Moderator: Maureen Madison
September 27, 2012
2:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are in a listen-only mode until the question-and-answer session. Today’s conference call is being recorded. If you have any objections you may disconnect your line at this time.

I would now like to turn the call over to your host, Ms. Maureen Madison. Thank you and you may begin.

Maureen Madison: Thank you. Hello and welcome to Peer-Driven Innovations: Changing Systems, Changing Lives.

Today’s webinar is sponsored by the Substance Abuse and Mental Health Services Administration’s Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health, also known as the ADS Center. SAMHSA is the lead Federal agency on mental health and substance use and is located in the U.S. Department of Health and Human Services. Please join the ADS Center listserv to learn more about social inclusion including upcoming webinars, new resources, and events.

This webinar will be recorded. The presentation, audio recording, and a written transcript will be posted to SAMHSA’s ADS Center Web site at http://www.promoteacceptance.samhsa.gov in late October.

The views expressed in this training event do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.

Our presentation today will take place during the first hour and will be followed by a 30-minute question-and-answer session. During that time, please press star 1 on your telephone to ask a question. You will enter a queue and you will be invited to ask your question in the order in which it is received. Upon hearing the conference operator announce your name, please proceed with your question.

Due to the limited time we may not get to all questions. If your question is not answered or you want further information, the presenters’ contact information is provided at the end of this presentation, so you can contact each of them directly.

People with lived experience know how significant and valuable peer-provided services are. This knowledge is supported by research over the last 10 to 15 years which has documented the benefits of peer support.

Peers have valuable knowledge and wisdom to share about their journeys of recovery. They offer hope to those they work with, they teach providers about the centrality of empowerment and self determination, and how to create supportive environments and relationships that assist people to recover from mental health problems and addiction.

Peer support professionals play a significant role in their communities, working as advocates to promote positive changes and a new paradigm for conceptualizing dignity and respect for individuals in recovery.

In their role as advocates, peers offer support to others who may experience discrimination and prejudice based on their history of mental health or substance use issues. They lead the way in efforts to ensure people in recovery get full access to resources, including health, social, economic, and cultural systems that promote recovery. In their many roles, peers are the primary drivers of a social inclusion perspective.

Recognizing that peers have valuable skills to contribute in a variety of roles and service settings, it is critical that they be afforded this range of opportunities to fully utilize their unique expertise to help others achieve a meaningful recovery; one which includes full community participation.

SAMHSA’s Recovery Support initiative, one of the eight strategic initiatives outlined in Leading Change: A Plan for SAMHSA’s Roles and Actions, 2011–2014, highlights the need for the active participation by people with lived experience in the development and implementation of a broader array of care and support services. It also provides a framework for moving communities and service systems to become more socially inclusive.

The SAMHSA ADS Center works to increase awareness and support implementation and replication of socially inclusive practices, programs, and procedures.

Our speakers today will share information about the great strides that both Michigan and Delaware have made to achieve large-scale systems change within the behavioral healthcare delivery systems of their States. You will hear how Michigan has used Federal funds to train and develop a strong peer workforce and promote peer support as an evidence-based practice.

You’ll also learn about the creation of a peer-driven service delivery system underway in Delaware, a concrete example of what can be accomplished with a powerful and effective collaboration between peers, State mental health leaders, and government officials.

Our first presenter is Pam Werner, Manager of the Office of Consumer Direction in the Michigan Department of Community Health, where she is responsible for the leadership and policy direction for the Certified Peer Support Specialist Initiative. She is also a member of both the Michigan Recovery Council and the Recovery Oriented Systems of Care Transformation Steering Committee.

Pam has received the Association of Territorial Health Officials Vision Award in 2010 for her creative approaches to public health challenges. She has over 20 years of clinical and administrative experience and is the co-author or author of journal articles related to peer support.

Pam will be sharing Michigan’s efforts to create, train, and support a robust network of peer support professionals. She will talk about the partnership that made the Michigan peer workforce possible, as well as the opportunities and challenges that remain.

Thank you for joining us, Pam. Pam, you can go ahead.

Pam Werner: Thank you. I would like to—I appreciate the opportunity from SAMHSA, and it’s an honor to be on the webinar with our national expert, Gayle Bluebird, and to also represent our strong peer workforce in our State.

A historical overview of where we’re at in Michigan and the foundation of peer services started in 1996 where Michigan has in the mental health code, a requirement for person-centered planning for all the individuals that we serve in our public mental health system.

In 2003, we also put, in our contract requirements with community mental health service programs across the State, self-determination. And in 2006, we were the second State, right behind Georgia, to receive approval from the Centers for Medicare and Medicaid Services to have peer support be a covered service.

For it being a covered service, Michigan has specific medical necessity criteria, and like other States, documentation requirements in order to make sure that peers are reimbursed for all of the work that they’re doing.

Our medical necessity criteria is different than others across the country, and it is designed to assist the beneficiary in attaining or maintaining a level of functioning sufficient to achieve his or her goals of community inclusion and participation, independence, recovery, or productivity. And that is taken right out of our Medicaid Provider Manual, and to me, really signifies the work that peers do within our State as they serve all of the individuals that have a serious mental illness in Michigan.

We have a variety of requirements for certification. And the peer roles and responsibilities are outlined in our Medicaid Provider Manual. And at the back of the presentation are resources and you can find that link right under our Web site at Michigan.gov.

So in our application process, before people are accepted to be—into the training, the one thing that we require that I believe is really unique and unusual is that individuals have to be employed to be able to attend the training. And the minimum amount of hours that they are required to work is 10.

We did that requirement because we really believed that unless we required agencies to employ peers and support them to attend the training, that we would end up with a voluntary workforce and that peers would not be able to do the things that they need to do or be paid for the work that they’re providing within the community mental health system.

The other thing that we do is during the application process, once an individual fills out their application, our State Trainer, John Fryer, completes peer-to-peer interviews and talks with all of the peers, clarifying exactly what their job duties are. The reason that we are clear about doing that is some people, they fill out their application, but once they’re interviewed on the phone they may be doing jobs like filing or driving, transporting individuals, completing med deliveries, and doing things that we don’t believe that is real peer support, but is important for people with a lived experience.

So our goal is to make sure that peers are supported to do what’s defined in the Provider Manual, which is person-centered planning, helping people with advance directives, homeless outreach, jail diversion, assisting individuals with arrangements to support self-determination, and a lot of things that we know that the people we work with need in order to move forward in their journey of recovery.

Our training is based on 56 hours. We have a 4-hour certification exam. And after individuals complete all those requirements they receive 3 community college credit hours from Lansing Community College.

And I wanted to show a graph here of the growth of our peer support specialists that started in the year 2005. As of just a couple of weeks ago, we have trained and certified 1,027 individuals in the public mental health system. We wouldn’t have gotten this far today if we had not had support from SAMHSA in developing and sustaining our peer-trained workforce.

And some of the things—and I think this is just a brief overview—of what I believe SAMHSA has done to support Michigan and other peers across the country, is the working definition of recovery in expanding and supporting peer specialists as a profession, has been, I believe, very, very important. And the definition that recently came out, to me, supports what peers do in our State and across the country.

