Boston University Sargent College of Health & Rehabilitation Sciences
Center for Psychiatric Rehabilitation

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Center for Psychiatric Rehabilitation

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Ask Me Anything About Employment w/ Kim Mueser, Ph.D. (Oct. 22nd, 2024) – Making the Interview Matter: Practical Strategies for Employment Specialists

“Ask Me Anything About Employment You're invited to ask an expert about interesting topics related to employment. This free event is not a presentation, but rather an interactive question & answer webinar. And YOU provide the questions! This session: Making the Interview Matter - Practical Strategies for Employment Specialists with guest expert Kim Mueser, Ph.D. Kim T. Mueser, Ph.D. is Professor of Occupational Therapy and Psychological and Brain Sciences, researcher at the Center for Psychiatric Rehabilitation at Boston University, and Adjunct Professor of Psychiatry at the Geisel School of Medicine at Dart-mouth. His research interests are on the development and evaluation of psychosocial interventions for persons with serious mental illnesses. His most recent book is: Mueser, K. T., Bellack, A. S., Gingerich, S., Agresta, J., & Fulford, D. (2024). Social Skills Training for Schizophrenia: A Step-by-StepGuide (Third ed.). Guilford Press. Zoom Registration: https://bostonu.zoom.us/webinar/register/WN_0Rbvf5CESiyhlZO3nuhoqg “

Register here

, September 25, 2024employment eventsama-employment interviewing psychiatric-rehabilitation supported-employment
Strengthening Age-Friendly Communities by Addressing Behavioral Health Concerns Among Older Adults

by Bronwyn Keefe, PhD, MPH, MSW

 

In 2022, the U.S. population aged 65 and older numbered approximately 58 million, or 17% of the total U.S. population, and by 2040, it is estimated that this number will increase to 78 million older adults. As the older adult population grows, so will the number of older adults who need mental health services and support. According to a report from the Substance Abuse and Mental Health Services Administration (SAMHSA), within the past year, 1 in 8 older adults had a mental illness and 1 in 11 had a substance use disorder. Individuals aged 85 and older have the highest rate of suicide compared to other age groups, highlighting the urgency of addressing mental health concerns in the older adult population (CDC, 2023).

Across the country, cities and towns are moving toward becoming “age-friendly.” The Age-Friendly initiative includes efforts to make communities more welcoming and livable for older residents and people of all ages. Many of the Age-Friendly efforts focus on features such as walkable streets, better housing, more transportation options, and access to key services and opportunities yet few focus on the mental health of its older adult citizens. In 2018, the Center for Aging & Disability Education & Research (CADER) at Boston University School of Social Work, along with Age Friendly New Bedford in Massachusetts, designed a program to increase attention to behavioral health issues among older adults in the context of an existing Age-Friendly initiative. With positive outcomes from this first initiative, CADER is now replicating this program with Salem MA through their Age-Friendly initiative, Salem for All Ages. The three-tier program developed and implemented by CADER addresses the barriers of stigma to mental health care, the lack of behavioral health knowledge among older adults, and insufficient workforce training in behavioral health and aging.

Tier 1: Anti-Stigma Campaign

One of the main efforts in this program focuses on addressing stigma. After an extensive review of stigma reduction programs, CADER developed a blueprint for an anti-stigma campaign that guided our activities. Together with the age-friendly community, we developed a media campaign, logo, and slogan so all efforts had an identifiable name and face to anchor our programming. We created media pieces (e.g., handouts, flyers, and articles) addressing aging and emotional well-being. These provided information on identifying and intervening around issues of depression, dementia, substance use, suicide, and social isolation. Each piece included the name and contact information of a relevant local community resource, where individuals could reach out for more information and support with the issues presented. Additionally, we translated all of these into Spanish and Portuguese to meet the needs of the area. These were distributed to housing communities, health care sites, libraries, community spaces, and through social media channels. Through this activity, we reached thousands of older adults and highlighted the importance of mental health as a key component in developing age-friendly communities.

Tier 2: Workshops for Older Adults

a group therapy session of people Behavioral Health Issues in Older Adults

Our next effort focuses on providing workshops to older adults in the community, as the more people know about behavioral health issues, the more likely they are to seek help. To increase knowledge and decrease stigma, we held community events covering behavioral health-related topics, such as:

  1. Enhancing Mental Wellness
  2. Combatting Social Isolation and Intergenerational Programming
  3. Substance Use and Harm Reduction among Older Adults
  4. Coping with Loss and Change as We Age
  5. Suicide Prevention among Older Adults

These workshops were well-received with comments such as “Very informative about mental illness” and “It’s nothing to be ashamed of. Talk to someone. Get help.

Tier 3: Workforce Training

a woman doing research into Tackling Behavioral Health Issues in Older Adults

Given the importance of workforce training in aging and behavioral health, CADER developed an online certificate program in this topic area. This 19-hour, self-paced Behavioral Health in Aging Certificate Program is comprised of the following five courses:

  1. Mental Health and Aging Issues
  2. Suicide Prevention among Older Adults
  3. Mental Wellness and Resilience among Older Immigrants and Refugees
  4. Substance Use among Older Adults
  5. Alzheimer’s Disease and Other Dementias

The goals of this training include increasing provider and community competence related to the recognition of signs and symptoms of common cognitive, substance use, and mental health conditions; increasing knowledge on suicidality; addressing the impact of stigma when working with older adults; understanding how and where to make referrals for assistance; and identifying the stressors and barriers faced by older immigrants and refugees as well as understanding the strengths and resources found in immigrant and refugee communities.

This online certificate was offered to learners from diverse settings, such as staff from senior centers, elder service organizations, housing authorities, mental health centers, medical centers, faith-based leaders, and first responders. Over 90%, agreed that the training expanded their ability to identify resources and services available for treating mental health conditions in older adults and their families There are a variety of training opportunities  for providers in the field of aging with a mental health condition, some of which can be found in the  SILVER RRTC Training Library

In conclusion, for older adults to be fully engaged in community life, behavioral health concerns need to be addressed with a focus on social isolation, depression, and substance use. Many Age-Friendly efforts do not address these issues even though significant numbers of older adults are impacted. Without a community-wide capacity-building effort, behavioral health issues among older adults often fade into the background. Our findings show that a three-tiered approach to incorporating mental health and wellness into Age-Friendly initiatives is a successful model that could be replicated across the country. Based on the knowledge gained, we will continue to work together with Age-Friendly communities to identify sustainable community-based initiatives to address the emotional well-being of older adults.


