GAINS Webinar: Supporting Peers Providing Services at Intercept 0

GAINS Webinar: Supporting Peers Providing Services at Intercept 0

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- [Erika] Good afternoon, everyone. Welcome to today's webinar presented by SAMHSA's GAINS center with the support of SAMHSA, which is the Substance Abuse and Mental Health Services Administration. Today's webinar is supporting peers providing services at intercept zero and the presenters are Darryl McGraw and Dr. Karen Fortuna. I am Erika Ihara and I am a project associate at Policy Research Associates. Before we start our presentations I have some housekeeping items. The views, opinions and content expressed in this presentation and discussion do not necessarily reflect the views opinions or policies of the center for mental health services, the center for substance abuse treatment, the substance abuse and mental health services administration or the U.S department of health and human services.

If you have any questions for the presenters or in relation to the technology, please go ahead and type them into the Q&A pod, which is on the right of your screen. And we will address as many of these questions as time permits. We will also be conducting a couple of polls and really appreciate your participation in these. So when you see a poll pop up on the screen if you can, we appreciate, if you can enter your responses. This webinar is being recorded and slides will be disseminated via the GAINS listserv or following the webinar. We will also notify you when the webinar recording is posted to SAMHSA's YouTube channel.

And finally, a certificate of attendance will be available for download at the end of the webinar. And please note, this is for personal portfolio use only and it is not a CEU credit. There is ASL interpretation for this event. And in order to view ASL interpretation, please go to the layout in the upper right-hand corner of your screen.

You then select hide non-video participants and change the layout view to full screen. And then finally select view all. Our interpreters for today are Maricka Larson and Dave Gratzor. There's also live captioning for this event. And in order to view live captioning, please select the accept bottom in the multi-tiered media pod which is in the lower right-hand corner of your screen.

And the color contrast of the caption pod can be changed as needed. We do recommend a high contrast style for best visibility. So next I would like to introduce the agenda for today.

After I complete the housekeeping and introductions I will be turning this over to Darryl McGraw and Dr. Karen Fortuna to present. And then we'll have some time at the end to answer questions from the audience. So now I would like to introduce our two speakers.

First Darryl McGraw who is CEO of Formerly Inc which is Connecticut's first criminal justice re-entry reform consultant agency. And it is predominantly staffed by formerly incarcerated individuals. He is a community activist and a philanthropist with expertise in re-entry and criminal justice reform as well as behavioral health and addiction services. Darryl has state certifications as an addictions counselor a recovery support specialist and criminal justice professional. Dr. Karen Fortuna, who is assistant professor of psychiatry

at the Geisel school of medicine at Dartmouth college she works with peer support specialists to co-produce and empirically test digital peer support technologies and trainings. She serves on the American psychiatric associations expert advisory panel on smartphone app development, as well as on the patient centered outcomes research institutes advisory panel on patient engagement. She also serves on the editorial board at the journal of participatory medicine.

So I'd like to just report on some observations about who is calling into this webinar today. The majority of you who have entered your responses to the poll are calling in from urban locations followed by rural locations and finally suburban locations. And our professional affiliations are primarily people calling in from crisis service providers community-based organizations and those are the two main categories. A couple of you also filled in other. So we'd like to welcome you all today and thank you again for joining us.

And now I will turn it over to Darryl McGraw to begin the presentation, Daryl. - [Darryl] Oh, thank you. Thank you so much. And hello everyone. My name is Darryl McGraw and I'm excited to be here. It's a little different style for me because I'm used to seeing everybody, but this this new world of Zoom, and we're gonna be about today, leveraging critical skills at intercept zero.

One of the things I just wanna add before I start my presentation I'm also a person in long time recovery which means I haven't used a substance since May 7th, 2007. I'm also a survivor of PTSD trial urban trauma as well as trauma from incarceration. So I like to say that because even though when I do my presentations, I like to know that I'm presenting from a lived experience perspective as well.

So thank you and enjoy and looking forward to the conversation at the end. So I live in Connecticut and COVID has definitely set us all for like taught us a new way to live. And some of the things that now like I'm a criminal justice advocate criminal justice reform advocate and activist.

So when we look to start looking at the data when COVID happened, that's like March 2020, right? And to June 1st, 2020 we started to see almost 2000 people released from prison. A lot of advocacy work, getting people out due to COVID. And so this what me, what I've been advocating for forever happened due to COVID right.

Decarceration. So I'm a big fan of getting people out and keeping them out. And that's what we're gonna talk about. But we're also gonna talk about 'cause we're talking about from intercept zero actual individuals not even entering the criminal justice system. One of the things that I do in my work with Formerly Inc is training forensic peer support workers. And these are individuals that work with justice involved people.

So individuals that are in coming out of the correctional system that may be in pre-trial status, maybe on probation like anybody that has criminal justice involvement. I train individuals how to work with them because those are, that are justice involved. They're familiar with the criminal justice system. Myself including one of the most difficult things I had to deal with what re entry of being reentering back into community it can be overwhelming, but just having any criminal justice involvement can be overwhelming.

And so, as the slide says, we live it's a new world today and forensic peer workers need to lead by example, what do I mean by that? I mean that since that they're justice, individuals are justice involved. So we're making sure that I'm treating people to work with this population. But being that things have changed where you're going to wear a mask in a lot, make sure your hands are clean and all different types of preventative measures. So people don't get sick. We, I train now we train forensic peer workers to lead by examples and many different ways not only in the community, but as times have changed with COVID asked them to also, role model, mask wearing and being safe and so on and so forth can very important that they safety and self care is important.

