Peer Support Specialists
An interview with Kemisha Fields, MSW, Amparo Ostojic, MPA, and Jeff Kashou, LMFT on what peer support specialists are and the value they bring to treatment teams, as well as the challenges and best practices in implementing these roles into clinical programs. Curt and Katie talk with Kemisha and Amparo about their experiences in these positions, exploring how their lived experiences created the successful integration of a more holistic approach to support clients. We also talked with Jeff about his journey in implementing one of these programs from scratch.
It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.
Interview with Kemisha Fields, MSW, Amparo Ostojic, MPA, and Jeff Kashou, LMFT
Kemisha Fields, MSW: Kemisha Fields was born and raised in South Los Angeles, CA. As a former foster youth, she has taken a professional interest in the commitment to serving the needs of children and families as a Children’s Social Worker working in Dependency Investigations. She has studied many modalities to bring healing to those in need. Kemisha is a life, long learner inspired by the abundance of opportunities available to enrich the lives of the people she serves. She earned her Bachelor of Science Degree in Psychology from the University of Phoenix. She received her Master of Social Work degree from the University of Southern California. Currently, Kemisha is a Doctoral Student of Business Administration with an emphasis in organizational leadership.
She has extensive experience working with children, families, and individuals as an agent of support and guidance. Kemisha has a strong background in case management for an array of populations inclusive to at-risk youth, individuals with intellectual disabilities, commercially sexual exploited children, victims of trauma, and families within the dependency system. As a lead Dependency Investigator with Los Angeles County Child and Family Services, she has direct practice with assessing for child abuse and neglect in hostile environments. Kemisha works directly with County Counsel to investigate and sustain infractions of the Child Welfare and Institutions Codes.
Jeff Kashou, LMFT: Jeff Kashou, LMFT is a manager of clinical product and service design for a mental health tech company that provides telemedicine to those with serious mental illness. Previously, he ran a county mental health program where he helped develop the role fo peers for adolescent programs county-wide and collaborated with peers to create management practices to support their professional development. In this position, Jeff developed a practice guideline for the utilization of peers in behavioral health settings for the County of Orange. Jeff has also served on the Board of Directors for the California Association of Marriage and Family Therapists, where he helped lead the association to support the field of Marriage and Family Therapy and those with mental health issues. He consults as experts in mental health for television productions, to ensure the accurate and helpful portrayal of mental illness and treatment in the media. Most recently, Jeff and his wife Sheila wrote a children’s book, The Proudest Color, that helps children of color cope with racism that will be on shelves this Fall.
Amparo Ostojic, MPA: Amparo Ostojic is a mental health advocate with personal lived experience. After working for the federal government for ten years, she decided to pursue her passion in working as an advocate to help promote recovery in mental health. She has worked as a peer specialist for a mental health clinic as well as volunteered leading peer support groups. Amparo has a close connection with the Latino Community and feels it is her duty to do everything possible to prevent and reduce the suffering of individuals living with a mental health condition. Amparo created a Spanish speaking support group in East Los Angeles to offer free peer support to members of her community. Amparo has a bachelor’s in business administration and a Master of Public administration. Amparo is a certified personal medicine coach and is working on becoming a National Certified Peer Specialist (NCPS).
In this episode we talk about:
- What a peer support specialist is, how they work
- What peers can uniquely bring
- The hiring process, qualifications, and what that means for individuals seeking these jobs
- The difference in perspective that peer and parent partners can bring to treatment teams
- The importance of lived experience
- Comparing holistic versus medical model treatment
- The medical model and the recovery model complement each other
- The importance of advocacy for individuals (with the support of the peer support specialist)
- How peer support specialists are best integrated into treatment teams and programs
- The potential problems when the peer support specialist role is not understood
- How someone can become a Peer Support Specialist
- Certification and standardization of the peer support specialist role
- SB803 – CA certification for Peer Support Specialists Legislation
- Ideal training for these professionals
- How best to collaborate with a peer support specialist
- What it is like to implement one of these programs
- The challenges of hiring a peer support specialist
- Exploring whether there are systems in place to support peer support specialists with their unique needs
- The recommendation for a tool kit and a consultant to support programs in implementing best practices
- The Recovery Model and peer support specialists in practice
- Multidisciplinary teams may have pre-existing bias and prejudice against folks with lived experience, the role of stigma in the interactions
- The shift that happens when peers become part of the team (specifically related to gallows humor and the separation of “patients” and “providers”)
- Demonstrating the value of this role and the use of the recovery model
- Prevention and Early Intervention
- How to be successful with peer support programs and the benefits at many different levels
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Who we are:
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
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Curt Widhalm 00:00
This episode is sponsored by Trauma Therapist Network.
Katie Vernoy 00:04
Trauma therapist network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work, and what they specialize in so potential clients can find them. Visit traumatherapistnetwork.com To learn more,
Curt Widhalm 00:27
listen at the end of the episode for more about the trauma therapist network.
