So, good afternoon or good morning, wherever you're calling in from. We'll be starting in just a couple of minutes. I'm Julie Goldstein-Grummett. This is the webinar for the Suicide Prevention Resource Center, lived experience leadership and peer support services. And while we're waiting for people to log in, how about we start using the question box. Let us know who's on today, where you're calling in from, what your role is, and maybe a comment about what you're, why you joined today's webinar, what you want to learn. We're very interested in an engaging webinar. We have a couple of wonderful speakers lined up for you, but we want to know also why you joined us today. So, please use the question box and go ahead and let us know who you are and where you're joining in from. And then we'll get started in another minute or two. Don't be shy. I see we have Louisiana in the house. I feel like Danita, you have joined webinars in the past. Your name looks familiar to me. So, having you on these webinars, Arizona, Colorado, Idaho. Love seeing where everybody's calling in from. Iowa, I was about to say we didn't have any duplicates, but I see a couple. So, we, for those of you just joining us, we, right, Danita, I love it. She's attending because everything SPRC does is great. So, we'll take the love. It's a good way to start Monday, start the week. For those of you just joining, this is the lived, experienced leadership and peer support webinar. And we're just taking a moment as people join in, saying a little bit about where you're calling in from, what your role is, and maybe about what you want to get out of today's webinar. Why did you join? And you can use the question box for that. Concord, New Hampshire, peer manager on a mobile crisis team. Nevada, Ohio. Thank you all so much for joining us. Massachusetts. If we could get all, I may not start until we get all 50 states represented. So, you may have to call some friends in to join us. New York, good. We'll give like another minute or two. I can see people still logging in. And I'm Julie Goldstein-Grumman, and as I said, we're just taking a moment to give people a chance to say where they're calling in from and maybe something even about your interest in today's webinar. I'll give you about one more minute. St. Louis and North Dakota, looking to involve more lived experience peer support in the hospital and outpatient settings. Well, good for you, Kirsten, because you joined the right webinar. I think we've got a good show lined up for you. I'm going to give it about one more minute if anybody else wants to let us know where they're calling in from. Illinois and North Dakota. And thank you everybody for joining us today. I'm a peer support specialist looking to gain as much information as I possibly can. So, I'm thrilled that everybody joined us today. I'm going to go ahead and get us started. You can keep chatting some of those questions in. We'll be monitoring the questions throughout the webinar today. And we will be holding for our question and answer session until the end, but we definitely reserve some time for that. So, feel free to type questions throughout. I'm Julie Goldstein-Grumman, and today is the Lived Experience Leadership and Peer Support Services webinar. Could you advance the slide? I'm with the Suicide Prevention Resource Center. I'm the Senior Healthcare Advisor to SPRC. We are funded by SAMHSA, and the views, opinions, and content expressed do not necessarily reflect the views of CMHS, SAMHSA, or HHS. Standard funding and disclaimer. The SPRC is at the University of Oklahoma Science Center, and I actually work for the Education Development Center in collaboration with the University of Oklahoma. Next slide. Nobody has any financial relationships or conflicts of interest to report. Next slide. For those of you who don't know SPRC, I can see some of you have been to our webinars before. I would encourage you to visit sprc.org. We are federally funded to advance the implementation of the National Strategy for Suicide Prevention, funded by SAMHSA. But SPRC is really a clearing house for effective suicide prevention and healthcare systems like we're going to be talking about today, but also states, tribes, communities, youth, really from birth to grave. We think about what are comprehensive approaches. How do we support systems? We have training. How do we really address suicide prevention across the lifespan? Really, I encourage you to take, again, a look at sprc.org. If you're not familiar with our resources, we also have many listservs, the Weekly Spark, and encourage you to take a look at those. Next slide. And join those so that you'll be up to date on funding, as well as latest research and newest tools available to help you do your work. Next slide. And I'm going to turn this over to you, Ebony, to get credit for today. Thank you, Julie. This course will offer 1.5 AMA PRA Category 1 credit. Physicians who wish to claim credit will be able to do so at the conclusion of today's live webinar. Thanks, Ebony. I think there's a couple other slides. Can you advance, please? Can you tell people how to get their handouts? I think also you are able to download the presentation slides for today if you would like to keep them as a reference. They will be located in the handout section, which is available from the desktop installation or from the instant join view. You can see today's presentation slides, as well as an additional handout that's available as a reference. Next slide, please. And as we've done so already, feel free to continue to submit your comments and questions via the questions box. We will be monitoring that throughout today's session and address all questions at the end of the live presentation. Great. Thanks, Ebony. Next slide. That's me. I'm Julie Goldstein-Grammett. As I said, Senior Health and Care Advisor for the Suicide Prevention Resource Center, and I'm also the Director of the Zero Suicide Institute. Next slide. So, zero suicide. It's really the idea that we want to challenge systems to be high reliability to be high reliability organizations. We want systems to be exploring patient safety goals that include suicide prevention by embedding evidence-based interventions that we know work, by collecting data to measure outcomes and fidelity, and by normalizing suicide prevention efforts. Next slide. There are seven elements that are critical to suicide safer care. It is a bundle of interventions. It's not employing any one of these interventions. It is the bundle of all of these interventions that we know that works. And it's not a continuum of start with one and go on to the next one. It is the need to do all of these interventions at once, continuously, sustained, by training all of your staff to do these interventions so that they understand what works to reduce suicide. We know that leadership has to be committed to suicide prevention efforts. It's really critical that leadership sees that suicide can be reduced, that suicide is a never event and can be prevented. That really is the idea of a just culture. And how is it that systems say suicide is something that we have to learn from? It's an adverse event. We have to treat it in a health care system the same way that we treat wrong site surgery or patient falls. We really need to see suicide prevention in the same way so that when suicide events happen, we learn from them. We don't blame it on any single individual. We see it as an organizational failure. And we learn from that event by collecting data and doing continuous quality improvement to improve our efforts and to improve training. We want to make sure that we have a system we want to ensure that we have stopgap efforts. So if we want to do screening at every visit with our patients, then we need to ensure that that's in the electronic medical record and that the patient record doesn't allow us to advance if we're looking for screening, if we're looking for screening of everybody. If we need to train clinicians about how to use that screening tool and ensure that they understand the utility, it's really critical that we use the tools that we have that are provided and say to somebody, are you thinking about killing yourself? Not. You're not thinking about killing yourself, are you? So just by putting the tools into our toolbox doesn't necessarily mean people don't need training. We have to make sure those tools are used in an ongoing, sustained way and used with fidelity, used in the way that they were meant to be used, with a system that trains their staff to use those tools, gathers the data to ensure that the tools are being used consistently, and then makes changes in real time, and shares the results with their team. There needs to be utmost of transparency in order to do zero suicide and to make sure that everybody knows what their role is, what their responsibility is, and that they feel committed that they can play a role in reducing suicide in the healthcare system. Zero suicide is relevant whether it's an emergency department or mobile crisis or inpatient or outpatient or community mental health clinic. The idea of using best practices in suicide prevention is relevant in any healthcare system door, and it's really critical that it not get siloed to behavioral health. We want any healthcare door in the medical field, people go to their OBGYN, they go to physical therapy, they go for oncology. Any of those doors should be the right door to recognize that they may identify somebody as at risk for suicide, and not necessarily just immediately refer them to behavioral health, because sometimes people don't go to those appointments. So all of those other departments need to be well prepared, well trained, and expected to care for people at risk for suicide, understand the basic tools of screening and safety planning, and reducing access to lethal means, and doing really strong care transitions and referrals. So that's a little bit about what zero suicide is, but one of the pieces that we're going to talk about today is the really critical role that lived experience plays in zero suicide. You can't do this work if you don't know how the individuals that you're identifying and caring for, what works for them? What