Thanks everyone for coming on this beautiful sunny day, spending an afternoon with us. So this is a very interactive session. We actually aren't going to spend a lot of time talking to you or talking at you. We're hoping to talk with you. I know it's a small group, which is actually really nice because we'll be able to kind of talk through this together. It'll be structured around a few case studies focusing on the importance and value of multidisciplinary or interdisciplinary teams. So I'm going to start by setting the stage a bit. We're going to have each of us introduce ourselves, talk a little bit about who we are, at least from our professions, our professional identity. Then we're going to go right into cases. We have three of them, and we're just going to kind of walk through them and problem solve together because a lot of this is about getting your wisdom and experience in terms of how you would think through solving these cases that involve different team members bringing their expertise into the team. So again, at kind of a high level, so we here, and actually a few of us in the audience, are members of the clinical expert team for SMI Advisor. SMI Advisor is a SAMHSA-funded, APA-administered training and technical assistance center that provides TA to improve care for people living with serious mental illness. We, again, we'll tell you a little bit more about who we are in a minute. Maybe we'll hear a little bit about who you are as well. And then we'll go into the case studies. So kind of the reason that SMI Advisor exists, and in particular that we have this clinical expert team of people across so many disciplines, is that caring for people with serious mental illness is complex. People with serious mental illness have a large range of biological, psychological, and social needs. And often, as clinicians, any given clinician will be trained in a particular discipline, which kind of makes them well-suited to treat one slice of those needs, but not all of them. But I would say that for many people who are working, caring for people with serious mental illness, that is one of, if not the most rewarding aspects of the job, is the opportunity, instead of working kind of one-on-one in private practice, to work as part of a broader team. And yeah, so one, just before we go into introducing ourselves, one distinction that I think is worth thinking about a bit, that I was thinking about as we were planning the session, that the session talks about a multidisciplinary team, which, of course, we are, and hopefully, maybe some of you have had the opportunity to work as part of. But I think we also want to think about how we move from being a multidisciplinary team to being an interdisciplinary team. A multidisciplinary team means you have a bunch of different people with different kinds of training, who maybe are kind of working parallel to each other. But to make an interdisciplinary team work, you really need ingredients. You need good leadership. You need kind of a core set of values, a mission. And you need a less hierarchical, more collaborative approach, which is maybe less top-down than we're trained to thinking about or working in. So that's kind of the framing, I think, maybe for us to think a little bit about as we go through some of the cases, the particular cases, is both sort of what the different members of the team are bringing to the table, but then also how they're working together. So now I think there's an opportunity for each of us to talk a little bit about who we are, specifically who we are in terms of our kind of professional identities. We're obviously a lot more than our professional identities, which is part of what a multidisciplinary team is about. So I'll just start, since I already have the microphone. So I'm a psychiatrist. My name is Ben Druss. And really, all that means is that I went to medical school, did a psychiatry residency, in my case, pretty much in the age when dinosaurs walked the earth. And it also perhaps means that what I can bring to the table in a team is some knowledge about some of the biological part of the biopsychosocial piece, as well as some knowledge about medicine and comorbidity more broadly, so thinking about some of the medical problems that often go hand in hand with mental health problems. But I should also say that I've become acutely aware over the years that that also comes with some blind spots and things that I've had to learn over time. So I would say that I've had to learn a lot since my training about the social piece, which we have other experts who have more directly trained in it, all of the social determinants, particularly that are relevant for people with serious mental illness, as well as kind of person-centered care. As physicians, we're often trained with more of a, again, kind of a top-down approach as opposed to really trying to understand what's most important to our patients, what can help them with their recovery. I'd say I've had to learn most of that stuff over the last, what is it, 25, 30 years since I trained, but really even more in recent years. And I've learned a ton of that working with SMI Advisor, and I'm very valuable for the opportunity to have learned that and to continue learning. And I think that's really part of what's important at the end of the day for all of us. So with that, maybe I'll pass it on to some of the other team members. You can kind of get to know who we are, and then we'll get to know who you are. Hello. I'm Shereen Khan. I'm the social worker of the group, so I'm going to talk just a little bit about what social workers do, which is pretty