You’re listening to the Modern Therapist Survival Guide, where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 00:47
Welcome back modern therapists. This is the modern therapist Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is part four of our special series of fixing mental health care in America. And today, we are shining a spotlight on peer support specialists and the role that they have in our behavioral health care system. And a lot of the advantages that these kinds of roles bring in, as well as some of the difficulties of getting peer support implemented despite a lot of very positive evidence in their role in treating mental and emotional disorders that happen in our world.
Katie Vernoy 01:27
I’m really excited about this particular episode, we’ve got two sections. The first one is we’re joined by two folks who’ve worked in the peer support specialist role who are both still in social work and in advocacy. First off, we’ve got Kemisha Fields, who’s a Master of Social Work who is was actually somebody I worked with, and she did a great job in one of the programs I was running. And then also person I was introduced to by one of our amazing friends of the show on Amparo Ostojic, who is an MPA and also someone who works in advocacy specifically about peer support specialists. So I’m really, really looking forward for all of you to listen to that and learn about what that role is. And we recognized also and I, I had a little bit of this, but Jeff Kashou LMFT is someone who has in the past actually implemented one of these programs, and he was able to talk with us about what it was like as a director, putting those things together. So take a listen.
Kemisha Fields 02:30
So my name is Kemisha Fields. I enter social services call for like 17 years ago, I took a entry level position at a homeless shelter. So that was my entry into social services. And from there, I’ve just kind of progress and work my way up. And I’ve worked with different populations. So I’ve worked with the homeless population. I’ve worked with individuals who are struggling with substance abuse. I worked in recidivism. I’ve worked in community mental health, and now I’m working in the child welfare system.
Amparo Ostojic 03:10
So my name is Amparo Ostojic. And I’ve been in mental health advocacy and peer support. For the last four years, I have worked to increase awareness about mental health, especially in the Latino community. And I worked as a peer support specialist for a mental health clinic for about seven months, I currently still do advocacy in the mental health space. And I work with individuals that want to know more about how to live, a quote unquote, normal life, even with my severe mental health condition.
Curt Widhalm 03:50
A lot of mental health clinicians, they may have heard of a peer specialist. I have found that a lot of my travels and talks in therapist communities that many people don’t know what a peer specialist does, can you help us understand what a peer specialist does what their role is in the bigger part of the treatment systems.
Amparo Ostojic 04:13
So a peer specialist is basically a role model of positive recovery behaviors. So it’s meant to give hope to someone living with a mental health condition and help them not feel as alone in this recovery process. So, in essence, a pure specialist will share their personal lived experience of mental health and oftentimes offer examples of what it’s like to deal with a condition. And you know, what they’ve done to get better, such as tips or a really useful tool is, for example, the living successfully plan or the wrap plans, where you go over with a client what it is like to be in a healthy space, what it’s like to see warning signs, and when it’s time to call your psychiatrist or go to the hospital. So kind of teach them about themselves and guide them in their self determination of managing their their health condition.
Katie Vernoy 05:17
So you’re really talking about from a place of your own experience and knowledge helping someone to plan for themselves,
Amparo Ostojic 05:26
right. And a lot of it is teaching them to self advocate for themselves, and put themselves in the driver’s seat of their health condition. So for example, a lot of times, it’s kind of directed from the top as if the psychiatrist or therapist is telling them what to do, or kind of teaching them what they should do. Whereas if your specialist is on the same level, and there’s no sort of hierarchy of who knows more, there’s a relationship of learning from each other, and really sharing what it’s like to live through this. I was given the example where it’s like, Is it someone that you want to work with, like someone that’s like a biologist that knows about like the forest or something or someone that lives in the forest, because that personal lived experience is really key to understanding things that someone else that hasn’t experienced them wouldn’t really know, or perhaps hasn’t dealt with.
Curt Widhalm 06:26
When you started in this, you started as a parent partner, how was that process of getting hired?
Kemisha Fields 06:34
So the qualification for a peer partner or parent partner would be a life experience in one of the systems of DCFS, Department of Children and Family Services, probation, and I believe education, like do individual education plan. And so my entry into being a parent partner was through my son’s IEP, Individual Education Plan. And, you know, it just kind of happened by chance, a friend of mine recommended me for the position and I follow through with it, the interview process, or the application process, they I was asked what my qualification to being a parent partner, so I did have to disclose some important information regarding my own experiences with my son. And we just, I remember asking, like, anybody could have kind of said, like, oh, yeah, I have this child that has a special needs, like, how did they confirm that information? So I was looking for them to kind of want some sort of documentation from me, and they didn’t. And so, at the time, the executive director says, usually confirmed based on the series of questions they asked me during the interview about different programs that may have been introduced to, to my son, which I found quite interesting, like, Okay,
Katie Vernoy 08:07
how was it for you to disclose personal things to get a job, because that seems like that would be a pretty vulnerable way to enter into a position.
Kemisha Fields 08:19
Very much so and because it’s the opposite of what we’ve always been told, typically, in interviewing process, you don’t share too much personal information, just your professional history. So it was a little different. But I always been transparent with my struggles with my son. So it was it was just a little different in I didn’t know this person, but it was okay. I you know, I feel comfortable through the process. And I didn’t, it was okay for me to, you know, share my experiences. Being a parent of a special needs child.