is meaningful to people at risk for suicide? How do you have a caring, compassionate clinical workforce without involving people with lived experience who are peer specialists? So we have a couple of wonderful presenters today to talk about how do you integrate the role of lived experience, and how do you have peer supports as part of this effort? Not kind of bolted on at the end, and check off box at the end of, you know, after you've devised a new strategy or policy, but built in right from the beginning as part of your team. I'm sure there are people on your team now who have lived experience, whether you know or not, and it's really critical that everybody feel really comfortable coming forward and talking about their lived experience to other staff, to patients, and being very clear that their role as a healthcare provider spans so many different ways that they can improve the healthcare system. It's a real strength of the healthcare system to have people with lived experience represented as part of the team, part of the leadership team, and part of the implementation as a zero-suicide approach. Next slide. Excuse me. This is our zero-suicide toolkit. It is zerosuicide.com. This is a toolkit to help you get started. It has a lot of resources, many of the things that I just talked about today. What are the seven elements? What are some of the outcomes of early adopters? We know that healthcare systems that have adopted a zero-suicide approach have reduced suicide by about 65% to 75% among their patients. Our zero-suicide toolkit is constantly evolving. We have many trainings that are free and publicly available, many resources, an organizational self-study, and a workforce survey so that you understand the current self-assessment of capacity of your staff, how comfortable do they feel doing this work. Then we also have a very robust listserv, about 3,000 people really generous in sharing their thoughts and their ideas so that you're not having to reinvent the wheel. We really encourage you to sign up for that listserv. I'll have Adam throw that into the Q&A box so that everybody can see that. Next slide. As I said, these are a couple of examples of the resources about lived experience that we have on that website. This is just a small example of some of our resources. Next slide. Our learning objectives, it's really to how do you understand strategies that foster an organizational culture that prioritizes lived experience as a central component of systems change? How do you identify staff training considerations and practices that facilitate peer support service delivery and leadership? How individuals with lived experience can help aid in warm handoff practices to ensure safe care transitions between services and levels of care? A couple of wonderful presenters. I'm first going to introduce Lisa St. George. Could you go to the next slide, please, Julia? Thanks. Lisa currently serves as the Vice President of Peer Support and Empowerment at RA International. She's a principal author of RA International's Peer Employment Training, and she was a board member of the International Association of Peer Supports for 15 years and sat as board chair for three years. She has many, many years, decades of experience in this area, and I want to thank you, Lisa, for joining us. I'll turn it over to you. Thank you so much. Next slide. Great. Today we're going to talk about the expertise and the abilities and some of the ethics of peer support in our service systems, and I have about 20 years of working in this field of peer support, and while I'm a master's level social worker, I've worked from my lived experience for the past 21 years. The years are flying by. Next slide. When I was preparing this, I came across this quote from Dr. Mark Reagans, and some of you might know him from the village in Long Beach, but he says this very descriptive idea of how it was that he was taught to believe when he began practicing, and it went something like this. People with chronic mental illnesses are permanently disabled. Medicate them and forget them. They are weak and need to be taken care of. They can't hold down jobs. They have no significant role to play in society, and the possibility of them having a meaningful life is slight. The prognosis is essentially hopeless, and really our systems of care functioned in that frame for a century, more than a century, and up until the early 90s when Dr. Bill Anthony began talking about recovery and other leaders in the peer support field, the survivor field, and in 1999 when Dr. Reagans met Bill Anthony and he said that the next big movement in mental health would be recovery, Dr. Reagans describes that as he almost fell out of his chair, but it was a change point for him, and so I hope that today can be a change point for you, too. Next slide. We are working in the most fantastic time to be able to work in this field because there is lots of hope now. We no longer think that people can't go to work. Oftentimes, many, many organizations have people with lived experience working right alongside their teams, and I know at RI International for the past 20 years, we've had a huge workforce of peer support, and we have about two-thirds of our staff of 1,500 people are individuals with lived experience, so we have so much hope. Next slide. So, the idea of lived experience as expertise isn't something new. People used to learn all the trades by working alongside someone who knew that trade. We learned how to do things in life from our parents by working alongside them, by baking with our mother, by gardening, by doing things like driving cars. We learn through the experience of others who have done that before us, and so when we talk about peer support as lived expertise, we're talking about peer support people with lived experience taking those experiences and making them meaningful to the people that they serve by bringing all of the wisdom that they've gained during those journeys that they've made to the table to work with people. Next slide. And so, some of the things that are really important to remember is that most states have training and credentialing for peer supporters, and there are practice guidelines developed by the National Association of Peer Specialists that have been developed, and SAMHSA has put together core competencies around the knowledge base that peer supporters should have, and there are companies that have peer support ethical values, and they include those in the other ethical standards of their company, and I have put in the handout section RI International's guidelines for peer ethical guidelines for peer workers, and these are guidelines that we use, but we've also shared them in our training, and we share them with organizations and systems often, but that's a whole additional training, but they're there for you to examine, and I invite you to please connect with me for questions if you need to. Next slide. So, what I see across a lot of service systems in the United States is that they have one or two peer support specialists on their team, and they sort of check that box, and they have those individuals serving very few people, and sometimes they're just greeting people when they arrive at the service center, and then sometimes they're filing, they're answering phones, or they're providing transportation or delivering medications, and oftentimes they're doing what clinical team members don't want to be doing or don't have time to do, but when we limit their scope of work in these ways, and we don't have them engaging people with people in the full scope of what they are capable of doing, we miss their gift. The service system misses their gift, and they will not feel the presence of peer supporters if we're using them in these minimized ways. Next slide. So, some tips that I would give you that we've learned over the long years at RI International is to hire enough peers that you feel their presence. Now, that depends on how big your team is, what kind of work you do, and only you can measure that, but I can promise you that it's more than one or two people, and make sure that before you hire these individuals, they've had the required training in your state. If they've had the required training in your state, then they will be allowed to invoice Medicaid services when they're signed off on by a clinician. They will be able to bring in the kind of encounter value that will actually pay for their services. So, it's important to make sure that they are trained, that you see their documentation of training before you hire them, and it's also a way to understand is this person a peer supporter or not, and then orient them when they're hired to what their roles and responsibilities are in their workplace. Be sure that they understand it just as you would anybody else. Then I want you to set really high expectations for them, and I want you to treat them as employees, not peer support employees. In other words, not a person who has a job. Treat them as a person who has a job and not a patient who happens to work. This is a really important distinction. They are coming to you as an employee, and that is their master status the minute they enter your workforce, and as long as we work with all employees in a strengths-based manner and include peer supporters in that strengths-based coaching and leading of employees, you will get the best from them. Next slide. When you bring peer supporters on your team, be mindful that they are not the only people on your team that have lived experience, and when we realize that people around us have lived experience that we might not be aware of, we get a sensitivity, and peer supporters speed up that sensitivity growth within the teams that they engage with. We know that mental health and substance use challenges, suicidal thinking has no barrier. It's prevalent in all aspects of our society. It doesn't care how smart you are, how much you earn. It can come at any time to any of us. And I think the last years dealing with COVID have taught us that we are all vulnerable should we get to a certain place in our life where things get really challenging. So at RI International, we want to hire not just peer supporters with lived experience, but