**Interested in more content like this from leaders in the field of healthy aging? We offer a free training library, regular free interactive webinars, and more! Subscribe in the sidebar to stay up to date on all the latest content and be sure to explore our other resources on the SILVER Portal!**


Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTHF0007). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, September 17, 2024articles healthy-aging-silver
CeKTER / KT Academy Webinar w/ Alice Feng (Sept. 19th, 2024) – Equity in Data Visualization

“Equity in Data Visualization” In today’s increasingly diverse world, data communicators must ensure that the way they analyze and present their data upholds the values of diversity, equity, and inclusion (DEI) and avoids perpetuating stereotypes, biases, or other types of harm. Taking a DEI perspective means considering how the specific lived experiences and perspectives of the people and communities we are studying, as well as our readers, will perceive the way we communicate data and informations. This session will offer a set of starting points on how to apply an equity lens to the way we visualize data, covering topics such as: Principles for creating diverse, equitable, and inclusive data visualizations; Ways o use language, order data, and choose color palettes and icons that reflect sensitivity and inclusiveness; Strategies for demonstrating empathy in data-driven communications; Approaches for handling missing data in an inclusive manner. Alice Feng. Alice Feng is a data visualization designer and developer based in the Washington, DC area. She is passionate about using design to make data and information more accessible to broader audiences and has been exploring ways to bring equity and accessibility into the way data is visualized through her work on the Do No Harm Guide series. Alice previously worked as a data visualization developer at the Urban Institute and the United Nations Development Programme and is currently visualizing data at Axios.

Register here

September 3, 2024eventscekter knowledge-translation kt-academy webinar
S.I.L.V.E.R. Ask Me Anything w/ Erika R. Carr, PhD (Aug. 12th, 2024) – Helping Older Adults with Psychiatric Disabilities Find Independence: A Hopeful Approach to Planning

You’re invited to a discussion with an expert about an interesting topic related to “Supporting Individuals to Live as Vibrant Elders in Recovery” or S.I.L.V.E.R. This free event is not a presentation, but rather an opportunity for you to have an interactive question & answer session. Erika R. Carr, PhD, is an Associate Professor at Yale School of Medicine and is also the Director of the Inpatient Psychology Service and Director of the Behavioral Intervention Service at Connecticut Mental Health Center in New Haven, Connecticut. Dr. Carr’s primary research and clinical interests are positive behavioral support interventions, unique concerns of women with serious mental illness, recovery-oriented care, trauma, and psychology training. Dr. Carr seeks to engage as a social justice change agent in the systems in which she works and broader society. Submit webinar questions before the webinar to: Lisa Krystynak at lisakaye@bu.edu Boston University provides reasonable accommodation upon request. Please send an email to lisakaye@bu.edu at least 14 days prior to the event with the specific accommodations you require. If less than 14 days remain until the event, please submit your request the same day you register, or as soon as possible, so we can make every effort to accommodate you. Registration Link: https://bostonu.zoom.us/webinar/register/WN_6GzWRPlOSsubcrLwSt23qw

This event has passed – view the recording in the S.I.L.V.E.R. AMA archives.

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTHF0007). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, July 24, 2024events healthy-aging-silverpsychiatric-rehabilitation serious-mental-illness silver-ama-aging webinar
Making Sense of S.I.L.V.E.R. Research w/ Michelle Zechner, PhD (Jul. 17th, 2024) – Old Before Their Time

Making Sense of S.I.L.V.E.R.* Research is a webinar series, designed for everyone! It presents a recent, relevant research study in clear, understandable language, with time for you to ask questions. Presentation: “Old Before Their Time” People living with serious mental health conditions (SMHC) are more likely to have long-term health issues at a younger age. While much is known about the health risks in this population, we don't understand as much about how aging affects everyday activities like walking up steps or bending over. This webinar will present results of a recent study which found that middle-aged adults with SMHC had physical functioning similar to that of much older people. Declining physical abilities can affect everyday life skills, independence, housing, work options, and personal goals. This presentation will discuss findings and offer practical recommendations for interventions and policies. Michelle R. Zechner, PhD, LSW, CPRP is an Associate Professor at Rutgers School of Health Professions in the Dept. of Psychiatric Rehabilitation and Counseling Professions. Her research focuses on multi-dimensional wellness interventions and inter-professional initiatives to improve health outcomes for people with mental health conditions. She develops multi-platform educational content for various workforce development initiatives and is passionate about mental health recovery and aging well for all people. This event is supported by funding from the National Institute on Disability, Independent Living, and Rehabilitation Research. NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this project do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government. *Supporting Individuals to Live as Vibrant Elders in Recovery Registration Link: https://bostonu.zoom.us/webinar/register/WN_2migh4DnRYy_6iXupZZ5-A#/registration

This event has passed. View the recording in our archives, here.

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTHF0007). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, July 17, 2024events healthy-aging-silvermssr serious-mental-illness webinar
Ask Me Anything About Employment w/ Joe Marrone (Jun. 20th 2024) – Doing the Right Thing in Mental Health Services: Tackling Long Term Unemployment

Ask Me Anything about Employment - Doing the Right Thing in Mental Health Services: Tackling Long Term Unemployment with guest expert Joe Marrone You’re invited to ask an expert about another interesting topic related to employment. This free event is not a presentation, but rather an interactive question & answer webinar. And YOU provide the questions! Joe Marrone has over four decades of experience in rehabilitation services, showcasing a remarkable career dedicated to this field. Currently serving as a contracted consultant and Program Director for an online Technical Assistance project at the Boston University Rehabilitation Research and Training Center (RRTC) on Mental Health and Employment, Joe brings his wealth of expertise to this role. Throughout his career, Joe has been deeply involved in numerous long-term employment and supported employment training grants, showcasing his unwavering commitment to advancing opportunities within this field. Submit webinar questions before the webinar to: Lisa Krystynak at lisakaye@bu.edu Boston University provides reasonable accommodation upon request. Please send an email to lisakaye@bu.edu at least 14 days prior to the event with the specific accommodations you require. If less than 14 days remain until the event, please submit your request the same day you register, or as soon as possible, so we can make every effort to accommodate you.

This event has passed. View the recording in our archives.

 

Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, June 24, 2024employment eventsama-employment unemployment webinar
New MSER w/ Dr. Uma Chandrika Millner (May 16th, 2024) – Thriving at Work While Living with Mental Illness

The Center for Psychiatric Rehabilitation is pleased to present “Making Sense of Employment Research”, a webinar series designed to discuss a recent published research study, in a clear and relevant way, even for those who know little or nothing about research.

This interactive webinar will highlight the conditions necessary for thriving at work among individuals living in challenging mental health situations. We will emphasize fairness as the foundation to thriving and the importance of (re)storying multiple perspectives, centering decent work as a basic human right, and identifying the psychological, social, and structural systems necessary for thriving. We will highlight the specific needs of Black, Indigenous, and Other People of Color (BIPOC) and Transgender individuals with lived experience.