much everything on a care team. I'm trying to say it in a way that doesn't seem, you know, like I know my audience here is mainly psychiatrists, but social workers really do do it all, right? So we're kind of the connecting thread. So we're usually the people that, when people first come in, that they'll see us for assessment and evaluation. We usually are responsible on a care team for the treatment plan and for coordinating that with the providers or the other people on the team, making sure that, you know, collaborating with the client patient as well as with the other team members. And then making sure that we're helping people reach their goals and problem-solving along the way. We also do, you know, counseling and therapy depending on the trainings. There's different types of social work that you can do. Most likely on this type of team, like on a care team, they would be a clinical social worker, meaning that they do have training in evidence-based practices to help people with mental health conditions. We also do a lot of case management, right? So we can help people get benefits if needed, you know, make sure they have access to food, anything that they need, get an ID, right? So they're able to then, you know, get insurance so they can receive treatment. So we really can do all of that stuff as well. We also do advocacy in our role, you know, if you're on a care team, you're doing it on a smaller scale. But there's also a branch of social work that is dedicated just to advocacy and kind of higher-level policies. We also do a lot with patients' education and crisis management. And all of this is done through a trauma-informed, culturally competent lens. That's something that is part of our code of ethics that we have to uphold. And if you think about a care team, what we do a lot is the care coordination. So we're a lot of times the point person who then is making sure that the patient knows, you know, they're supposed to meet with Megan on this day to talk about this. And they have, you know, every three months they meet with Ben. So we really make sure that the patient knows what services, other services they'll be receiving. And we even help them to those appointments at times too, depending on the type of setting. So we can take people to doctor's appointments, you know, make sure that they understand if there were any changes to medication or anything like that. And then schedule any follow-up or referrals that are needed. We also do, you know, family support and education, but you'll hear more about that from other people. So yeah, as I mentioned, we kind of are the golden thread right throughout who facilitate to make sure that the person is treated holistically. So. Excellent. I'm Megan Arrett. I am a psychiatric pharmacist and work at the University of Maryland School of Pharmacy. Many of us think as pharmacists that work at CVS, Walgreens, Sprite Aid, Stop and Shop. Those are our dispensing pharmacists and they also do a lot of administration of vaccines and now long-acting injectables as well. And so that's might be where you interact with pharmacy. There's pharmacists in the hospital. They're making the IVs, sending things through the tubes, doing all the interactions and order entry. And then there's a host of pharmacists that work on clinical care teams. You might hear them called advanced practice pharmacists or clinical pharmacists. And they're working within the team. Many of them have a scope of practice like physicians. So they might have a collaborative practice agreement where they work with a provider. It could be a nurse practitioner, it could be a psychiatrist and they have a scope of responsibilities on the team. It might include ordering labs. Some of them have prescribing privileges and seeing patients to titrate medications or look for side effects or drug interactions. They do this both for medical and psychiatry. So it's not just here. And many of them are board certified. So after graduation they have two years of training in psychiatry and they can sit for a board certification exam. And so really sort of is the gold standard for what we think of a psychiatric pharmacist. So we're in a lot of academic medical centers, VAs. We do a lot of education and training. We do therapeutic drug monitoring, administration of LAIs, I think Clozapine. We do the formularies, pharmacogenomics, pharmacokinetics, all of the things that people tend to not want to do with medications. That's where your pharmacist is. And there's probably about 1,600 psychiatric pharmacists in the U.S. So if you have one or know one, consider yourself lucky because there's not a ton of us around. But we're all here to help. Good afternoon, everybody. I'm Alexia Wolf and I'm the Social Determinants of Care Expert with SMI Advisor. And I'm really glad to be with you today to talk about the role of peer support specialists on multidisciplinary teams or interdisciplinary teams, as Ben said. I was one of the first peer leaders in my state and I was closely involved in implementing peer support at our state hospital during our Olmstead Settlement Agreement. I supported people who had been hospitalized for years and in some cases for decades in transitioning to the community using the power of peer support. So what is peer support and what are some of the ways the peer on your team makes a difference? Peer support includes a broad range of activities that foster connection between people who have similar experiences living with mental health conditions, substance use disorders or both. And the hallmark of peer support is that the peer openly shares aspects of their