey from participant to peer specialist and how that that supported him in his wellness. And we're also just going to take a little bit of time to talk about the training as well as the support structure for peer specialists within OnTrack New York. So we're excited to have you with us. I see people introducing themselves in the chat box. It's wonderful to see you all. And please, as you have questions, ask them. We are looking to dedicate a pretty fair amount of time to the Q&A section just because we know there are always a lot of questions about how exactly this work looks. Wonderful. So next slide, please. So we thought we'd start off with the basics. This is the model for OnTrack New York. Those of you who are familiar with the RAISE study will see many similarities. But there's a really, really important addition that makes OnTrack New York unique. And that is the bar for peer support and the understanding that that is really a pivotal way for young people who have been diagnosed with first episode psychosis to find their own path to recovery. And we really think the role of peer specialist is crucial to the experience. And having someone with lived experience who's able to work with someone in a mutual reciprocal way is just a really powerful tool that we think goes beautifully within a coordinated specialty care team. Next slide, please. So people have asked for specific role responsibilities. And at OnTrack New York, we've delivered. We've worked really hard through the OnTrack Central training team to develop a clear outline of the 11 role responsibilities of peer specialists that are some things that all team members take on. But we really try to be mindful of the specific spirit of peer work. And once again, that's mutuality, that's reciprocity, that's taking our lived experience and leading with that understanding that we are just people coming together to support one another, which is one of my favorite things about peer work, just because it really allows us to continue our own journey and to continue growing and changing and learning through our work. So we're supporting participants in doing it. And we're also doing it ourselves and participants are supporting us in that process as well. And so here you'll see all of our role responsibilities, just to get a nice snapshot of that. But what I'm also going to do is I'm going to break it down a little bit. So if we could go to the next slide. These are the role responsibilities of peer specialists in their work with participants. Some of this is pretty self-explanatory, but I'm just going to go through each bullet and just talk for a moment about the way that peer specialists tend to do this work. So outreach and engagement, we really strongly encourage teams to lead with their peer specialist. Peer specialists are frequently the person who is going to visit a new referral who might still be hospitalized, going to a neighborhood coffeehouse to meet someone who's thinking about on track New York. We find that when a peer introduces the team, we're really starting the process off saying this isn't practice as usual. This is something that's really going to hopefully support you in finding your path to wellness. So peer specialists do a fair amount of the outreach work, they partner with the rest of the team to speak about their own experiences to talk about what the role of peer specialist is. But also the peer specialist is just a great engagement tool. They're so frequently texting, reaching out, connecting with people, touching base about missed appointments, checking in to see how they're being served and if there's things that they'd like to change. So the outreach and engagement is something that really lasts throughout a young person's experience. We're really always re-engaging and checking in and seeing if we're doing things the right way. And supporting participants and expressing themselves if things aren't going the way that they want or if they're feeling a little distance. So that is the first one outreach and engagement. The next is relationship building, which all staff members on CSE teams do, of course. But with peer specialists, the relationship is the primary element of her work. That is what we're doing. We're looking to meet people and build relationships with them. And that's really what peer support is, is just building relationships and just ensuring that those relationships are, as much as possible, relationships between equals. We're not meeting with people to tell them what they should do, to have an agenda, to move them forward in any way that they're not comfortable with. We're really trying to build relationships to support someone in figuring out what they would like to do next, how they would like it to look, how they want their support to go. So relationship building, I think, is probably the primary aspect of the work of peer specialists. This next one is something that I think is so crucial on a CSE team within OnTrack New York, is embracing creative narratives. This is, once again, something that all team members do. But as peer specialists, it is so important to us that we support individuals in finding their own understanding of what's happening with them. And sometimes that may align with the rest of the team, and it may be well within the medical model that they identify as having a mental illness, and their diagnosis is supportive of them, and that's how they explain themselves. But for other young people, that might not be it. They might see this as a spiritual experience, a result of their trauma. They might be attuned to things a little bit differently. And as peer specialists, it's so important that we stand by that. The understanding that a young person has on our team about their own mental health, about what brought them to OnTrack New York, we honor that. And that means that if they're not in the room, if we're in a team meeting, if we're in a conversation with their family member, we want to utilize the language and the understanding that they've found. But we also want to introduce new ideas to our participants, and ask them about their understanding and how they came to it, and if they'd like to learn about people who might understand things a little bit differently. So I think that this is really a crucial element of peer support, a foundational element, is that we are aligning with the understanding of the person next to us. And that's what we want to carry through. So I think that's one of the things that's a little bit different about our work, is we don't need to identify someone as their diagnosis. We don't need to talk about their mental health, if that's not what's interesting to them. We're really there to support them in making meaning of their experiences, whatever that might be. So that's just, just something we feel so strongly about. And we spend a lot of our peer support calls talking about that. And the next one is co-creating tools for success. I think wellness and wellness tools and strategies are something that all people benefit from having. I think in our current world, with everything that's going on, finding tools and strategies for success has become more important to all people, even those living without a mental health diagnosis. But we've been, we've been doing this for a while at our end. So just supporting people in trying new things, in exploring what makes them feel good, in learning about tools that can really help them on the treatment end. Personal medicine is something we talk a lot about. Supporting people in decision making processes, shared decision making is a huge part of OnTrack New York. And