Dr. Uma Chandrika Millner (she/her) is an Associate Professor in the Department of Psychology and Applied Therapies at Lesley University and part-time faculty at Boston College. Prior to Lesley, she worked as a Research Scientist at Boston University. Her overall professional approach is grounded in anti-colonial frameworks and intersectionality. Dr. Millner’s research focuses on work and wellness for marginalized and minoritized communities including individuals with psychiatric disabilities and Asian Americans. Dr. Millner has conducted numerous research projects involving qualitative and quantitative methodologies focused on community integration of adults with psychiatric disabilities.

 

This event has passed. View the archived recording, here.

 

 

Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, April 24, 2024employment eventsmser-employment psychiatric-rehabilitation serious-mental-illness webinar
MSSR w/ Nathaniel A. Dell, Ph.D. (Apr. 11th, 2024) – Promoting Recovery Among Older Adults with Serious Mental Health Conditions: Strategies for Implementing Psychosocial Interventions in Community Mental Health Settings

MAKING SENSE OF S.I.L.V.E.R RESEARCH. Making Sense of S.I.L.V.E.R.* Research is a webinar series, designed for everyone! It presents a recent, relevant research study in clear, understandable language, with time for you to ask questions. *Supporting Individuals to Live as Vibrant Elders in Recovery. Presentation: 'Promoting Recovery Among Older Adults with Serious Mental Health Conditions: Strategies for Implementing Psychosocial Interventions in Community Mental Health Settings' This presentation will discuss the needs of older adults who have serious mental health issues and the way that we're working to help them in their communities. We'll discuss a program we've developed to improve their health and social skills. We'll also look at the different ways we've tried to make this program work, what's been successful, and what hasn't. We'll talk about how the organizations involved and the resources in the community affect how well the program works and whether it can keep going in the long run. Nathaniel A. Dell, PhD, a licensed clinical social worker, is an Assistant Professor in the Department of Psychiatry at Washington University School of Medicine in St. Louis, MO. His research interests include evaluating evidence-based practices for people with serious mental illnesses & co-occurring disorders; promoting the uptake of evidence-based, recovery-oriented psychosocial interventions; leveraging big data & data science approaches to identify the behavioral health needs of hidden and hard-to-reach populations, such as people experiencing homelessness. Join Us: April 11th, 2024, 12:00 PM EST Register Here: [URL provided]. This event is supported by funding from the National Institute on Disability, Independent Living, and Rehabilitation Research. NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this project do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government

This event has passed. View the recording in our archives, here.

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTHF0007). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, March 21, 2024events healthy-aging-silvermssr psychiatric-rehabilitation serious-mental-illness
SILVER AMA w/ Dr. Laura Leone, Lyn Legere, and Karen Gross (Mar. 22nd, 2024) – Forging a Resilient Alliance to Promote Connectedness Among Older Adults with a Psychiatric Disability

S.I.L.V.E.R. Ask Me Anything. Join us on: Friday, March 22nd, 1:00 – 2:00 PM EST. Forging a Resilient Alliance to Promote Connectedness Among Older Adults with a Psychiatric Disability with guest experts Dr. Laura Leone, Lyn Legere, and Karen Gross. You’re invited to a discussion with an expert about an interesting topic related to 'Supporting Individuals to Live as Vibrant Elders in Recovery' or S.I.L.V.E.R. This free event is not a presentation, but rather an opportunity for you to have an interactive question & answer session. Zoom Registration: [URL provided]. Laura Leone, DSW, MSSW, LMSW is a consultant for the National Council for Mental Wellbeing. She has worked in the behavioral and integrated health field providing organizational leadership and direct services across the lifespan, including for older adults. Having published, trained, and consulted nationally, Dr. Leone has extensive subject matter expertise in health and wellness, including in Aging with Mental Health challenges. Lyn Legere has lived a life in many chapters, including living as a 'mental patient' and building a life in recovery. Now, at 70, she is in a new chapter, navigating life that, in part, includes consequences of the past and recovery tools to thrive. Karen Gross has been an advocate and caregiver for an older sibling who experiences severe mental health challenges. Now that her sibling is 72, she wants more help for his care but is very weary of governmental services that might diminish the quality of his life in exchange for what a system deems mandatory. The content of this presentation was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), ACL, HHS, and the Department of Health and Human Services (HHS). This content does not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

This event has passed, view the recording in our archives, here.

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTHF0007). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, March 19, 2024events healthy-aging-silverpsychiatric-rehabilitation serious-mental-illness silver-ama-aging
State of the Science: Supporting Elders to Live as Vibrant Elders in Recovery (S.I.L.V.E.R.)

Steve Bartels MD, MS

It is my distinct privilege to provide this inaugural commentary as the Senior Scientist for the recently funded Rehabilitation Research and Training Center “Supporting Individuals to Live as Vibrant Elders in Recovery” (S.I.L.V.E.R. RTCC) at the Boston University Center for Psychiatric Rehabilitation. The 5-year S.I.L.V.E.R. RRTC is funded by the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR), Administration for Community Living, HHS and under the direction  of Drs. Marianne Farkas and Zlatka Russinova of the Center for Psychiatric Rehabilitation at Boston University.

 

Over the past three decades I have been involved in research with a research team including  researchers on the S.I.L.V.E.R. RRTC ( i.e., Sarah Pratt and Kim Mueser) focused on the growing numbers of older adults with serious mental health challenges. What have we learned?

First, with the aging of the baby boomer population, the numbers of individuals who are over the age of 60 with serious mental health challenges has been dramatically increasing. However, this increase is qualified by a dramatic health disparity for middle-aged and older adults with mental health diagnoses such as schizophrenia and bipolar disorder. This health disparity is manifested in a 20 to 30-year reduced life expectancy, largely due to high rates of health-related conditions such as obesity, tobacco use, cardiovascular disease, diabetes, and cancer.  In addition, people with serious mental health challenges between the ages of 50 and 65 are three and one-half times more likely to be admitted to a nursing home, despite most individuals preferring to live independently in the community.

The United States Supreme Court “Olmstead Decision” interpreted the Americans for Disability Act (ADA) as a directive that individuals who prefer to live in the community with a disability should have that choice. Tragically we have not delivered on that mandate. There are many reasons for this shortfall, including a lack of affordable housing, a lack of appropriate community-based mental health and physical health care services, and a lack of rehabilitative and support services tailored to meet the special needs of older adults with mental health challenges living in the community.

Of note, this shortfall in services is not due to a lack of research on evidence-based practices. We know what works, but evidence-based practices have not been adopted by state mental health authorities or broadly implemented. There is a small, but significant body of research on effective psychosocial interventions and treatments for older adults with serious mental health challenges.  To provide guidance, I was pleased to lead the development of an evidence based resource guide for the Substance Abuse and Mental Health Administration (SAMHSA) titled “Psychosocial Interventions for Older Adults with Serious Mental Illness” that is now featured in SAMHSA’s Evidence Based Resource Guide Series

(https://store.samhsa.gov/sites/default/files/pep21-06-05-001.pdf).