Our ability to grow our workforce and to provide great continuing education opportunities has really resulted from the use of our Adult Mental Health Block Grant funds. And we have had significant funding, from back to 2005, that has really helped us be able to provide peer trainings at retreat centers, and I’ll talk a little bit about that later.

SAMHSA has also really provided a lot of opportunities for continuing education and the webinars like today’s and several of the other ones that I know we have all participated in over the last couple of months, have really helped strengthen recovery. The SAMHSA publications and technical assistance has been very useful, and the recently released Consumer-Operated Services for Evidence-Based Practice and that toolkit has really supported and, I believe, pushed peer services forward.

Our partnerships have been important in our State, and I know that we, the peer workforce and myself, we would not be able to move to where we’re at without those partnerships. And one of them again is Lansing Community College where we definitely are providing individuals with a career ladder and provide 3 elective credit hours so that individuals can go forward and use that for higher education if that’s what they choose.

Another partnership that we have is that we’ve had a really strong initiative for the Chronic Disease Self-Management Program through Stanford University. And it’s an evidence-based health and wellness, 6-week program that classes last 2 1/2 hours per week.

In our State we call it Personal Action Toward Health. But we have been selected as part of a research study to evaluate the work of peers helping other peers in health and wellness from the whole area of individuals with a serious mental illness. And they’ve collected the data and that should be released in the next few months. That was under our partnership with Dr. Kate Lorig.

The other really great things that we’ve been able to do has been through Transformation Transfer Initiative grants through the National Association of State Mental Health Program Directors. And I’ve met quite a few people across the country who have also received TTI grants, many of them focused on peer support.

Our first TTI grant a few years ago really supported the beginning initiatives in the background of developing our Chronic Disease Self-Management Initiative and also our Personal Action Toward Health.

The second one that we just received this year is very creative. And what we’ve done with that TTI grant is we have certified peer specialists who are working in FQHCs through the Primary Care Association in Michigan. And so we right now have worked with two sites—Muskegon, and Jackson, Michigan, and we’ll be adding a third site later, and we have some really great outcomes that we’ve already seen by peers helping peers with primary care and making sure that their medical needs and mental health needs are supported.

The peers that are working on the FQHC aren’t just health and wellness coaches—that’s very important—but they also have a built-in role of doing systems navigation, helping get people to specialist appointments where they may have difficulty with transportation, assisting individuals with smoking cessation, tobacco recovery classes, and a whole variety of things.

The other partnership that we have in our State, and I hope some individuals from Michigan joined that, are part of our Michigan Peer Specialists United organization, and they provide a lot of opportunities for networking and support.

And the last partnership that I wanted to mention is the support that we receive with the Veterans Administration for peers to attend our training. And we know that veterans have really benefitted our State by working in partnership with us and being at the trainings.

And this is another graph that we put together that shows that we have, over the past several years, trained and certified 38 veterans who also lead vet-to-vet groups, do homeless outreach, and attend a lot of our continuing education training.

Some of the things that we continue to provide for peers in our State is, of course, we offer Wellness Recovery Action Planning, another evidence-based practice where we’ve seen some great results. And a lot of peers that attend that go back and lead groups, but use it also to improve their own lives.

The Chronic Disease Self-Management Program that I’ve already talked about, we have several activities that we do around trauma-informed care, and have a very important relationship with Ruta Mazelis out of Ohio. And she comes in and provides quite a bit of training for us.

We’ve also done work on self-determination and helping people with arrangements where they get to choose the services and supports that they need based on a budget where they know what their cost of services are.

We’ve done some work on recovery goal writing to help people move from traditional medical models but to look at a support model and to write goals that make sense for the individual and for peers to be able to help that individual work towards recovery.

We’ve just started to work on Emotional CPR and have had a really great response to that. And we have a group of individuals who are trainers, and we’ve also just sponsored a couple of workshops for people to be more aware of that and to also be part of the classes.

And we’re real excited that we have our fourth annual conference this year that’s centered on health and wellness, and we’re looking a lot at how we can prevent early deaths. And Michigan peers are real concerned to address the whole morbidity and mortality report that individuals are dying 25 years earlier than the general population.

And so our conference, which is next week, is titled A Foundation to Health and Wellness and Learning, Leading, and Living. So we’re really looking at promoting health and wellness, and we have about 400 people in-state that will be going to that, the majority being peer specialists.

In supporting the workforce we offer a lot of ongoing continuing education opportunities at retreat centers. We have a career ladder with lots of opportunities for advancement, looking at employment of all levels and areas of the agencies where peers work in jail diversion, homeless outreach, employment, hospital settings, consumer-operated services, Assertive Community Treatment, individuals who will work in clubhouse, psychosocial rehabilitation programs, and a lot of other areas. We’ve really looked at creating work environments with a foundation of recovery.

This is some pictures of one of the retreat centers where we have approximately 140 certified peer specialists all coming together a couple of times a year. We’ll have an initial training group, and what we also do is we run multiple other trainings at the same time. So peers who have already been certified are also at the retreat center networking and working with individuals who are just starting the whole process to become certified. And as you can see, it’s a gorgeous place. We have a wonderful stay.

Challenges and opportunities for change—and it’s unfortunate that we have to have titles and slides that talk about challenges and opportunities, but I think that’s why we’re here today is to really look at prejudice and discrimination that can occur in work environments and with—generally with—persons with mental illness. And one of the challenges that I know that we need to work on in our State, and I also believe nationally, is the wages and the benefits and having an array of both full- and part-time employment positions for peers that really are set with other professions and provided salaries that are a living wage. And so one thing that I’ve been concerned about is peers making minimum wage, which is real confusing, when they could hold down Medicaid funding.

We in the State cannot just say we think peers should be paid this or they should be paid that, because we cannot do that, and do not do that with other disciplines like psychiatrists or case managers. But in our leadership at the department, we’ve been real clear that people should earn a living wage. How wages are determined varies nationally, and I think that that’s something that all consumer groups need to work together and hopefully change.

We do not just pay minimum wage in our systems, and that in fact is rare and unusual. We have peers that make all the way up to $18 to $20 an hour, depending on exactly what agency they’re at.

Some of the other things that is a challenge and yet an opportunity is making sure that peers are supported to attend regular and ongoing continuing education. We are able to offer our trainings because of our Adult Mental Health Block Grant at $50 for WRAP and PATH and many of the other things that we do, and that is significantly lower than what it costs to support people to attend training. So we know that with that continuing education that just like other places in the country, we have to find a way to financially make the initiative viable so other people can get supported to attend some of the great things we offer.

Instilling a foundation of recovery at agency practices to support peers is both a challenge and an opportunity. Back in 2005 we had way more complaints from peers that were working in the system. But as we’ve grown our workforce, we’ve seen a really big difference on how people see peer specialists as an enhancement to a team of individuals, and also providing a role that nobody else can do. And none of the other disciplines and professionals are able to really meet people with their lived experience at the level that a peer can, and to share some of the public mental health experiences that peers would have. So to me that’s really been something that we’ve improved on.