we really want to partner with people to find what's going to bring them success. And that might be, you know, finding a local hobby shop that does Dungeons and Dragons nights. You know, that might be a faith community, that might be a self help book. We really want to maintain that flexibility and support people in finding whatever it is that's going to lead them to the life that they'd like to have. So our next role is with participants, but it's also outside of participants, because we're supporting and we're partnering with family members. And just something to touch on really briefly about this role in peer specialists. Frequently, when a young person comes to a CSE team, when they come to OnTrack New York, they are coming from hospital, they're coming from really intensive services. And families sometimes get this messaging that things aren't good, that things have changed forever. And it's almost it's a mourning process, mourning the the child that you had the life that you had expected for them. And what we want to do as peer specialists is we want to like shake that off a little bit, and, and support people in seeing that recovery is possible, that wellness is possible for all people. And, and allowing them to ask us questions about our experiences to talk about the things that we have overcome, using our lived experience to offer hope, not only for participants, but for their entire community of support. So that's a really powerful piece of our work. And the next is bridge building. And it's sort of I like to talk about it as being two bridges. So as peer specialists, we're regularly bridging participants with the rest of our team. Because our relationship looks different, because we're bringing in different principles of support, we will form different relationships than the rest of our team members will. And a huge part of our work ends up being bringing it back to the team. So whether it's supporting a participant in figuring out how to share something they told us with the rest of the team, whether it is doing a joint session, bringing people together, using collaborative documentation to really capture what our experiences with participants are and share that back to the team. And then the other bridge is between the participant and their community. OnTrack New York is a time limited program, we really want to make sure that people are understanding that the support they're getting from the team now, that there's things out in the world that can offer that support. So connecting to peer support resources, connecting to communities of faith to any any part of their identity that they really are interested in learning more about, we want to find resources in the community, we want to find places that are welcoming to people. And we want to bridge that gap between participants and the things they'd like to do in the community. And group facilitation is a really exciting piece of work, because I think it's something that we as peer staff have been doing for a really long time. Peer support groups are the classic. But we also have peer specialists having video game groups, doing outings, going on walking groups, taking opportunities to to bring people together to introduce new things. But I also want to talk a little bit about groups that aren't run by peers. Peer specialists can be really, really helpful in the running of clinical groups as well. They can occasionally be co facilitators and offer different perspectives. But they also can sit in on groups, learn alongside with participants, talk about their own experience in that way. Just one moment, excuse me. And then the final one is ongoing community building. The community that we're looking to build as peer specialists is between participants. Sometimes a part of receiving a diagnosis as a young person includes feeling really isolated, really lonely, like you are the only person who is going through this. And in our work, we want to support people in seeing that that's not true, that there is a community of support, that there are other people who might have had similar experiences, who might walk through the world in a similar way. So we want to encourage people to build that community, to plan potlucks, to host graduations when people move on from teams, to do things together that just let us feel like normal people in the world. Not like mental health patients, but just like young adults. And I think that that's a really important piece of the role of peer specialist is it shows that you don't necessarily have to take the expectations that other people have put on you because of your own diagnosis or your own experience in the mental health system, that you can really make the life that you want for yourself. And we really like to lead with that. And we also want to encourage people to So I've seen some questions coming in. We're going to take a ton of time for Q&A. So I really appreciate how involved you all are. Um, but next slide, please. And then we also have role responsibilities that aren't just working with participants. And that's something that's a little bit unique to peer specialist, is we have role responsibilities that are just about our work with the team. Um, and it's, it's challenging, and it's interesting, but our approach, our perspective, it can sometimes look so different than a clinical approach, that a big piece of our work ends up influencing the culture of our team, and how people view those diagnosed with mental health conditions, how people think about recovery and wellness and the possibilities. So we really work to influence team culture, just by being there. And by being advocates and by speaking up about our own experiences about how things made us feel about things that served us and maybe didn't serve us in our own experiences. Um, and again, this is that the way that we hold space for participants when they're not present. We're making sure that even if they aren't there, we are always speaking about them in the language they use about themselves in a way that is respectful in a way that that sees them as whole people, that holistic view of someone as, yes, a participant of an OnTrack New York team, but also as a son, a sibling, a parent, a friend, a community member. We really want to make sure that we are always seeing the whole person. And in doing that, that can shift the way our team thinks about things. That can sort of take people who only see the participant through that clinical lens, who's just meeting with them to talk about goals to help them move forward. We're sort of offering this this other side of it that richens the image of the person that allows us to see them more completely. This next one is team communication and collaboration. And it's a role responsibility, but it's also just a way to support the way that we influence team culture and by really connecting with our team members to share about our perspectives, to learn about theirs, to find that productive synergy that comes out when two people with different approaches collaborate. And that can really be through a number of things, just casual conversations with co-workers, scheduling joint sessions, particularly in that bridge building role responsibility. If you have a strong relationship with someone who's just not that connected to the supported education and employment staff, if they're not that connected with the C's, but are really passionate about going back to school, the peer specialist in the C's can have a joint session and can talk through it. And the peer specialist can sometimes be an active member, but sometimes we might just be there to support the