This review provided detailed descriptions of five evidence-based psychosocial interventions with proven effectiveness, including two developed by our research team: Integrated Illness Management and Recovery, and Helping Older People Experience Success or “HOPES.” With the newly funded center, S.I.L.V.E.R. researchers are engaged in building on what we have learned in prior research to develop and test exciting new interventions and programs over the coming years.

 

Among the most pressing impediments to advancing mental health access is a substantial shortfall in the trained workforce. I also had the recent privilege of participating in a National Academy of Medicine workshop on this topic titled “Addressing the Rising Mental Health Needs of an Aging Population.” This 2024 report provides a valuable overview of data on the incidence and prevalence of mental health conditions in older adults – it describes mental health disparities and the role of social determinants, as well as approaches to improving access and quality of services. This report also provides critical recommendations for addressing the workforce shortfall, and key approaches to advancing supportive communities and future priorities.

'addressing the rising mental health needs of an aging population'

(https://nap.nationalacademies.org/catalog/27340/addressing-the-rising-mental-health-needs-of-an-aging-population).

As we dedicate efforts to gaining knowledge on optimal approaches to improving services for older adults with serious mental health challenges, there are many high impact opportunities. For example, a team of S.I.L.V.E.R. researchers is currently engaged in a multi-state project to determine the status of dedicated state plans and policies for older adults with serious mental health needs. Other opportunities include modifying and adapting the proven evidence-based practices to improve broad uptake, implementation, spread, and sustainability. These efforts will benefit from considering health equity as a major goal and understanding factors contributing to physical and mental health disparities. The Knowledge Translation team at the S.I.L.V.E.R. RRTC will be contributing to determining the most promising approaches to developing a trained workforce prepared to address the needs and preferences of older adults with serious mental health challenges and the policy initiatives necessary to achieve effective service delivery for this important and rapidly growing population.

I am excited by the amazing opportunity provided through funding from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) supporting the newly funded S.I.L.V.E.R. RRTC. I look forward to working with our extraordinary team to make a difference in the lives of older people with mental health challenges. Details on many of these efforts will be featured in future blogs. Stay tuned!

Dr. Bartels is Senior Scientist for “Supporting Individuals to Live as Vibrant Elders in Recovery (SILVER RRTC) and the James J. and Jean H. Mongan Chair in Health Policy and Community Health, Director of Mongan Institute, Massachusetts General Hospital, Professor of Medicine,  Harvard Medical School.

 

 

 

Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTHF0007). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

 

 

 

, March 4, 2024articles healthy-aging-silverpsychiatric-rehabilitation serious-mental-illness
Reclaiming Peer Support: Make Your Credential Work For You

By Laysha Ostrow, PhD

Live & Learn, Inc.

March 4th, 2024

 

A vast majority (90%) of the public agrees that there is a mental health crisis in the United States. The causes of this collective crisis are numerous, but regardless of where you live or work, you likely know someone who has struggled to get the support they need for emotional distress, drug use, or despair. Maybe you have been that person.

Over the past three decades, and around the country, peer support specialists (sometimes called peer supporters, certified peer specialists, or simply “peers”) have entered mental health service agency’s workforce. While each state has its own training and credentialing process, all peer support specialists have personal experience of mental health or substance use challenges – including depression, thoughts of suicide, drinking or drug use, hearing voices, autism, and in some cases may be family members.

a line of silhouettes holding hands up in the air against the backdrop of a sunrise

Unlike mutual support groups (such as AA, which is run by volunteers), peer support specialists are paid professionals who receive training to use their lived experience to help others. Peer support means connecting with others who are struggling with similar issues by relating as a compassionate equal and empowering them to choose their own path to recovery. It has a positive impact on both service users and the peer support specialist.

Peer support specialists pursue this line of work because they want to give back and help others. They are generally satisfied with their jobs, making it an appealing career opportunity. However, they also face barriers that other healthcare professionals do not. Many peer support specialists say that they don’t have enough prospects for career advancement.

Compared to other healthcare workers performing similar jobs, they are paid relatively low wages ($15-18/hour), struggle to find jobs, and often lack financial security. We hear from peer support specialists that coworkers don’t respect their work or understand their role, and it may be difficult to obtain disability accommodations. Disparities are particularly problematic for women and BIPOC individuals.

 

several signs that say 'career' pointing in different directions

Our research has found that about 30% of credentialed peer support specialists want to develop a business to support in their community. Those who were interested in self-employment were more likely to have experienced negative workplace dynamics. Being self-employed in your own private practice means that you can have more flexibility in the hours you work, the customers you choose to work with, and the way you do your job. It may also mean earning a higher wage and more job security, which we hope to research in the future.

Peer support businesses can expand and improve services for community members who want more choices in their treatment. In fact, our research found that in areas where there are not enough mental health providers, peer support specialists were more likely to stay in the field rather than leave for other opportunities. This means that peer support specialists may be able to fill some gaps in healthcare provider shortage areas.

If peer support services were more readily available it could improve access to services, and create better working conditions. A win-win.

Other healthcare providers are empowered by the law to open private practices but there is no designated avenue for private peer support practices. Credentialing and training of peer specialists, unlike other practitioners such as psychologists and social workers, typically occurs through a state entity, may vary widely in quality standards, and is not necessarily administered by a professional association or credentialing entity. This means there is no licensing process, which is typically the first step to practicing independently. There is no formal infrastructure or guidance for peer support specialists who want to start a practice business, and a lack of understanding of how jurisdictional liability and health insurance would apply to such a practice. They may face challenges such as how to bill Medicaid, receive required supervision, get professional liability insurance, and manage finances. It isn’t even certain that a peer specialist can move states and qualify for the new state’s certification. Nonetheless, peer support specialists are forging the path towards independent practice, such as through online platforms such as HeyPeers.com.

Starting a business is hard work, and often doesn’t pay off for a few years. It is extra hard to start a new type of business, built upon an innovative idea, particularly when you have struggled with poverty, disability, long-term unemployment, and discrimination. There are freely available resources in every community to help people start a business (such as SCORE or the Small Business Development Center), but often these services are not designed to help people with mental health challenges around work, or they simply aren’t knowledgeable about peer support services and the requirements of the job. If you are on Social Security benefits, there is also support such as the Plan for Achieving Self-Sufficiency (PASS) or vocational rehabilitation, but services from the Department of Rehabilitation are not always geared to help people start a business.

'Reclaiming Employment'

Because of my love for owning my business and wanting to help the peer community, my team created Reclaiming EmploymentTM. The program offers self-employment education and a community of support for people with mental health-related challenges around work. In preliminary research, Reclaiming Employment has been shown to improve feelings of self-efficacy around entrepreneurship – the feeling that I can do this. This summer we’ll be launching a new cohort of users that may also receive one-to-one and group coaching from a peer support specialist. If you’re interested in being a part of our community, please email info@reclaimingemployment.com and let us know to extend an invitation!