nurses and doctors, clinicians, anyone that we can get on our team. We have a preference for people who understand. We think it creates an empathy and a kindness and a place that they come from in their heart when they're doing the work with people. And peer supporters get the kind of training in those, you know, state certified trainings that helps them to work within their scope of work from their unique perspective. And they do have a unique perspective. And we want to make sure that we open spaces for them to use that unique perspective that they bring. Next slide. And so what I often hear when I speak at conferences is that people will come up to me afterwards and they'll tell me, you know, I work in a mental health setting and I have a license. I'm a licensed therapist and I have a mental health diagnosis of whatever kind they say. And I could never talk about that at my workplace. That's troubling to me because our workplaces should be a place where we understand and we get it. We know that this happens to anybody. And that we believe in people enough to make it safe for all of our team members to not just work from their professional expertise, but work from their lived experience so that we can gain extra insight that we might not have if we're kind of squashing that insight coming forward from all of our team members. Next slide. So these are some of the places that peer supporters work at RI International. And basically what you see there is all of our services. So all peer supporters work in every service that we have. On the left side, you see our living room model in several different locations. And you can see that they are bright, they are airy, they have windows, they are hopeful environments, they have places for people to gather and talk. And part of the direction on building our services like this was the people on our teams who have the lived experience. Now at the bottom of this list, you see crisis receiving centers, 23-hour retreat model, and living rooms, and medication-assisted treatment. And we have peer supporters working in all of those settings right alongside our doctors, our nurses, and our clinical team members as an equal and valued member of the team. And what all of these positions in our company also have is a career ladder. So RI is a company that has made a commitment to ensure that people don't just come in at an entry-level position and stay there, but they can grow within the company in lots of different ways while maintaining their peer support role or not, should they choose that they want to move in a completely different direction. Next slide. So some people say, should peers be working in places where people are brought against their will? And my answer to that is yes. That is exactly where we need to be. We need to be in hospitals. We need to be in every crisis center. We need to be on mobile teams. We need to be throughout the system of care. One thing that we've seen in Arizona with the outpatient, assisted outpatient treatment, which is outpatient commitment, is that people are brought against their will frequently for having missed appointments or refusing to take their medication, and they're brought into our 23-hour crisis service center because of that court order. And this causes sometimes tremendous distress to people. And this is in addition to people who are in the community being brought to us. And one of the things that we see in Arizona is that many, many people are brought in the back of a police car, and we never say no to the police. We take everyone who comes to us. We take everyone who walks in, everyone who's brought by a family member, because we want to be a place that stops the pipeline into jail for people with mental health challenges and also puts an interception in the way of sending people to sit for hours and days in emergency departments prior to receiving the kind of help that they need. And so where else do peer supporters need to be? Everywhere. Next slide. Now, RI International works from a certain perspective that we call the RI way. And in that RI way, we have this fusion model. And it's what I'm talking about, that we fuse peer support specialists as equal members of the team with doctors, nurses, clinicians, and we bring in family and friends. We work with people in their community. We work with their teams, their primary care. And all of this fuses together to create a positive energy and positive support for people who are at the center of all of this support, attention, caring. Next slide. So the old system of care, as I mentioned before, was kind of creating our pipeline into jail for many, many people who have mental health challenges, addictions, and other issues that are coming up for them that bring them in an encounter with the police. And I'm not speaking ill about the police. I'm just saying it doesn't need to be that way. The other place is the emergency department, where people can get stuck for long periods of time before they get the kind of help that they need. And again, it's not that the emergency departments are bad or anything. It's just they're not created to help our folks. And so what we're trying to do is create a new system. And the entire system of behavioral health is in a big change right now that is very positive. And that is that 988 will come online in 2022 and replace the current system of 911 for behavioral health care so that when people call 988, they will get a helpline with people who are trained in behavioral health who know how to help them, or they will be able to access a warm line with peer support. And if they need someone to come to them in the community, it will be a behavioral health specialist and a peer supporter. And if in those various few cases where people need to have the intervention of a police for safety reasons, then the police will attend. But the behavioral health practitioners and peer supporters will be there also. And we hope that this will alleviate some of the bad outcomes that have occurred. So we call that someone to call, someone to come to you, which is that behavioral health worker and peer supporter, and somewhere to go, which are these 24-hour, 23-hour, 59-minute crisis centers where people can come and get the kind of help that they need at the right time. Next slide. So it's a human rights issue, really. And I found this quote from Dr. Puras and Dr. Gooding that creative responses are needed that foster therapeutic relationships based on trust and empowerment in ways that avoid the pitfalls of the past, which is built on, you know, this harsh system where you didn't have a lot of choices and options. And this, to me, felt like a prescription for peer support. That's sort of the sweet spot where peer supporters fall. Next slide. So one of the reasons that peer supporters are important to people who are receiving services is that they get where people are coming from. They really get it. And you think, how do they know that this peer supporter understands them? I've been watching this for 20 years. And it is so interesting how peer supporters are able to build a very quick, trusting relationship with people. And that relationship is so important for the individual, and it is what creates the positive outcomes in behavioral health, more than anything else, is that relationship of someone believing in the person. And when that person has also been there, that helps the individual that they're serving feel confident that they can share things, that they can talk about things that are important to them, and that they can really get down to the business of recovery. Next slide. So a peer supporter says, I understand. I understand where you are. And that might be that they understand the benefits and challenges of medication. They might understand the experience of crisis. They might understand the experience of feeling intensely suicidal. They might understand the losses of job, family, homes that comes with substance use or behavioral health challenges. And these things, when someone else really understands them, it just breaks down barriers. Next slide. And it creates hope, because what I've seen over the past 21 years is that often unspoken, what comes up for people, hey, if they can do it, I can do it. If you can do it, I can do it too. And so they have this idea that if someone else just like them can get to a better place, maybe that's possible for them. And I'm not saying that they have to go to work or anything like that, but that they know that their life can be more satisfying, more hopeful, and more contributing, even within the limits of having mental health challenges. Next slide. So we know that the mindsets of people who believed that behavioral health recovery was not possible will be challenged by people who are coming in as peer supporters. And when those trusting relationships are built, peers can be the bridge back to the rest of the team to build communication, connection, and trust between that team and the individual that maybe didn't exist before. And this is one of the major contributions that peer supporters make in the teams that they serve. And then the language being used about people slowly begins to change because we're working alongside individuals that maybe we want to make sure that we speak of in a very positive way. Next slide. So I just created this little word cloud with some of the types of language thoughts that we might be having. Is our language compassionate, helpful, hopeful, respectful, honest, thoughtful, sensitive, nonjudgmental, truthful, empathic? And there's a lot of words there. And so I'm not going to go through them all, but one of the key things that I see is that people start paying attention to how they talk about people when there's a peer supporter on their team. And because the peer supporter uses gentle, common human language, all the language starts to shift into more understandable, caring, and compassionate language. Next slide. So a little bit about our history is we developed our curriculum for peer training in 2000. It's in its sixth edition. In the beginning, we just created it for us to be able to hire peers on our teams. But now we've trained over 15,000 peer supporters in the United