participant and feeling comfortable to remind them and say, oh, this came up when we were talking just to be a conduit for the process. And then lastly, something that's so important for for peer specialists specifically is ongoing professional development and we wrote it in as a role responsibility because the expectation is that peer specialists on OnTrackNY teams will have access to an opportunity to continue learning. Because our role is not connected to higher education, to degrees, because we do all go through the certification process. We're in New York State, so we have a pretty robust certification process with a lot of education, but it's limited and you do those courses and there's so much more to learn. So we really strongly encourage peer specialists to attend trainings, conferences, webinars, and to learn about the work in the mental health system and to learn about the work in the community, to have these opportunities to grow. We acknowledge that we're a relatively new position sort of considering everything and that in order to keep our workforce growing and developing, we want to keep learning and growing ourselves. So we've included that as a role responsibility. And so I see a couple of questions. We will definitely be getting back to this in the Q&A, but this is just like a little peek into the 11 role responsibilities of peer specialists on OnTrackNY. To learn a little bit about what it looks like on the ground. We're going to move on to Danny now. Thank you. Thank you. Hi. How you doing, guys. Uh, yes, this is about, I think there should be one more to this. I apologize. I jumped the gun. I had one more slide. I'm so sorry, everyone. So our next slide is peer specialists and the team. We really want to talk about sort of The role of how we do this collaborative work, how we influence culture. And one of the things I wanted to highlight is the That productive synergy we talked about and how peer specialists collaborate with their team members. So the first team member, we want to talk about is is really the one we have been talking about the most important member of the team. That's the participant. Our job is to partner with them to align with them to work together with them and to support them in identifying what they would like their life to be and how their time with OnTrackNY can support them in that. Next. And the next one is family, which we really have talked about a bit. Um, we think it's so important as a time limited program to Continue to offer support and education for the entire community and the family, family of choice, friends, community members, all of that's included. We count them as team members because They're the ones who are going to be in that support position. Once we are no longer in the participants life. So it's really important that we partner with them as well. Next. The team leader, the team leader is such a crucial role on the team. They're really guide the the culture of the team, the work of the team, the The team as a whole. So partnering with a team leader is tremendously important and team leaders having awareness of the role of peer specialists, what your specialists do what they don't do How it looks all of that is so crucial and in OnTrackNY the team leader is also the supervisor. Um, so we'll talk about that a little bit later on, but really making sure that team leaders have resources and support in order to then support the role of peer specialist Next. So the psychiatric care provider. This can be a psychiatrist. This can be a nurse practitioner and We want to collaborate with them. We want to work together. There is this myth out there that peer specialists should not talk about medication. Incorrect. Talking about medication is such a great part of our work, because when we're connecting with someone about medication, we're not carrying with us what the psychiatric care provider has. We're not carrying that level of expertise. We're only there to support a young person in identifying what plan they would like, how medication could potentially support them, what side effects might impact their lives. When we're talking with someone, we don't have an agenda, but we are available to utilize tools to support them in the decision-making process, and then to support the psychiatric care provider, to make sure that everybody's communicating and keeping it, using that shared decision-making to guide the process. Next. So, the supported employment and education specialist, the SEES, this is the other non-clinical role on the team, so I feel like there's always such a strong relationship between the SEES and the peer specialist. It just so happens they frequently share offices. They do a lot of great work together. Just by being people who identify as having lived experience and working, we are already a tool for SEES to use, because we can talk about our journey. We can talk about our own educational or employment journey, what helped us and what didn't, and we can share about the resources that supported us as well. Next. The PC, the primary clinician, this is the therapist on our team, and once again, a great opportunity for collaboration. If someone is working with our primary clinician, and they've identified that, mindfulness might be really helpful. We can then, you know, go to a meditation group with a participant. We can go to a yoga class. We can practice in the park. We can sort of take those ideas that are discussed in sessions, and we can bring them into practice. Next. Outreach and recruitment coordinator. I spoke a little bit at the beginning about outreach and engagement, which is just such a powerful way for peer specialists to collaborate. So the ORC on the team, partnering with the peer specialist to learn about peer resources in the community to do outreach work to, to bring them into more clinical settings to talk about the role of peer specialist. All of these are great collaborations. And then, finally, we have our wellness nurse, which is another part-time position on the team. And this tends to be a little bit more about, like, physical health. So maybe their goal is to increase activity. We can go to the gym. If their goal is to introduce more fruits and veggies into their diet, you know, we could potentially go to the grocery store. We can talk about our own experiences with nutrition. We really can use our lived experience and our mutual support to partner with all of the team members. Excellent. So now I'm going to hand it off to Danny. My apologies for that. Thank you. Hi, guys. I'm Danny. This is pretty much my experience leading to me becoming a peer specialist, and also kind of what I do either day-to-day or also on a broader scale. So kind of my story starts as that I was a member of an OnTrack. I was a participant in an OnTrack team. I was there for around two years, a little bit more than two years. And my time at the program was coming to an end. And I kind of wanted, when I started coming into the program every week, I kind of wanted to learn more about what was going on. I never really had any experience like this before. I never really, I didn't know how to explain how my outlook on life was different. I thought recovery back then meant I was going to learn an answer to what happened and that would fix it. And then slowly I had to learn that it was more about, I had to almost attain vocabulary that kind of understood what was going to happen if this ever happened again. I've luckily only experienced an episode once or an experience once, but it's always something that I have to work on. And slowly that helped me understand how not only lucky that I am, how