 

 

Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, March 4, 2024articles employmentpeer-support psychiatric-rehabilitation serious-mental-illness
AMA w/ Dr. Anneliese de Wet (Feb. 16th, 2024) – Stigma & Stigma Resistance… the #1 Reason for Peer Worker Turnover

You’re invited to ask an expert about another interesting topic related to employment! This free event is not a presentation, but rather an interactive question & answer webinar. And YOU provide the questions! Ask Me Anything About: Stigma & Stigma Resistance...the #1 Reason for Peer Worker Turnover w/ Dr. Anneliese de Wet Anneliese de Wet completed her PhD in Psychology at Stellenbosch University in South Africa in December 2020. Prior to coming to the United States, she developed an individual measure of recovery for a South African context by exploring the understanding of recovery, as well as the barriers and facilitators of recovery, for people using services, their careers and service providers. Previously, she explored the lived experience of recovery from first-episode psychosis in a South African sample and worked on a Canadian CIHR-funded international, multi-site study on community engagement in HIV vaccine research. Anneliese is particularly interested in peer support work. She recently completed a research project in which she tried to understand how mental health peer specialists withstand or shield themselves against experiences of prejudice and discrimination on the job.

This event has passed. View the recording in our archives here.

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, February 8, 2024employment eventsama-employment peer-support webinar
College Mental Health Education Programs: Accessing Facilitation Guides, Curriculum, and Support (Jan. 23rd, 2024)

Boston University Sargent College of Health & Rehabilitation Sciences Center for Psychiatric Rehabilitation

COLLEGE MENTAL HEALTH EDUCATION PROGRAMS: ACCESSING FACILITATION GUIDES, CURRICULUM, AND SUPPORT

Join us JANUARY 23, 2024 – 2:00pm-3:00pm

The College Mental Health Education Programs (CMHEP) team at Boston University has partnered with colleges, universities, and organizations across the United States and internationally to successfully adapt and adopt several curricula designed to support college students facing mental health challenges during their higher education journey. CMHEP provides structured lesson plans that are tailored to the unique needs of schools and organizations, offering detailed facilitation guides, workshops, and support. Their programs combine wellness and resiliency skill building with academic instruction and coaching, delivered as in-person or distance learning opportunities, to help students who are struggling on campus to thrive. In this webinar, presenters will share details of three specific, open-access programs designed to help students facing mental health challenges. Participants will be encouraged to rethink how we deliver college mental health services to include recovery and rehabilitation interventions that can support students with mental health conditions to remain in, return to college, and develop new strategies to alleviate the burden on staff.

REGISTER NOW

 

Presenters:

 

Chelsea Cobb, LMHC

Assistant Director, College Mental Health Education Initiatives

 

 

Ali Theis, LICSW

Senior Training Associate, College Mental Health Education Programs

 

 

 

January 19, 2024othercmhep
MSER with Dr. Marta Elliott, PhD (Jan. 31st, 2024) – Benefits and Challenges of Employment for Individuals Diagnosed with Mental Illness: Qualitative Findings and Ongoing Research

 Dr. Marta Elliott is a Foundation Professor of Sociology at the University of Nevada, Reno who graduated with a PhD in Sociology from The Johns Hopkins University in 1995. She specializes in the social determinants of mental health, the causes and consequences of mental illness stigma, and the subjective perspectives of people diagnosed with mental illness. She is writing a book entitled Borderpolars that features perspectives of people diagnosed with and bipolar disorder and borderline personality disorder. Ever wonder what researchers are finding out about employment for people with mental illnesses/mental health conditions? The Center for Psychiatric Rehabilitation is pleased to present “Making Sense of Employment Research”, a webinar series designed to discuss a recent published research study, in a clear and relevant way, even for those who know little or nothing about research. “Benefits and Challenges of Employment for Individuals Diagnosed with Mental Illness: Qualitative Findings and Ongoing Research” During this Webinar, Dr. Elliott will present qualitative findings from interviews she conducted with working professionals who self-identified as having mental illness. The results will be drawn primarily from this publication, co-authored with Jordan Reuter. The presentation will highlight benefits and challenges people reported about being employed, and about having mental illness on the job. It will also explore policy implications of the findings and a preview of her ongoing related research. January 31st Join Us: 12:00 pm EST Register Here: https://bostonu.zoom.us/webinar/register/ WN_ruYtVfjpTsO9mfD_zkJ9Ag#/registration This event is supported by funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this project do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government. Register HERE (https://bostonu.zoom.us/webinar/register/WN_ruYtVfjpTsO9mfD_zkJ9Ag#/registration) or go to : https://bostonu.zoom.us/webinar/register/WN_ruYtVfjpTsO9mfD_zkJ9Ag#/registrationThis event has passed. View the recording in our archives here.

 

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, January 8, 2024employment eventsmser psychiatric-rehabilitation serious-mental-illness webinar
KT Academy / CeKTER Webinar with Marianne Farkas, ScD (Jan. 8th, 2024) – Training Your Staff: What Works? What Doesn’t?

In-service staff training, regardless of staff discipline has long been a central tool to develop the ability of providers to translate research findings about new approaches to working with service users, into practice. Training staff on an ongoing basis to deliver new interventions, however, is a costly enterprise both in terms of the cost of the training itself, as well as the cost of covering for staff who are absent due to the training. As a result, the most popular trainings are brief seminars or workshops. The webinar will present answers to questions such as: What have we learned before and during the pandemic about this strategy for implementing new interventions to benefit those being served? Are there solid principles for developing training programs that will achieve new competencies or strengthen current ones that program managers, agency leaders, trainers should know when creating a strategic plan for developing the workforce? Marianne Farkas, ScD Dr. Farkas is a Professor (Clinical) at Sargent College of Health and Rehabilitation Sciences at Boston University, Director of Training, Dissemination & TA at the Center for Psychiatric Rehabilitation and is one of the two co-PI leading the Center on Knowledge Translation for Employment Research (CeKTER). She has authored or co-authored over 150 journal articles and book chapters, 4 textbooks, and 10 multimedia training packages for professionals and peers. The contents of this website were funded by the National Institute on Disability Independent Living and Rehabilitation Research (NIDILRR). Grant #90DPEM0004. NIDILRR is a Center within the Administration for Community Living (ACL). ACL in the Department of Health and Human Services (HHS). The contents of this website do not necessarily represent the policy of NIDILRR, ACL, or HHS and you should not assume endorsement by the Federal Government.

This event has passed. View the recording in our archives here.