The other area that continues to need, I think, addressing across the country and in Michigan is to make sure that we have sustainable funding and that peer positions are prioritized. We have some agencies that have a large number of peers that are working and they may have 10, 15, 20, up to 30 individuals, and yet there are other places that would only have two or three. So to me the more peers that are working together, the more you see the transformation process and the more that people get support.

Encouraging choice—a lot of people would like to meet and work with peers, and yet we’re not sure that that’s really provided as an opportunity during the person-centered planning process. We’ve had a lot of peers develop brochures to advertise and talk about some of the great things that they do and how they can help people with services and supports, and that has been a big help. But we also are really looking at how can we make this a fundamental choice when people are developing an individual plan of service through a person-centered planning process.

And the other thing, we had Pillars of Peer Support last week was in Atlanta, Georgia where States were coming across the country, and consumer groups to really talk a lot about research and evaluation, looking at peer support as an evidence-based practice, and also the role of peers and recovery coaches.

So there was quite a bit of information that was provided as a promising and best practice, and also showing that peer services are evidence based.

I would not be able to do this webinar without really showing a picture of our 1,027 certified peer specialists, and this is the group that we had that was just certified in May. And we really know that all of the individuals that are part of our peer workforce have made a difference in the lives of the people we serve and also a difference in my life.

So it’s exciting to represent that group of individuals, and I appreciate spending some time talking with everybody about the great work we’re doing in Michigan. Thanks.

Maureen Madison: Pam thanks so much for sharing your story, and all the strategic work and perseverance you’ve put in, in your efforts in Michigan. Creating, maintaining, and advocating for a professionally trained workforce is very important and your work is truly groundbreaking. Thank you so much.

Now we’re going to hear from Gayle Bluebird, Director of Peer Services for the State of Delaware.

Gayle has been in the consumer survivor movement for almost 40 years. Her experience as a psychiatric nurse and as a consumer has given her a unique perspective as an advocate. She led the pioneering effort to develop comfort rooms as an alternative to seclusion and restraint, and she continues to replicate this work in hospitals throughout the country.

In 2010 she received SAMHSA’s Voice Award for her advocacy work. She continues to work nationally to promote networks for talented consumer artists, and create peer roles in inpatient settings.

Gayle will be sharing the story of the system-wide transformation underway in Delaware, including how in a few short years Delaware has moved in the direction of integrating peers into meaningful leadership roles within the Delaware mental health system.

She will tell about Delaware’s creative approaches to hiring and training peer professionals, including the innovative approaches to wellness and the important role that art and creativity play in the work that they do.

Thanks for joining us Gayle and please go ahead.

Gayle Bluebird: Thank you Pam. That is really a hard act to follow. I really enjoyed your presentation. I think it is interesting to note that where you were a few years ago is where we are just starting, so you can be sure that we’re going to be in touch with you.

I would like to thank Lauren Spiro and Ruth Montag for inviting me to do this webinar. I would also like to thank my staff for assisting me, especially Ashley Welton, my Executive Assistant.

Following is the story of Delaware as it was a few years ago, how it is now, and how we envision it in the future.

Delaware is happening fast when it comes to changing the mental health system. I think of Delaware as being the mental health jewel because we have the luxury of starting fresh, creating new programs in a very small State with peer support as a key element, and being able to implement new ideas. It is an exciting time.

In 2007, Delaware State Hospital was front-page news. The hospital was called a warehouse because many clients had been here for years. Accusations included client negligence; clients being left alone; inadequate housing, which only consisted of group homes; and no other housing options. There was an accusation made that a patient had died after collapsing without adequate attention, and staff was being accused of making huge amounts of money working overtime hours. One person whose salary was $20,000 made $100,000 due to his or her working overtime. Seventy people and more had been identified as discharge ready.

In 2011, the Department of Justice signed a settlement agreement with the Department of Substance Abuse and Mental Health that outlined a list of requirements to be monitored over the next 5 years.

Moving forward and catching up—one of the first changes began to occur included changes in administration in 2009. Kevin Huckshorn was hired to be the State’s Mental Health Substance Abuse Commissioner, serving in a dual role as Hospital Director for her first year. Kevin came with an extensive background in leadership, most recently from NASMHPD, the National Association of State Mental Health Program Directors, where she revolutionized mental health care to eliminate the use of restraint and seclusion.

She developed a curriculum called the Six Core Strategies and developed a team of national experts to work with her, myself included as part of her team of consultants. Following Kevin, I came to Delaware Psychiatric Center in 2010 to develop a peer services program. I had worked with Kevin for many years at the South Florida State Hospital, at the Broward County Department of Mental Health, and later at NASMHPD.

I had worked to reduce seclusion and restraint for many years, and as part of that work developed comfort rooms that are voluntary comfortable rooms where people can go before they go into crisis. I also had developed a national arts network called Altered States of the Arts which continues to thrive today.

One of the biggest challenges I would face at the Delaware—at DPC was finding peers that knew anything about peer support. Delaware was way behind in respect to other States who had peer support in place for a long time.

Our initial group of peers came from the Vocational Rehabilitation Department. Staff also had to adapt to new ways of thinking. Recovery became more than a word and had to be applied to treatment teams where people began to have a voice.

This slide shows how far we’ve come in reducing the use of restraint and seclusion. From 2008 to now has seen a drastic change. Rarely now is it ever used.

In our peer services development, this reviews the types of roles of peers who have been hired since 2010. Six peers were originally hired to work in the inpatient setting. A year later six additional peers were added as bridge peers who would transition people from the hospitals to the community.

My role expanded with a new title as Peer Services Director. Kevin ingeniously placed my position through the Mental Health Association where others of my senior staff were also placed so that we could have adequate salaries with benefits. This was not the first time she had done this, as a similar strategy was used to place a consumer team, our CATS team, in Broward County years ago, in a different agency, in an outside agency.

Our community system has gone to an ACT team approach. Six teams now serve all persons in recovery in the State including persons discharged from the State hospital. Each team has a peer who has been hired to work on the team. As this is a new program, peers are still being hired to fill these roles.

Two community programs were started in the community, the Rick VanStory Center, and the Creative Vision Factory. Both of these programs are highly successful peer-run programs and have already been featured on the front page of the local newspaper.

Peers have been—our Delaware State organization, DCRC or the Delaware Consumer Recovery Coalition, is being developed and reorganized with the leadership of Bryce Hewlett who came to us from Pennsylvania, from the Pennsylvania Clearinghouse under the direction of Joe Rogers.

This is a photograph of our current executives—I’ll call it our executive staff, our managerial supervision staff. We have found that hiring people from the top down ensures that we have peer supervisors in place to lead different parts of our program. In the lower left-hand corner is our latest supervisor, Rhonda Elsey-Jones, who just recently started to work with the Trauma Grant Program.

How we hire—as our positions have become more complex, we have established careful hiring practices. We have found that several interviews are often necessary, both formal and informal, because it allows both parties to make decisions about their readiness for the job.