Over 7 million people are currently involved in the criminal justice system due to incarceration, parole, probation community corrections, one in three adults have has a criminal record. And one of the things that when I'm doing a talk I always point out like, you get a lot of different opinions about the criminal justice system and the services that we provide even at intercept zero before going in or people getting out, what have you, any 95% of the people that are in prison are going to be released. And I always say that we not, we may not be responsible for how an individual goes into prison but we should be concerned how they come home. And I'm a big component down that we've in Connecticut when I wanted to point out is that when I went to prison there was 20,000 people in prison. Now Connecticut is down to 9,000.

So we're under 10,000. So we've cut our criminal, the unfortunate bus in the COVID. We have actually cut our population in half. So now I'm looking at how do we, and many of you that are on this call many States have done the same. How do we keep those individuals out? How do we support them while they're out? Because, and the interesting thing is that the release the mass release of individuals with that they have had we show that here there are 356,000 people with mental illnesses in prison. And that was a slide from some, an older slide but the numbers are still high.

And those of you that work in the field and work with this population know that we did some of the data shows that maybe 90% have mental illness or substance use or both co-occurring disorders, right. And 85% of the 2.3 million inmates in jail are substance and involved, right? So the interesting thing and this is what I wanted to point out is that with COVID and the decarceration people not going in prison are getting out of prison early.

Some of you that know like or work with this population, or that are my people that are in recovery, right? Know that some people use jail as a form of rehabilitation rehab, right? So they go in and they get their weight up and they stop they're not using in there. They're they use, they take that time to heal themselves to get back to that time that they're in, well, when COVID happened people weren't going to jail or they were getting out of jail and they got out before they had mended those fences or with their families. And they were released before they expected to so those bridges weren't repaired.

And so people weren't prepared to come back out. And so now they went in thinking that they were gonna be there for a while. And now they're out.

So as forensic, peer support staff, we are here to, we need to be there to support those individuals in those situations as well. And individuals that are in court and that are on probation and that are any forms of justice involvement. How do we support those people in the community? So the forensic peer support specialist to navigation through the reentry process. We're just gonna talk about the reentry process. I know that we're gonna really focus today. And when you hear my colleague Karen talk and we're on this particular webinar we're talking about intercept zero, but it's important for me to always talk about the navigation through the re-entry process, because that's this is all inclusive.

So you guys are getting a little extra today, right? So the navigation through the reentry process the criminal justice system, finally community supports. This is where that forensic peer. And if you're not familiar with it, reach out make sure you throw it in the chat box. You asked me more about that for peer training because this is something that we can't just glaze over. It's super important that we make sure that peer workers who are working especially in the midst of COVID are skilled in this skillset to be able to engage these individuals that are justice involved. And that comes with finding community support and being knowledgeable about community support.

Where are the foods at where these services are at especially in the midst of COVID when things are closed now, we've gotta make sure that we are, these individuals that we are, that are trained forensic peer support specialists have this knowledge increase in accountability. Those are individuals that we are individuals that are have ourselves been just as involved. So we may have, we have a criminal record but we have this accountability to like be role models upstanding citizens, because we want people to know that change is possible.

Change is possible. I spent 10 years of my life in and out of the correctional system. And today, now I run my own organization. I've worked at State level, I'm sitting on numerous different boards and so on and so forth.

But my main goal I had two main goals getting out of incarceration. One was to not use substances anymore. And the other was to stay free. And now that I have found my path it's my duty to help others get out. I'd like to call it a modern day our modern day underground railroad.

So role modeling for peers who like similar to what I was just saying role modeling for peers who have successfully completed their criminal justice obligations. So there are many of us 62 million Americans have justice has a criminal record. So many of us, and I know there's some of my people on the call.

I know there's some of you out there that are listening to this, you have successfully transitioned back into the current forensic world and then you've transitioned back into the community. And now you want to give back. That's one of the number one things we want to give back.

So what we do is we help individuals train and we train individuals to work with this population. And through that training you've learn how to advocate for clients, advocate for clients. Sometimes a client may not have the ability or the skill set to articulate certain needs. So sometimes that may come through in the way of role modeling or just talking it through and saying, hey, you know what? I've been there. This is how I would handle it. And so on and so forth.

But one of the important things, and it's not on the slide but I wanna make sure that we that I mentioned it when individuals are justice involved and at intercept zero, they may still be going to court. We make sure that a well-trained forensic peer support specialist knows that they're not a lawyer. So we do not give legal advice.

Our goal is to support through the process whatever that may look like. So, and then also supporting people who are life skills that they may be lacking. And these are just some of the gifts that we give that forensic peer support we offer is the ability to instill hope, modeling one's example of recovery, mentoring the engagement. Street-smarts one of my favorites because you have to be savvy. You may have moved on. What I like to say is we've turned the criminal genic thinking into a tool that we can no longer use criminal generic thinking, but use our street-smarts to help others transition and be successful in the community.

Get out, stay out and not worry about going back into prison. And education. Education for me is key.

Education was the key for me. And it was a big component of my recovery story. And once again, we lived as we climb, right? So it even though that I have removed myself from the criminal justice criminal world I am still in here reaching back in for my brothers and sisters and pulling them in pulling them out and trying to show them the way. A lot of appropriate settings for I believe we should be everywhere. Do you know, I'm just gonna say that I'm just gonna say we should be everywhere.