Curt Widhalm 09:01
I have to imagine, and this is prior to being hired in this position. Did you have somebody serving in that kind of a role for you, somebody that you relied on while you were going through your child’s IEP process and all of the struggles that that usually entails?
Kemisha Fields 09:19
That is… I love that question. I absolutely love that question and Yes, but very informal. So I did not have a formal being like, Whoa, this is your parent partner, and she or he’s going to help you through this process. What I have was professionals who kind of just stepped up I had one of the very first school psychologists who helped me through the process of my son’s assessment, what to look for what questions that I should ask and she helped me not on a professional level but a personal level. She kind of walked me through that process. So I was grateful for that. So I’ve had a lot of support with my son, just from individuals who cared enough to show me what this looks like and what questions I should be asking. So I appreciate that.
Curt Widhalm 10:20
I have to imagine that working with the mental health systems, the people in those roles, there has to be some difficulties in getting integrated into the more professional sides of the organizations, what kinds of challenges to peer specialists end up having, trying to help clients be able to advocate for themselves and fit into this professional system as well.
Amparo Ostojic 10:45
The professionals, such a psychiatrist, therapist, they usually operate from the medical model, which is very top down, like I mentioned, and it kind of has this perspective that I no more in teaching the patient how to, you know, work with medications, or live with this condition, where as peer specialists work from the recovery model, that look at everything, the main four points are home, community health, and purpose, that’s really important, like your reason to get up in the morning, right? That sometimes the recovery model is not taking us seriously, it’s a more kind of holistic approach, looking at the person. And in the medical model, you’re looking at the condition like it’s a problem to be solved. And I’m looking at the person as the whole and how their whole life could be better. So my focus may be different than a psychiatrist, their focus may be to reduce the symptoms, and let’s say get rid of hearing voices, things like that, or as my role is really to make that person as a whole better. So for example, I usually medications is a big thing must take medications, or as my role may not necessarily say that I typically never tell the client, you know, don’t take medications, but I really allow the client to the side that and some other parts of the medical team may not like that. But also, my role may not be taken as seriously because, for example, in my experience working with a mental health clinic, they worked with people that were homeless, and I would say extreme cases. So as someone with bipolar disorder, they kind of put me in this category that, you know, I probably couldn’t offer as much. And my perspective wasn’t as valuable. So it was really hard. Working with therapists or psychiatrist that saw me as someone that was in the space of like, part of the problem. I don’t know how to describe it. But it was really hard, because at the beginning, I definitely felt like I wasn’t taking seriously. And it took a while to gain trust, and get there super for me clients. And those were one of the challenges,
Curt Widhalm 13:01
I have to imagine some of the providers are like, you’re just completely undermining all of the treatment by using trust, none of this professional experience that we’ve learned. How did those conversations go? Because it seems like so much of a treatment plan would be developed from, you know, the scientific and medical model sorts of approaches. And then for somebody to come in with lived experience to be able to be like, maybe the medication thing is something that you want to talk to your doctor about.
Amparo Ostojic 13:33
Well, I take medication, and there was five years that I didn’t from when I was 20 to 26. And I was fine. I think, you know, I used to run marathons, I was super fit. And there was a time that I didn’t think I needed medication. But then having more episodes, I realized that it does benefit me. So I never really tell a client, don’t take medication. But I’m not as I guess pushy into that they may need I needed something to happen for me to sort of learn my lesson and realize, you know, it’s it’s easier, my life is a little easier with medication. And that may not be the case for everybody. So I definitely don’t think they see it as me undermining them. But the recovery model and the medical model are supposed to complement each other. And I think that’s the hesitation at the beginning. There’s no better treatment or a they say they’re supposed to complement each other and offer a level of understanding and acceptance and validation that sometimes the professionals can’t offer because they haven’t lived through that. So for the most part, I’m never, you know, moving them away from medication or therapy and validating their experience but perhaps they may tell me, you know, I didn’t like my psychiatrist. And this is what happened. And I will be honest and say I’ve had psychiatrist that didn’t work with me and didn’t work for me. And I had to find a different one. Or I had to advocate for myself and say, you know, this side effect is, is not working for me, you know, maybe this is working, like, the symptoms are, you know, improving. But, you know, it’s, it’s making me sleepy, and then I can’t get to work on time, things that are important that sometimes I think clients are afraid to say, because, you know, like, the main symptom that they’re after is maybe under control. But other aspects of your life have completely lost balance now.
Katie Vernoy 15:42
Yeah, I think for me, and I was that person at one point. So
Kemisha Fields 15:46
Katie Vernoy 15:48
But I think the thing that felt very powerful when I entered into that program, and saw how it was set up was that the team had set up this structure to make sure that each member at the table was heard that each person was allowed to share ideas. I had been in other programs where folks were subjected to that hierarchy, where the therapist or the psychiatrist got the most air time, they’re the ones that were making the decisions. And to me, I think, whether it was making sure that the parent partners were supervised by the director, and or really having a culture of, we are all here supporting the family. And we all equally bring important things to the table, I think it was really effective. I think we just get worried because I did see even with programs that were and maybe it was because it was intense now that I’m thinking about it, because like less intense programs, sometimes folks were using either parent partners or bachelor level providers to do like, copying and filing. And it’s like, no, no, these are mental health providers, these are people who are at the table. And so to me, I think when when people are able to integrate into the team, it can be really good.
