Across the U.S., Coordinated Specialty Care (CSC) for a recent onset of psychosis providers are increasingly integrating Peer Support (SAMHSA, 2019). This trend is promising for improving care experiences and outcomes among those with a recent onset of psychosis– and providing meaningful employment opportunities for those in recovery from an onset of psychosis. Peers importantly bring a non-clinical, alternative perspective that disrupts team language, practice, and systems rooted in the more traditional medical model (Deegan, 2017). However, recent research summarized empirically established peer workforce issues in community mental health (e.g., Jones et al., 2020; Mancini, 2018). These include on-the-job stigma and discrimination, low pay and no benefits, isolation, unclear work roles, burnout, limited professional development opportunities, and high turnover. With the proliferation of Peer Support integration into CSC, providers are becoming acquainted with these challenges in building and sustaining a peer workforce. Our presentation compares: (1) the vision for peer support integration into CSC with the (2) current reality facing peers on CSC teams. We propose innovative solutions from CSC Models OnTrackNY and EASA as well as emerging approaches from across the country that target organizational and systemic reforms to improve peer workforce experiences and outcomes. 

 The Vision: Peer Specialists will work successfully within multidisciplinary teams, support service engagement, influence team culture to be more responsive to young person lived experiences, strategically share their story, document services, maintain wellness and professionalism, role model and coach, provide community support, host groups and social activities and build strong working alliances with CSC participants. 

The Reality: The dominant narrative within CSC, and where CSC is implemented, is clinical and does not embrace (and arguably rejects) core Peer Support principles, including mutuality and "nothing about us without us." Most CSC teams operate within adult community mental health or university-based clinics, not peer-run or youth-centric organizations. Other disciplines on CSC teams (e.g., psychiatrists, social workers) are taught to limit self-disclosure and use evidence-based methods that inherently reject alternative illness and healing narratives. Compared to other CSC team members, peers tend to be lower paid, younger, and individuals of color. In a recent study with 25 CSC teams with peers, 84% had only one peer and most were part-time (SAMHSA, 2019). Thus, peers, who are the lowest paid and who have the least power (and presence) on CSC teams, must educate colleagues on the value of their role, challenge the dominant clinical narrative, and speak up "appropriately" when colleagues make discriminatory, racist, sexist, classist, and/or ablest remarks. Peers are subject to tokenism, microaggressions, being ignored, and feeling pressured to advocate or answer uncomfortable questions – and later regretting their responses. Particularly during COVID-19, peers have been leveraged as self-care and virtual technologist experts – educating their colleagues on how to maintain health and wellness when stressed and facing adversity as well as how to best use smartphones and computers to engage CSC participants creatively through video chat platforms. 

 The Solution: Peers need equitable roles on CSC teams in regards to pay, benefits, responsibilities, support and professional growth opportunities. Peers cannot be solely responsible to be the culture carriers and engagement specialists on CSC teams. CSC Models must value and centralize peer support principles and practices to the extent that they do other treatment modalities. CSC teams must support peers in connecting to national and local peer networks, and professional development opportunities. Team-, program-, and system-level strategies aiming to build and retain peers in CSC must be evaluated.

Format

Recorded webinar, non-interactive, self-paced distance learning activity with post-test.

This presentation was recorded on November 13, 2020 at the virtual conference, Third National Conference on Advancing Early Psychosis Care in the United States: Addressing Inequities - Race, Culture, and COVID. 

Learning Objectives

• Describe aims and promise of effective, sustained peer support integration into CSC teams.
• Explain the reality of on-the-ground peer support experiences in CSC and community mental health settings.
• Identify innovative and practical solutions emerging nationally within and beyond CSC to improve CSC workforce experiences, professional development, and impact.

Outline

• Peer support principles and practices
• Current challenges faced by peer support on CSC teams
• Solutions for improving team integration, influencing team culture, sustaining professionalism

Target Audience

Psychologists, Social Workers, and Other Mental Health Professionals

Instructional Level

Introductory

Estimate Time to Complete

Estimated Duration: 1.0 hour
Program Start Date: May 3, 2021 
Program End Date: May 3, 2024

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit™, CE credit for psychologists, CE credit for social workers, or a certificate of participation may do so by completing all sections of the course, including viewing the full video (≥60 minutes) and submitting an evaluation. A multiple-choice quiz is provided based on the content. A passing score of 75% must be achieved. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians), CE certificate (psychologists), CE certificate (social workers), or certificate of participation (other disciplines) showing the completion date and hours/credits earned.

Continuing Education Credit

Physicians

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The APA designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Psychologists

The American Psychiatric Association is approved by the American Psychological Association to sponsor continuing education for psychologists. American Psychiatric Association maintains responsibility for this program and its content.

Social Workers 

American Psychiatric Association, provider #1743, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. American Psychiatric Association maintains responsibility for this course. ACE provider approval period: 05/18/2020 – 05/18/2021 and 05/18/2021-05/18/2024. Social workers completing this course receive 1.0 (clinical) continuing education credits.

Continuing education requirements vary from state to state. Many state boards grant reciprocity with national accrediting organizations and other state boards. It is the responsibility of each professional to understand the requirements for license renewal or check with the state or national licensing board and/or professional organization to become more familiar with their policies for acceptable continuing education credit. Social workers and Psychologists should contact their regulatory board to determine course approval.