Forensic peer support specialists would be everywhere, but in traditional courts, halfway houses, juvenile detention, jail detention, mental health centers, emergency rooms you do see emergency coaches. I actually was on a call today with someone who has over 20 emergency room coaches. And they were looking into this forensic peer support training. So the forensic peers is a specialty, right? So someone's a doctor, right? But you wanna be a brain surgeon or you're special. So the forensic peer is the added.

So what we look to train as individuals who may have recovery coaching or peer support training and then we add the forensic, that's the specialty to it my favorite part in churches, there's no place that we shouldn't have specialists, specially trained peers. And, so, as I said, certified recovery coaches peer recovery coaches. This is a qualification and every state is a little different, but as anybody knows we have challenges once we get out, I think people should be settled stable, stable in their recovery, but we like to see in Connecticut, we like to see two years of substance for use no use. And that does not exclude MAT.

If a person is in, is using medicated assisted treatment that works too. But two years of not using mine substances minimum of six months of volunteer experience, working with individuals in the criminal justice system successful completion of the criminal justice system requirements. And that's when your timing, if you're working with individuals who are justice involved, you, some of the criteria is you wanna be off of any type of supervision. So you can work successfully with these individuals, because if you yourself have some type of supervision it may be difficult to fulfill the role. Not currently on parole or an ability to tell a story of success in a meaningful way. So what does that mean? Like using that story as a tool, like it's not in a meeting and when you engage everybody and you don't go through that.

But when I tell my story or if I'm telling pieces of my story I make sure that we tell it at a certain we tell the story of the engagement piece. When we're engaging individuals, we make sure that we tell the story in a successful way. I think I just see, and I can only see a few things.

And I think someone said it was, looks like intercept four. Here's the intercept. What I wanna make sure is that you understand how forensic peer support works. So it can work technically through all the intercepts from intercept one, two, three, four, and five.

Today, we'll talk about zero. When you're actually engaged in people on the outside before they even enter the system before individuals that may be in the pretrial status may just be interacting with law enforcement where we're connecting with police officers. And we have police officers that may say to me, hey now I got this guy. I don't really want to lock him up. He's not, a lot of times police officers or prosecutors will say to me, I only have one recourse. It's either lock them up or let them go.

And I don't feel comfortable letting them go without supports. So this is where your forensic peer support staff comes in really strongly intercept zero as when the you could actually meet with them in the community and try to help those individuals be successful in the community before intercept one, two, three, four or five becomes a reality in their life. So one of the things that due to COVID we've been understanding that the new normal, right? So a lot of this just like we're doing today is, interacting with people through digital peer support or even some of the trainings. I've done several trainings now with different States where we've done the forensic peer support training over zoom because of the, of COVID, which is an interesting thing is the fact that the challenge may be that some individuals when you're talking about providing peer support for them they may not have the resources. They may not have internet. They may not have a computer.

A lot of times I'm engaging guys on their cell phones. And then the other challenge is that this forensic peer support has to be I have to engage this person once or twice in the community to show them. I know I was working with a guy who just did 14 years yesterday, and he wanted to do some spoken word on the, at a conference. And he was hired to do spoken word but he had just been 14 years in a federal institution. So he's out now, and he's trying to figure out how to navigate this new world.

And he was like, I don't know how to access my email. I don't know how to use Zoom. I don't know how to do this. So we need to make sure when we're working with individuals out here we're meeting them where they're at and we're actually showing these individuals, how to utilize and how to engage and use this new technologies and their cell phones whether that be texts, Zooms, face timing or whatever's comfortable for the individual and meeting them where they're at and understanding this was an older individual. And he felt really challenged that he could not engage at that level.

And he was just so apologetic. He was like, man, I've been locked up a long time. I'm just trying to figure it out. And you know what, as a forensic peer support supporter of this individual, would you say, don't worry about it.

We're gonna be there for you. And you just teaching people, it kind of working with individuals and intercept zero when we can engage with them physically and just using all whatever, whatever technology, whatever place the person feels comfortable. I have people that call me through Facebook Facebook messenger, because they don't have phones. They're using texts, or they're doing this. And sometimes when I'm working young people who are in the system that are justice involved and not arrested yet, but we find out that they're doing things on Facebook and on different media platforms. That's another form of engagement and talking to them because a lot of times police do their find now, well cases and things to do their social media.

And then is the role of the forensic peer support person to kind of like educate them on what are you doing? You're putting this out there for the world to see. Just common barriers for those that are justice involved. Right? So you and when you say justice involved that is an individual that may not have never been in prison.

Maybe they've always been an intercept zero but they still have the criminal record. And they still have these problems, transportation, employment. I talked to a guy yesterday and he was a former attorney and he was telling me that he's still with the criminal record and he has these barriers, right. And he had the education. These are issues here. And I was just talking about the gentleman yesterday the lack of the knowledge that using technology or those family issues, individual ones doesn't wanna go to prison.

They don't want to go to jail. They're justice involved because of maybe their family environment. So there for offering forensic peer support to say that trying to support that person in the community as best as we can. And just reiterating the fact that a lot of this support will may come through which would normally be in-person being now be through electronic devices whether it be Zoom, or if that individual has a phone we have to figure out how to make sure that everyone's safe using technology and teaching people. So I just want to make sure that we're focusing on.

I know my colleagues is going to get really deep into that. Is this under normal circumstances, we would just be making under normal circumstances, pre COVID. We make contact with individuals provide services in the community and offer services in the individual's home.