fortunate I am, but how much I could help somebody that is less fortunate. So eventually the program came to an end and I had a discussion with my mother and she told me that one of the things that she wanted for me was, she wanted me to at least try to become more active in my life. I had a job, but it was a supermarket job and it wasn't that it was bad, but it felt that it wasn't the right fit for me. I don't really do sales well. I don't really pitch myself that well. So she was, maybe you can get something in electronics or computers or even just anything, just like, just try it out and ask if there are any opportunities. And so I did. I texted my C's. I still remember going down to the bus stop before going to work and texting, like, I don't want to, nothing important, but I just kind of want to talk a little bit and ask a question, nothing too serious. And he told me to come in and stuff like that. And we had a relationship. We had about, ever since he came, it had to be like a year that he was a new C's. And we would have conversations, when I got the job, kind of, what does it feel like? How important is it just to have a minimum wage job? What can I learn from it? I became more outgoing. I started talking to people, starting easier to have conversations. And then eventually we led to the big question is like, you know, is there, are there any jobs out there that I can do that are better than working at a supermarket? And he said there was. So he talked to me about the peer position and he felt that it was something that I could do. He felt that it was something that it would be a good opportunity for me and it would be a good fit just the way, the way I kind of am, the way I kind of analyze a lot of the stuff that was going on. And I accepted. And I said, you know, it sounds like a good fit and I feel like I can do it. And he sent me on my way. Could you change to the next slide, please? So I interviewed, I got the job. I went to, through a three month training program and I also did the, the online, online qualifications and I got my certificate. For the, for the first couple of weeks, couple of days, I kind of didn't know exactly what the work would entail. I had an idea, a faint understanding of like, I would talk to people and I would tell them something and maybe that would, maybe that would like motivate them or something or, or like give hope, but didn't know exactly what that meant. But one of the things that I, I remember very vividly was when I was having my interview, the question about, about what, what are like, what are my interests? Like what, what am I really like passionate about? And one of the things that came up was video games. And before this, there was no, no video game group or anything like that. So we were talking, it took about three or four weeks really talking about like, what would that entail? How would we do it? What, what could we get? Like, is it like, is it expensive? Is it hard to understand? Like are people interested in this? Do they already like, they're like, already have a computer at home and I don't really want to play video games in this place because like, it's not my kind of style and stuff like that. So we had a lot of conversations and finally we settled on, on a switch, which is a kind of like a, a very easy to understand project or project game system that like you can easily pick up and, you know, just press a couple of buttons and something happens and pretty colors come out. And so that started, what was there before I got there was a young adult group. I am the first peer of my program, so they never, they never saw my position in work and action. And they, I think we're also new to the experience. So I, I went to that group, I started the video game group and, and I also, I got to be in the meetings and also in the beginning I was, was trying to get as many experiences with different participants in different stages. So right when they're in the beginning, when they're middle and sadly when they have to graduate and leave the program. And then I also, along with, with these kinds of webinars and other conversations was part of outreach, you know, trying to find out what the community thinks about, you know, the program. So pretty much that's kind of the broadest way to kind of explain what was going on in the first couple of, of, of days on it. And then slowly as, as time moved on, I had to specify it. I had to become more aware of the small details of what exactly do I do when somebody talks to me for the first time or how, how do I engage with somebody that doesn't want to do anything with me, like they don't want to talk. And and that's kind of what my day to day is. It's how to, I prepare for like pretty much five minutes of conversation. That takes me a couple of not days, but it takes me a couple of like tries to try to not get it right, but kind of understand what are, what's actually going on when I'm, when I'm speaking to somebody. Could you move to the next slide? Thank you. So this is some events that were going on. Some of these events were already there before I got here. Some of them are, are new. So the, the talent show was something that was running before I got there. I think it's one of our, to me, it's, it's probably my favorite thing that I've seen. I, I, I know it's very cliche, but it is very amazing to see that everybody has a talent. I've seen things that I, I would normally pay for, like it is, it is so transformative. I'll just use the word as plainly as I can. And it really affects me. You know, it, it's, it's amazing to hear people sing. It's amazing to hear people express themselves artistically and every iteration that there is. And, and these kinds of things I think are important because as much as I like talking, I know somebody likes singing. And then as much as I don't like dancing, I know somebody doesn't like to draw. And these things are good to show and these things are good to share with each other because they make us more, more, more connected. And I definitely do believe that. So going on the, the family night and the presentations, these are there to continue to make connections with family members. A lot of times parents want to get this over with. They want to, you know, they want to just forget about this time. They don't even really want to like kind of almost have the conversation because it, I, I've seen it in my mom's eyes and, and my father, when, when, when, when he helped me was that, that it's, it's so hard to understand somebody that they themselves feel that they're alone. Like Abby said in the beginning, it's just so hard to make that connection and, and, and hopefully these family nights and these presentations better explain exactly what's going on and what, what not only is the program trying to do, but what is, what is the participant trying to do? Like, I know some people really want to leave where they are right now. And sometimes it's because of their family dynamic. And sometimes it's just because they want a fresh start. And those kinds of conversations are very, are very important to support. And we, we hope that, you know, when we hold our family nights and their presentations, we give both the family members and the, we both give the family members and the participants as many tools as possible to have that conversation as healthy as possible. So the holiday party was something that was new. We we figured it was around the time of the season and the new year was coming up. And this, we held it two times already, last time being last December. And I think, I think it's a big hit. I have a lot of fun with it. The