Our application keeps getting more complex, particularly with added questions related to a person’s ability to do critical thinking. Situations are presented with no right answers but with many possibilities about how to approach an individual situation.

Maybe not sparkly personality is required, but we do look for people that are animated, assured, and confident. Having a sense of humor and being able to laugh at ourselves is a big part of our job.

As innovative peers, we know our history and honor the Consumer/Survivor Movement. These are photographs of people who participated in our early ex-patient protest movement. All peers need to know our history and become familiar with early activists and heroes. I will not note all of them, but in the top left corner is someone highly revered by all of us, Howie the Harp.

In the middle on the right-hand is Judi Chamberlin who wrote On Our Own, the first book to give us a blueprint for self-governed support centers known as drop-in centers. I am on the left middle photograph with Kinike Bermudez Thompson, a singer and songwriter from Texas. I proudly claim myself as one of the early members of the Consumer/Survivor Movement in the 1970s. I think it’s very important for us to know and understand our movement as it is very much a part of our roots and civil rights movement.

As innovative peers we dress casually and make a statement about who we are as unique individuals. When we first started working my staff was insistent that we should wear professional attire, while I was insisting the opposite. I have compromised and so have they, but I still wear my hats for which I am known. Above is Dara Hagans who always wears a flower in her hair as well as bright colors.

What we wear is a way that we connect with people and inspire trust. Dressing is also a way for us to communicate our cultural and ethnic backgrounds.

As innovative peers we prioritize finding out about a person’s interests and strengths so that he or she can use their own individualized approaches to healing.

Clinical records ask questions about a person’s interests or hobbies, but it is information that is seldom paid attention to by providers. This is frequently where we start finding some golden nuggets that touches on someone’s passion. This is incredibly helpful, particularly when clients come to our Drop Zone, our new activity and resource center, where they can learn new skills and pursue art and other activities.

As innovative peers we address people naturally with attention to their culture and language. One anecdotal story comes from Franzswa, our Trainer/Educator, who worked with a woman from East Africa who only spoke Swahili. While other staff never thought to do this, Franzswa looked up in the dictionary simple words in Swahili and was able to determine that Gayla wanted a simple banana. So that is what she got and later a trip to an Indian restaurant. That relationship helped to ensure that Gayla was not isolated and that someone took a special interest in her. An interpreter was also found who could speak her language and translate for her what she was trying to say.

As innovative peers we are comforting without words. We learn how to touch in simple ways, which can often affect people profoundly. Comforting touch is an important tool that we use. A handshake when we first meet someone, pats on the arm or shoulders to congratulate, support, or to reassure, or just to make contact, which can be a powerful connection.

Touching has been one of the taboos in our society, and in psychiatric settings an often unwritten, no-touch policy.

Tiffany Field, a Researcher on touch at the Miami Institute, states that in addition to being critical for growth and development, communication, and learning, touch also serves to give comfort, reassurance, and self-esteem. We have also learned how to use touch—simple touch—when someone is upset and potentially going into crisis by stroking someone’s back. It is always important that someone be asked first. Training on how to use simple touch is going to be included in our training curriculum.

As innovative peers we use a person’s full name whenever possible, and with his or her consent. In the cartoon, you’ll notice that people have paper bags over their heads and the doctor I think, is saying, “Nancy, I’m not sure that that’s what HIPAA had in mind.”

Maybe we don’t have people in paper bags, but we do often cite HIPAA as a reason not to use persons’ full names. HIPAA laws were meant to protect confidentiality, but often have an opposite effect. People often begin to think of themselves as non-persons. The key is to ask; the purpose is to honor.

What has served as protection of confidential information can also begin to define a person as their mental health diagnosis. In our work with people we have them sign consents, which allows us to use their full names in posting their artwork, in our newsletter, the Snappy Yappy, and in other forms of communication. We believe this gives them confidence and a sense of self-respect.

As innovative peers we introduced wellness techniques creatively. Some of the examples are nail painting; employment; searching on the Internet, which we are the only ones in our Drop-In Center to have—to allow people to use the Internet, healthy snacks, walking, affirmations, our Drop-In Center Resource Center, creative arts projects, restaurant outings, and our drumming circles.

Words have meaning—charts give us a direction, but the success of how we activate or encourage wellness programs may be dependent on approaching things in new and different ways. Think of what you do to create wellness. Do you go to a Zumba class, take walks on the beach, paint a picture, or go to a party with healthy snacks? The list of possibilities on how to be creative wellness coaches is endless.

Our drumming circles have been a really big hit. It has allowed for physical emotion, creating rhythm, and exercising individuality with a person’s own drum beat.

Arts and creativity—in the slide is a picture of Franzswa’s hand—I believe it was Franzswa—which says “My Hand in Recovery!” You might be able to read some of the words—faith, love, in my creator, is in the center.

The Hand Project is one that we have started where peers are instructed to trace their hand and ask their hand to talk to them. What does your hand do? How does it contribute to your wellness? What does your hand say to you?

The varieties of decorated hands is amazing and people have a good time doing the project.

Arts and creativity is a big part of our work in Delaware. The emphasis on creativity is due in part to work that Kevin and I did years ago in Broward County where we started an art center. At the time Kevin was District Supervisor of the Mental Health Department. And when I and other consumers went to her after a meeting and asked for funds for an art center, she said simply, “Sure.”

Years later, 9 Muses in Broward County is a model for the country for being a consumer-run art center, and is often used as a model for other art centers to be developed in different parts of the country, including here in Delaware.

Philosophically, art and creativity has become widely accepted as a means for peers to tell their stories, for them to express themselves, for its power to heal and transform lives, and increasingly, a means of self-sufficiency for some.

Most often art is considered an important component of wellness, but only as an activity or part of learning. We believe the arts need to take center stage and can be the most important component in our work and in our peer specialist training that we are developing.

The following slides focus on some of the unique ways in which we use creativity in our support activities in promoting it as a treatment recovery strategy among clinicians. Some of the examples of how we use arts in creativity is first our community creative arts factory which is called the Creative Vision Factory named by members of the new center, I think now 9 months old. It is a peer-run art center and is directed by Michael Kalmbach who himself is an artist well known and connected to local arts promoters.

Artists at the Creative Vision Factory is already on the monthly arts loop or arts walk—Community Arts Walk—and is getting publicity that ensures their longevity as a successful program.

Recently the Creative Arts Factory started or has placed an art exhibit in the administration’s building lobby—some of our local administrators, the District Secretary came. It was a time that was meant for everybody to celebrate and to share our love for the arts.

We have several Comfort Rooms in the hospital that now need revising, which peers will be doing. Our drumming circle continues, and we have an arts postcard project that is underway.

Arts and wellness can be combined in a carnival atmosphere. We did this recently at our summer institute where Peggy Swarbrick came and did blood pressures, and the rest of us had different art activities at different tables.

In the right-hand corner at the bottom is Henrietta, myself as an outrageous character, a little fuzzy lady but always trying to figure life out. Creating skits is another way for people to promote recovery.