Kemisha Fields 17:05
My personality type wouldn’t have allow for that, if I’m honest. Like no. And I think when you come in and you kind of demand a level of respect, you get that level of respect. So I’ve never had a problem, I think, in my whole career of value, my experience as a parent partner, it laid the foundation for so much of the work that I do now. So I’m still connected to a lot of those colleagues, who at the time were clinicians and I, at that time, I wasn’t even I had not completed my undergrad studies yet. And we’re like the best of friends. So my experience as a parent partner is one that is really great. And had you know, a lot of good things have come out of that for me,
Curt Widhalm 17:59
I want to change the conversation here a little bit to talking about how people can become peer specialists and what the certification process is like. And I understand that that’s quite different in many different parts of the country.
Amparo Ostojic 18:15
Yeah, and even within California, each county has different guidelines. So first of all, California just passed SB 803, which is going to allow pure support specialists to have a certification, which will hopefully increase the use of peer specialists in mental health clinics. So 48 states now have peer certification, including California. And the, the principles are pretty much the same. But how a peer support is used in different parts of a state or country is going to vary. So it’s difficult if someone moves to another state or another county, and they try to use the same principles. It may not work as effectively. And it’s basically it’s not standardized right now. So it’s hard for someone working in that field to have many options of going to different places, and even like a client that’s moving from another county and experiencing pure services in a different way.
Katie Vernoy 19:26
So if someone were to want to jump into this, where it sounds like it’s starting to become more regulated, there’s certification in 48 states, that’s great. What does it look like? How does someone become a peer support specialist?
Amparo Ostojic 19:39
There’s a few organizations that are considered certified to train for peer support. And, for example, the training that I took was an 11 day course, where, you know, like 40 hours a week, and you learn the principles of peer support. And then To become a certified peer specialist, you need 3000 hours of supervised work or volunteer experience providing direct peer support. And you need a letter of recommendation from a professional and from supervisor that has overseen your peer support. And then there’s an exam that you would take and pass. And that’s how you would become national certified peer specialist. And on top of that, like I said, California is still in the process of creating their peer support guidelines. So in addition to that, you know, whatever guidelines that they’ll come up with will be the California guidelines for certification in California,
Curt Widhalm 20:45
a lot of research gives you more credit than being a middleman, that when we look at outcomes for treatments, when we look at treatment, we see that peer counselors, we see that parent partners are more effective towards client outcomes than even just working directly with licensed professionals. And a lot of it is due to a lot of the problems that therapists just kind of face and being approachable themselves for the mental health system themselves that there is a down to earth Ness that having that lived experience really does embody that, yes, you can get through this. And I’ve got some experience to be able to say that not only do I actually demonstrate that I know what you’re going through, but that you can get through it, there’s a way through this, that there is a light at the end of the tunnel. How do you think that peer partners, peer counselors can be trained should be trained to best exemplify that part of treatment,
Kemisha Fields 21:51
I would say they should be trained the same way that any other team members trained in I know, from a clinical perspective, there’s a different type of training that comes into play. But for our child and family team specialists that you know, we have trainings, usually agencies are sending you out to different trainings, and I I believe that parent partners should be a part of those trainings, if they are not already a part of those trainings. And that should and will help them in their role as a parent partner with the life experience on top of that,
Katie Vernoy 22:32
how can therapists psychiatrists, other people in mental health clinics, support peer specialists?
Amparo Ostojic 22:38
one of the most important parts is understanding and learning to see how we can be used. I think, once you collaborate with a peer specialist, and notice the different perspective that they offer, I think both psychiatrists and peers, and mental health professionals, other mental health professionals can learn from each other. And I really appreciated that with one of the psychiatrist that he like, I could see that he really learned from me, and that gave me a lot of confidence. And I learned a lot from him. And it didn’t feel like a top down relationship. And it really felt like he valued my perspective as a professional. And that helped a lot because basically just have faith in in something even if you don’t understand how it works. You want to try and see how you can work with this person and encourage them to do actual peer support. If at first you don’t know what to do as far as how to work with them. There’s really good guides. There’s one that I really recommend, that is put out by Castro. And they are basically recovery organization. And they have it’s called the meaningful roles for providers in an integrative healthcare. And they really break down the different positions that peer specialists could do the different roles so like a peer navigator peer advocate, wellbeing coach is sometimes what they call it. And it really spells out things that a peer specialists can do. And it helps both the pure and the professional because they will say, you know, they could serve as a bridge between the community based organization, they could help clients in enrolling with health insurance programs, they it really spells out things that a client can do with a pure specialist, and that helps both the pier and the clinic.
