Hello, and welcome. I'm Dr. Amy Cohen, Program Director for SMI Advisor and a clinical psychologist. I'm pleased that you're joining us for today's SMI Advisor webinar, Peer-Supported Reentry Program for Incarcerated Individuals with Behavioral Health Disorders. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Now I'd like to introduce you to the faculty for today's webinar, Patrick Hendry and Casey Moyer. First, Patrick Hendry is Vice President of Peer Advocacy Supports and Services for Mental Health America. He provides national advocacy and develops new services and training for peers within the behavioral health system. Patrick has worked as an advocate and initiator of peer-run services for 27 years in a variety of leadership roles, including former Director of NISTAC as a consultant for National Council for Behavioral Health, the University of South Florida, SAMHSA, NASHVT, among many other agencies. And then Casey Moyer. Casey Moyer is the Executive Director of the Mental Health Association of Nebraska. She assisted in the development and implementation of the first state-funded peer-directed programs in Nebraska. Casey is also an appointed member of the Restricted Housing Workforce, focusing on people living with behavioral health issues who are incarcerated. Patrick and Casey, thank you for leading today's webinar. Thank you, Amy. And I just want to say that we have no relationships or conflicts of interest in doing this program. Next slide, please. The learning objectives for today are that at the end of the webinar, participants should be able to describe why individuals with behavioral health disorders are frequently reincarcerated, identify the core elements of the real peer-led reentry program, and discuss the benefits of peer-led reentry programs in general. Next slide, please. So one of the things that we really know is that far too many people with serious mental health problems get caught up in this cycle of reincarceration, and our prisons and jails have become our de facto hospitals over the last 30 years. And we see that people go in and out, almost like a revolving door kind of thing. It's just something that we haven't yet figured out how to break, because we don't have the resources in our communities that we need to really serve people in the way that they deserve. Next slide, please. So reentry programs have been looked at for a long time, and they've been in effect for a number of years. Recently, people have started going back and looking at some of the work that was done in the mid-'90s, and the importance of what they refer to as social ecology and community, and their impact on breaking that cycle of reincarceration. The mass incarceration policies that came in in the 90s have had a really terrible effect on low-income minority communities, and particularly people living with behavioral health disorders. Next slide, please. So when people come out of prisons, they already face a number of roadblocks in almost anything they try to do. It's difficult to find employment, and generally, people coming out, particularly on parole, are required to find employment within a certain amount of time. Immigration becomes difficult, because a lot of public housing will not accept people with a criminal record, a felony record. Education is difficult to access. Personal relationships are really affected by people's past and their past behavior. And then even getting identification, when you come out of prison, or you come out of jail, and you have to get a new driver's license, or you don't have your records going back, it just becomes another thing that becomes an impediment to just living a life in the community. And it's even more difficult if you're dealing with a mental health diagnosis at the same time. It's difficult to access services. It's difficult to find transportation to and from services. It's difficult to know what supports and resources are available in the community. And then so consequently, all of these things kind of piling up for a person who's coming out of prison, they may be dealing with a mental health diagnosis. The world has changed around them. They may be returning to neighborhoods where their original behavior caused their incarceration. They may be returning to very high-pressure, high-stress environments. And so reincarceration becomes not only possible, but actually very likely for people, unless they get the type of service that they need. I'm so excited about really what we're going to talk about today, because it's really what Casey's going to talk about, the programs that they're doing in Nebraska that are really a model for the whole country. We do know that peer support can be really important in navigating all of these barriers that I was discussing. Next slide, please. So lived experience is key to building trust with people. The provision of peer support by people who have lived experience with a diagnosis, mental health diagnosis, substance use diagnosis, but also experience with the criminal justice system, can be really a major step forward when you're trying to build trust with somebody who's been incarcerated, living in an environment where trust is extremely difficult to maintain. Trust is a precious commodity for people when they come out of incarceration. And for many people who have been incarcerated, particularly people who've been incarcerated for long periods of time, it's just an experience of long-term, prolonged trauma. And that has a lasting effect on the way that people view the world around them when they finally do come out. Next slide, please. So we know that trauma is a reaction to events or prolonged events, or even a series of events that threatens us both in our physical presence, our psychological wellbeing, our social, spiritual, and even our worldview. It's a natural protective system that we have in order to experience extreme experiences in our life or to go through extreme abnormal experiences in our life that we perceive kind of on a very visceral level as life-threatening, even if it doesn't involve physical threats. Prison by itself