This slide is a photograph of the ribbon-cutting of the Drop Zone. Rooms at the back of our administration building were filled with files dating years back. Some people, including Kevin, didn’t even know the room was there. It did not take much convincing, however, to convert the rooms to a resource center for peers in the hospital, except for finding a place for all of these outdated files.

The photo above from left to right is June Butler, our first Director of the Center; Kevin Huckshorn; myself; Greg Valentine, the Hospital Director; and Pam Freeman who works with us in many capacities, sometimes as our personal counselor. When we need to talk we go to her, but also work with her on many projects, most recently for peers to take complaints and suggestions to cut down on the number of grievances that were being written.

Ken Segal is one of the artists at the Creative Vision Factory, our peer-run art center. His identity as a patient ended a long time ago when he realized his talent as an artist. The painting above is one of the ones selected to be in a note card project that will be used as a center fundraiser. The Governor of Delaware, Jack Markell, was introduced to the project and is taking the assortment to a national governors’ meeting.

Note that each card features their name, their photo, and their bio. I’m going to read just a little bit of Ken Segal’s bio. Ken Segal has battled a stubborn dose of bipolar affective disorder and seasonal affective disorder his entire life. He was a frequent flyer on the mental wards of Pennsylvania and Delaware. He describes himself during that time as addicted to suicide, making dozens of attempts over the years. The making of art was one constant in the real world and on the hospital wards. It was an important element of recovery. Ken now celebrates 7 years of freedom from the wards. I think his bio was quite creative.

One of the things that we developed is something we call Hope Totes. They’re admission comfort bags. Each person is given a Hope Tote when they’re admitted that contains information about their rights, a client handbook, and information about peer support.

Everything had to be approved for safety, but we were able to include a small stuffed animal, a turtle, which everyone says is their favorite item. Everybody loves their bags. And if a client does not get one, they are sure to call and go after Nicole, one of our people that works in the Drop Zone, to make sure they get one.

We also give discharge Hope Totes to clients when they are discharged. Much larger bags hold socks, shampoo, and other health-related items.

The trauma booklet featured in this slide was created in 2011. It was written and designed by peer support, myself as writer, and other staff as the designers. It was written in easy-to-understand language and illustrated with national talented artists’ artwork. The artwork used in this booklet was done—the cover of the trauma booklet was done by Meghan Caughey from Oregon, who did the above painting titled “Hugging Form.” I include her Web site in the resource section.

Some of our projections, 5 years from now—our future, peers will make up 30 percent of the mental health workforce. If Kevin were doing this call she would say 40 percent. All employed peers will be supervised by qualified peers.

The State hospital will no longer serve long-term clients. Adequate housing will be in place with adequate supports.

Peer support services will include 24-hour crisis and respite services. Peers and providers will work in collaboration to create a seamless system. Trauma services will be available to all clients.

Peer specialist training curriculum is being developed and will emphasize creativity throughout. Peers in Delaware will be national consultants as we are already being, presenters at conferences and being asked to present.

Bluebird, myself, will be traveling in her RV with a driver, driving Ms. Bluebird and stopping to say hi.

I just want to say one thing about—I hadn’t written anything about challenges, but I am constantly saying to Kevin that we need to go slower. We go so fast and we put so many programs in place all at the same time. It’s a good thing and frequently we’re catching up with what we’re doing. Our programs are thriving. Another challenge that we’ve had that I might have mentioned is finding consumers or peers in the Delaware community. That too is changing as the word is getting around about these available positions as peer specialists.

Remember—my last two slides—peer support is a professional job. Peers are treated like any other employee, and is not a pampered role. However, taking care of yourself is the number one priority. Thank you very much.

Maureen Madison: Thank you Gayle. And as you can see, some resources here that Gayle has provided. And Pam also provided resources at the end of her presentation which will be up on the SAMHSA ADS Center site.

Thanks so much Gayle for sharing how change can occur quickly when you have that strong collaborative relationship that you enjoy in your State. And the way that you use creative arts is thought provoking and inspiring, so I’m sure many people will be eagerly following your work and the development of the recovery movement in Delaware. Thank you so much.

Before we open the lines we want to ask each of our speakers to share their vision of what full and meaningful inclusion of peers in the behavioral health workplace would look like.

We’ll start with Pam. Pam, what is your vision?

Pam Werner: We really are continuing to look at health and wellness and the morbidity and mortality report. So my vision is I believe a blend of what the vision is of our peer workforce and it’s that peer specialists, as a respected evidence-based practice, will support individuals in leading self-determined lives with a focus on health and wellness to increase both quality of life and life expectancy for individuals in their pathway of recovery.

Maureen Madison: Thank you very much Pam. Gayle, what is your vision?

Gayle Bluebird: I know this is going to be kind of funny because I have been asked to change this vision, and I kept coming back to these words. So this is my vision and I’ll explain why.

Peers will have learned to embrace creativity, to use humor, and to tell their stories to honor themselves.

My reason for that vision is number one, I’ve got a staff who do tell their stories, who do embrace creativity, and who enjoy each other using that as our core I would say. And the other thing is that nationally I am constantly campaigning trying to put arts on the table. I’m a member of the Consumer Advisory Subcommittee at SAMHSA where people can always count on me to say, “And what about the arts?”

So I’m trying to reverse things here where we put arts first and we add information, we do our role plays; we do everything creatively. And my goal for Delaware is that we shine in that area for the rest of the country. Thank you.

Maureen Madison: Thank you very much. Thanks Gayle. And thank you both for sharing your vision of the future of peer support. We really do appreciate it. Thank you so much.

Our speakers provided some great resources at the end of their presentation. And on Slides 49 through 52 there are some additional resources for you to learn more about the topics that have been discussed today.

We will now take questions from callers. To ask a question, please dial star 1 on your telephone to be placed in the queue. Be sure to tell the operator your name. If you do not wish to use your full name then please only state your first name.

Because time is limited, please ask only one question. After the conference operator announces your name you may ask your question. Once you’ve asked it, your line will be muted so the presenters may respond.

Operator, do you have a question on the line?

Coordinator: Yes ma’am; your first question comes from Moe Armstrong. Your line is open, sir.

Moe Armstrong: Hi, thank you very much both Pam and Gayle for a wonderful presentation. I wanted to remind you that with the Vet-to-Vet program we also have evidence-based stuff that’s coming out of Yale University that shows the effectiveness of peers doing peer support in the workplace.

I’d just like to kind of get something from Pam on that conference on the Seven Pillars, a little more detail of that if I could Pam, to understand what that was from a national perspective and what their ideas and directions were.

Pam Werner: Thanks Moe. There were about 75 people there, and there’s also a Web site that’s on my resources, of Pillars of Peer Support.

But they looked at national credentialing of peers, and then also how you embed recovery as a foundation to services in all of the places that we’re at, so it was very interesting.

And Larry Davidson was there. And John O’Brien talked from a CMS perspective and talked about how peers are a requirement of health homes across the country when people apply to CMS to really look at that as an option and moving towards integrated care.

All of those slides should be on the Pillars—the Web site that’s provided. And I think they’ve been uploaded here within the last couple of days.