We don't right now, that's not something that's happening in sometimes rare cases where people don't have technology we're meeting people and in the community with mask on usually outside would not in their home. And it's also showing individuals like another thing that's a challenge is, are is many those that are accepting applications many of those applications and uploading resumes or what have you that everything is pretty much done online. So those involved people really shrug our people that are justice involved at intercept zero that are struggling and finding themselves having interactions with law enforcement, finding themselves in court settings and AIC, and all these other situations. Probation will have you not incarcerated but still struggling with just trying to adjust in the community. Some of the skills that we would help them with is anger management, budgeting renting, filling out applications.

Like I said, using technologies, being a good friend, father and mothers, these are the things that, these are things that lead people into situations that may cause criminal justice involvement because of the struggling with all these issues. We try to support those individuals there and figuring out the public transportation system. I know I struggle with that myself and I've been home almost over 10 years now and grocery shopping. And we've been able to do some really cool cooking shows online, right? Doing cooking shows.

And, some of it is like helping people show showing people how to set up utilities online, which is one of the things as many of these things can be done. A lot of these things can be done virtually now. And getting one of the one of the cool things is helping people get library cards which is a little difficult now, but making an appointment and get a medication filled right now in the midst of COVID trying to get people to learn trying to show individuals and talk them through actually getting registered for vaccines online has been one of the challenges one of the most significant challenges lately and just go through this really quickly, just, some of the, these are just common barriers that individuals face justice evolve and name any intercept these are still some of the challenges as we mentioned earlier, and those no transportation lack of stable housing, hunger, everybody's struggling now to have food and all of these different things and mental health challenges. And how do we engaging these individuals that are used to receiving just walking into the place to receive support.

Now we have to teach them a different way of accessing support for themselves. Just a relationship, relational safety, as peers, forensic peers, we definitely regardless of how we engage with these individuals we're striving for the connection. The connection is key, one of the things that we pride ourselves on especially as peers is treating people as humans when the system has given up on them, we have not and having that ability to do that training we learned how to notice disconnect and talk about what the needs are what's the need to do to reestablish connection. And both people matter.

It's not just a one-sided thing. I'm not better than you because I'm a peer. I worked for this organization. I got a badge.

This is not that it's, I'm here to help you. I am a support system for you. And just and this are common disconnects. This is common disconnects. Yeah, Brett.

Brett's asking about those slides, Brett's wanna know if we're gonna get the slides we'll make sure we get you to get them. I see the chat popping up and just kind of disconnects, ordering directed, arguing, lecturing, telling people what to do. A lot of people are adults.

And this is a program of suggested we work with people. We don't tell them what to do, or we're not a parent where we're a peer support person and being unaware of your power. So this just comes through training. And another common disconnect is over relating.

Like, oh yeah, I get it. Oh, that happened to me. Or questioning your probing. I noticed is a trigger for me whether even in employment settings and a lot of times employers miss this. People that tend to be justice involved when you're over questioning it almost feels like an interrogation and it can be triggering. So making sure that you're staying focused on the issues of working with the individual changing the subject is difficult.

And this is challenging when we're talking through texts, a lot of things get missed. Things get misconstrued through texts and steering the conversation and pushing your own agenda. It's always about me.

And really we try to be person more person centered as a forensic peer support staff person. You want to make sure that it's more about the individual and less about you. Yes, your story is important, but we use it as a tool. Not it's not, like I said, once again it's not a meeting. And reacting and responding, reacting just quick reactions instead of taking your time this is a difficult time for everybody and everyone is struggling. So we gotta make sure how we respond and how we react are important that we're keeping ourselves in line even though it's a struggle for both parties.

But when you're working with individuals in the community especially at intercept zero who may be in the pretrial phase and struggling about worrying that they're gonna end up in prison thinking about the things still, and maybe feeling remorse or guilty about the action that got them arrested. So you wanna make sure that you are your reactions are not aggressive. We know that you're working because think about it.

That person needs you to be supportive for them. So your responses need to be your responses need to be different than everyone else because the police and family members and everyone that person may be going through a lot. So we want to make sure our responses are proper. And before you react, respond you should always just and this is for individuals that work directly.

And even if you're not a forensic peer support person you get these slides and you really look at it and think about the relationship and how you want to interact with individuals. In this time we wanna make sure that people have space. Of course, we're dealing with people in compassion.

I'm always monitoring to making sure my tone is correct. Let it go instead of holding on and cherishing and personalizing. And we talk about that. And then sometimes we're all human, right? We're human.

So of course, if you make a mistake apologize, when you do fall into that make sure you apologize. Apologize, own your part. I know when I'm talking to my kids and they they're, they're having a disagreement or I'm working with other people that are in the community who work with justice involved people 'cause there's a lot of disconnected intercept zero. There's a lot because people there's a lot of struggles going on.

And a lot of challenges that space it's not like a person who was in prison and had some time to think about it. This is happening right now, right? Their situation is current. It's not like, oh, I had some time to think about it.

I did some time though this is happening right now. So we want to definitely be as supportive as we can when we're working with those individuals. So once again, apologize, own your part.

I always tell my kids, what was your nickel in that dime ask if you said something that bothered them because that disconnect either over phone, Zoom, in person, six feet deep you can feel that disconnect happen and you can see it. And it's more about connections than disconnections. And expressing empathy is we're seeing a lot of this when people have their own struggles right now in the midst of COVID, the individuals that do this work have sometimes I know I've talking to a lot of friends who have lost touch with their own feelings. So it will be difficult to be able to support someone else if you're struggling. And I always say you gotta to check in with yourself before you can actually go out there and do this work.

Situations or problem may be similar or too close to your own. Like a lot of times, someone loses someone, this person be that might be a little too close for comfort, as we say so you wanna make sure you're checking in with your network. I always say my network is my net worth. Your supervisor, whoever's your support system.