can be dangerous and traumatizing places for even the most healthy amongst. Next slide, please. This is one of the things where peer support is very good, and that is in building trust. And the way that peers build trust, one, is because they speak from experience. They can share that lived experience with the people they're talking to, which gives them some credibility with people, and then they know that they've experienced similar life experiences. Having a sense of safety is the first step when you deal with somebody who's experienced trauma in their life. Peers do this in a number of different ways. One is that peers, again, their lived experience gives them credibility, but also they have to demonstrate that they're trustworthy. They mean what they say, and they say what they mean. They do what they say and deliver where they can, and where they can't, they're very open and honest about that. Trustworthiness and transparency, where there's no hidden agenda and as little of a power imbalance as possible, is a key part of making somebody feel safe when they're coming back into the world and everything around them is, to a large degree, very scary. Next slide, please. So peers can be effective in a number of different ways, and they can help people to prepare for employment. They can help people to begin to self-manage their own healthcare, both mental health and physical health. Self-management is really key for people to succeed in any kind of treatment venue, because once we begin to self-manage and we take that responsibility for ourselves, we're far more likely to stick with the type of treatment that we agree with and that we've helped to select and helped to manage. Peers are really good at helping people to set goals and figure out how to achieve them. One of the things that's really difficult for people, whether they're coming out of incarceration or long-term hospitalization, is they come out with a very narrow worldview. If you ask somebody who's just been released from a hospital or a jail, what are your goals? And particularly if you're speaking to somebody who lives with a mental health diagnosis, you're probably going to hear something like, to stay out of jail, to stay out of the hospital, to take my medication. So this is a very narrow worldview. Peers have the privilege of helping people see that really the whole world is open to them if they begin to figure out how to live successfully for themselves, and they begin to pick their own goals, and then they find their way through using the resources that the community can offer them. Peers are also good at helping people improve their communication skills, which can be difficult for many of us, particularly when we're not feeling particularly strong. They can help in housing issues and connecting community resources like transportation or benefits, coming out of prisons and getting back on benefits, whether it's state or federal. So peers can really make a difference for people who come from these difficult circumstances back into this very confusing world that we all live in. Next slide, please. When a person is leaving incarceration and they have the support of another person who has earned their trust and gone through a process to build that trust, who understands the journey that they have to take to achieve their own personal goals, who helps them make the contacts and find the information that they need in their own community, and believes in their ability to succeed in recovery, that's a major process for people. The idea of believing in your own ability to succeed, it's a difficult thing for many of us to find when we've gone through severe circumstances, when we've got somebody who believes in us. When we were first starting to talk about recovery in the mental health field, about 30 years ago, when we started having these conversations, I was running a peer-run organization and we got together with a number of other organizations and we sent out these surveys asking people about what they attributed their own personal recovery or however they termed it. And the number one answer, three years in a row, was having at least one person who believes in you, one person who has your back, one friend. So that's a very powerful thing to have and it's potentially life-changing. And now I'd like to turn it over to Casey and she can tell you about all the wonderful things going on in Nebraska. Good afternoon, everyone. Thank you for having me. I want to start out with this, really reinforcing the fact that MHA has not done this alone. Our community partners are strong and the ones I'm going to talk most about today is our relationship with the Lincoln Police Department, the Community Health Endowment, which is our funding source. A lot of times we get a lot of funding now and I'll talk about that. And then the Nebraska Department of Correctional Services. I want to first introduce you to our crew. These are most of the peers. MHA was founded in 2001. I actually just hired more staff. So I have more than 38 staff. I'm at about 46 staff. Every single person that works for MHA has lived experience, whether that's mental health, substance use, trauma, years of incarceration, all of the above. We all come with a history and have lived experience. We develop all of our own programs. We implement all our own programs and we operate all of our own programs. When we do look at starting programs, we also involve the participants of our programs when we're looking at gaps in services and how peers might be of assistance. One of the things that is really important to the Mental Health Association is the diversity of our employees and our peer specialists. I need to tell you, you know, we have two veterans on staff, 33% of my staff identify as belonging to the LGBTQ community, 34% of my staff are not white or are minority, 23% of my staff are voice hearers or what you may know as having a diagnosis of schizophrenia, 11% of my staff have been on Social Security income for many years of their life and have worked their self off by utilizing the work incentives, and 