, November 24, 2023events othercekter knowledge-translation kt-academy psychiatric-rehabilitation training webinar
MSER with Paul J. Margolies, PhD and I-Chin Chiang, MS (Nov. 15th, 2023) – IPS Supported Employment in the 2020’s: New York State Experience

Making Sense of Employment Research: IPS Supported Employment in the 2020’s: New York State Experience Date & Time: Nov 15, 2023 01:00 PM The world was a different place when IPS was introduced more than three decades ago. Yet despite changes in the economy, employment opportunities, hiring practices, evolution of the Internet and the ubiquity of mobile devices, and our experience of the COVID-19 pandemic, IPS has continued to be the gold standard. Today’s webinar will explore two papers based upon data collected through New York State’s extensive IPS initiative which focus on successful IPS implementation in the 2020’s. Two questions addressed are whether digital platforms (e.g., employers’ websites and online application processes) have diminished the importance of IPS employment specialists’ time spent in the community, and what has been the impact of the COVID-19 pandemic on IPS implementation and outcomes? Paul J. Margolies, Ph.D. is Associate Director for Practice Innovation and Implementation at the Center for Practice Innovations at Columbia Psychiatry (CPI), located at New York State Psychiatric Institute and Associate Professor of Clinical Medical Psychology (in Psychiatry) at Columbia University Vagelos College of Physicians and Surgeons. Dr. Margolies is a licensed psychologist who received his doctoral degree in clinical psychology from the State University of New York at Stony Brook. I-Chin Chiang, M.S. is Director of Data Analytics at the Center for Practice Innovations at Columbia Psychiatry (CPI), located at New York State Psychiatric Institute. Ms. Chiang received her training in computer science from the California State University, Fullerton and the University of California, Irvine, and considers herself as a generalist with experience in database development, data analysis & reporting, and quality assurance testing.

This event has passed. View the recording in our archives.

 

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, October 17, 2023employment eventsmser psychiatric-rehabilitation supported-employment webinar
Cognitive Self-Management Strategies for Work and School

by Dr. Susan McGurk and Dr. Kim Mueser

 

We are constantly barraged in our daily lives with new information competing for our limited attention. And there is even more information available than ever before, at the tip of our fingers, on our cell phones and computers. We need to manage the beckoning alerts of tweets, beeps, pings, and other sounds our devices make to inform us something “important” has happened (such as receiving a cell phone text) or try to be mindful of the accumulation of unanswered messages, posts, and other communications whose arrival we have allowed to go unannounced. Our computers and cell phones are a minefield of emails, prompts, and the bottomless pit of the internet, promising infinite information without protection from the perils of endless distractions. Even the mere presence of your (turned-off) cell phone can drain your attention. It is not surprising then, that we often end our day feeling mentally exhausted but without completing the tasks that we need to get done.

 

Although attention is a keystone thinking skill and a precious, limited resource for managing information, it is just one of several cognitive domains that serve us in our day-to-day lives. We also need to learn and remember information, plan ahead, solve problems, and think on our feet. One other often neglected, but critical thinking area is self-thinking. Negative thinking can adversely impact our confidence and effort to achieve what we want to. We need skills to enhance our awareness of such thoughts, challenge them, and replace with them with more optimistic, hopeful, and realistic thoughts. Optimistic thoughts about ourselves and our ability to achieve our daily tasks and reach our long-term goals can fuel the effort that we need to succeed. Proficiency in the full range of areas of cognitive functioning are critical to achieving goals such as returning to school, completing a degree, getting, and keeping work, living independently, making, and keeping friends, and having deep and rewarding relationships.

 

The good news is that we can sharpen and extend our mental capabilities and maximize our chances of succeeding in any area we choose.  We can do all of this by using cognitive self-management strategies. Although some may not be familiar with the term “cognitive self-management strategies,” all of us almost certainly use at least some these strategies in our daily lives. Have you ever:

  • set an alarm to remember to take a medication, feed the dog, or turn off the oven?
  • left yourself a phone message to remember to send a birthday card to your mother?
  • tied a string around your finger as a reminder to buy milk?
  • put your keys in a special place when you come home so you know where you can find them?

 

If so, then you’ve used cognitive self-management strategies. And if you have used one of the above, then you’ve probably used some of the other many possible strategies. While everyone uses cognitive self-management strategies, the more we use the better, and everyone can benefit from learning more strategies or how to use them more efficiently.

 

We describe below self-management strategies for optimizing and extending thinking skills that can be used in all walks of life. Self-management strategies help us utilize our cognitive skills and the demands on them to maximize their efficiency and effectiveness. Additionally, and perhaps surprisingly, practice and expertise in using these strategies, and incorporating them into our daily routines, further enhances our cognitive abilities in areas such as attention, memory, planning, and flexible (and positive) thinking! Thus, in addition to helping compensate for the cognitive limits everyone has in specific cognitive areas and extending our cognitive reach, practiced use of these strategies can also improve our raw brain power.

 

Learning and using cognitive self-management strategies can help optimize functioning across a range of daily life activities, such as self-care (such as grooming and hygiene, sleep, managing a medical condition), organizing one’s living space, planning for meals, shopping, connecting with friends or family, work or school, and just plain enjoying life (such as getting out to that movie we’ve been thinking of seeing). For example, common problems such as being late or missing appointments, having difficulty keeping focused on a task, or forgetting instructions or someone’s name can all be prevented by using strategies such as maintaining a personal schedule (and using alarms as needed), removing distractions from one’s environment (such as cell phone or computer alerts), and repeating back/paraphrasing what someone has just said, respectively. Some of these strategies focus primarily on one area of cognitive functioning, such as reducing distractions in one’s environment to improve attention and concentration. Other strategies are helpful for improving the broad range of cognitive performance in daily life (e.g., attention, memory, problem solving), such as developing routines at home, when looking for a job, and at school or work. Because obtaining a job (or getting a promotion at work) or completing a degree or certificate program at school are very common goals for people that have a range of cognitive demands, we address some self-management strategies that are particularly helpful for success in these areas.

 

The table below contains examples of cognitive areas that are important for work and school, signs of a problem related to each cognitive area, and self-management strategies for addressing (or preventing) each problem

 

Thinking Skill Signs of Problem Self-Management Strategy
Attention -Having to frequently re-read sections of a homework assignment

 

-Forgetting a step of a task at work

-Identify and eliminate distractions (e.g., turn off TV, radio, email alerts, and phone; put phone in a different room)

 

-Follow along passages with a finger

-Read out loud

 

-Increase attention span by scheduling brief rest breaks between work periods (with a timer) and gradually increasing the focused time during work periods

 

Memory

 

-Can’t find your stuff before leaving the house for work or school

 

 

-Difficulty finding things you need at work or for school (such as supplies, tools, books, stationary, etc.)