first time we did it, we did a banana dance. It was one of like a YouTube video kind of thing. It was pretty fun to be a part of that. There's a video going around. There is also the second year was we, we, we looked at what happened the first year and we see what we can improve. We added an ugly sweater contest. That was also pretty nice to do. And we have like a little kind of presentation with all the other ugly sweaters. We have our prizes. I believe there was one like an Echo Dot. There was another one that was like even like Pez dispensers, you know, for participating and being creative and being a part of the event. So that's, that's a lot of fun. And I think, I think I look forward to, to holding the next holiday parties. Pizza and game night. That was one of a very good thing that. that I get to be a part of. So game night is usually board games and I have a passion for gaming and video games and physical games. So I get to see people play Pictionary and I get to see people be frustrated that no one gets their drawing and their stick figures are poorly made. But it is a lot of fun. And it is a lot of times that I see the parts that I don't normally get to see of somebody. The pride of getting something right, the pride of connecting, of having fun, of teasing somebody, of telling them, oh, like, you know, better luck next time and stuff like that. And those kinds of things really fortify the connections more than usual. And we have them three times a year. And I think every time I look forward to it, I don't think there's been a moment that I wish I could fix. Movie night, that was a new thing. One of the things is I really like movies and movies themselves helped me. It wasn't the movies, to be honest with you. It wasn't the quality of movies. I do enjoy watching the movie anytime in almost any movie, but it was more about the company when I was doing it by myself. And I think going out to the movies, getting the popcorn, talking about what you like, what you don't like, what you wanna see, beautiful effects and all that stuff, I think that itself is valuable. And I don't think we hold movie nights because we wanna see the best movies. We hold movie nights because we want to see people come and have a good time. And I definitely do think that that does happen. Next slide, please. So these are the daily routines. Like I talked about earlier, these are more like specific kind of things that go on kind of beyond just like, we are gonna hold a movie night in a week or two. So review, one of the things I do firmly believe is that I try to get better at my job, but also I try to be better as a person going through this experience. So I figure I have a week to understand what changed. It doesn't have to be a big change, but it does have to be, to me, a review about what happened and what I could learn from it. Recently, I felt that I needed to be more outgoing. I am a very introverted person and I like to think a lot and talk a lot, but it's very much only on one way. And I very much enjoy seeing the people that can hold conversations that bring out somebody's personality. And those are the things that I'm working on. And that's happening on a constant daily basis. And that's happening in a way that I feel is productive to not only myself, but everybody involved. Communication, there is, to me, there doesn't need to be, but there is a very large part of being a peer is seeing what other peers do. Because there are some things that I am not good at. I remember my very first time I went to a group, I believe it was the first or second time, the trainer or the person that was leading the group and was gonna set an example of how what I was gonna do with the group said that he, I have heard conversations about him that he was like the best group leader of peers that anyone's ever seen and stuff like that. But what he said really astounded me, which was that he just tries stuff because it feels right. And when it doesn't feel right, it's because he tried it a second time. And that doesn't mean it was a failure. It was something that he learned, he learned from it. And if he could learn something, I figured I can learn something. Even if it's just to barely grasp the level of that kind of communication. So I think it's really important. And I've met other peers and the stuff they do is amazing. When I meet new peers, when they have the same questions that I have, I think that's amazing also because I get to tell them what I learned, but also I get to learn what is the new idea? What are people being taught and what peers are? Other roles, it's important to really talk to the other team members. And I also, I feel like I am very privileged to talk to other team members as not a participant. So I get to ask the questions that I could never ask before. I get to see behind, I said before, the curtain. I get to see what the wizard looks like. And it's definitely a good conversation to have. And also they get to see what I am like. Like I am very guarded. Like it's one of, if we had my therapist here, she would say that I am. And it's very hard to even squeeze sweat over that rock. But I am very forthcoming with what I think. And I think it's important to be a peer that way. I think it's important to be a peer that is honest and is as helpful as possible because I am here for the participant. I am not here for me. I have my own path and that path is being helped by my own therapist and my own family and support and stuff like that. And I feel that together is better than me a little bit on top and somebody going, like that to me, it just feels like a conflict and I'm not interested in those kinds of things. Family, I enjoy definitely talking to family members because I get to pretty much see my mother and my father in every one of their faces. And I think it's important. It's important to hear a mother say, like, I don't know what's going on and I don't know what to do. And I really need to stress that, that even hearing those words coming from my mother was important to me and it made her human. It made me understand that she is trying to help. It's just that she liked the tools at that time. And more than anything that just wanting to help is sometimes enough. And sometimes you have to work on that. Next slide, please. Schedule updates. These are pretty much even more minutiae. Individual meetings. I do have one-on-ones. Sometimes they last three weeks, like once a week. Sometimes they can last sporadically, like one time every month. They're important. I think eventually all these, like, you know, the fun activities and stuff like that is important, but eventually you have to go down to the nitty gritty and you have to talk about medication. You know, what do I think about it? My usual response is I do think about it. It did help me, but I don't think that somebody that does not want to take medications is in the wrong. I think they need to express that. I think it's important. And I think the best way to be at it is with honesty. I really want them to feel that they're in a safe place because living with that kind of pressure, that feeling that you're doing something wrong, even though you feel that you don't have any other option is pretty torturous. And I would not, I've lived through that life and that's kind of an experience that I wouldn't wish on anybody. So the next point is future events. As a peer, I want to leave the best possible way for the next peer to do something. I want to give them, like, all the tools. Maybe they're not going to be interested in video games. Maybe they're not going to be interested in movie night, but maybe they're