36% of my peers, the staff have felony backgrounds and have been incarcerated. So we really, especially living in Nebraska, we really are proud of the diversity that we have and we continue to make sure that we represent the population that we serve. I want to tell you a few of their stories because when I speak, a lot of times I will hear things like, well, you must not work with the same types of people that we work with because our folks are so sick. And I have permission to share these stories. They actually wrote them themselves and they know that I am presenting this. So this is Melissa, Melissa was in and out of hospitals, the Lincoln Regional Center, which is our state hospital, really deals a lot with psychosis and suicidal ideation. She had no work history when she came to me. She actually was told that she wouldn't work and that she would need to live in assisted living where they could manage her medications and do all those things for her. Well, Melissa, in about 2005, found WRAP, which is Wellness Recovery Action Planning. And she has been with me as an employee since then. She is a full time peer specialist. She's also our benefits analysis. So she helps folks who are on social security income or disability who want to try work. She helps them understand how it will affect their benefits. She is part of the management team. She is now married. She's a homeowner. She has her own car. She really beat the system and what was being told to her when she got her discharge papers from the state hospital. This is Tony. Tony is a Native American who grew up on the reservation. He has struggled with drugs and alcohol his whole life and ended up experiencing psychosis. Tony began, he was incarcerated in 1974 and was released in 2014. So he did many years in prison. He struggled to find employment with his crime and with his mental health and the things that he dealt with. He really had no idea what he was gonna do for a living. And then he was introduced to MHA and he became a volunteer and wanted to learn more. And now Tony says that we're his new tribe and he works overnights at one of our houses and he is very intentional and he is an excellent peer. This is Tessa. Tessa at a young age experienced a lot of trauma, domestic violence. She too deals with a lot of mental health and state hospital stays. She had a 20 year addiction that started as an adolescent. She also spent several times in the county jail but ended up in the state correctional facility for women which is where I met Tess in a rap group. And when she was released, she came to us and now Tess has been out for four or five years now. And she runs one of our rap, she runs a lot of our rap groups inside the state facilities. I'll talk more about that. She works really close with our law enforcement officers and our outreach program. Like I said, she's an advanced level rap facilitator and she is teaching, facilitating intentional peer support inside the prison. I'll talk about that later. And she's currently in school for to get working towards a bachelor's degree. And I didn't put this in there but I know that she recently just bought a house. Tess is busy. This is Amy. Amy has been with me also about five years now. She had her first drink of alcohol at the age of 12, started doing meth at 19. Amy has 56 criminal convictions. She was one that just cycled in and out of jail due to substance use and mental health. She has a long history of psychosis. She still hears voices today. We talk about all the things that she struggles with and we have a support plan for her but she is an amazing outreach worker. I'll talk a little bit more about what she does. She has now lived independently in her home for the first time in eight years. She is reunited with all her family and is allowed to go back inside now as a peer and hopefully stop that cycle of reincarceration. So the key component to running peer run programs, it's training, supervision and staying true to the evidence-based practice of peer support. With the training, we receive a lot of training. My fear is though is that if we keep putting all these credentials that we think peer specialists need to have, you lose the authenticity of just engaging on a level of understanding from your own experience. That being said, we do have all our peers trained in intentional peer support. We train them on how to share their story. We train them in WRAP, the Wellness Recovery Action Planning. ASIST, which is Applied Suicide Intervention Skills Training. I also created an engagement model which talks about how to reduce barriers when you're working with somebody and trying to keep that mutual relationship. Trauma-informed care, de-escalation, working in a state correctional facility. And every Wednesday, we all get together and we debrief for one thing so we can keep ourselves well. And then we also talk about how we are gonna stay true to the peer support model. It's so easy to get sucked into case managing or giving advice or becoming transportation or all of those things which are not part of peer support. So we have to really keep ourselves in check and do what we are trained to do. The supervision is also critical. A lot of times people think that peers should be treated differently than your other employees. Everything I do is based on their ability to do the tasks of the job. So relapse does happen. If they come to me and they said that they've relapsed and they'd like to work on it and it hasn't affected their job, I'm of course gonna do that. They don't lose their job if they're struggling. I might have them do some in-house stuff like catch up on files or paperwork, but I definitely am not going to terminate them. If necessary, I will also help them get the services they need. I fully believe that my peer staff should be treated just as we would any participant of our program. Our relationship with law enforcement, I will talk about that later, also assists in that. If they do break the law, it doesn't mean that they're necessarily terminated right away. It's what did you do? What happened? How can we fix