Faculty and Planner Disclosures

Instructors

• Vanessa Vorhies Klodnick, Ph.D., L.C.S.W., is the Director of Research & Innovation for Youth & Young Adult Services at Thresholds in Illinois and is affiliated with the UT-Austin Texas Institute for Excellence in Mental Health. Dr. Klodnick's research and consulting focuses on understanding and improving experiences and impact of multidisciplinary community mental health services designed for youth and young adults with emerging mental health conditions. Her work to enhance, blend, and study evidence-based practices has translated into several journal manuscripts, best-practice guidebooks, workforce development activities, and tools for improving peer support and mentoring integration into youth and young adult community mental health services.  Reports no financial relationships with commercial interests. 

• Abaigeal Duke is a New York State Certified Peer Specialist and the New York State OnTrackNY and ACT Peer Specialist Trainer with the Center for Practice Innovations. For over a decade, Abbe has held a variety of peer support and advocacy roles within child and adult mental health service divisions. Abbe currently provides training, consulting and technical assistance to 22 OnTrack Coordinated Specialty Care teams across the U.S. Abbe has further refined OnTrack peer role expectations and best-practices, co-facilitates the Stanford PEPPNET Lived Experience Workgroup, and delivers webinars, conferences presentations, and trainings to improve peer professional development and CSC integration.  Reports no financial relationships with commercial interests.

• Nybelle An-Vi Caruso is a Co-chair of the Early Assessment & Support Alliance (EASA) statewide Young Adult Leadership Council and a Coordinator of Peer Delivered Services at LifeworksNW serving Portland's metro area. Since 2015, Nybelle has supported EASA quality improvement as the EASA Leadership Council Co-chair. Nybelle mentors multiple Peer Support Specialists at LifeworksNW and contributes to peer support program development and expansion. Nybelle has shared her lived experience and contributed to the national discourse on peer values, Coordinated Specialty Care and psychosis through co-authoring multiple journal manuscripts and speaking at national and international conferences on early psychosis.  Reports no financial relationships with commercial interests.

 Program Planners

• Steven Adelsheim, M.D. Reports no financial relationships with commercial interests.
• Catherine Adams, L.M.S.W., A.C.S.W., C.A.A.D.C. Reports no financial relationships with commercial interests.
• Susan T. Azrin, Ph.D.  Reports no financial relationships with commercial interests.
• Iruma Bello, Ph.D.  Reports no financial relationships with commercial interests.
• Gary Michael Blau, M.S., Ph.D.  Reports no financial relationships with commercial interests.
• Teri S. Brister, Ph.D., L.P.C.  Reports no financial relationships with commercial interests.
• Nybelle An-Vi Caruso, B.S.  Reports no financial relationships with commercial interests.
• Amy N. Cohen, Ph.D.  Reports no financial relationships with commercial interests.
• Robert O. Cotes, M.D.  Dr. Cotes discloses the following relationships: Consultant: Saladax Biomedical, American Psychiatric Association Grant/Research: Ostuka, Lundbeck, Roche, Alkermes
• Judith Dauberman, M.A., Ph.D.  Reports no financial relationships with commercial interests.
• Steven P. Dettwyler, Ph.D.  Reports no financial relationships with commercial interests.
• Lisa B. Dixon, M.D., M.P.H.  Reports no financial relationships with commercial interests.
• Melissa Edmondson Smith, Ph.D.  Reports no financial relationships with commercial interests.
• Chantel Garrett. Ms. Garrett discloses the following relationships: Stock: Invitae, stockholder Livongo, stockholder Color, private equity holder Consultant: Maine Health Northwell Health One Mind Grant/Research: One Mind National Institute of Health
• Tristan Gorrindo, M.D.  Reports no financial relationships with commercial interests.
• Kate Hardy, ClinPsych.D.  Ms. Hardy discloses the following relationships: Consultant: SME for Click Therapeutics
• Robert K. Heinssen, Ph.D., A.B.P.P. Reports no financial relationships with commercial interests.
• Brian Hepburn, M.D.  Reports no financial relationships with commercial interests.
• Patrick Kaufmann, B.S.  Reports no financial relationships with commercial interests.
• Sherin Khan, L.C.S.W. Reports no financial relationships with commercial interests.
• Steven R. Lopez, Ph.D. Reports no financial relationships with commercial interests.
• Ted Lutterman.  Reports no financial relationships with commercial interests.
• Tushita Mayanil, M.D.  Reports no financial relationships with commercial interests.
• Ryan Melton, Ph.D.  Reports no financial relationships with commercial interests.
• Oladunni Oluwoye , Ph.D.  Reports no financial relationships with commercial interests.
• Abram Rosenblatt, Ph.D.  Reports no financial relationships with commercial interests.
• David L. Shern, Ph.D.  Dr. Shern discloses the following relationships: Grant/Research: Through my employment at NASMHPD, I co-chair the dissemination function of the Early Psychosis Intervention network as part of the national data coordinating center at Westat. Westat was awarded the coordinating center grant by NIMH Other: serve on the Board of Livanta

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