own lived experience in recovery. The mutuality that's inherent in peer support inspires hope with the individuals that the peer is supporting as well as the team. The team may be used to seeing people living with mental health conditions at some of the worst moments or worst day of their lives and the peers are a constant reminder that people get better and that recovery is real. Peers help counteract stigma and limiting beliefs about mental illness. And peers offer a degree of understanding and acceptance that may be very different from what the client has experienced and what other members of the team have experienced. And I often think of peer support as being like the team's recovery navigation system. So think about your car's navigation system. If you're driving and you have the map up in your car and you start to deviate too much from your intended destination, you'll see a message that says rerouting. As a peer, my role on the team was often to provide that rerouting message. So when I was one of the first peers in my state during our Olmstead agreement, there were tremendous pressures on the last individuals to leave the long-term units of the hospital to hurry up and get out, even though they had been there for decades or years. The teams for those units were also under tremendous pressure. And so my charge as a peer was to support the person in finding their own connection to recovery on their own timetable, not the timetable of the hospital administration or the community provider or even the Department of Justice. And if we started to get pulled away from the foundational principles of recovery, like expecting positive outcomes, supporting people in living a self-directed life and reaching their full potential, I can use a variety of strategies to help the team reroute so that we stay centered on the individual and their recovery. What are some of the ways that peers add value to teams and systems? The foremost peers hold the hope when it's hard for the person to access their hope. And we know that people respond better to a hopeful stance. Peers offer practical tools on self-determined goal setting, strategies for building a life of the person's choosing where they can thrive and not just survive. This is important as the peer is crucial in encouraging the person to think big and have hopes and dreams for their life. Peers are great connectors. They provide linkages to all kinds of resources to address the social determinants. And the peer is a great asset in neutralizing power dynamics that may get in the way of the person's relationship with other team members or among members of the team. Peers are a catalyst in moving the team and the organization towards a recovery focus. Peers are great at helping you see your policies and workflows from the patient's point of view. They can help you identify system gaps that advance your work and lead to transformation to make your services more person-centered and trauma-informed and enhance engagement. I often suggest having the peers on your team do an environmental scan from the perspective of someone participating in your services. We did that when I worked at a state hospital and we ended up transforming the rooms that had been used for seclusion and restraint into something we called a comfort room where people could go in and read, listen to music, sit in a rocking chair, find a place of peace. Some tips for maximizing the role of the peer. Peer support doesn't work if the peer is isolated or if their input isn't respected. So Ben was speaking about the importance of interdisciplinary work. There's never been more interest in peers. And you often hear of people saying we're going to add peers to this program or add peers to the system and somehow it will magically transform. The peers can't do this work alone. So please ask questions when you're working with a peer. The more open you can be to fully utilizing and integrating the peer with your team, the greater the benefits to your team and the people you support. And last, creating an environment where the peer can function to the full extent of their intended role will reap incredible benefits to your team in terms of engagement and the flourishing of people in your services. Thank you. Let's see how far this will go. All right. I'm Terry Brister. I'm the chief program officer at NAMI, the National Alliance on Mental Illness. And the things that fall in my shop at NAMI are our education programs, our support programs, I hope you've heard of some of them. But we're really the nation's largest mental health organization doing advocacy information and support. I'm a recovering clinician by profession. I worked in community mental health centers for almost 20 years before coming to work at NAMI. So I have been there where you are and want to thank all of you for what you do and being here this late in the afternoon for this session. My role with SMI Advisor is as the family engagement expert, bringing to the table, and I want to thank my colleagues for their openness and willingness to listen to Alexa and I as when things have come up, various things with the SMI Advisor resource development where we've been able to provide the patient and family voice openly and honestly. And that's really the role I want to talk to you about here is thinking about the family as part of the treatment team. Think about the family as part of that interdisciplinary team. And family doesn't necessarily mean someone who you have a legal relationship with or someone that you share DNA with. It may be your next door neighbor. It may be the roommate of the person. Almost