Cause we should have support systems who you can't be in support system without having your own support system. And if peers believe the person's background or crime is horrendous empathetic response may become blocked. A lot of times, people who do this work when you're working with justice involved people and you meet them at the courthouse or you meet them at AIC meet them in the community and you find out what they did that might be, there might be some bias or something that you may struggle with. So, and always the lack of self care.

If I'm not taking care of myself there's no way that I can help anyone be a good forensic peer support staff person to those individuals. And all this is discussed through the training. When I'm doing training, you wanna make sure you're you and your staff are getting trained. You wanna make sure you're getting trained by somebody that makes sure that we cover all these bases. And just staying connected, how to stay connected.

If the individuals in recovery we're working with them and another disconnect that we don't talk about is a lot of times, it's a person may be in recovery. They may have worked on themselves, but at intercept zero this person may be not ready for recovery. This person may not be there. These individuals might've already worked on themselves. So you gotta be able to check that and just encouraging for the individual, working with those just and try to get these people to focus on doing things different, doing life a little bit different and encourage them to themselves to stay, spend time with those people that they loved and doing something fun.

I mean, today in Connecticut, it's about 50 degrees outside which is a first or so. I mean, it's been cold. So getting outside getting some sun on your face because we've been trapped in the house just being in a moment. And this is for both I say for more focused towards the individuals that are doing the work but also this is like it's a mutuality. So we also offer it to the people that we work with. Like, not taking your work home and being there for your family and trying to figure out how to balance work life trying to figure out how to balance this situation that you may be in and always practicing mindfulness.

And, this may be a struggle but it's more important for our forensic peer support staff to embrace these staying connected tips because this work can be difficult. I tried to get it all in really quickly. If I spoke too fast, I apologize is kind of difficult working through this stage but I'm going to introduce my colleague Karen Fortuna who's gonna take you to the next part of it. If you have any questions for me we'll see you at the end.

Karen, how you doing? - [Karen] Hey, Darryl. How you doing? That was great. - [Darryl] Got through it. - [Karen] I always learn so much from you. And so, and always happy to co-present with you. So this is very exciting.

- [Darryl] Honor and a privilege, thank you so much. - [Karen] I hear you. So welcome everyone. Thanks so much for having me here. I'm an assistant professor of psychiatry at Dartmouth college and my background is in social welfare. And so it's quite interesting and working within a school of medicine and in bringing forth the social determinants of health and working with peer support specialists now across the world in developing, designing, testing digital peer support technologies.

And this is one of the ways that individuals can connect with one another outside of a traditional type of environment. So we're gonna take a deep dive into some of the technologies that are available for individuals to support one another at intercept zero. So this is exciting.

So if you don't mind just going to the next slide please. And I do have some, oops, sorry. I do have some disclosures for individuals. And one of which is some consulting work I do with social wellness, also Trusst app and also Inquisithealth as well. So next slide, please. We do have some very exciting grants from the national Institute of mental health and I'm also working with NARSAD or the brain and behavior foundation on the young investigator grant for the work we've been doing in pure tech which is a smartphone application that we have developed with peer support specialists as partners.

Next slide please. So just briefly, and for our facilitators, I'm gonna speak until 3:30, if that works okay with folks. And if not, just let me know if we need to shorten a little bit. For the agenda for today, I'm gonna talk about, well, what is digital peer support? I'm also going to speak to some of the competencies in peer support. And so if you were a forensic peer support specialist or an individual who's justice involved, what are some of the competencies that individuals should have to advance their work and I'll speak to the digital peer support training. And then also what is really fascinating is that more and more peer support specialists including forensic peer support specialists are actually developing technologies.

And so we're gonna speak to how to develop some technologies to promote health equity, equal access for individuals. So next slide, please. So really, what is digital peer support? And so this is defined within the scientific literature as live or automated peer support services delivered through a technology media. So here you see the history of digital peer support and know this is within the scientific literature. There's actually a lot more out there that hasn't been published on in peer review journals and by a peer review journal. I mean that the journal is reviewed by multiple scientists to ensure that it meets a scientific standards.

And so here we see digital peer support expanding across the globe, starting in 2005, all the way to 2020 which is when COVID has, embarked on our world. And so then we have this rapid use of digital peer support. And what is so interesting about this is that Darryl was talking about maybe it's a telephone call. Maybe it's a text message and maybe it's video game maybe it's a smartphone app, maybe it's actually virtual reality. One of the great things about digital peer support is that it could be delivered through any type of technology medium.

And it's really about connecting with the other person on the other end of that vice versa. So it's supporting people in the community and that technology is just the medium to actually do that. So what do we know of next slide, please? What do we know about digital peer support? And so this is quite fascinating. I'm going to talk about some unpublished research that will be coming out very soon. And so just a little bit about the landscape about what that looks like and we'll talk about what we know about that. And so with a survey we did with 463 peer support specialist, we asked them and this was during COVID.

What types of technologies are you using to support other people in the community? And we saw in that chat and let us know what you think some of the technologies individuals are using and I'll walk us through what we were seeing. So we saw that almost about 42% of folks were using telephone calls. So warm ones are checking in on people and 35% of individuals reported using video conferencing to connect with other individuals. And this is really neat, 28% of individuals are offering texts message peer support. And that's really exciting because you can offer this at any time, any place it could be.

If it's okay to text message the person late at night, you can text message when people are in need of support services. And we know from the scientific literature that text messaging between peer support specialists and service users promotes health behavior change promotes recovery and social support for folks. So that's really exciting. And 16% of people are using smartphone applications.