it? And then it becomes a tool when they're engaging with other peers on how they screwed up, what weren't they doing with their wellness to stay on track. I like to have peers in all aspects of recovery because we can all learn from each other. Whether you've been sober two days or you've been sober 10 years, or you recently were ticketed for something, we can always learn. That being said, there are times where people continue to choose to go down the wrong path and I have to terminate you because you're not working in recovery any longer. So I wanna talk a little bit about our relationship with the Lincoln Police Department. Just to give you an idea of how big our police department is, it's probably pretty small compared or larger to others. There are 350 commissioned officers. Last year, they got about 120, 121,000 calls for service and a little over 3000 of those were mental health investigations. They EPC'd or were the individual was taken into emergency protective custody 340 times and they weren't taken into emergency protective custody almost 3000 times. So that number has gone down since we started working with law enforcement. The idea is to be able to hopefully avert continuous jail and then hopefully not have somebody end up in the state correctional facility. So we wanna be preventative and get them the service before it even happens. So we work inside the county jail. We work alongside law enforcement. And a lot of times people are reincarcerated or incarcerated in the first place is due to addiction and lack of resources. Most of that I'm saying is lack of engagement and appropriate services, but the resources not only financially but Nebraska's behavioral health providers, 88 out of 92 of our counties have a behavioral health shortage. So peer support I think is something that can be very utilized and complimentary to the services. The main thing that people are incarcerated with and the main theme that you might have noticed with the peers that I introduced you to, and that's also the case with all the other peers on staff is trauma. I really believe if we focused a lot more with people who are in jail and incarcerated on addressing the trauma and the childhood trauma that we would have a lot less people cycling in and out of our system. I had one individual who was incarcerated five times for meth addiction. For one, she had never been offered drug and alcohol treatment. And after talking to her, we learned that she witnessed the suicide of her adolescent son, that she never connected to what was happening with her. So I really believe we need to start looking at people's traumatic experiences. With law enforcement, you can see here that top line is the calls for service that they received. And then you can see the blue line, it's kind of hard to tell the difference, but that top blue line is their mental health investigations. And then that bottom line, you can see it's decreased slowly, but it has decreased the times that they are taking people into custody for mental health reasons, which means they were a harm to themselves or others potentially. So how does the REAL program work? We have excellent relationships with our officers and they are trained on how to identify people who are struggling with mental health issues. And then they offer our support. This number is old, I apologize. We've received 4,000 referrals from the Lincoln Police. We're averaging, now they've gone up with COVID, about 10 referrals a week. And it also expanded. We have an email address where they send it to and it's LPD at MHA. And then it was strictly for law enforcement, but somehow physicians, bus drivers, landlords, and a lot of other people got ahold of that email. So we started getting all kinds of referrals and of course we addressed those. I'll talk a little bit about how it works, but the fact that almost, there's more than 320 of the officers have used our services, it's because they see a difference. We use the recovery model, we engage on our own experience and the whole goal is to divert them from higher levels of care. Law enforcement officers don't show up on your best day. They see all of us at our worst. So it's really important for them to be able to see us working and living in recovery. So when we first started this program in 2011, they would send us an email that said the name, the date, the birth date, and the contact information. But this is what they look like now. They will put a lot of energy into it because they do want people to get help. So these are some of the emails. You can see this first one. He tried completing suicide. He's diagnosed with depression and anxiety. He went through a recent breakup and he lost his job. He returned to here in Nebraska to see his mother and he was planning to complete suicide. He then ended up robbing a pharmacy and taking pills and ended up in jail. So what happened was this officer made this referral to the county jail and we start helping him figure out what his plan and how he's going to get the services in the community that he needs so he doesn't end up in this position again. The other one, I won't read them to you, but I think it's just awesome how this officer put in here that Kathy has a cat named Ollie. So they're engaging with people because they know it's the right thing to do. I really do believe that. But they also are giving us engagement points and an understanding of what's important to these folks and how we can try and connect with them. The officers, the culture has changed so much on how they view people with mental illness and substance use. They're very caring and understanding. And the goal is to do community policing and get them the community services so they don't end up in the county jail where they don't need to be. And more importantly, they don't end up in the state correctional facility. So the core elements of the REAL program are trained peer specialists. We train, and I told you a little bit about that. We also train the law enforcement officers. We follow through, and that is so important. So once the officer sends the