going to be interested in painting. Maybe they're going to be interesting in group sharing and meditation. Any of those things, I have very interest. I sometimes, I enjoy meditation. Sometimes I can just do five minutes and that's enough for me. But all these kinds of things are important. And maybe one day I am going to become very outgoing and pull people in and stuff like that. But I think it's very important to always maintain that kind of consistency and also progress. And then the final one, updating groups and maintenance. These groups, sometimes they're the best thing that ever happened. And other times they're kind of a daily occurrence. And I think we have to find what's good and keep working at it and what's bad and trying to not fix it, but trying to see why didn't it work? And trying to see how can we make it work? Is it worth it? And stuff like that. And I think it's important. I do think it's important to continue to iterate and to continue to seek perfection. Not for perfection, but for feeling that we could do a better job. And I do think we do. Can you go to the next slide? And this one is one of the things that was apparent, but I didn't really focus on it a lot is demographics. Kind of like what does it look like at the people that I see? And it's the two ones that I do want to highlight is most of them are males. 75% and 27% females. And most of them, the average age is 21 years old. When I was part of the program, I was 24, 25, and I was a male. And I feel that it's very easy to me to see myself in every one of the participant's faces. And when I don't, I do have to be aware of that. I do have to be aware that there's other experiences that, sadly, I can never fully understand. And that kind of work, to me, is important. Because my story is only one of many. And I think my job as a peer is to highlight not only my story, but the story of the neighbor, of the person that comes in, of the participant that doesn't want anything to do with us and just wants to come in once every month. And I think both of our stories is important. And I think both of our stories should be supported and furthered. So I think that's my last slide. Thank you for your time. Thank you. If you wouldn't mind, Judith, just going back to that last slide for one moment, I apologize. And I also just want to highlight, you'll sort of see that our OnTrack New York teams within our demographics, we have a lot of diversity. And at times, we have teams that represent a diversity of intersecting identities that might not be parallel to that of the peer specialist. And I do just think it's really important for us to mention. And we work diligently to include social justice in our conversations, to talk about the way that each participant's many identities that they carry with them impact them, not just their mental health diagnosis. But looking at them, and it all goes back to that holistic approach, but acknowledging also that we might not always be a peer to them. Um, and then knowing about resources in the community that we can connect them to, I'm getting ahead of myself, I've been reading some of the chat questions, but thinking about the LGBTQIA plus community, if that's not an identity that is held by the peer specialist, how we can ensure that we're offering participants access to support in the community to peer support, creating pathways to understand that to be a peer specialist isn't necessarily the same as to be a peer, we might not always have these shared lived experiences. And just knowing that knowing our blind spots and knowing how we can support people in connecting to the various parts of their identity and how they would feel how they see themselves and how they want their support to look. Um, so now we can move to the next slide. And we'll also if there's more questions, we're happy to highlight, I'm going to fly through this, just to make people aware, sometimes peer specialists are just one person on a team working independently. In OnTrack New York, we work really hard to create a community of support for peer specialists. And that comes through my position and my team at OnTrack Central. So every peer specialist on our 23 teams statewide will have collaborative calls with other peer specialists, doing the same work on other teams. And we're very fortunate that OnTrack Central we have Dr. Pat Deegan as a consultant. So she joins those calls and helps to sort of hold us accountable, keep us honest, make sure that we're really staying here in our work that we're we're doing the work that that we were meant to do that we're not sort of shifting into clinical thinking or talking about assessing people or labeling people that we're really maintaining that peers. And we also have a great tool called OnTrack Maps, which I meant to highlight in the role responsibility, my apologies. And so we also have calls dedicated just to OnTrack Maps, just to talk about this tool that we use. The whole team has care consultation calls, where they bring up tricky participants, things that they're, the team is struggling with something and they're not sure what to do, they can turn to this collective knowledge of all the teams statewide and have these collaborative discussions. Team leaders also have support around the role of peer specialists, because they're supervising peer specialists and might not necessarily have that lived experience themselves or that awareness of what a peer specialist does. So Dr. Pat Deegan joins those as well. And we just support team leaders and understanding the work and understanding supervision and understanding what looks a little different. We also offer regular trainings and webinars and create learning communities to come together and learn together. So I just want to highlight that because I do think that that's something that has, isn't always the case. For myself, I worked as a peer specialist for almost 10 years, and very rarely had a professional circle of support. I could find my own, but it wasn't just a part of the job. And I think it's just something so wonderful about OnTrack New York. Next. And then very last, I just wanted to share a little snippet of a tool that we use, which is the OnTrack New York Peer Specialist Supervision Checklist. Acknowledging that our team leaders are not peer specialists, that they might not be familiar with it, we did create sort of a guidance document, a checklist that team leaders and peer specialists can use to make sure that supervision is serving them. Because if you're a peer specialist doing peer-focused work and receiving clinical supervision, like it's not going to match. So we really want to make sure that team leaders and peer specialists have this support. And we chose a little excerpt of it just to show about remaining peer, because that's a true tension in the work, is to be the only voice of peer specialists among many clinical, academic, our team members who have so much expertise and knowledge. We want to make sure that we're honoring our own expertise as well, which is that lived experience. Great. Next. Just in case you're interested, a couple of support sites. OnTrackNewYork.org will give you lots of information about the OnTrack New York team's practice innovations. We are hosted through the Center for Practice Innovations. And this website is just offered to many, many, many educational resources. And then I've talked a little bit about Dr. Pat Deegan. We're huge fans of her over at OnTrack New York. And as a part of our contract is we're able to offer recovery library access to our teams and to our participants. So it's just a wonderful resource. All of these, you'll