13% are using social media like Facebook to offer support services. And these are some other emerging areas we're seeing about 3% offering peer support through virtual reality. That's those headsets that people put on and they go into these virtual worlds and about 2% are offering peer support services through video games. And so within that, people are joining and playing a video game at a certain time with their friends. And as they're playing the game they're actually offering people support services. So what do we know about this? Well, there's no geographical or time limitations.

Individuals could access some of these we'll say social media at any time, any dates, it doesn't matter. And if you're offering Medicaid reimbursable services you can offer services within your respective States. And so if you're in a city within your state you can actually offer peer support services in rural areas. And those folks usually don't have a lot of services and have a lot of access challenges. And so it's exciting that we can reach people in these specific areas. We also know too that digital peer support engages people outside of a clinical environment.

And so we know that mental health challenges or substance use challenges that is a really high prevalence among individuals who are justice involved or an intercept zero that people need support outside of traditional nine to five Monday through Friday. These challenges that individuals have, they don't happen at a scheduled time, Thursday at three o'clock. No, no, no. It could happen on a Saturday at 4:00 AM.

And so what's really great is that we can engage people outside of these clinical environments. Also, we can expand the reach of peer support services. And so if Darryl is offering even training, training to individuals in person, maybe it's 10 people per month and I'm just making this up.

So Darryl has correct me if I am completely off. Now, Darryl potentially using technology could train more people, maybe have 30 people in one meeting using different types of technology or if you're offering support services using technology maybe we take out the transportation we take out the initial, the transportation for folks that people could meet one-on-one just know too that even though we can increase the reach of these peer support services, also we're hearing as leading to digital fatigue. If anyone has heard of that go ahead and put that in the chat.

Let us know you've heard what digital fatigue is and if it's impacting you yourself. So it's happening. People are going from meeting to meeting to meeting and offering support services through different technology features. And there's not enough time for people to recoup perhaps self care.

And so while we expand the reach of these services we also have be very aware that it could also impact retention on the job. Also, we can increase the impact of your support services without additional in-person sessions. And so when people need extra support what Darrell was talking about, getting people, helping people get to the grocery store help people with housing, help people find a job. You can actually increase the impact of your support services using technology. So what that means is text messaging in between sessions following up with phone calls in between sessions having a social media group to for people to support one another. And you're actually increasing your impact by doing that which is quite amazing, at least according to the scientific literature beginning to see that.

And then you can access hard to reach groups like individuals in rural areas, which I spoke to before and also home bound older adults. So if you don't mind going to the next slide, so. Sorry I tell you all about this. Well, is it effective? Does it actually do anything? Well, yeah, digital, what we're seeing within the scientific literature is that digital peer support is effective and know that this is a new area of scientific research.

So we're reporting on what we know about it from smaller studies, not large studies with a big population and advance methodology. And so we're seeing early evidence that it is effective in enhancing hope quality of life, empowerment, social support, and recovery to enhancing functioning, or living in a community helping people reduce mental health symptoms and it's improving engagement in services. And this is around mental health. And if you go to the next slide, you'll see, we have there's some research done on substance use challenges as well. So again, really early areas of research. However, we're seeing promising evidence that is either showing reductions in risky substance use.

High levels of satisfaction and perceived benefit. And it's also promoting engagement in services. If you don't go to mind going to the next slide the digital peer support competencies. So this is exciting.

And this is actually a really new area that is currently unpublished, but we are publishing this within the scientific literature. We have collaborated with 40 peer support specialists across the globe, and we asked them what types of things do you to know and be really capable in to offer digital peer support services. And within that group included forensic peer support specialist as well. And together out of 40 people, we came to a consensus about what are these competencies that we need to know? And one on the left-hand side here is that affordability and access.

We need to know how to get people technology that is affordable for individuals and see if there's an provide people services so they can have access to technologies to connect with one another. And so that's increasing the access. If we go down you see the digital communication skills. This is really important. This is, how do you send a text message to an individual? What times should you send the text message and how do you portray yourself through these certain types of technologies? Next, we have separating work and personal life, which is which has been very challenging because many people are still working in their homes and offering these digital peer support services.

And so how do you separate this work and personal life? And even if you're offering in-person support services in combination with some digital like telephone calls or text messaging, how do you make sure that you're respecting your own boundaries and also the boundaries of the service user that you're working with as well. And then up here on the right hand side is beliefs and preferences. This is incredibly important. And they're always speaking to older adults and technology use, which is really a whole group of individuals aged 65 years or older who may or may not have been justice involved or at intercept zero who are engaging in technology potentially for the first time ever. We know that about 88% of people with the lived experience of a mental health challenge access and use a smartphone applications.

We know among peer support specialists, it's about 95%. And we know that those rates are a little bit lower among older adults, more around 65% for older adults. And so when we want to promote engagement in services especially for certain populations, such as older adults or individuals in rural areas we have to consider their beliefs and preferences in technology. And so if someone is an older adult maybe they haven't used technology before, literally the first time ever.

And if you're offering digital peer support services offering services through virtual reality may not be the most appropriate way considering that the older adults preference is through the telephone. Another way to look at this too. What if you're offering text message support and an older adult is using a smartphone. Yes as individuals age there's normal age related changes that could change our dexterity meaning actually being able to type on a smartphone that may not be the best way to connect with individuals and could lead to disengagement. And so just some things to think about the importance of preference. And then technology literacy.