Katie Vernoy 24:53
How about letting us know a little bit about if someone’s interested in this I think from many different angles I wanting to advocate for better utilization of peer support specialists within mental health programs advocating for swift implementation of SB 803. For California, you know, or even this advocacy for individuals who are navigating mental health concerns themselves or with their family members, and how they can advocate like, it seems like there’s a lot of lot of potential calls to action for our listeners here. What resources would you recommend that they look into, and we’ll put all of those in our show notes.
Amparo Ostojic 25:33
So definitely the I would guess, I guess, I would say, one of my favorite organizations that I worked with for the past two and a half years is Cal voices. And they have different programs, the advocacy space, is access. So access stands for advancing client and community empowerment through sustainable solutions. So they’re kind of a systems change perspective. And they have really great e learning toolkits that give you tools on how you would advocate for yourself and for systems change within your community. One of the great resources that Cal voices has is their Ys program, which stands for workforce integration, support and education. And they have what they call the YZ University. And it’s created by peers, it’s taught by peers. And this is where I got my training for becoming a peer support specialist. And they basically provide a lot of support in what a peer does. And like they have wise Wednesdays, where they provide information about something related to peer support and learning about how to, you know, either be a peer specialist or work with a peer specialist. And that’s everyone’s they. And so, it’s a great program, because like I said, it’s peers that are teaching and creating the curriculum. And I think that’s just wonderful because receiving that information for someone with the lived experience is very powerful.
Curt Widhalm 27:21
Switching gears here and talking about the implementation of peer support specialists, here’s our interview with Jeff Kashou. We are joined by Jeff Kashou, a licensed Marriage and Family Therapist. He’s a former Service chief who oversaw collaborative behavioral health program in Orange County, and had opportunities to oversee the implementations of peer counselors into some of the programs.
Jeff Kashou 27:51
Yeah, well, first off, thank you for having me on. And I’m very much appreciated that you guys have this podcast and give the opportunity for topics like this to be covered.
Katie Vernoy 27:59
The thing that I find very interesting about these roles that I know you and I both have hired these roles, but people have to claim lived experience in order to get these roles. And so it’s it’s a very interesting line to walk. There’s there’s very interesting things there. But what do you see as the difficulties that are associated with hiring peer counselors?
Jeff Kashou 28:20
Yeah, so I think, very specifically, what makes the role unique and special also makes it kind of a unique challenge in the interviewing process? How do you ask about one’s lived experience as a direct, you know, in theory qualification to have that job is what makes it a unique role to a to an organization or an agency. So I would, you know, really encourage anybody who is looking to start a peer program to bring on a consultant who can really help you think the process all the way through and how to have those conversations without inadvertently walking into equal opportunity ramifications or accidently discriminating against someone while also being very mindful that you’re bringing into the room into the interview room and process someone’s vulnerabilities. And so being able to manage that very tactfully and professionally, while also ensuring that this person, you know, feels comfortable to share that as well. That’s your first introduction to somebody and they’re interviewing you in that, that process and they want to ensure that your program has really thought through how they’re going to be not just added to their system of care, but how your entire system of care embraces and is made better by having peers on board. Oftentimes peers are looked at as very client facing but really in the best situations for them are those for the entire service model is made better by their presence.
Curt Widhalm 29:48
A lot of the talk that we’ve had on this show about how programs barely take care of their mental health professionals within the work systems. Is there any management that is actually being put towards looking after peer counselors in this way without infantilizing them. I mean, if we’re not doing this with the brunt of the behavioral health health workforce, are there other implementation problems when it comes to ensuring this kind of stuff or incorporating them into treatment teams,
Jeff Kashou 30:19
when I created a practice guidelines of like best practices for the entire Orange County systems, and not just County, but the entire behavioral health system for how to conduct supervision with peers, I leaned very heavily on a toolkit that I found from the city of Philadelphia, that there Department of Behavioral Health and intellectual disability services put together on how to create a peer support system, from the first moment you decide you want to all the way through to supervising them to managing disciplinary things to supporting their growth. And looking at it even from you know, how is the entire system set up to support them, even the interactions that they have within the multidisciplinary team, you know, they face an additional layer of potentially of scrutiny or challenges by constantly having to explain who they are, why they have any authority to work with patients or clients. So there’s, there’s added stress to the question or the systems in place to actually take care of them. You know, I would really look at that toolkit that the city of Philadelphia put together as sort of a way to evaluate if your system is there, I’d say, it’s certainly lacking just to be completely blunt, the county that I worked for, from the children’s behavioral health side was not equipped at the time to take them on effectively. And it required a lot of having to build the plane while you fly it, which I think for some roles, it’s okay. I think for peers, it can add additional stress. And it means, you know, workplace ambiguity is stressful enough. But when it comes to all the other challenges of integrating them and supporting them and explaining their role, and giving them the right training, and so on, and so on. There’s just another level that needs to be thought all the way through.
Curt Widhalm 32:11
How are pure counselors implemented into treatment teams, and how are their voices in actual practice, kind of placed into the role where there’s a bunch of other potential licensed professionals across a wide variety of interdisciplinary systems?