everybody, even people who are living on the streets, almost everybody has someone that's important to them. So ask the people that you're serving, you know, who is your support system? Who could we involve in this process? And what families, again, family in the loose term, think about that. What families really want is information. They want facts. I have a colleague at NAMI who talks about if she took her son to the emergency room with a broken limb, the limb would get treated. There would be an x-ray. There would be a cast. There would be instructions on how to wash the limb with the cast on, how long to wear the cast, aftercare appointments with the primary care physician, and probably a bag of things to help take care of the cast. If you go to an emergency room in a psychiatric emergency, frequently you're boarded in a hallway. There's not a bed for you to go to immediately. You're separated from your family for whatever reason. If you're an adult, often it's because of confidentiality. So families, whoever that family happens to be, just want to be looped in and included. They want a prognosis, and by that I don't mean how long it's going to take the medication to work or how long it's going to take this treatment to work. They want to know relatively what to expect. You know, is my loved one ever going to be the way that they used to be? Is there any reason I should have hope for them having a good—they want to have some kind of an idea of what to expect. Even if you're telling them, this is going to be a long journey, and we may go through several medications before we find the right one. You can deal with things if you know what you're dealing with. They also want to know it's not their fault. So even sharing information about the fact that this isn't something that you did or didn't do as a family member or something that the person with the condition did or didn't do that caused them to develop it. It's a biological—I mean, it's a combination of things, complex illnesses. And what they're really looking for is hope and help and support for themselves so that they can do what they need to do to help take care of their loved one and help them get to a point in recovery where they're living their best life. To the point of confidentiality, just to speak about that for a minute, we all know about releases of information. Again, worked at the mental health center for years and years and years, and it was usually the person at the front desk who asked for a release of information. Frequently, the person doesn't really want to be there getting treatment anyway, and then they get this question from someone that they don't know. Also, frequently, they say, no, there's nobody I want you to talk to. As the clinician, as your role on the treatment team, if there's not a release of information, don't give up asking. You know, is there anybody that we could involve? Is there anybody that we could reach out to? So don't give up asking. I want to emphasize that. And also, the question coming from a clinician can help the person understand that it's part of recovery. It's not so we can tell on you. It's not so we have somebody to report to. Talk with them about what you would and wouldn't share, but again, give them the facts. And remember that you can listen. The rules of confidentiality say you can't share information, but you can listen. You don't even have to, and you can actually say, I can't acknowledge one way or the other whether your person is in services here or not, but you can still listen to what the family has to say. And ultimately, NAMI's role in all of this, kind of as a de facto part of the treatment team, is there are 650 different NAMIs across the country, all offering education, information, and support. And we can provide some of that support for the families and the individuals that you're not able to in a clinical setting. So just, there are resources out there for you that you may not automatically think of. So that's part of the role that I bring to this conversation today. Thanks so much. Yeah, I mean, it's, as I said, it's been a, you know, it has been and remains a privilege working with all of you. So I think what we're going to do, so now, remember I said in the beginning, this, most of the session isn't us sort of talking at you. It's us kind of talking with you about this and working together. I think we're going to break up into two groups. We can do case study one and case study two. It sort of sorts out pretty evenly over the left and the right. So if folks want to kind of move together with your group, and then all of us can kind of disperse among the groups to facilitate the discussion. We have two different case studies. Each of the groups will get one, and it's an unfolding case study. So we'll kind of get more information as we go along. We'll kind of discuss it, talk it through, and then we'll all come back to the larger group at the end to kind of share what we've come up with and lessons moving forward. So if folks want to, again, kind of divide out in the two halves, and we can, I guess we can just sort of divide ourselves also among the two groups, and that would include the CET who aren't up here as well. Yeah, yeah, Donna, go ahead. Donna, here. This one's hot. All right. I'll come up here. I just want to thank you guys for your presentation, and Terry in particular. I want to say thank you for the whole recovering clinician thing. I'm going to go with that, and I'm going to steal that from you. So thank you.

interdisciplinary teams

serious mental illness

collaboration

holistic care

case studies

mental health