email, we turn around and we let them know whether or not we contacted them or not. And we give them just an overall. We don't get into any of the HIPAA protected information, but just the fact that we did make contact and they were willing or not to talk to us. And then the communication and our own accountability is so important and that we do follow through. We try and connect with people within 24 hours once the referral is made. So does it work? Yes, half of the people that have been referred, they're pretty much half female, half male. You can see here that the average age is probably 20 to 39 for most of the folks that are referred to us by law enforcement. This is pretty representative of Nebraska. Most of the people referred are white. And not a whole lot of people self-report their mental health diagnosis to police officers, but when they do, this is most often the things that they are talking about, the depression, bipolar, schizophrenia, anxiety, and PTSD. So out of all the people that are referred, our number's a little higher right now. That says 50%. We're actually contacting about 63% and that was because we try and reach them sooner after the referral's made. So we even try and reach them that day if possible, but for sure not more than 24 hours. If we can't find them, it's usually because they're homeless, they don't have a phone. Sometimes the officer will say they're homeless and they're on this corner at this time typically, and we try and catch people, but sometimes it's just not possible. But once we do find them, about 85% of the people accept our services and most of them just want peer support. So what's important about the REAL program is that law enforcement agencies collaborate with people with mental health advocates and the community providers, and they need to understand that it might take more than a year before they see the decrease in calls for service. People didn't become where they're at with their mental health and their substance use and the trauma in days, it's years. And so it takes years for them to start coming around sometimes. And what we're seeing is that you really see the calls for service for folks decrease about 12, 24, and especially 36 months out. So we can either put our resources into these types of services, or we can continue to spend money cycling people through our county jails, hospitals, and the other ineffective alternatives. So if they unfortunately do end up in the state penitentiary, we also go inside there. There are 10 facilities in Nebraska. We have access to all 10 of them. Here you can see a women's rap group that graduated and on the other, you can see the men's rap group. In the men's picture, there's a guy there with his arm up on the shoulder of another individual on the far left. He actually was released and is now a peer specialist and worked for MHA. He's also doing disaster response at this time also, because we had some flooding in Nebraska. So he's been absolutely wonderful and he's an excellent employee. But we work on re-entry planning with individuals on the inside and we provide peer support. I think it's really important for us to engage with folks on the inside, get to know them, get to build those relationships. So when they come out, they know who we are, they know what we do and a lot of them can't wait to get to us. So then we decided we could train people who are incarcerated in the intentional peer support model. So we have individuals here that most likely have life sentences who we have trained 40 hours in the intentional peer support. And now they assist us when we go inside when we need them. I'll tell you a quick story about the guy on the right there. They had an individual who was in a cell who was hitting his head against the wall, kicking, screaming, spitting at officers, you know, the scene. And they were ready to suit up four or five officers deep to extract him from his cell. And before they did that, they decided to send Lamont there. Lamont went in. He sat down. He started asking questions like, dude, you don't want to do this. They're all coming out here pretty soon. And the individual eventually sat down with him. And the both of them then got up and walked out of the cell. And Lamont walked him to where the individual was supposed to do with the correction officers behind him. So there was no extracting, no mace, no tackle. It was two individuals who understood each other now walking out of the cell and doing what they needed to do. And there's a lot of stories I can tell you about that. If you're interested in watching a video and listening to these guys talk about intentional peer support inside, there's an excellent YouTube news media clip of them. It's called groundbreaking prison program helps inmates in segregation. It's KETV news in Omaha, which is just the where the where the who took who videotaped it. So after we've engaged with them inside, and we're helping them do those create wrap plans and reentry plans, and we're helping deescalate situations on the inside. Once they are released, we have some services available to them as well. So this is Hanu home. It's a 20 bed facility. I hate the word facility. It is a home. And what's important to know about that is, so there are no we don't double up. And there's 14 bathrooms. So you might have two people sharing a bathroom, but that's it. A lot of people when they first come to us, they get the keys to their room and they will literally cry. The rooms inside I often compare it to like a Pottery Barn magazine, because they're absolutely beautiful. We what we did was we organized a community event. And we had a competition where interior designers, decorators, judged who created the most beautiful, recovery oriented, safe room for individuals. And these rooms are just like I said, they're just gorgeous. What's cool about that is a lot of the people who formed teams to do the rooms are parole officers, correction officers, police officers. We had doctors offices, but we had a lot of community providers come out and help us decorate this home and it's just so clean