Jeff Kashou 32:30
Yeah, so I can speak to my experience, and then also kind of broadly to and the research that I’ve done on the topic. So it’s often implemented as a top down approach, it’s, you know, people in leadership, saying, we’re gonna add this program to our larger organization, without ever really embracing maybe the full scope of what it means to engage in a recovery service model, which is really antithetical to the principles of the peer program, you know, which is meeting people where they’re at. So a system of care, really understanding from the bottom up what’s happening on the ground level, that’s really where the entire program began with. But the ways that they’re being implemented, we have that additive approach that systems of care will take. And from a very top down perspective, oftentimes, systems need a way to recoup revenue by bringing on this workforce and, you know, supporting the work that they do. And so when it comes to Medicaid, for example, it’s involving them in the billing system. So it requires choosing a diagnosis for the person from the list that the other providers have diagnosed the individual with, which is sometimes very new and a bit challenging. I think, sometimes for peers who don’t want to necessarily see someone as a diagnosis. But you know, our current system of billing practices and documentation practices requires that also, multidisciplinary teams really don’t know about peers, and can have a lot of prejudice as they go in. So systems need to really be thoughtful and do a self assessment before they decide to bring on this very important role, you know, on are this system set up? Or what are the prejudices or preconceived notions that other providers on the team have of people that come in with lived experience? Right, you know, oftentimes, we have that sort of gallows humor as providers when we talk about our patients or whatever. But, you know, now you have to be very mindful of that, not just because you don’t want to upset somebody, but due to having that internal shift of like, you know, I actually really maybe need to check myself when it comes to that, and why I engaged in something like that in the first place. So really thinking about decreasing the stigma and helping the rest of the team even before peers come on, understand what it is that they do, the value that they add, and how they’re going to be just as important of a member of a treatment team. So really leading with the why through this process. They’re often brought a board you know without much structure I Which, you know, leads to them being assigned a lot of admin tasks as well. One of the things that I learned a lot when working with pure forums was that peers are often assigned, you know, a lot of filing tasks or, you know, paperwork kind of tasks, because the program wasn’t really trained or made to be aware of what appear is going to do. And so managers will get, you know, assigned X amount of peers and hire them on but not really know what to do or may not have the bandwidth to train them and think through that whole job requirement. Similarly, what I experienced was, sadly, even partway through the interview process, we found out that we were actually interviewing for peers, but the program was set up, they had to find a job title or job classification that they could fit these folks within, so that we can hire them in a timely manner. And so when we were hiring mental health workers were actually supposed to be hiring peers. And so we found out midway, that we were hiring peers, which meant as managers, then we had to shift and reevaluate what we were doing which we put a lot of emphasis and fervor and figuring out and making it a smooth process as much as we could. But it was by no means ideal. And the cohort that we hired, certainly struggled with a lot of the ambiguity and sometimes just having to sit around and wait while we figured things out for them.
Katie Vernoy 36:16
You’ve mentioned a couple of times the the money element of it, that oftentimes these are folks who are hired to do an important service that isn’t always reimbursable. And it makes me think about the value. And this speaks to the prejudice as well. But it makes me think of the value that people hold for this role. You know, they’re not generating revenue, typically, or not generating a lot of revenue. They’re not seen as experts, although they’re oftentimes more expert than the folks in the room that are doing the treatment planning. And so what are the ways that you have found whether it’s best practices or what you were able to accomplish in your program, of integrating these folks more successfully into, you know, kind of explaining the role? Like, why is it so important? What is the value of this? Because I feel like, and maybe you’ve already said this, and maybe this isn’t needed, but it does feel like there’s a case for this role. There’s an importance to this role. And I just feel like maybe we need to be more direct and saying it, I don’t know.
Jeff Kashou 37:25
So yeah, so there’s really two directions to think of when it comes to how do you demonstrate the value, there’s two those who would be, you know, deciding to bring on this role, which would be those key stakeholders. And then you also have the provider teams as well. And then I guess, there might even be a third group, which are the patients or clientele that you would be serving. So when it comes to demonstrating the value, I think the message needs to be pretty clear all the way through, which is when you’re working with, you know, with individuals with serious mental illness, or those with CO occurring disorders, some of these more serious conditions, we know we preach about prevention and early intervention. And this is the rule that really helps with that. And this is the rule that allows us to make that big shift towards a recovery model, and not just pay lip service to saying that, you know, we meet our patients where they’re at, and, you know, we want to, you know, improve the quality of their lives and help them reach their full potential. Now, that’s, you know, a bit more idealistic and trying to sell it maybe to those that population level into the stakeholder level, but to the provider team, it’s also a matter of, you know, recognizing that they will complement the services that, say, a therapist or psychologist or psychiatrist provides as well. And so it’s more of like a meshing of gears versus like, people running off into separate directions, you know, where we know that metod here, it’s a very important thing. Medications is a very important aspect of treatment. And if individuals, you know, go to their psychiatrist and they prescribe them an antidepressant, we oftentimes know that adherence drops off very quickly, either because the person has some sort of side effects, or because they start to feel better, and they decide they don’t want to take the medication anymore. What you know, for multitude of reasons, here, the peer can actually meet with that person, you know, right after they meet with a psychiatrist, or maybe even be in the room with them when they meet with a psychiatrist. And help them ask the questions that are there might be uncomfortable asking, or ensure that they’re asking the questions they didn’t think to ask, creating that plan afterwards with them for how they’re going to fill the prescription, how they’re going to, you know, lay out their medications for the week, how they’re going to make sure they maintain their motivation to take it or communicate changes that they need with their medications. When it comes to treatment adherence, you know, we assign individuals journaling to do for example, but I don’t know about you guys and how often we assign tasks to to patients to do in between sessions, it’s extremely hit or miss. And then you end up spending your next session processing, why they didn’t do it when you’d rather be processing what they did. And so it’s not to say it’s 100%. But a specialist can really help with complementing services in those ways. I think ideally, we know that there’s attrition, oftentimes with this population. So here’s how we keep people engaged in care. I think the other thing is we think about completing goals or completing treatment plans. But that’s not really the case. Again, it’s not like that broken leg where your leg gets mended, and you don’t have to really do anything afterwards, you have to maintain those gains for the long term to allow you then to get to those next levels of functioning, or satisfaction or fulfillment, whatever they might be. And that’s where the period specialists can help somebody in the sort of aftercare discharge planning or even long, long term support through their maintenance of their goals.