find videos, you'll find manuals, you'll find reading. They're just a great place to go for some extra information. And now we will go to the Q&A portion of today's presentation. Thanks, Judith. And thank you, Abby and Danny. That was absolutely phenomenal. And I'm not sure I've ever seen quite so many questions come in. I am a complete Luddite and cannot copy and paste. So I've been furiously writing and I have run out of paper. There's that many questions. So it's also just chatting with Judith about whether we can get some of these questions, maybe written answers from you guys, because I don't want to leave people feeling super frustrated. There's nothing worse than that. One very practical question, Abby, how do we get hold of that peer supervision list that you just mentioned? Let me follow up with my office and see if we're able to share widely. If so, I'll be able to email, I'll share it with Judith and Kate and they can send it out. That would be awesome. Thank you. And then the question, Danny, was around how does the rest of the team accept different perspectives from participants with maybe a different world view? It seems to be that was something that was really emphasized from both you and Abby. How do we support the team to do that? I think the best part about it is that I'm part of the team meetings. And I think that's where, and also the group care calls are pretty good places to kind of have that discussion. But if there's a specific, not problem, but if there's a specific viewpoint that is hard to either understand or hard to put into words, that's kind of where I can go in into either a one-on-one meeting or stuff like that. Most of it is updates. So, thankfully, I'm part of most groups, if not all groups that the program offers. So, I get to be well acquainted with people and people get to be well acquainted with me. And if they ever have, I guess the role of the peer in that part would be I am the most easiest to kind of discuss things because I don't, like Abby said, I don't have an agenda. I can't give you medical advice. I can't give you like a prescription. So, I can only tell you about what I think and also what worked for me and what didn't. And hopefully that itself makes a connection. And if ever somebody really wants to kind of say no very firmly, it is within my ability to say what that feels like, what that pressure to just say no. Because I think that's one of the things that is hard about being a peer is that you very much want to prevent somebody from feeling that they have no one to listen to. Like no one can listen to them. No one hears them. And I think the very almost a golden rule of a peer would be like you are the ears. You are the first ears. Like sometimes you're the last ears, but you are the ears. And you try to really as softly as possible introduce those kinds of viewpoints to other people and to not only give the original voice, the participant, you know, power. You know, it is within their rights. Part of the shared decision making is that it is a conversation. We can't force you to take this medication. Sometimes the medication is just like a habit. It's not even, like it doesn't clear anything. Like it won't change your address. It won't get a job for you. It's just one of many tools that the program offers. Absolutely. And I just want to sort of second that and say the work of peer specialists, particularly in New York State, is born out of advocacy. And I think we all consider ourselves to be advocates for ourselves, but also for participants. So when being the ears doesn't work, sometimes we'll be the mouth too. And even just little things, like if you hear someone use language that we're not in support of, we will then rephrase it and use it with our language or with the language of the participant. We will remind people, just gentle reminders. Oh, you know, it might be an opportunity to say, like, don't forget, like these are the pronouns that we need to use. And this is the understanding that they have. And when we're in team meeting, I think it would serve us all to make sure we're using the language of the participant. And just really reminding people. And the fact that it's in our job description that we're influencing team culture has left space for us to advocate as needed. Gently when possible, but sometimes, yeah, we do. We have to challenge things. That's why we're there. So it's important that we support each other as peers so we have the confidence to then walk into a room and make sure that we're holding that space. Fantastic. Thank you. And there were quite a few questions about training and training opportunities outside of OnTrack New York, certification process, and sort of summarizing a few different questions here. Could you speak a little bit to that? So we are from New York State. We live in New York. New York has a super robust training program through the Academy of Peer Support that we fortunately, all OnTrack New York peer specialists are required to become certified within a year of starting their job. So not every, you don't have to be certified to be hired, but there is an expectation you'll go through the certification process, which includes 13 online classes and modules that you take, as well as a reference process. So that's a pretty big thing in New York State. And then we do a fair amount of training through OnTrack New York, but we also just, we try to stay connected. We have a great peer run agency in New York State, which is Niaparas, and when they have free trainings, we attend. One of our teams was, the entire team was agency, all their peer staff were trained in intentional peer support, and that's wonderful. Many of our peer specialists are trained in wellness recovery action plans through the Copeland Center. So there are these wonderful trainings that are available to all peer specialists, but we do happen to be fortunate enough to live in New York State, which has a really well-developed peer specialist credentialing process. And do you know if that's in any way available to people outside of New York State? That's a great question. It's the academyofpeerservices.org. I would say it's worth a visit if you're an out-of-stater to see what's available to you, because I will say they also have a number of elective courses that aren't required for certification, and I think we all, all of us at On Track New York, we frequently are checking in and taking new classes on there, so that's definitely a great free resource for us. Awesome, thank you. Danny, there was a lot of excitement and questions around the different events that you talked through, and so a couple of things around that. First of all, are they attended by clinical staff on the team? Who organizes them? How frequently are they happening? Where do you get funding for, from, for that? And how do you choose the movie? Okay, so a lot of questions. Okay, so for the, for the movie, I technically have final say, but I do try to bring as much participants in, but there is a clinician that goes with me, our team leader. She comes with me and sometimes other clinicians. I just, I feel like it's also a good opportunity to see the doctor at the office. Like, I feel like it's, it's good for, for, for like, to like, to, to introduce everybody to, you know, movie night. Like I said, it's not really about the movie. Like, I don't, like, I do have one request from my team leader usually that we can at least see one romantic movie a year maybe, and I do, I do try to hold that to that. It's just that sometimes I don't think people are interested in it, but it is in good fun. For the other parts, we are