and it's a safe place to be. We don't have a whole lot of rules here. It's not about rules. It's about living in the community and learning how to be an adult because you want to be an adult, not because you have somebody telling you all these things that you need to do. I can tell you that the average stay is typically, you can have somebody who just needs a couple weeks, we've had people stay a year. So one of the individual that has stayed a year, he went in at the age of 13 and was released at the age of 40. He had never lived on his own. He had never paid rent. He had never paid a bill. He has never drove. He never had a relationship outside of prison. So this individual really, really struggled to be able to reacclimate to society. We actually had to assist him with a number of things. So at the house, we provide things like rent wise, again, wrap. We've now started teaching people how to drive. We purchased a van and got all the insurance and liability and everything because a lot of these folks have never driven. We teach them how to shop, how to cook, and how to socialize. A lot of these people don't know when their jokes are appropriate. They don't know how to flirt appropriately. There's just a lot of things that we work on that others don't think about, I don't think. We're all concerned about employment and housing, and we don't think about all the other things that folks struggle with when they come out, especially if you're living with a mental health and substance use issue. So we have folks that practice their non-verbals, how they approach people. All those things in prison are way different in prison than they are in the community. So we provide supportive employment. We have a 73% success rate, which I think is amazing because our priority, again, is people with significant mental health and substance use issues. And then you add to it that they have a felony as well. And during COVID, this has been especially hard because now you have competition of people who have lost their jobs, who don't have those things. And so now it's even been more difficult. So we've amped up the supports for folks that are trying to find employment. COVID has not stopped people from being released from prison, so we still need to figure out how to provide those services. It's also really important for us to help people find jobs that they find their purpose and that they enjoy, rather than just hurrying up and finding places for them to be. I already talked to you about the peers that we have on staff, and so those are old numbers. So there's Amy. I introduced you earlier. Here's a couple of guys. They're being released on a holiday. And of course, the buses don't run. You can't cash a check. Most of the folks, a lot of them, I don't know about these two, but we have a lot of folks who get released from the Nebraska State Pen who aren't from here. A lot of them are from Omaha or are part of the western state, or they're from out of state, and they just get dropped off with their jacket in their box. So we want to make sure that we meet them at the door. They've already met Amy because she goes inside and facilitates RAP. And we want to make sure that they get what they need, because otherwise they're going to get what they need by doing what they've always done, and then it ends them up right back where they were. This is Kia House. So once somebody leaves HONU, they are hopefully in their own home and doing well, but sometimes when you're dealing with mental health, we need a place to be that safe and not in our own head. So Kia is a peer-run respite. You can check in. It's a four-bedroom. You can stay up to five nights. You can get peer support. You can work on wellness. You can do all the things that you need to do to stay well and, again, stay out of the system, hopefully. Kia operates 24-7. It's staffed 24-7 with peers. Law enforcement is very, very protective over Kia House, and they work with us very well. One of the things that I want to talk about is our relationship with the neighborhoods and the community. HONU Home sits right north of an assisted living for elderly, and Kia House is in a neighborhood. They both are in areas that have neighborhood associations. We belong to the association. We participate in all of their events, neighborhood garage sales. This year, the assisted living that's right next to us at HONU purchased $200 worth of fireworks for our folks so we could light off fireworks for their folks. So not only are they tolerating us being in their neighborhood, they are communicating with us, working with us, doing things in the neighborhood together, and it's really cool to see. The neighbor with Kia, she built a privacy fence all the way around except for between our house and hers because she wanted to continue to engage with the people there. This is our law enforcement training. We are very involved in the training from new recruit on. So here you see a picture of all the new recruits at Kia sitting on the porch. We talk about what's helpful when they engage us, what's not helpful, what it's like to be experiencing voices when they come up to talk to us. We train new dispatchers. We have a beta training, which is a training on behavioral health threat assessment. So we're talking about the difference between mental illness and threat assessment. We train about 65 officers a year in that program. But then, like I said, we do the ongoing training as well. So they're in-service trainings. Next week, we are doing a cultural awareness training with them, and they're going to come through Kia and talk to some of the staff. So we're constantly educating them on mental health, substance use, trauma. They all know about RAP, and we get them involved. So with both of our houses, the officers will show up and have coffee with us. I've even had them play basketball with people, bring cookies. They've donated stuff. But it's really important for our officers to see us on our good day. That doesn't mean, like even some of my staff, that they might have contact with them, and they'll let me know, and we'll work