Katie Vernoy 40:56
I think another element for the treatment team, and this is something where, you know, we had the conversation with Kemisha about this, but they’re also an expert on the lived experience. I mean, obviously, each person’s experience is different. But there’s so much that I think my treatment teams anyway, we’re learning from our peers, because they just hadn’t been in the situation themselves. And so I think there’s, there’s also incorporating in that way, like here is another member of the team who has really valuable and valid feedback that you need provider. Because I think it’s I think it’s hard, I think it’s hard to understand this. And I think that we’ve hidden behind a hierarchy that clearly doesn’t work, we need to have, we need to have a whole bunch of human beings working on this on a level playing field.
Jeff Kashou 41:47
Yeah, I’m really glad you brought that point up, Katie, I remember, and you guys probably had to do this in your grad programs as well, where we were assigned the task of attending a 12 step meeting to understand what the recovery community is like. And we can see what these you know, non therapeutic support systems are like, and it’s a way to get that experience. But we were only assigned that at one point in time, and there is so much value that appear can add in terms of to use your your point expertise in these areas, you know, the approach, I think a lot of us take in the recovery systems, you know, I will get asked oftentimes, you know, well, are you in recovery yourself? And I think as a therapist, you make your own call in terms of self disclosure. And I would say the while I can tell you yes or no, it’s more important for you to tell me what your experience is like, rather than me telling you all about what your experience is like. But I think there’s a way we can sort of fast track that by having peer specialists add that level of detail to us upfront so that we’re not always taxing individuals to have to educate us each and every time if that’s not something that supports their care in the short term.
Katie Vernoy 42:52
Curt Widhalm 42:54
There seems to be a lot of mixed evidence on the effectiveness of pure counselor type programs, with the United States in particular lagging behind a lot of other countries when it comes to the implementation of this, some of which is highlighted by some of the funding stuff that you’re talking about within things like Medicaid, and we even see some of this going on and private insurance type programs where this stuff can’t be implemented. What do you see is the difference between a successful incorporation of pure counsellors versus the ones that kind of fizzle out,
Jeff Kashou 43:32
it’s going about it with a systematic approach. And that’s I’d really emphasize either, you know, utilizing one of those toolkits, like I mentioned, the city of Philadelphia created, which is extremely comprehensive, and very much focused on the existing org and not necessarily on what peers need to be doing. But I think in the absence of that, it’s really identifying just like with any big change that you want to make for a business, it’s identifying, you know, what, you know, doing your SWOT analysis, and then looking at what is your measure? What’s your success metric going to be? And how will you know you got there and then be flexible, to iterate and improve upon things as you move forward? Again, to that authenticity point, it’s just like how we work with our, you know, our clientele, it’s, you know, we don’t expect perfect, but, you know, let’s talk about what didn’t go well, and let’s improve upon it, we need to be able to do that authentically, as well. I think, unfortunately, in healthcare, and especially behavioral health care systems, where we’re kind of the afterthought in terms of funding and attention and resources, you know, we just have always learned to make do and stay the course. And then on top of it, you have folks in power, who don’t necessarily understand what we do, and they just kind of keep adding more and more stipulations and regulations and so on. And so it’s also a matter of like, can you cut through some of that maybe sometimes even through the side door, like in California, we have our mhsaa funding that peer programs are oftentimes Funded there, which is very nice, and that they don’t have to be capturing revenue through Medi Cal. This is through funding that has less requirements to it. But it’s also pushing back and saying, do they really need to do this level of documentation? You know, so I do think it’s a matter of like, thinking things through from bottom to top, like doing that assessment and really assessing yourself like, can we take this on, and being very brutally honest with yourself as a system of care, it’s an exciting program, it’s an exciting idea. It’s one that can bring a lot of benefit. But you have to really understand what it is that you’re bringing on. There’s other companies that I’ve worked for that have said, you know, hey, we’re, you know, one day down the line, we’ll have peers and that way our current clientele can engage and give back, it’ll be kind of a lower level service line. I think if you’re thinking about it from that perspective, only, and really seeing the dollar signs as part of that image. It’s not to say that, you know, money isn’t the driver here, but it can’t be that upfront. Otherwise, what you’re doing is you’re commoditizing, a service provider who is designed really to add value simply by them being there and engaging with clientele in that way, without necessarily generating dollars by increasing retention by increasing engagement in services. We know outcomes improve, when systems can demonstrate improve outcomes. Oftentimes, they’re the ones that get the next grant are the ones that get the renewed contract, sometimes even a larger contract. So it’s really, you know, credenza question in a short way. It’s, it’s all about approaching it systematically. And not just Yeah, that sounds really exciting. Let’s do this.