States, Canada, England, Scotland, Ireland, New Zealand, Singapore, and recently the Czech Republic. And we have trained thousands of veterans during this time, too. Since 2008, we've had contracts with the Veterans Administration. And that has been a really important part of the work we've done training peer support specialists. So all across the world and multiple facets of society have taken our training and stepped into the role of peer supporters. We added peer supporters to our crisis services very early on in 2001 in an in-home crisis service that we call Home Recovery Team or HART. And we've had peer supporters in all of our crisis centers since 2003. Next slide. So one of the things that we've seen that peer supporters can help with is this idea of, you know, the clinician's dilemma is that they see people all the time, especially in hospitals, where they're not doing well. And they forget that when people go outside of the hospital, most of the time they're having a good life. They're having easier time than they're seen in the hospital. They're not ill constantly, 24 hours a day, seven days a week, for the most part. And so when we bring peers into these settings, it brings hope to everyone, the staff included. Next slide. So when we started introducing peers in our company, it wasn't just easy peasy. Some folks did get off our train. But we trained the entire staff to understand their role, what they were coming to help us do, what we could help them do, what we were all focusing on, which was the individuals we serve or we call them guests. Next slide. And so I talked about the credentialing to pull down Medicaid dollars. And we need to have organizations really understand what peer supporters are coming in there to do. So helping organizations through training, what peer supporters do and do not do and who they are and what they can do and what their limitations are is important. And staff with or without lived experience who are supervising peers need to understand and have training around how to do that well. And when you prepare the way in your organization for peer supporters, everyone will have a better experience. Next slide. Some programs are funded through the state and they don't have to use Medicaid. But Medicaid is funding more and more roles that peer supports play. And those dollars can help sustain that workforce. We now have the introduction of the Promoting Effective and Empowering Recovery Services Peers in the Medicare Act for 2020. And that is looking at Medicare as being able to use peer supporters in their billing. Next slide. And so we know that these challenges, these bumpy rides that peer supporters are having and our systems are having have happened before in our field and the field of medicine. Because when new things happen, people have to get used to it. And nurses went through a very bumpy ride before everybody accepted them. And so did osteopathic physicians and midwives are in that bumpy ride right now. And so what we found is how can we do medicine now without nurses? We can't. And osteopaths have been a core part of our medical system for years and years now. And hopefully, in many countries around the world, they've used midwives for years and years. And so hopefully, they'll be joining our ranks soon too. Next slide. And so remember, when you hire peer supporters, not one, not two, but a tipping point needs to occur. A tipping point where you feel the presence of those individuals to get the best effect of peer support in your organization. Thanks for your time. Have a great day. And now I'm, oh. Thank you so much, Lisa. That was perfect and so fascinating. You make it seem so compassionate and doable and elegant and just the right thing to do. I think everybody in the webinar is thinking, of course, how could we do anything but that? And I know it's not easy, but I think that you gave so many wonderful examples of how this can be so safe and so effective. So let's hear what you all think. People can use the Q&A box to please share one key takeaway from that presentation. What is something that you're walking away with already thinking, I never thought of it like that? Or this is what I want to do in my organization. As I said, we'll take your actual questions at the end after our next presenter speaks. But what are you already starting to have some light bulbs going off about? I can see somebody said, my agency has peers in every program. They run groups. And I look to them at times to know I'm on track with my thoughts about therapy. Anyone who doesn't take advantage of what they can offer is losing out. I think that's such a wonderful way of looking at it, that this is so additive and such an opportunity. A couple other comments I'm seeing, love to hear, include them in your staff enough to truly feel their presence. This is something that people, it's not a bolt on, it's not an afterthought. It is something that is as integral to the work as every other position on the team as it is to having people sign in when they get there. It's routine, it's baked in, and it should feel that way to everybody on your team. It should feel that way to your peer supporters. It should feel that way to your patients. That's the culture you want to set. We have a lot of people saying how important peer support is, not tokenizing, peers need to be on every single unit, and some comments also about the police and mental health crisis intervention. Thank you, Lisa. As I said, people can keep going with their comments and their chat. I saw a couple of questions come in. We will have time at the end to get to those. Thank you all. In the meantime, I'm going to move us over to our next presenter. Next slide, please. Our next presenter is Tony Stelter. Tony serves as the Director of Recovery Supports for the Oklahoma Department of Mental Health and Substance Abuse Services. Tony is a certified peer recovery support specialist and a licensed professional counselor. He has many duties in his current role, and he will use them all to give us a wonderful presentation today. Tony is a founding member of the Lived Experience Advisory Committee of the Suicide Prevention Resource Center. I'm going to turn it over to you, Tony. Thanks, Julie. I really am honored. I just want to say I'm really honored to be asked to speak today, and I'm honored to be able to speak with someone like Lisa. She did such an amazing job, and I'm going to have to follow her, and I hope I can do that in some fashion, but I'm going to talk more about my career in just a little bit, but first off, one of the most important things about myself is that I'm a dad to a 12-year-old, and if any of you all have any preteens or teenagers, it's super easy to embarrass them. I don't have to do much, but one of the things I like to do is tell bad dad jokes, and so I'm going to start this off with a bad dad joke, so I'm sorry in advance for that, but why do melons have weddings? Because they cantaloupe. So I can't see any of you cringe because this is a webinar, but I'm sure that's happening right now, but we can go ahead and move on to the next slide. So I'm going to, these are the points I'm going to be touching on as we go through this. I'm going to be talking about the valuable role of lived experience. I'm going to talk first about creating a culture of recovery, followed by the value of lived experience in the workplace, and then I'm going to end it with warm handoffs, an intervention we're using right now or have been using for some time at the Department of Mental Health and Substance Abuse Services, and we're seeing a lot of great outcomes with it, and so we can go ahead and move on to the next slide. So when I'm talking about, when implementing peer support or talking about peer support or just talking about the times that we're in, it's important to recognize that we're in a paradigm shift. We're shifting from, you know, the old way, the maintenance model, to a recovery-oriented service model. And if you, many of you have probably already shifted to this, or you're in the process of shifting to this, or you're going to, if you're not on that train yet, you want to hop on board, because this is where it's going. And if you don't, you're going to be left behind, and you're missing out on a lot of quality service that you could be providing to the folks you serve. So, when looking at this, the maintenance model, that first thing it talks about there is stabilization. When you think of stabilization, you think it's about managing or reducing variation, or creating predictability. That's not what we're really trying to do for our clients. What we're trying to do is build resilience, which resiliency is about the ability to handle change or outside influences. And so, if we're really wanting our folks to get better and recover, instead of just stabilizing them and creating predictability, we want to create resilience. So, whenever those outside influences come to them, that they are more able to conquer those challenges. So, we don't want to make them, we don't want to get folks to just where that they're okay, and they're stable, and they're easy to predict. We're wanting to build that resilience in them, so that they can face those challenges in everyday life, and not need us. That's our goal, right? To work ourselves out of a job. So, the old way, too, the old paradigm used to think, we used to talk about disease and disability from a deficit standpoint. Whenever I first started in the field, and I've been in this field for over 10 years, I was taught to look at only the negatives in clients, right? That's what my progress notes were supposed to be out, looking at the negatives. But now, what we're doing is, as things have shifted, we're realizing, let's focus on what the strengths are, the wellness of this individual, and how we can work with that and build on that. Focus on those positive things. And that really goes with this next one. Instead of looking at what's wrong with that person, we're going to look at what's strong with that person. A strength-based approach. Lisa talked about that previously, and it's so important. Instead of staff-driven services, we're looking at consumer-driven services. We're going from a staff, an old-school