Moe Armstrong: Oh thank you very much.

Maureen Madison: Thank you. Thank you for your question. I have a question from someone online. Ronald asks Gayle, Delaware seems to have made a lot of—have a lot of accomplishments in this area. How are you able to get the quality of staff?

Gayle Bluebird: Well that’s a really good question. How we develop leadership came about just because it evolved. When we first started with six people it probably took us 3 months to find out that two had been—one had been a bank vice president and the other had been a mental health administrator in Florida.

So though we started—we all started off kind of slow in getting to know each other and finding out what peer support was, it didn’t take long to realize that we had people that in the future, would be able to work at a different level.

I think the other thing we did was to try—we didn’t advertise a whole lot, but we had word of mouth going out. We started to let people know that our—particularly when people are working in inpatient, you need people with higher qualifications.

And again, people seemed to emerge—Franzswa is one—who is now our Training Coordinator, who was hired in a totally different position and 9 months later found her niche.

So leadership came to us just as sort of magic if you will, and leadership was also planned. In Rhonda’s case, who just started with us, she was hired because we interviewed nationally for the position that she is in.

So we’re kind of proud. And it was always my vision that you put your supervision in first. You put your infrastructure in first. Now I’ve got people, each one, who serve to complement me, to provide leadership to their own teams, and who serve on a variety of committees at the hospital and at the executive level. Thank you.

Maureen Madison: Thank you Gayle. Ronald actually has a followup question as well—where do you see the Peer Support Movement at DPC after the DOJ settlement ends that you spoke of?

Gayle Bluebird: I know that Kevin Huckshorn is on the line, and I would really like her to answer that because we’ve had people here also—Bryce Hewlett has repeatedly asked that question and, you know, sort of has a feeling that this may not be always possible. But Kevin always has a different answer so Kevin, if you’re there, would you answer that question.

Maureen Madison: I’m sorry Gayle, she’s actually part of the—she may be able to answer via chat but she can’t answer as a—unless she comes in.

Gayle Bluebird: Well let me put that on hold so that maybe later she—the only thing I can tell you is that she feels and is very confident that our State will prioritize peer support as a major part of our workforce.

I think I can go back and answer the question also. Because we are providing—because the positions that we’ve created are almost indispensable positions, I don’t think they would go away.

And our peers that we’re training are also being trained really well so that when they go into a setting, they are really prepared to work with people in a professional capacity. But other than that I, you know, would have the same question, but Kevin seems to know the answer. So maybe we’ll hear from her later.

Maureen Madison: Okay, well thank you. Actually Ronald if you’re on the call still, you could contact Gayle by e-mail and then, you know, you can talk to Kevin that way as well. So perhaps there can be a conversation afterward offline about this.

I’d like the operator to—do we have another question in the queue?

Coordinator: Yes, ma’am, we’ve got quite a few. This one comes from Rosemary. Your line is open ma’am.

Rosemary: Yes hi, I was wondering, I just wanted—I think it was Pam, to clarify the workforce, is this—when you offer peer specialists training, did I understand it that one of the criteria were that the individual had to be working previously or at the time that they applied for the training? Is that correct?

Pam Werner: They have to be working when they apply and before they come to training, and their work has to be done through what’s described in our Medicaid Provider Manual, so that they’re being reimbursed for the valued role that they do within the systems.

So the only individuals that do not have to work are the veterans. And it’s really great that the VA Administration now has put out quite a bit of money to hire a couple of vets at each of the VA Administrations across the country. Of course I don’t think it’s enough, but there are quite a few now that will be hired.

And Moe Armstrong who was on the call, talked about Vet to Vet, but those are the only individuals that are not required to work just because of their particular circumstances.

Rosemary: Thank you.

Maureen Madison: Yes, thank you. I have another question here written. This is for Pam as well.

Pam, can you talk more about the career ladder for the certified peer specialists? How high have the peer specialists been able to get in this system, and to what extent is their voice at decisionmaking tables?

Pam Werner: I think that just with other States, the voice at decisionmaking tables really has to do with the philosophy of the agency, the leaders, the directors. And in our State we have some great visionaries that do that. I also believe that just like other States in the country, we have areas that need to work much harder at that.

The career ladder is dependent on what that person wants to do and what she—I go to all the trainings, so I’ve met all 1,027 individuals that have been trained and certified, and it really varies on what people want to do.

There are people that are getting their bachelor’s and master’s degrees in mental health. There are other people—other peers that have left to develop their own businesses, so the career ladder is really varied. But many people do really drift more to mental health and have chosen careers in that area.

But just like the population in general, that career ladder is just defined by what they want to do and we do not right now keep any data or track of that.

Maureen Madison: Thank you. Gayle, do you have anything to add on that topic? Does that resonate with you?

Gayle Bluebird: It did a moment ago and then I lost it. That’s what happens when you get older.

Maureen Madison: That’s okay.

Gayle Bluebird: Let’s see. The career ladder here again, I think that we’ve already established people in positions at different levels. As we’re putting peers in the community agencies we’re having to do some work training the community providers on how to hire peers, and we’re just really starting that. But again, I think—and I would agree. I want to go back and agree with Pam on our peer specialists training which is also going to require that people are working in positions.

And just like she said—I think she said that was controversial, we believe that’s important because the amount of trust that people are going to build with themselves in that training are going to extend after they take the training.

And being in jobs, I think, is important so that we’re assuring a person that they will have a job or that they’re in the job when they leave that training and they don’t get frustrated about either being hired or not hired. So I just want to give a similar answer to that.

Maureen Madison: Thank you. Thank you very much. Operator, could we take the next question?

Coordinator: Yes, this question is from Darlene Woods. Your line is open, ma’am.

Darlene Woods: Hi. I’m encouraged by these States that are opening opportunities for peer specialists but, I am and have been frustrated by the path I’ve been forced to take to get a job and my credits needed to continue my certification as a peer specialist. The face-to-face credits that are especially difficult to get. I spent quite a bit of money getting my last one.

In my area, one of the few positions that are available—and it’s best that you not be friends with anyone in the organization, nor be a consumer at that particular organization. To attend and find one of these few local seminars, it’s best to work for or attend one of these local organizations.

Do you have any suggestions to me as to how that I am to either help Tennessee to get more on the ball with this or how I might get those credits?

Pam Werner: This is Pam, and we’re looking at developing our CEU process. And I’m not sure if that’s what you’re talking about…

Darlene Woods: Yes, yes.

Pam Werner: …on the face-to-face. But I would just work with whoever you have in the State that really runs peer support services in Tennessee and try to sit down and work that out.

I do believe that it’s hard for people who are in—and I don’t know your situation—that are in a situation of poverty and asking individuals to go and pay for classes and pay to maintain their certification isn’t necessarily what I would say is a support model.

The one thing we do in our State is we do offer scholarships for peers who are no longer working, to be able to make sure that they still attend training. But we do not have the face-to-face credits yet. A lot of the peers we’ve hired have come from agencies where they’ve received services. But again I agree with you on getting services from where you work isn’t a benefit to peer specialists.