Katie Vernoy 46:43
I think it has to be baked in, it can’t be like, let’s add this on to the program. It’s almost like you have to build it from the ground up, to have these truly integrated into whatever the treatment program is.
Jeff Kashou 46:56
Yeah, there’s kind of three different approaches that that Philadelphia tool toolbox outlines, just like that additive approach that I discussed, there’s that selective approach. And then it’s really taking on the one that has the greatest level of success is what’s called a transformative approach, which a lot of systems are understandably nervous to take on. But to make a program successful, you have to be willing to transform things, sometimes top to bottom to make it work.
Katie Vernoy 47:21
Yeah, it’s interesting, because the the program that I had, it was, it was baked in, it was like, my agency decided to do a wraparound program. And at the time, it was called an FSP. Program. And so as, you know, maybe you move clinicians into it, but it was like, here is how you do it. And it was baked in. So it wasn’t like, Oh, you’re already doing services, let’s add this on. Functionally, maybe it looked that way. Because we had clients who then you know, like, followed their therapist, and then got these other services added on. But the program itself was well defined by LA County. And so there was discrete roles, there was training that was required. And like, especially with wraparound, there was like, a week long training where you, everybody went, and there were people from all different roles, and you went when you just first started and all the managers had to go to, so I had to go to it as well. And we would sit there for a full week and interact with other people in our same roles or in the in the peer or the you know, the all the different specialists roles. And so to me, it was, it didn’t feel as chaotic because it was like it was completely structured. And it was baked in.
Jeff Kashou 48:31
Yeah, and a wraparound program is oftentimes very much set up for that, you know, they traditionally will have either bachelor’s level providers as PSCs, or personal service coordinators, which truthfully appear would be phenomenal at which it sounds like that was the role that you had at your program. And because
Katie Vernoy 48:47
No we had we had bachelor’s level folks, we had peers, we had a facilitator, and we had a therapist, so there was four or five people on the team.
Jeff Kashou 48:56
That’s a tremendous program. You know, and we’re the approach, you know, you’ve probably experienced this as well, the approach of a wraparound program is like whatever it takes, you know, this is a child, an individual, a family in such a challenging situation that we have to throw everything at this person that they need, and and some to get them to the, you know, to a better place.
Katie Vernoy 49:17
Yeah, yeah. I think it just is a good way to think about it as if you actually create a program from the ground up that includes these roles. I think that is stronger. I’m really glad that we’re that we did this episode that we’re talking about this related to our fixing mental health care in America. I know that it was mentioned in the RAND report, but I also recognize that one of the elements of this is it has been viewed. I think we did this in one of our more recent advocacy and workforce episodes as a way that we take away work from licensed credentialed mental health professionals and I really see this as an important adjunct a positive step forward. And I think we were able to really see that in the conversations that we had with our three guests today.
Curt Widhalm 50:08
And I mentioned a couple of times in the show, both this episode and recently about how little using supporting roles, like peer support specialists is actually taught as part of therapists education.
Katie Vernoy 50:22
Curt Widhalm 50:23
And there’s a lot of emphasis on therapists education that’s on what we as individuals can do to help with clients, but don’t help us to look at the overall workforce system. And I’m echoing your happiness of this episode. And being able to amplify that really good. Mental, behavioral, emotional health treatments, takes a village. And it does take people from a lot of different viewpoints to really help create healing. And especially those people who have that lived experience and have a really great way of helping to help our clients interact with the system to be able to navigate it in ways that makes sense for them. So continuing to emphasize this will be part of our ongoing role in bringing mental health advocacy to the world. And we encourage you to do so as well.
Katie Vernoy 51:24
And for folks who were really interested in this, there are a lot of links in the shownotes that will help you with some of the some of these concepts, we’ve got the the guides and those things both onpattro and Jeff sent stuff over that are very helpful for folks who either want to be a peer support specialist or who want to implement those programs. So definitely feel free to reach out to us if can’t find it on our show notes. But those things are just the really amazing resources that we were able to put down there.
Curt Widhalm 51:55
You can find those show notes over at MCSG podcast.com. And check out our social media out give us a like or a follow and schrinner Facebook group modern therapist group to further these discussions. And until next time, I’m Kurt Wilhelm with Katie Vernoy.
Katie Vernoy 52:11
Thanks again to our sponsor, trauma therapist network.
Curt Widhalm 52:15
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Katie Vernoy 52:52
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