through that. But they understand as officers that they've had officers that have done some things and relapsed or got DUIs, or we've had officers that have gotten things. So they understand that the peer staff are going to do that as well, and they work really close with those. We're also pretty big into advocacy and legislation. We teach people how to be a voice in the policymaking process and know what their rights are. Of course, a lot of times people can't vote with their felony background right away, but they sure can go talk to a senator and talk about what needs to improve, what's helpful, what programming is helpful, especially with the recent events, with the protests. They were pretty active in advocating for what needed to change here in Lincoln. But we definitely want people to know and understand the process, and we also inform them of how to register to vote, so when they're able to do that, that they know how important it is and why they should do that. So recently we decided that we also wanted to just get out there and have fun and be in the community. So we started kickball and softball, and here we're at a hockey game and one of those. We're doing softball right now, but what we did is we involve everybody. So on our softball team, for instance, we can have people who are living at Honu or Kia or a participant of our programs, staff, law enforcement officers, correction officers. We have a therapist who has now decided to play. So they are now on the same team and they're getting to know each other and they're getting to be able to work together from a completely different perspective. So you might have an officer who arrested one of the folks and now they're playing softball together, but it's really awesome to watch, and again, it's stigma. It breaks that stigma down. So I guess what I want to be able to show everyone is when peer support is done right and you can show the outcomes, we do collect a lot of data and we don't collect our own data. We have outside folks that do that, so it's not us reporting on our own great work, but what we do is we have people compile the data for us and it shows that it works. So we started out in probably 2004 with one peer support job and it was actually Melissa who was the first peer you met. She got hired as a medical, as a van driver for the community mental health service. So we have gone from that one peer specialist position. Then we started our peer employment. So we work on the model of peer support, supported employment, the evidence-based practice. Then we opened up Kia House. Kia House has been open for 11 years this year. I think it's important to note too that we ran, Hania was about five years old and Kia, like I said, will be 11 this year. We have never had a violent incident. We have never had a chair thrown. We've never had an assault. We've never had anything. The biggest thing that we struggle with, and it's mostly at Hania, of course, is substances and our relationship with the police department really helps us in that area. After starting Kia House, we put peers in the mental health emergency department. That worked so well that they no longer let us employ them. They hired their own. So we no longer do that, but we did start that program. Then in 2011, we started our work with the Lincoln Police Department. Then we started working in the Lincoln Public Schools. We're in the high schools. We do rap support groups in the high schools, which also was a pretty big deal to have people with our backgrounds going into high schools, but they do allow that and we've been pretty successful in that too. Then five years ago, it was 2015 actually, that we opened Hanu Home. We didn't go to the bigger building until two years ago. So we've started out with a five-bedroom and the demand was so... I think we had like a three-year waiting list. People would make referrals that weren't getting out for like five, 10 years. So we decided that we needed to look for something larger and we found it. Then we got the contract with the Nebraska Department of Corrections to be working more in the facility. So it started out that we were just doing rap in those facilities, but now we're in all the facilities and we're doing rap both in general population and restricted housing. The goal is to work with people in restricted housing to help them understand their mental health and how to get their needs met and so that they can go to general population before they're released. We had way too many people getting released straight from the hole. So why is it important to look at peer-led re-entry programs? The benefits of it. We can engage with people. There's a level of understanding that Patrick talked about earlier. You don't have to explain and you don't have to talk about all of what happened to you because most of us understand it. We have a connection and I also don't have all the rules of if you're working in corrections, you must have been a peer who was in corrections or if you're a veteran and you have to only work with veterans. I have a variety of folks and they will connect with who they connect with. I have some veterans that really like to talk to other veterans. I have some veterans that do not want to talk to other veterans. They do not want to rehash what happened or talk about it and so it's really important that people engage on a level of understanding and most of us know what it's like to feel alone, hopeless, helpless and all of those things so we definitely can connect on those. It's about moving toward. I love the language of being able to move towards something and not just stopping everything. It's a win-win for folks and we're available anytime you need us. The other thing that's been a really cool benefit is that they re-engage with us. They'll be gone for a couple years and then they'll come back. That's the presentation that I have for you. Thank you.

SMI Advisor webinar

Peer-Supported Reentry Programs

Incarcerated Individuals

Behavioral Health Disorders

Peer Advocacy

Lived Experience

Trauma-Informed Care

REAL Program

Positive Outcomes