So this is what are all these new technologies coming out there including natural language processing digital phenotyping machine learning? Oh, like what the heck is all this stuff, we're learning more and more that peer support specialists are becoming social entrepreneurs and engaging in developing their own organizations around digital peer support and some of the new analytical techniques like how you look at the data. And also some of the actual technologies may not be aligned with the values and principles of peer support specialists. And so having a really strong understanding of what technology, the technology you're using what people are doing with the data is really important especially if you're also offering peer support services that you want to let the people you're serving know this as well.

And for individuals who may have lower rates of technology adoption. So they may not be as familiar with some of the technology we're gonna we know within the scientific literature that individuals that are not as familiar have more skepticism around some of the technology and what people do with the data. And so, and the last one there is compliance and privacy and confidentiality. And so we know that the world of digital peer support is changing literally every day. And so understanding what is the latest in compliancy related to HIPAA to make sure people are to make sure people are offering digital peer support services in a way that is promotes the privacy and confidentiality of not only the peer support specialist but also the service user.

If you don't mind going to the next page, just speak briefly to the digital peer support certification. This was co-produced with peer support specialist and peer non peer academic scientists. This is really great. And some of the research that has been completed on this by our team, we've seen that peer support specialists were able to compress their ability or capacity to offer digital peer support services throughout this three month certification. And so really, really exciting work that's being done.

And what's interesting is that other fields of study like psychology, social work psychiatry, they've had years and years of training on tele mental health their tele-health and a peer support specialist. This in March of 2020 was the first time ever the that digital peer support became something that was used rapidly all over the world. And there was nothing, no formal or informal training in more advanced types of technologies beyond warm lines. And so really exciting to see this happen. It's a really formalized, how to offer these services. So briefly if you go to the next slide will just speak to supervision.

And so this is, if there's any supervisors out there offering support services or supervisors services to digital peer support specialist some of the things that are really important as a supervisor's checklist is understanding the policies of the organization in that what if we're using Facebook to offer peer support services? Is that okay? Is that aligned with HIPAA standards? Also understand the technology needs of the staff that you're working with? Do people need data access, do people internet access, do people need phones? Do they need tablets also understanding individual's work schedules and maintaining those cause it's really easy to connect with people, at 10 o'clock at night, when you have an idea but maintaining those work schedules and both bottling that to individuals. And so they know to only work during the times that they are actually working. Have a communication and accountability plan, which is really important. A lot of people when it was happening for digital peer support specialist and supervisors they're receiving text messages or then hours later a telephone call and then people are getting 30 emails in one hour, so the people were connecting in different ways and leading to supervisors, potentially having a technology overload because they're getting all this reaching out from individuals. And so making sure you have a communication and accountability plan, one of which Yahoo, one of my colleagues is a peer support specialist who was just speaking with today. Their communication and accountability plan is using Slack.

And so it's a group chat that people can check in with at any time. And that means that the supervisor is able to connect with individuals in an asynchronous way meaning it's not time dependent. And then they're also not being inundated by telephone calls, emails, and texts. And so one of the great things about that, and of course model confidence, maybe it's their first time using some of these technology features.

And so modeling confidence is a great way to encourage people to use technologies. And then also understand the safety needs or safety huddles when necessary when we've developed digital technologies we need to make sure that we have are using them. We need to make sure that we have crisis plans in place not maybe not crisis plans, but at least warm lines or support services in place just in case someone gets an email, text message that someone isn't feeling well and staff needs to respond.

And so just encouraging people to have these plans in place. And I may have five more minutes. That's okay.

You just cut me off if this is not. You can go to the next slide, please. So what factors impact digital peer support technology selection? So this is the long digital peer support specialists themselves. So one of which is having access to the technology. Also the accessibility features if you're working with people that maybe older adults maybe have some maybe challenges seeing the technology or visual impairments, making sure that some of the technologies have accessibility features which you can literally turn on on smartphone which is great. You can go into settings and turn on the accessibility features or you can access some of these things on a tablet.

So it's actually larger for individuals, of course having trainings as well. So having training in how to use virtual reality, is a great way, or even at trainings and using a video games to offer peer support services. And there's some literature coming out of the veterans administration offering video and peer support, really exciting work, very new. Next is preference multi-modal pathways for connection. And so if you're connecting with individuals who maybe they don't they maybe don't wanna use a video game or they don't even want to connect by telephone multimodal just meaning having lots of different pathways that people can connect with you. So maybe it's through text maybe it's through video conferencing maybe it's through the telephone.

We can never forget. We it's about connecting with individuals, not the actual technology, but if you offer many different ways then you're offering other people opportunities to align with their preferences. We're seeing that anecdotally that younger adults are preferring text messages. And in one of our data sets that we looked at, we saw the only difference is that within age is that older adults are preferring to use video conferencing. Younger adults are not.

So that's the only difference we've seen in technology use, including smartphone apps virtual reality, video games and telephonic peer support. And of course, make sure these technologies align with your values and ethics. And so having a keen understanding of what the technology is doing where your data what's going on with your data, knowing that if someone says they're not feeling well and the technology what is the plan that will happen on the technology if someone reports that and then of course cost and sustainability as well. And so what we're hearing and what we're seeing at the policy within the United States many States are advocating for that to keep digital peer support around after the COVID-19 crisis and have an option to offer in-person and digital peer support services. And I think in the interest of time I'm going to ask us to go to the next slide and then I will, and I'll stop there. So I just want to speak to the digital disadvantage as well.

And so this is a slide of a Pokemon go. I don't know if anyone remembers this app that people could download. And this was an app where you hold up your phone. If you have a smartphone and you walk and collect Pokemon and it's using like augmented reality to do that.