-Designate special places (or memory spots) to put things needed when leaving the house (wallet, car keys) and work/school supplies (such as ID badge, uniform, keys)

-Organize work or study space to avoid misplacing things and wasting time looking for them

-Forgetting instructions from supervisor right after hearing them -Repeat back or paraphrase instructions to ensure that they have been heard correctly and retained in memory
Planning -Missing appointments -Keep an appointment book or schedule
-Showing up unprepared for class -Create a checklist – update it daily or weekly to keep track of and prioritize assignments
-Falling asleep at work or in class -Develop a bedtime routine, including what time to be in bed with the lights out
-Feeling like you can’t get anything done -Prioritize tasks using checklists or to-do lists

 

-Develop routines for home, work, and/or school to increase efficiency for daily tasks in order to save time to accomplish important things

-Often being late to work or class -Develop a home routine for getting ready before leaving the house at a specific time
Problem solving -Getting flustered by unexpected problems -Use 5 Steps of Problem-Solving to solve unexpected problems:

a) Define the problem

b) Brainstorm possible solutions

c) Weigh the pros and cons of solutions

d) Pick the best solution (or combination)

e) Plan how to implement chosen solution

 

-Identify a “problem solving” helper at work (coworker, supervisor) or school (academic advisor, classmate, specific teacher) who you feel comfortable asking for help

Optimistic/ realistic thinking (vs. negative, self-defeating thinking) -Feeling hopeless about reaching goals

 

-Losing motivation to keep trying at work or school

 

-Feeling “down-in-the-dumps” or bad about yourself

-Recognize, challenge, and change inaccurate, self-defeating thinking underlying negative or distressing feelings

 

-Be aware of your personal strengths, including your skills, personal qualities, and resources

 

-Write down your strengths on an index card and carry it around

 

-Ask friends or family members for input  about your strengths

 

-Remind yourselves of your strengths throughout the day

 

The Thinking Skills for Work* program contains a rich curriculum of cognitive self-management strategies which are incorporated into a series of educational handouts for clients. The self management topics include Cognitive Skills for Work, Recognizing Your Strengths, Challenging Negative Thinking, Improving Attention and Concentrations, Reducing Memory Difficulties, Getting Organized at Home, Getting Organized for Your Job Search, Planning Ahead, Solving Problems, and, Improving Thinking Speed. The handouts provide information about strategies for improving cognitive performance at work in attention and concentration, memory, information processing speed, planning, and solving problems. In addition, several other handouts are devoted to enhancing motivation which can contribute to greater effort and persistence at cognitive tasks, including understanding the relationship between cognitive functioning and work (Cognitive Skills for Work)developing an awareness of one’s personal strengths (Recognizing Your Strengths), and overcoming negative thinking or defeatist thinking that can interfere with getting or keeping a job (Challenging Negative Thinking), (e.g., “No one will ever hire me for a job”). Strategies geared toward successful work are also highly applicable to success in school. The Thinking Skills for Work intervention is a comprehensive program for improving and optimizing your cognitive skills. A comprehensive description of the program can be found at here

*SR McGurk, KT Mueser (2021). Cognitive Remediation for Successful Employment and Psychiatric Recovery: The Thinking Skills for Work Program. Guilford Press, New York.

Information about the book can be found here.

 

 

 

Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, October 11, 2023articles employmentcognitive-remediation psychiatric-rehabilitation
MSER with Dr. Judith Cook (Sept. 13th, 2023) – Developing a Peer Workforce for Provision of IPS: What Can Research Tell Us?

Developing a Peer Workforce for Provision of IPS: What Can Research Tell Us? This webinar draws on findings from a project in which vocational staff of a peer-run program were trained to deliver IPS along with work-focused health and wellness supports. Recipients of peer-delivered IPS plus health promotion achieved higher rates of competitive employment compared to those receiving peer-delivered generic supported employment services. The peer IPS team also achieved high fidelity to the IPS model's principles and practices. Discover the benefits of integrating peer support into the delivery of evidence based IPS, and what research reveals tells us about how this can be done. Dr. Judith Cook is an internationally recognized authority on mental health services research, specifically the study of clinical and rehabilitation outcomes of children and adults receiving community-based care. She directs a federally funded research center along with numerous grants and contracts focused on intervention science, psychiatric epidemiology, and outcomes research. She designs and implements innovative programs to enhance the health and behavioral health of vulnerable populations. She works with federal, state and local authorities on behavioral health service system redesign and alternative financing strategies. Her recent work focuses on randomized controlled trials of evidence-based practice treatments for serious mental illness, and outcomes of individuals with co-occurring mental illness and chronic medical conditions. She consults with federal agencies including the National Institutes of Health, Social Security Administration, Department of Labor, Government Accountability Office, Substance Abuse and Mental Health Services Administration, and Veteran’s Administration. This event is supported by funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS).

 

This event has passed. View the recording in our archives, here.

 

 

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, August 28, 2023employment eventsmser peer-support psychiatric-rehabilitation webinar
MSER with Dr. Susan McGurk (June 12th, 2023) – Does Race Influence Response to Cognitive Remediation and Vocational Services in People with Severe Mental Illnesses?

Title: “Does Race Influence Response to Cognitive Remediation and Vocational Services in People with Severe Mental illnesses?” Description: Research shows that Black adults with SMI have lower employment rates as compared to White adults with SMI. Black adults report more negative experiences when receiving mental health services, resulting in higher attrition rates in vocational services. There is a lack of knowledge about whether evidence based cognitive remediation and vocational programs are successful in engaging Black adults in ways that support their employment goals. This presentation will discuss the article “Comparison of Black and White participants with severe mental illness in response to cognitive remediation as an augmentation of vocational rehabilitation”. Dr. Susan McGurk, PhD is a trained neuropsychologist and professor in the Departments of Occupational Therapy and Psychological Brain Sciences at Boston University. She is Director of Cognitive Remediation Initiatives at BU’s Center for Psychiatric Rehabilitation where she studies cognitive remediation methods to promote employment, academic pursuits, and independent living in persons living with sever mental illnesses.

This event has passed. View the recording in our archives here.

 

 

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, May 23, 2023employment eventsmser psychiatric-rehabilitation webinar
AMA Webinar with with Guest Expert Noah Abdenour (May 12th, 2023) – Influencing State Policy Regarding Peer Support

Ask me anything about employment - interactive Q & A webinars with an expert in employment

Influencing State Policy Regarding Peer Support with guest expert Noah Abdenour. ASK ME ANYTHING INTERACTIVE WEBINARS WITH AN EXPERT IN EMPLOYMENT

Save the Date: Friday, May 12th 12:00- 1:00 PM EST BOSTON UNIVERSITY You’re invited to ask an expert about another interesting topic related to employment! This free event is not a presentation but rather an interactive question & answer webinar. And YOU provide the questions. Submit webinar questions before the webinar Le MS lynleg@bu.edu’

This event has passed. View the recording in our archives here.