medical model, where the provider knows all, and then the client just needs to listen and to conform to that, which is, we've realized that doesn't really work. What, I mean, it may work for some folks, but for the majority, it does not. Whenever it's consumer-driven, when that consumer is sitting in the head of that table, because they are the expert on themselves, and their voice matters, and we're taking what they say into consideration in their treatment plan and using what they say, using their own goals to work with them, that's when we have the best outcomes. So, and that goes to, instead of a staff-consumer hierarchy, it's a staff-consumer partnership. We're working together. We're all going for that same goal. It's for that client to be healthy and happy and satisfied with their life and be able to take on the challenges that are in their way. So, it's our goal to help remove those barriers, right? Instead of looking at, too, with this shift, this paradigm shift, we're no longer just looking at mental health and substance use, behavioral health. We're looking at, we've realized that we're treating the whole person. SAMHSA has those eight dimensions, and what we've realized is that our behavioral health, our mental health, in order to get well and treat our substance use disorders, we have to look at those other aspects. We have to look at our physical health, because that plays a part of our financial health, our environment, our social life. All those things play a huge part. No longer, too, are we trying to just, and this goes with what I just said about those dimensions, social inclusion is so important when it comes to treatment. We aren't trying to isolate people anymore. That's like, we're all about the least restrictive environment, because we realize that people don't get better when they're isolated. They get worse. So, keeping people isolated and locked up is not the way to help people recover. No longer are we looking at compliance. It's kind of like we talked about with stabilization. People are just doing what they think they need to do in order to get out, and they're not really buying into it. They're not going to probably get better, right? We need people to be engaged in services. That's a recovery. We do that through all the things we just mentioned, by being a strength base, being person-centered, having a partnership, and then also, instead of dependence, we're looking at interdependence. We're all working together for the same goal. We can go on to the next slide. Okay, so there's been, I know a lot of you have probably heard of cultural competence, and this is so important, but I think part of being culturally competent is also being recovery competent. Looking at your, and what do we need to do? You need to look at your, what is your own organization's recovery competence? How well are we doing these things? Are we a person-centered organization, an agency, or if you're in a private practice, are you person-centered? Are you really listening to what that client says and making sure that what they say is valued? Are they setting their own goals? Are you trying to get work with them to get to where they want to be, not where you necessarily want them to be, and then help them get to that point? I know sometimes our clients may have low expectations, and it's up to us to help build those and show them their value and their worth, and that too, but that's being person-centered as well. Being strength-based and not stigmatizing. So many places, I've worked for some really great places, and I've also worked for some places that had some work to do, and I don't think that it was intentional, but like Lisa said, one of the best ways to bust that stigma is to employ and deploy peer support within your services. Having folks with that lived experience, if it is specifically for being a peer recovery support specialist and working that role, it's great, but also employing folks that have lived experience and that work in other roles as well, because what that does is it busts that stigma. It shows that it dispels those myths that recovery isn't possible, because these folks have overcome it, and they are working in recovery and killing it. So what that does is that creates a culture, a recovery-confident culture where folks, it normalizes being in, having a behavioral health issue, and that's what we're going for, and that's what's going to make consumers want to come back to your place, and that's going to help consumers get better, and that's what we're going for. In order to do that, though, you have to make sure that people understand the value of peer support and its role. So a lot of certifications and auditing bodies require this, but even if they don't, the ones you have don't do that, it's a good practice to have, but make sure you're doing at least annual training for all your staff on the value of peer support and its role, and it has to be, and Julie talked about this right at the very beginning, but leadership must be committed. Just like leadership must be committed to the zero suicide prevention practices, leadership must be committed to a peer recovery support model and a recovery-oriented model. If they're not, it's not going to work, or it's going to take a really long time. Also, make sure you're having specific training for those that supervise peers on the role. Here in Oklahoma, we provide a supervisory training, and we require it within our contracts for as far as if they're contracted with the Department of Mental Health, and if you're, if you have peers working for you, you're required to take a supervisory training class, and that's for, just like Lisa said, for RI International, that includes if you're a peer yourself or if you're not a peer, if you're a non-traditional role. One way, too, that folks here in Oklahoma, in our system, are helping build the recovery competence is they are having traditional providers shadow peers, so as part of their onboarding process, whether you're a doctor, you're a clinician, you're a nurse, they're having those folks shadow a peer as they do their role, and what that does is it shatters maybe any prior beliefs or maybe negative thoughts they may have of, you know, peers working in that professional realm and shows them, oh my gosh, like, just like Lisa was talking about in her process, how well they're able to connect with folks and how it's not, it's not like they're not taken away from, you know, the nurse role or the clinician's role, the licensed mental health professional's role or doctor's role or anything like that. They're supplementing that. They're helping engage that person and letting them know that, you know, going through and doing these things to help better yourself is going to help you, and you can overcome it just like I did. It provides that hope, and then one of the most important things to do as well when you're implementing peer support is making sure that peers have a valued voice and a seat at the table. Sometimes we can employ peers. We have peers, you know, in our place, but we don't necessarily value them like we should, and we don't have them sitting at the table, and we don't take what they have to say because they may not have, you know, maybe the education, you know, the formal education. They do have an education. There was an education in life and being in recovery and overcoming that, so that's valuable, and they've sat at the other end of that table, and they know what it's like, and, you know, we talk so much about, you know, we do, you know, consumer surveys where we're wanting to get that information. We can have someone that's on our team that can bring you that information, and so make sure that they have a valued voice at the table. We can go on to the next slide. So, going with what I just said, one of the most important roles, there's a lot of those, but one of the most important roles is peers advocate for the client. Sometimes they can be a voice for the client when the voice is not able to speak for themselves because they've been there themselves, but with that, one of the most important things peers do if they're doing their role correctly is they're working with clients to empower them to advocate for themselves, just like we want to do when we're going to our appointments is we want to advocate. That's what we want for our kids and our family members and our loved ones. We want them to advocate for themselves when they're going through treatment, and so what peers are doing is they're helping our folks learn to advocate for themselves and teaching them those skills in order for them to do that, and we can go on to the next slide, but having said that, if we're employing peers into our workforce and integrating peers into our workforce, we need to advocate for that peer role just like peers are advocating for their clients. We need to, like I already said this and Lisa said this, and it's because it's so important is because we need to make sure peers have that voice and a seat at the table, and we need to make sure that voice and seat is valued. We have to be aware of our stigma and our stigmatizing language and our stigmatizing practices. We have to make sure that we're overcoming those, and a good way to do that is having somebody with that lived experience having a seat at that table letting you know, hey, that's not necessarily the right way to do it or that kind of makes me feel not good, and so it could be completely innocent. You're not knowing that you're even doing it, but having that role there can enlighten you, and a lot of times we need to be enlightened. I've been enlightened by it. I'm a peer myself, and I've been enlightened by other peers like, whoa, Tony, that's probably not the best way to do it, and I was so glad that they said that because that made services better for the folks we serve. Make sure that we're supporting a person-centered and trauma-informed and recovery-oriented environment. Trauma-informed is so important, especially when it comes to, like, no matter what practice you're doing. I feel like we just need to go throughout our lives being trauma-informed because trauma is so common within our population, and if we're not, we need to make sure by