So I do advocate that people look within the population who has received services from them. But again, your question is really great and I hope that you’re able to make the systems change for the rest of the peers in Tennessee.

Maureen Madison: Gayle, do you have anything to add to that?

Gayle Bluebird: Just that I want to say hi to Tennessee. I have a son that’s there, but that’s irrelevant I guess. Just hi Tennessee.

We’re really looking at all those issues, and this is again a situation where some of us are being asked to kind of move quickly so that we get a State certification in place with, at the same time, our training curriculum. But I realize in talking with a lot of people and looking at what some people have written that have faced some of these issues that we really need to do some study on that. That it may be a hardship for people to take the training or renew their certification.

So I would agree with Pam that it’s—we need to make sure that we’re being supportive to people other than—you know otherwise, we’re going to be catering I believe, to an elite kind of group that can manage to get the money together or to, you know, maintain all the requirements.

There’s a little bit of both, so I think there’s some balance that’s needed. But I definitely think it needs to be studied and carefully looked at.

Maureen Madison: Thank you. I’m taking another online question. Sandy asks: We have a peer-run agency, how and what can be billed to Medicaid or Medicare? And maybe Pam can start that off and then Gayle.

Pam Werner: In our State we have over 50 consumer-run drop-in centers that have a lot of peer specialists. Most of them have a certified peer specialist, if not their entire staff that work there.

Some of those areas have the ability to draw down Medicaid services but it’s separate from that anonymous consumer-run philosophy. It’s for individuals who say yes, I would like the peer-to-peer services in my plan of service.

The really being able to draw down Medicaid funding depends on what kind of relationship you have with the Federal Government and with CMS, so I would go back and look at that.

And I also think that there is a lot of creativity where peers can do roles that are described in Medicaid within each State, but it may not say peer support. So in our State individuals could be a support coordinator assistant, they could do community living support, and peers that have any kind of education that fits within other provider areas would be able to do that.

So I would again recommend that you go back to your State office and get some help with them to draw down Medicaid funding. So everyone in every State has the ability to work with a peer specialist.

Maureen Madison: Okay, thank you. Gayle, did you have anything you wanted to add to that or should we just—or would you like me to move on to the next question?

Gayle Bluebird: Yes, I think so.

Maureen Madison: Okay, all righty. Actually this question is for Pam as well. Franzswa who I believe works with Gayle asks—and we’re paraphrasing a bit here—what is the process for becoming a certified peer specialist? How long is the training and is there a test or certification board that you have? Pam?

Pam Werner: To get into the training, again you have to be working and there are some other requirements. And then an individual—we have a partnership with the Appalachian Consulting Group who has done our training with us in partnership since 2005.

And so individuals attend like a 56-hour training and we have that written up community college credit hours. And it includes going through a variety of different modules completely related and centered on peer support.

Then individuals attend a study session, and then they attend an exam that we have for 4 hours. Some individuals finish that earlier and others, you know, don’t. And so that’s our certification process.

And anyone who struggles with any part of the testing process, we have accommodations and we also do not have a limit at all on how often and how many times an individual can take our certification exam.

Maureen Madison: Thank you. Operator, could we have another question from the queue?

Coordinator: Yes ma’am, and this next question comes from Bonnie. Your line is open.

Bonnie: As a former member of Altered States of the Arts with Gayle, I naturally was interested when I was Director of Consumer Affairs and collecting consumer art and putting writing on our Web site. And I worked for a managed care company in North Carolina and many people turned in things with a spiritual base because that was part of their recovery.

And all of those pieces, artwork and writing, was rejected by management because of separation of church and State, and I was appalled. And I wonder if you’ve ever run into that and how you would deal with it?

Maureen Madison: Have either of you ever run into that situation?

Gayle Bluebird: This is Gayle and think the only thing that I would relate to is we’ve talked about in our Drop-In Center, of the issue of separating our spiritual lives—not spiritual because that’s a very broad kind of word and has a different meaning, but our religious practices from our work. So we don’t have religious things that are in our rooms or in the common areas.

I’m not familiar with artwork being rejected for reasons of, you know, religious depiction, so that’s not something that—you know Bonnie, you and I have worked together so I don’t know if we remember any time that…

Bonnie: No, we never ran into that. But I certainly ran into it—I mean in the Deep South I ran into it.

Gayle Bluebird: Okay. I just really don’t know. You know, I don’t have any answer for that except to say it’s appalling.

Maureen Madison: I’m sorry; I went to play with the mute button there. Thank you. Actually I do have a followup question to that from someone online. Gayle, this might speak a little bit to your background.

Do you find that training and other support has to be changed when dealing with different cultures, for example, Native American? How has your programs and organizations adapted your training to meet the unique cultural needs of the demographics that you serve?

And we can start with Gayle and then check in with Pam on that one.

Gayle Bluebird: Right now we’re developing our curriculum, and one of the modules is on we’re calling it cultural—uniqueness. So we’re trying to put different words on things. We sometimes do role plays. Actually we just did yesterday and it was interesting that a particular role play was played differently by people that reflected on their cultural backgrounds. I think we’ll be paying a lot of attention to that.

Our staff, that’s another thing, and I think it’s an intention really. I know it’s subtle. It’s not like I put out a sign that says, you know, we need somebody, you know, of this particular culture but, it has happened that we have a very, very mixed group of staff.

And the other thing that I think about culture always is that I hate the fact that we’re always having to talk about how you do cultural diversity when it’s open for all of us to have friends of different cultures. Not necessarily to have a potluck where somebody brings something that relates to their particular culture, but that we mold that from the beginning and we cultivate it and we honor it.

So I see it as a very important element, but I see it as a natural part of what we do. I don’t know if that makes sense or answers the question but, that’s my answer.

Maureen Madison: So that’s very good. That’s very good, thank you. Pam, do you have anything to add about that question?

Pam Werner: Can you just clarify that question? I think it was talking about peers working with other cultures?

Maureen Madison: Yes, right, other cultures and how you might have to change your training or your approach based on not only the people who come in for training but the demographics that you serve.

Pam Werner: Okay, thank you.

Maureen Madison: Sure.

Pam Werner: With Michigan working from a person-centered planning process, our—and I’m sorry, I apologize for sounding like a bureaucrat—but we follow a 1915(b)(3) waiver. And so with that kind of waiver, people have to have a choice of who they want to work with. And so they could say geez, I’d rather not work with Pam, I’d rather work with somebody else—with John, because he has the cultural background that really fits where I’m at.

We’re also in our State have a variety of peers that practice from different beliefs and backgrounds, and we do have individuals from the Native American population and we also have individuals who are Hispanic. We have a peer who is from Brazil, and so we really look at supporting that.

But to me I think it goes back to how people define their spirituality and then who they may choose to work with, and that all of us really need to be culturally competent, and that’s a word that people use a lot.

I really think that that’s something that needs to be defined better and to really look at that within our peer workforce.