And so this is a picture on Twitter with the hashtag my pokehood, because there was actually in this place in other urban places around the United States, there were no Pokemon. And so this is Chicago. And so everyone within the scientific community was like, oh this would be a great health promotion activity. People can get out there, walk. This is great. But what about people in the South side of Chicago or other places like Detroit or other urban areas? And so we need to be really aware of the digital disadvantage.

And so what this means is that when people create technologies incorporate something called user centered design and within that they use they talk to people and ask them, do you like this? And tell us improvements that you wanna make. And so what happened with my Pokemon go is that they used algorithms from a very wealthy area that was predominantly Caucasian and that's where they placed the Pokemon. And so that's why we don't see this on the South side of Chicago. And so when you're looking at technologies it's not gonna be written in their privacy statements that they're promoting health equity and they've included algorithms that incorporate all people of different age, race, everything like that.

And so a lot of that is understanding how the technology was developed. Was it co-produced with peer support specialists was it produced by peer support specialists themselves? And that one way, understanding that if the technology is equitable and so in the interest of time we can go to my thank you. And I'm happy to answer any questions. Thank you, everyone.

- [Erika] All right. Well, Darryl McGraw and Karen Fortuna, thank you both for your presentations. A lot of really interesting information shared today and we have quite a few questions from the audience. We will try to cover as many of them as we can today before the end of our time. So I will start out with, we have quite a few questions around specific questions around training, but let me just kick off with, let's start with a question for Darrell around engagement and engaging people.

So one of the audience members wanted to know, Darryl do you have guidelines or protocols around initial engagement for peers who are working at intercept zero. - [Darryl] Well, so always. And I appreciate the question. So the initial, I mean, there's the guideline is always safety first. So it's always going to be safety first knowing your environment, like, meeting people in public.

And so in each agency would have their own, different like you want to, you wanna make sure that like especially for the first engagement usually than a public place, Dunkin donuts or a donut, someplace that's open and always making sure your the individual is safe. So I would say that the agency that engage with people especially if you're engaging with them in person those are the, you wanna make sure that safety first is always safety first. - [Erika] Thank you for that.

Darryl, this second question I think I'm gonna send to you first. So we have quite a few questions from the audience about lived experience and becoming trained as a peer. And so I'm going to try to combine some of these into one just in the interest of time.

So, a couple of people are asking, does somebody have to have lived experience of incarceration in order to be a forensic peer or to be able to be eligible for the training and then part two of that is in regards to recovery, somebody wants to know, can they become trained as a peer recovery specialist while they are undergoing MAT? - [Darryl] So the answer from the answer, the first one what we recommend is that, and when I do trainings I normally like to, I've trained one or two people like very few who don't have the like, so recovery coach or recovery specialist training, that's kind of, one of the criteria is that way they already are familiar with the peer model. They understand what peer support is. Our recovery coaching is.

And then the, for the forensic this enhances their skillset. And there's another tool to be used in the toolbox. So we prefer people to already be trained in recovery coaching, or a peer support model whatever their state has, like whatever certification the app and referenced to that. I have trained one or two people's special circumstances and family members were involved in criminal justice system and so on and so forth. So, I mean, that was a case by case basis, but it's a lot it makes more sense to train people who are already trained in peer support of some sort or recovery coaching.

And the other part with the lived experience from addiction idol, I think, I mean, I'm sorry with the MAT piece we have to come, we as people in recovery we can't discriminate, especially, we don't discriminate. Individuals would have to know where they are and their recovery path because I think that those individuals that are who use MA or mat can be very resourceful for individuals that may also be entering that part of their recovery journey. But it also depends on where the individual is at. So I will say yes, that that person absolutely could be.

I have friends that are on MAT and that are forensic peer support staff members but they're also solid in their recovery journey. And I believe that individual knows what I mean when I say solid in the recovery journey. - [Erika] Thank you for that. So the next question is around video games and social media. So I'm going to direct this one to Karen. Somebody wants to know that their question is around privacy, things like HIPPA and 42 CFR any tips for navigating those privacy issues when looking into how to employ video games or other social media platforms in general, in the context of HIPAA, 42 CFR and other privacy concerns what are people finding these days? - [Karen] Sure, that's a great question.

And so what is happening at the policy level is that we're seeing new technologies being developed that could be used within organizations that are aligned with HIPAA. And so with that, I would recommend one of which is staying tuned, because these will likely in the future be something that is reimbursable and developed with HIPAA compliance in mind. And so also within that is that a lot of peer run organizations are doing that and they are using fake email addresses and names when people register. So within that people's individuals names aren't actually offered within the video gaming platforms.

And for social media, I have not seen anything around the privacy and confidentiality. And I do expect in the very near future that there will be some apps that are developed out there or even websites where the support services can be offered on a HIPAA compliant type of platform. And within social media too, or video games, you can if you're offering these services amazing you also can encourage people to engage in these types of services outside of the peer support services that you're offering. And so working with friends setting up social support groups for individuals to use video games, maybe at your organization to connect with other individuals. Great question, thank you.

- [Erika] Thank you, Karen. So the next question is also around technology and the use of algorithms. So someone is, when you had asked people to write into the chat about their experience with using technology. So one audience member says that they're using an algorithm to detect and flag language that might indicate someone is at risk for suicide, and that flags somebody to one of the peer moderators to do outreach. And could you comment on that like maybe other uses of algorithms that are or that you're seeing are being used in similar ways? - [Karen] Oh, yeah. That is really great and

2021-08-25 10:51

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