being trauma-informed we're sharing power. We're doing all those things we just mentioned. We're being strength-based. We're person-centered. We're being aware of where that person is coming from. We're not assuming things. We're not shooting on them. We're not telling them what they should do. We need to make sure that we're providing ongoing and consistent support and supervision to peer support staff. Sometimes I think we're, whenever we employ peer support staff, we're afraid to have those difficult conversations because we're worried. It's kind of like when it, like, just because you talk about suicide with somebody or ask them about it, you're not going to make them, you know, go commit suicide. We've learned that. You need to have those difficult conversations with peers and not steer away from them. Otherwise, you're not helping them. You're not helping them, like, if they have a difficult situation that they need to work through you on, make sure y'all work, go through that together. Lean into those difficult situations. Do what Brene Brown says. She says to lean in. I'm a big Brene Brown fan. If y'all don't know about her, you should check out her stuff. She's great. We also need to, and Lisa touched on this, it's important to promote peer recovery support staff, whether that be in that peer recovery support way, put them into more of a leadership role, or if they promote them into other positions, if that's what they want. But make sure that you have a way for peers to grow because, like, just like in any field, we have to feel like we can grow, and that can be in different ways, but just make sure that we're promoting them and allowing growth because that's how we lose folks. If they feel like they can't go anywhere, that, you know, they're at the peak, then they're not going to want to stay, and we're going to lose some great, great folks. So make sure that you're providing a way for that to happen. And then provide continuing training, support, and education to all staff on the peer role. You have to keep that going because sometimes we forget. Sometimes we have new staff coming in. We just have to make sure we're doing that consistent, continuous training on the peer role so we make sure we're using it effectively, and that we're up with the times. All right, we can go on to the next slide. All right, real quick, how do planets clean themselves? They take a meteor shower. All right, sorry about that, but I'm going to tell you a little bit real quick on my story real fast. Before I got into recovery, this was from a very, very young age. I had some traumas happen to me. I also had that, you know, already a core belief that I was not worthy. That fueled some maladaptive coping strategies, and then I suffered from depression. You know, I had a lot of suicidal ideation at a very young age. I ended up having my wisdom teeth out at one point, and I discovered opiates at that time, and you know, I was able to kind of numb myself. But the problem with that is it numbed both the good and the bad things. I had other maladaptive coping strategies, perfectionism, something I still have to work on, and people-pleasing for sure. I would put on a mask and try to be who I thought people wanted me to be for a big portion of my life. My depression got to the point where I did have a suicide attempt, which I lived through. I also had a very, very close friend pass away from suicide. I had a lot of self-destructive behaviors, destroyed relationships, really alienated people and myself. But finally, with a lot of supportive folks, despite my behaviors, I had people that loved me, and I finally was able to realize that I needed to get help, and I did. And whenever I started doing that, I started learning that I needed to love myself, right, that I was worthy, and I got into treatment. And from then, it was like a completely different story in my life. I mean, not that I didn't have ups and downs. That's, I still do. That's for sure, and struggles. But I'm able to challenge those struggles without, you know, completely, you know, without needing to destroy it, totally blow everything up, right. Now, I'm a loving dad. Like I said, I have a 12-year-old that has to listen to my really bad dad jokes. I have a great career where I get to give back and help others, and I get to use my lived experience, even not necessarily as a peer recovery support specialist in many of the roles I have, but I got to use my lived experience to bust stigma and dispel myths whenever I was in those roles, and to help people, both like in a, you know, maybe in some large settings, and then also in one-on-one settings with co-workers that may have been struggling themselves to help them get through situations. I got to do that a lot, and then also, as well as the clients that I served as well. I get to have positive relationships now. I get to focus. One of my big things that helps me stay in recovery is my overall wellness. I quit smoking, which is a big deal. I just ran 20 miles yesterday. I'm training for the Oklahoma City Memorial Marathon, and that's a big deal. So, we can go on to the next slide. So, with my lived experience, since being in recovery, I have over 10 years now working in behavioral settings, but it's been in a variety of roles, like I said before. I started as a, like, a mental health tech at Children's Recovery Center in Norman, Oklahoma. That's one of my most favorite jobs. That's when I first used my lived experience to, with a client, to help engage them, to help them show that there is, you can, that you can overcome challenges, that there is hope. I worked on a program of assertive community treatment as a case manager with a community mental health center in Norman, Oklahoma as well. Following that, I've worked as a consumer advocate, advocating, making sure that folks' rights aren't violated, that the various organizations within the behavioral health system in Oklahoma. I worked as the community response team lead. That, I was a, I was a therapist, but I also had that lived experience. And so, in that position, I supervised a lot of peer recovery support staff, but we got to work alongside police officers. We went, we went, we went to the various homeless shelters and many, many community partners to help, help make sure folks are, that have left crisis services aren't, you know, fallen, fallen in the cracks, but also whenever folks did go into crisis, we would help respond to, to help make sure that they got it, the services and the resources they needed as well. From there, I got, I got promoted up to assistant director at a crisis center here in Oklahoma County. You know, I, I feel like having that, that lived experience has helped me in my career be better at my career. I think it's also helped me bust stigma within the organizations I've been in and helped show folks that you can be a professional and you, you just be, you know, like we're, we're not different than anyone else. We've just, but we are in some ways, you know, because we've overcome something, but there's, there's not necessarily a limit on what we can do, right? And now in my role, I get to help spread that throughout the behavioral health system in Oklahoma. So I'm, that's one of my jobs is to integrate peer recovery support. We oversee the certification here. And then I also oversee our employee assistance program and our wellness as far as it goes with the behavioral health system. All right, we can go on to the next slide. So what does being a professional with lived experience do for an organization? Well, it normalizes behavioral health, which is where we need to be. Like right now, no one has any qualms talking about any kind of physical issue really they have. Like if you break your arm, you know, like you have no problem calling to work saying, you know, I broke my arm. I'm not going to be able to come in today. I'm getting treatment for that. Right. Or so, but you say you're having a behavioral health crisis. People are not as well. They don't, they, they're not able to talk about that as much or not. Some folks are, but right now we're not at the point in our society where that is, you know, a lot of folks are resistant to saying that. And because, and you know why it's because of that stigma exists. So the more we can normalize that lived experience, because so many of you probably are working with folks right now that are still in the recovery closet, as you may say, you know, they're not, they're not out yet. And that's because of that stigma. My, my hope is that one day we can all talk about it. Like we can talk about our physical health. I think we're going to get there, but we're not, we're not there yet. But that's what hiring people with lived experience does. It helps get us to that point where we need to be. And until we get to that point, people are going to stay, you know, and then people aren't going to seek services like they should, you know, because they're worried about that stigma, that judgment that's going to happen to them. Hiring folks with lived experience dispels myths about what being a professional with lived experience is. That, you know, it helps like, you know, people that, you know, I had a heroin addiction, but like, it doesn't mean that I am, you know, you know, low life and all that. I'm a good dad now, you know, I'm a professional, I was able to overcome that. I wasn't a bad person either when I was on it, I just needed help. Having folks with lived experience increases recovery competence within your organization. It busts stigma. It brings value, valuable perspective that you may not be getting, you know, it's like you want to have people from all different backgrounds and cultures and experiences on your team. That's how we, we don't have group thing. When we have group thing, usually bad things happen. We have a bunch of people that think the same way we do, have the exact same experience we do, then we're not going to come to the best possible solution to the problem, most likely. So it also helps with your culture. If you can have a culture that's non-stigmatizing, and that is always looking for what's best for the client that we're serving and for all as well as like the team that you're on. And that's