Maureen Madison: Thank you. Thank you very much. Pam, this is also to you from online. Randy asks, even peer support specialists need peer support. So does the State allow meetings with fellow peer support specialists while on company time? And also who is supervising peer specialists and what training do they have to provide supervision?

Pam Werner: And those are really great questions. Supervision is dependent on agency to agency but again, our consumer-run drop-ins, individuals who work there are all supervised by peers.

We have a couple peer-run organizations where that’s the same, where people are supervised again by people in a lived journey of recovery. So there’s a variety of supervisory situations that occur across the State.

The one area that I think we need to do better at in Michigan is to look at training, work environments, and training supervisors to really work from a foundation and a base of recovery. And we have started to do some of that work with the Appalachian Consulting Group, and they have designed, in partnership with peers across the State, a 1-day training on that. And we are going to move forward and pilot that out and hope that that’s going to make a difference.

The other piece that you talked about: Absolutely people need support from each other. We all do. And peers need support, and that’s the one thing that I believe is really rich about what we’ve done with our training.

So whenever we have a training at a retreat center, we have a whole other group of peers that are coming back and learning and picking up some new skills on other topics. That group bonds with new groups. People meet each other that have never met before. Michigan has this big Facebook outreach page and you can go to Facebook and put in Michigan Peers and it’ll bring up Michigan’s Certified Peer Support Specialists. And there are people across the country that go in there and put out questions and look for peer support.

And when we have those trainings that aren’t in like a college environment or a mental health center and that they’re at a place where only peers are there together, that peer support really generates itself. And individuals that may be in the Upper Peninsula may have friendships that develop in Detroit, or over on the west side of the State. And to me that’s when we really see peer support in action.

There are some places where peers do meet and they meet on work time. And then there are other places where they’ll say well we don’t have case managers all meeting together on work time and it ends up being a little bit different. So that varies across the State.

I do know that peers will eat during lunch together, and they’ll go outside after work. And so how that sets itself up, whether it’s formal or informal, I just would advocate from your question that we need to have that everywhere.

Maureen Madison: Thank you. I think we have time for one or two more questions. Operator, could we have the next question from the queue?

Coordinator: Yes, this one is from Felix Martinez. Your line is open, sir.

Felix Martinez: Thank you. Hello everyone; this is Felix Martinez. I’m currently on the Consumer Advisory Council, but I’m also a certified peer specialist. And the problem that I’m having in getting a job as a certified peer specialist has got to do with my past criminal record.

In the State of Texas for some reason—I mean this is something that happened to me 20 years ago. And, you know, I’m still having to pay the price for that and I can’t get employment as a certified peer specialist but yet I work at a—excuse me—at Mental Health Mental Retardation Authority of Harris County in Houston, Texas.

I work on the Consumer Advisory Council, and what that is, is we’re mainly all consumers of there’s currently 12 members on the council. And we’re all patients but we also work at the MHMRA of Harris County and we provide services for the consumers. And basically listening and getting input from them and then we present that to the Practice Manager and we try to resolve those issues for the consumers.

Unless it’s something that they have a very important issue, then we try to take care of that as soon as possible. If in our point of view it seems like it’s something that needs attention right away then we bring it to the Practice Manager’s attention at that point.

Maureen Madison: Thank you Felix. I’m going to turn your question over to the speakers. Pam, do you have any experience with the question that was raised regarding the criminal background and the possibility of working as a peer specialist?

Pam Werner: Well to me it just violates the whole foundation of recovery and what a contradiction. So if I’m an individual that has that background, I would personally work with—choose to work with somebody who walked in that same journey of recovery with that same shared experience. So I think it’s really sad that people aren’t looked at more well rounded.

I wonder if the people who aren’t peers, aren’t certified peers and aren’t individuals in a journey of recovery, if they’re allowed to work in the system if they have a criminal background. That was one thought I had.

In Michigan, we have places that have hired individuals who have been to prison, been in jail and that they look at again, individuals with that background as having that as a gift, having that as their own education that they bring to the table.

On the other hand there are areas that won’t hire anyone with a criminal background that may even include a misdemeanor. And Ruth or somebody on the phone could maybe—or Lauren could maybe help me with this, but I believe it’s LaVerne Miller who has a specialty background and a passion for working in this area. And I think she would just be a great resource for you to contact.

And I hope someday the State that you’re in will make sure that peers are employed and have valued jobs so when you go to trainings you can give back to all the people out there that are probably benefitting from the work that you do now.

Maureen Madison: Thank you Pam. Felix, if you contact the ADS Center, Ruth can help you find—contacting LaVerne Miller.

And I’ll leave with Gayle. Gayle, do you have anything to say about that issue? And then we’ll probably end our question-and-answer session for the moment.

Gayle Bluebird: We’re generally—well I think that basically Pam really gave a very full answer. I just want to say that in Delaware we are able to hire people that have criminal backgrounds with the exception of a few, and I’m not going to name what they are, but there are certain criteria that is more difficult. And even then I think we look very carefully to see who the individual is, what skills they have, and can we, you know, make an exception in somebody’s behalf.

I can think of one situation we did that and really it’s been a very positive experience. So, you know, we don’t have, you know, any kind of hard and fast rules.

Maureen Madison: Thank you—thank you Gayle. Well I’m sorry we’re going to have to draw our question-and-answer session to a close. And I want to thank everyone for such thoughtful questions and answers. We had way more than we could handle. It was great.

If you were unable to—if we were unable to take your question or you did not get your question answered fully, you can reach out to the speakers directly or you can contact the ADS Center at promoteacceptance@esi-dc.com.

Contact information for each speaker is available on Slide 54, and you can read more about each speaker on Slides 55 and 56.

We value your feedback. Within the next 24 hours you will receive an e-mail request to participate in a short anonymous online survey about today’s training. It will take about 5 minutes to complete.

Please take the survey and share your feedback with us. Survey information will be used to help determine what resources and topic areas need to be addressed by future training events.

This conference has been recorded and the audio recording and transcript will be available in late October on the SAMHSA ADS Center Web site.

If you enjoyed this training teleconference we encourage you to join the ADS Center listserv to receive further information on recovery and social inclusion activities and resources including information about future teleconferences.

To learn more about SAMHSA’s wellness efforts, go to http://www.samhsa.gov/wellness.

We’ve come to the end of the time today. If you have more questions or would like to follow up, please contact the SAMHSA ADS Center by phone, fax, or e-mail. The Web site is http://www.promoteacceptance.samhsa.gov. For future reference, ADS Center contact information is on Slide 60.

On behalf of all of us at the SAMHSA ADS Center, I want to extend our sincere appreciation to Pam Werner and Gayle Bluebird who have taken the time to share their experiences with us. Their hard work, creativity, compassionate—I’m sorry—compassion, and innovative approaches to the field of peer support are leading the way forward.

Their work and the work of all the dedicated peer support specialists, especially some of you who are joining us today, along with the providers, administrators, and all the others who are contributing significantly towards a more socially inclusive mental health and addiction public service system, thank you to all.

And thank you to our listeners for taking the time out of your afternoon to join us. And thank you in advance for completing our survey. Goodbye.