lucky to be grant funded, and there, there is an opportunity in our budget. Most of it, if not all of it, goes with the team leader. The team leader pretty much has an idea and, and we give her our, our, our two cents. And that's one of the good things about my team is that we have been very willing to try out new things. Like, the holiday party was pretty much an idea that came out of the blue because we noticed that it was a good slot to use at the time. So, all these events are usually attended by, by, by the staff, by clinicians. And I think it's a, I think it's important because they get to ask questions and they also, they also sometimes don't know kind of like what I do because there's not that much of me going around. Like, there's, there's, there's me in the team. And like I said, I was the first one, so there's not much history to develop. And I hope that that changes one day. I do hope that there's, there's not every, everybody's a peer, but very much everybody's aware of what a peer does and what we can offer and what we can contribute. Was there a question I missed? That was a lot. I think you did awesome there. Well done. It was like a memory test for you. Thank you. I have a question to both of you, I guess, to jump in either way. So how is, how is SHED within the team building a relationship within a framework that a peer specialist has participated in developing? What does SHED decision-making actually look like? Kind of a couple of questions in that. Yeah. So I'll start on that because I will say something that does make OnTrack New York a little different than other CSE teams is that we do have OnTrack Central, which is the training and support people who, and the fidelity structure for OnTrack New York, which really makes sure that all the teams are working within the values of OnTrack New York. And shared decision-making is a key part of that. So we're training the entire team from the beginning on not just their role, but on the role of all the team members on how shared decision making works on all, we're offering tools for support. It's, it's not a choice. It is a voluntary, it is a mandatory part of our program that if you're going to work for an OnTrack New York team, that you are going to participate in shared decision-making. It really is just an expectation. But I mean, let's, let's be truthful. There are still tensions in the role. Just by sitting at the table as a person with lived experience, we are challenging the power structure of traditional mental health. And that's complicated. And I do think that we're fortunate because in order to the, the staff who, the colleagues that we have, our team members, they chose to work in OnTrack New York, which is a progressive and unique type of program. So there is, I do think that we have it a little bit easier in that way is that people are getting really thoroughly trained and educated on the recovery model, on shared decision-making, on the role of the peer specialist within the team. But those, those power differential, they, they exist. And I'm not going to do anybody any favors by just smiling and saying like, oh no, we're great. We don't have that struggle. That is a struggle for all peer staff all over, I think. And we challenge it every day by showing up and doing our best and really fighting for and alongside our participants. But it, sometimes we have to call things out and name them and turn to each other for support and supporting each other as peer specialists, but then also utilizing that power structure and making sure that, that we are communicating with our team leaders about it, that team leaders are holding responsibility for the inclusion of peer specialists and thinking. But yeah, I don't have a great answer, but just to know that we're aware of it and we talk about it a lot. And I think that's the first step is really bringing it out and saying, how can we make sure that people understand that the expertise of all team members is honored? And that expertise includes that of the participant as well. So it is a parallel process. The relationship with the peer specialist in the team, the relationship or the attitude towards the participant, it all sort of flows together. So we just, we call things out as we see them. We work really hard to be transparent and to talk about the power structure, even within our own relationships. Like we are not friends with participants. Friends don't get paid to hang out with you. Friends don't write notes about each other. So we really do want to highlight the power imbalance when it exists, just in the spirit of transparency, which is a huge part of our work. Awesome. Thank you. And I want to be mindful of time, but there's still so many questions. So I think we will try and get a couple of written answers for you guys, but I kind of wanted to finish up on this one, Danny, which was what's been the most rewarding element of the position and what has been the most challenging? Rewarding. I definitely remember the first time I felt that I made a difference, which was we were having a youth group and one member took the lead. I think I think having a participant almost do my job and even do my job better. I think that that was amazing to me because I think that that's what it is. Cause when I was part of OnTrack, there was no peer for me. When I left, there was a peer coming in and I would have loved that. I think that's, that's the difficulty is that, you know, there's so few of us, you know, that's, that's what's hard about it. Like I would love to have a library of just every single peer that's ever, you know, worked for OnTrack and what of our techniques, what of our thoughts, what of our ideas. And I, I hope, I hope this webinar is that. I hope, I hope I, I contribute to the knowledge of what a peer is and I might be wrong on some things. I might be right, but I am definitely looking for the future of a peer. One, one day I might, I might leave the position, but I definitely want to feel like I contributed to, to, to, to our ideology that, that we matter, you know, our, our experiences matter. And one of the reasons why I wanted to give back is that OnTrack honestly helped me and they needed a peer, you know, and I, I can be a peer. So I stepped up and I, I definitely think those those kinds of experiences are worth highlighting. And, you know, the people that helped me the most are the people that didn't have training. You know, they weren't, they weren't doctors. They didn't know about medication. It was my mom, my dad, my uncle, a random stranger that said something, you know, those, those are the things that helped me. It's not, it's not, you know, it's not a, a, a single sentence. It's, it's an experience. So, yeah. Brilliant. Thank you so much. And thank you to you both, Abigail, Danny. It's been absolutely fantastic. Such a critical role, much needed and much needed. We need more. And as we see from all of these questions, great conversation to be having as well. So I can imagine we will be continuing this conversation down the line, but thank you so much for your time. And thanks to everyone who joined, tuned in today and participated and provided comments and questions. So thank you, everybody.

digital mental health

serious mental illness

implementation

barriers

facilitators

Consolidated Framework for Implementation Research

interventions

privacy and security concerns

peer specialists

OnTrack New York program

role responsibilities

participant advocacy

shared decision-making

community-building events

challenges faced by peer specialists

power dynamics in mental health systems

positive impact