what that should be what we're going for. And so what is the potential of having professionals with lived experience and non-behavioral health settings? The exact same that we just talked about just now, like it brings all those same things to your organization that we just, we just talked about. It helps you understand the clients you serve, no matter whether they're behavioral health clients, or you're serving clients through like, you know, a law firm or anything like everyone we, we talked to has those lived experiences. And that the people that we're working with, you know, there's a high likelihood that they've overcome something or are working through something. So having those people and as well as your whole team, your whole culture, your organization, folks, all within your organization have lived experience. And so if you can be a place that's accepting of that, where that's, where that's just as normal of a thing as having a physical issue, then that's where we need to be. And we can move on to the next slide. Okay, I wanted to make sure I hit on this. And I'm going to go through it here pretty quick is how you can use peer recovery support to close the gap, you know, the warm handoffs. And this is something we're doing at the Department of Mental Health and Substance Abuse Services. I think we're doing it pretty well. And so we can go on to the next slide. So what is a gap in care? What I what I define is that it's at that space between the levels of care. Sometimes it's like it's a missing connection between that person and going to that next from that one level to that next level in those care providers. It can be a danger zone. It's a time when individuals can relapse. It's a time when individuals are most at risk for suicide. We can go to the next slide. And this is a good this, to me, this statistic, these statistics just blow me away and shows you how important it is that we close these gaps and make sure that people aren't falling through them. Because for individuals with a history of suicide risk, that that time right after discharge from inpatient or crisis care, it's a critical gap. So in the first week, for those that have had that past suicide risk, their death rate is 300 times higher than the general population. That's someone that doesn't have that risk. And in the first month after discharge, the suicide death rate is 200 times higher than the general population. And that's staggering. So we need we need to and that's why zero suicide and SPRC exists is they're trying to close that gap too. We can go on to the to the next slide. So the old way of thinking we kind of talked about that right in the very beginning, we were talking about the you know, the maintenance and then shift into a recovery warrant system care. But in that old way, the consumer was admitted to inpatient or crisis stabilization unit, right? The consumer was a passive participant in their treatment. The clinician dictated the course of treatment, the consumer didn't have like a real real little say in their in their goals, or like the for their treatment plan, they would write their goal, but then nothing really that that was part of their treatment plan, like was anyway associated with their goal, you know, it was almost like a cookie cutter treatment plan that they you know, that they just made that was easier to do. And that's what they thought that the consumer should do. So the consumer would say the goal and they would put that maybe in quotes, but then not have that. And that's that's not person centered. And that some folks didn't even do that they would make the goals for them. And then once the consumer is stabilized, they receive a prescription of medications and a paper referral to a local community center or a private physician or a private therapist or and then they would send them on their way. That's the old way. So we're gonna go to the next slide here. And a lot of folks, they wouldn't show up to their appointment. And those providers that gave them that referral, or like, like, didn't they have a referral? Why didn't they go? Yeah. So but when individuals aren't allowed to be an active participant in their treatment, they don't have buy in, you know, like, why that that's not what they wanted for their life. They didn't they weren't they weren't active in their treatment. They didn't buy in. They didn't have there was no connection to that next level of care. So some things that they asked themselves like that, and this is this comes from experience, right? I've been there too. How can they help me like, I don't even know who they are. I don't know what really what they're about. They kind of told me a little bit, but I don't know anyone there. So I don't think I'm gonna go. They don't even know who I am. So you know, I feel like I'm just, you know, another, you know, something on the conveyor belt, you know, and then, and then I don't know what to do. And I don't know what's going to happen when I go there. So let's, let's go on to the next slide. So what we've moved to is, is the better way, a way that's works better. It's person centered treatment, you know, which is part of a recovery oriented system of care. We don't put folks into inpatient care, unless it's, unless it's absolutely necessary. We go with the least restrictive environment. And we do that by keeping folks in an outpatient system as possible using cams or another evidence based practice. If the risk, though, is too high, or the person that doesn't necessarily have the resource in order to maintain safety, you know, we, in those cases, they may need to be inpatient or in a crisis setting. And when that does happen, we need to make sure that that consumer is the expert, that they're the head of their treatment team, that they're, that they are allowed to have input into their goals and input to their treatment plan and input into their discharge plan and what's happening when they're going there, that they're telling that they're able to feel like they, they have a voice and they're, what they want is going to be listened to and, and taken seriously and as part of like, and help set their goals. That if we want folks to get better, that's what we, that's what we got to do. And then, so that's what's, that's what's starting to happen now and is happening. So we can, we can go on to the next slide. So what we're doing now is we're bridging that gap. We're including the outpatient provider and the discharge planning right off the bat. And that usually works best if you include a peer, because just like Lisa was talking about in hers, they can build that, they can build that connection really quick and they, and they, and they're also providing that hope, right? They're that beacon of hope that like this recovery is possible, this person did it, I can do it too. So a way that works is the peer from the outpatient provider is, you know, has a relationship with the peer and the, and that higher level of care. It's a real good idea to make sure you're doing those releases of information and making sure you're doing those, you know, memorandums of understanding between organizations or agencies that helps you make sure that you're, you know, keeping people's privacy and confidentially, confidentiality, confidentiality, make sure that we're doing that, because that's very important. So we're involving the, the, them right, in treatment team, right, in the discharge plan, right off the bat. Everyone's working to get together, the consumer, the treatment team, and the outpatient provider, that next level of care are working together to work on their discharge plan and meet their needs and make sure that that person has resources when they leave and understands those resources and has a connection with those resources. The outpatient peer maintains communication with the consumer and assigned inpatient peer throughout the duration of the client's stay. This is dispelling those, like some of those scary thoughts of what might be happening in that next level of care, because they already have a connection there. They know what's going on. And they see that it's possible. And then we can go to the next slide. So if you want evidence that this works, here, here's some stats for you. So in fiscal year 2020, those discharging from inpatient or crisis services, and this is within ODMHS, SAS's Behavioral Health System, like the CCBHCs or CMHCs, those that are discharging from a crisis center inpatient service, received follow up within seven days, 83% of those folks received follow up within seven days, seven days, 78% did not readmit to inpatient crisis within six months, and 81% were engaged in treatment within 45 days. So I really appreciate y'all listening to me and giving me time to speak and, and listen to my bad dad jokes as well. And I appreciate the time and being allowed to do this. And I guess we're going to answer some questions here in a second. Thank you so much, Tony, I have a couple of kids right in that age group at home. And I think I wrote them down. I'm gonna throw them out there myself. So I loved it. I got more. Email them, put them in the chat. I think we all need some good jokes over dinner tonight. I really want to thank you. That was just so informative. And I really want to thank you for sharing your story. And you know, in your story of recovery and how you use that. And, and also, I think, you know, for me, one of the takeaways, I've been doing this work for a long time. And I really want to acknowledge, you know, you're talking about kind of the way we used to do things and the way we do things today. And I know for many of you, it and for all of us, it's a continuum. Right? It's not, it's not a light switch that you just kind of flip on and go, Oh, we did it like that. Now we do it like this. And it's done. But I, I respect many of you may still be doing things the way that we called it the old way. And that's okay, you join today, you're clearly on your own journey organizationally to figure out how you can do more. And I do respect that it is a journey. And it's it is something that we all have to learn to do. But I'm so mindful of the, the roles that you both play and the importance role of peer, peer recovery supporters and how I don't know that 10 years ago, this was a webinar that we would have, we would have had as this much this level of information and people saying, Oh, in my organization, where we're already doing all this, right? To me, that's what I'm really walking away with is how much the field has just moved in the last couple of years. And thank you, it's because of people like the work that you guys are doing. So, um, you know, a takeaway, a key takeaway, maybe from what Tony just said, you know, we're going to move into q&a overall. But, you know, I want to give people a moment to say what key takeaways did you have from Tony's presentation just now? And Tony, I should acknowledge, there were some shout outs for you and your marathon, and that you're an inspiration. So I, you know, I don't want you to walk away thinking that we're not not with you when you're running a marathon, not physically, because I'm not running a marathon. But we are with you. And I see great dad jokes, the staff, the Oklahoma stats are impressive. I will say, I think using your data always for everybody on today's call, always use data to support, you know, stories are important. So people understand the, you know, these are people we're working with your stories, the stories of the consumers you're working with, but also data and that, you know, these the work that we're doing matters and actually makes a difference. So collect that data. You mentioned cams. I see. So we'll start there. And actually, I since that was a question, Tony cams, it is it a training that you see as valuable for peers, in addition to clinicians? Is that something you guys did in Oklahoma? I think for the most part, it's we're it's it's clinicians that are mostly trained in cams. But I do think that it's it's Dr. Jobes that does. I'm a doctor job. And he I know he has mentioned in the past that like, it doesn't have to be a clinician that does that training. And so we just don't, we try, as far as Oklahoma goes, we try to use peers most effectively and using their story. And then we we try to I think a lot of times most other providers within Oklahoma system, generally don't use peers for cams, and they use them for more of like that engagement and targeted outreach. And, you know, those support groups with whenever they're within treatment. But yeah, usually here in Oklahoma, we're not using peers, peers aren't using cams. And I saw somebody asked what cams is. Cams is the collaborative assessment and management of suicide. It is a evidence based treatment approach that, as Tony said, was created by Dave Jobes and in his lab. And there's training available for that. It is typically used for clinicians, a training that's geared towards clinicians. But I do think having the system understand the purpose of cams, you know, the peer, the peer supporters and other people in the system understand what is the purpose, what is the goal is sort of part of your overall approach to how you want to think about suicide care. I'm gonna have a couple of questions that came in. So Lisa, I am gonna one question that came in was how can I share my experience without it becoming about me and rather be about helping my client? Yeah, that's a really good question. And it's, it's something that we teach in our training, but but peers really have to understand that. I always say it's like spicing your food, a little bit goes a long way. And so the story should never be about you, it should never be in support of you, you should never be seeking for the individual to become concerned about you. So you know, there are stories can be traumatic. And so we don't want to share that kind of detail. Typically, let's say you're working with someone who who's homeless, you don't need to go through the whole six years or three years that you were homeless and everything that happened. But you can say, I lived on the street for a while myself, I know what that's like, and they know that you get it. And then when you're working together, together, some of the questions that come up or things that come up, you've got some experience around things to not tell them what to do, but say, you know, these are options I thought about, what do you think would work for you? Thanks, Lisa. Any other any thoughts, Tony, to add? All right, unmute. I agree. I agree with exactly what Lisa said. Only only tell your story if it's going to benefit only and only tell parts of your story that's going to benefit the other person. If you're, you're not getting your needs met, in that case, you're helping that person reach, you're helping, you're trying to help the other person. So that that's the only bias I have with that. Several people are asking about training and what the accreditation process is like. Somebody asked where to get the training. Tony, I'll start with you. How do people go about getting, how do people train peer support, recovery supporters? There are there are some national and Lisa could probably speak more more about as far as that, that from that standpoint, and some states are will adopt some of those national trainings and certifications. But as far as Oklahoma goes right now, we only because ours is a Medicaid reimbursable service. And the way we have it is you have to go through our training that's within the state and other states are like that as well. But some some states have a way for you to use that certification and apply to become certified within that state with a national one or possibly from another state if you're certified. But what you have to do is there's an application process just like there is for for other certifications. This one just has some unique parts to it where you have to, you know, you have to be willing for as far as our state, you have to be willing to talk about your recovery. You know, as you have to, there's a there's a training, a 40 hour training that's involved where you actually we teach people how to share their story and empowering in an appropriate way, just like the previous question asked. And then which you and you have to do that as part of that training to as well as pass a certification test. Do you know, Lisa or Tony, some people are asking who or what the organization is that certifies this? Is there a national organization or is it done on the state level? So typically, state by state has certifying entities or a state certification. And so either they adopt trainings that people should take one of these trainings that they've accepted or the state will have a certification of their own. And that's really important. However, let's say you trained in Arizona and you took one of our trainings or you trained in Massachusetts. You took your training in Massachusetts. If you move to Arizona, Arizona will say you need to just take a competency test. And it's really quite complex to know who trains what and and who accepts what. But just make sure that they've been trained in the state that you are or have a certification from there that they've been tested or whatever. I saw one last question. So I'll start with you, Lisa. And the question was, what advice do you have regarding the dangers and only having one or one or a few peers in an agency? And does that limit then the perspectives to draw from? And how might you handle that? The dangers of having one or two peers, you know, if you have an organization of 10 people, maybe two is enough. But if your organization has a few hundred workers, one of the challenges that I hear is that they feel other or tokenized. And that is an issue that comes from two things. It's from not valuing the work that they do and not having them in a seat at the table, as Tony made clear, was really necessary. So there's ways to devalue people that can happen when you don't have enough peers to sort of feel their presence. And you haven't begun to realize that you can go to them and ask them about things that you're thinking about to get feedback from how did how was it when you were homeless? How was it when you were having, you know, suicidal thinking? What are the kinds of things that you needed? Because this person is telling me they don't know, you know, or whatever. We can be a consultant around our lived experience, so to speak. So when you don't have enough, people just mostly they feel tokenized or they're overloaded with work or they're minimized. Tony's nodding, so I'm thinking he agrees with everything you just said. I'm mindful of the time. Many of the recommendations that Tony was talking about about care transitions have been captured in a recently released report by the National Action Alliance for Suicide Prevention about care transitions. We're going to go ahead and put that in the chat or the Q&A and push that out so people can see it. I want if we can advance the slides. I want to make sure I mentioned the Listserv. I know we put that in the chat, the Listserv access to sign up for that. It's free. Any more questions that come in after today or, you know, you hang up and you think, oh, I wish I had asked this last question, please feel free to post that to the Listserv. There are several, a couple thousand people willing to answer your question and provide some resources. Lived experience and peer support specialists are a really critical piece of Zero Suicide. So take a look at ZeroSuicide.com and, you know, look through that for your organization. And the next slide. And there's a lot of resources at the end that have been mentioned throughout today or that I think are really good to supplement the conversation that we had today. So just want to draw people's attention there. I really want to thank Tony and Lisa for their incredible, warm, insightful, and just really wonderful presentations that, you know, show us this is possible, leading the way with such expertise and passion. And commitment. I want to thank you both for your presentation and thank you everybody for joining us. Hope you'll all join us at our next webinar. Thank you again.

webinar

lived experience leadership

peer support services

suicide prevention

cultural shift

organizations

role of lived experience

culture of recovery

consumer-driven services

integration of peers

person-centered

reducing stigma

supportive environment