 

 

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, April 24, 2023employment eventsama-employment peer-support psychiatric-rehabilitation webinar
Coaching for Peer Specialists

by Sally Rogers and Lyn Legere

 

 

The role of peer specialists in behavioral health settings has grown dramatically in the last couple of decades. But, as a relatively new addition to the workforce, it is experiencing “growing pains”. Common experiences relayed by peer support workers include a lack of clarity about how their role fits into the mental health workplace and confusion about what their work tasks should and should not be. For some behavioral healthcare workers, research suggests that this results in stress, distress and burnout, all of which have worsened because of the pandemic (Edú-Valsania, Laguía, & Moriano, 2022; Sklar, Ehrhart, & Aarons, 2021).

The Center for Psychiatric Rehabilitation has a long history of collaborating with peer specialists in a variety of ways. In this case, we wanted to support peer workers and were troubled by the usual approaches. We often saw solutions suggesting that the peer worker needed therapeutic intervention or that the job needed to be redesigned to lessen the stress. We found both of these approaches to be objectionable, as they merely reinforced the idea of pathology on the part of the peer worker rather than considering the work setting issues related to integrating a new workforce.

Looking at the situation from a workforce perspective, we decided to address this problem with a somewhat novel approach: that of coaching. We know that coaching is an effective tool and has now been applied not only to the sports context, but to lifestyles, wellness, and recovery (Sforzo, et al., 2018; Grover & Furnham, 2016). Most relevant, it has proliferated in work settings, including Executive Coaching. We wondered if Executive Coaching for peer specialists, which keeps the focus squarely on the workplace, might be an effective approach to address work related stressors.

an image with the word coaching connected to the words potential, development, skill, and support

Coaching shares many values of peer support, which makes it very attractive. Some of the advantages of coaching support is that it focuses on establishing a good working relationship and mutual respect, on co-developing goals, and on bringing self-directed strategies to bear to support the person as they strive to reach their goals.

However, we wanted to differentiate coaching for peer workers from typical “Executive Coaching” in that we did not want to have any affiliation with the person’s employer. Coachees were free to tell their supervisors about the coaching, should they choose. At the same time, we believed that having a firewall between the employer and the coach gave the peer worker a greater sense of safety to fully share their work situation without fear of reprisal.

In 2019, the Center submitted a proposal to develop and research this virtual coaching intervention for peer support workers to the National Institute on Disability and Rehabilitation Research, which was funded.

To develop the coaching program, we consulted experts in both fields: peer support practice and coaching. We got input from a small group of peer specialists/advocates and also from the Harvard Institute on Coaching (to learn more about coaching from this institute, visit: https://www.instituteofcoaching.org/). Since the coaching would be focused on work issues, it was clear to us that the coaches must have experience as a peer support worker as well as coaching skills. Lyn Legere, herself certified as a life coach and a peer specialist, took the lead on the development of the coaching guide, working with Zlatka Russinova, Director of Research at the Center, and the input of consultants.

The peer worker coaching manual consists of several sections providing guidance to coaches. One important section specific to this coaching intervention is “Coaching vs. Peer Support.” The coach’s background in peer support provides knowledge needed to understand challenges that coachees may be experiencing. Here, however, their role is that of a coach. We were very fortunate to have hired two highly experienced peer specialists who were trained to be coaches for this study and who have done an exemplary job.

Another important section of the manual is what we called the Topical Guide. This section focuses on areas that we know can be particularly challenging in peer work, including:

· Role Overload

· Role Confusion/Ambiguity

· Work/Life Imbalance

· Stigma and Role Devaluation in the Workplace

· Dealing with Conflict in the Workplace

· Training Gaps or Job Mismatch

· It is What it Is: Dealing with Issues Beyond your Control

· Wellness Tools for Work

Each section has information on the topic as well as tips, strategies and worksheets that can be used in whatever ways seems useful to the coachee.

an image of a woman meeting virtually on a computer

 

Of course, funded research has to see how effective any newly developed intervention is. Using surveys, we are trying to learn if the coaching had an effect for people in areas such as role clarity, role confusion, burnout, job satisfaction, organizational climate, job stressors, and turnover intention. Participants complete the survey measures when they first enroll in coaching, and then at the 4, 6 and 9-months mark.

Since this study was developed as a randomized trial, only half of the people we enrolled will get the full coaching (designed to be up to 16 weeks long) and the other half are offered one informational session. This will allow us to make good comparisons about the effect of the coaching. Because the project is ongoing, we do not have this data compiled yet, but hope to have some initial outcomes by the endo of 2023.

In the meantime, we have also been conducting qualitative interviews with folks who have received coaching. From these interviews, we are learning of the value that participants place on having a knowledgeable peer specialist/coach to discuss their workplace difficulties with, someone who can provide perspective, context, and understanding. Here are some of the things the coachees said:

• “Coaching helped humanize my work”

• “My coach was a lifeline during a difficult time for me personally”

• “I could trust my coach when I hadn’t trusted other providers”

• “Coaching was terrific”

• “It was lifechanging for me…I learned about myself as a peer and it helped me in my life”

• “Personal growth and development—coaching helped me be the best me that I could be and bring that to work’’

• “They listened…”

• “Overall, for me, what feels the most helpful, is knowing that when Sunday at 1 comes, there was somebody who gets it, who gets what it’s like to do this work, who gets what it means to have a mental health condition—that alone has been helpful—knowing this carried me through each week”

For those interested in learning more about the work of peer specialists, please visit the NAPS website: https://www.peersupportworks.org/

The Substance Abuse and Mental Health Services Administration also has information about peer specialists: their role and their competencies. https://www.samhsa.gov/brss-tacs/recovery-support-tools/peers; https://www.samhsa.gov/brss-tacs/recovery-support-tools/peers/core-competencies-peer-workers

 

If you want additional information about this project, please contact E. Sally Rogers, Project Director at erogers@bu.edu or Lyn Legere, Senior Training Associate at lynleg@bu.edu.

 

 

Citations:

Edú-Valsania, S., Laguía, A., & Moriano, J. A. (2022). Burnout: A review of theory and measurement. International journal of environmental research and public health, 19(3), 1780.

 

Grover, S., & Furnham, A. (2016). Coaching as a developmental intervention in organisations: A systematic review of its effectiveness and the mechanisms underlying it. PloS One, 11(7). doi:10.1371/journal.pone.0159137

 

Sklar, M., Ehrhart, M. G., & Aarons, G. A. (2021). COVID-related work changes, burnout, and turnover intentions in mental health providers: A moderated mediation analysis. Psychiatric Rehabilitation Journal, 44(3), 219.

 

Sforzo, G. A., Kaye, M. P., Todorova, I., Harenberg, S., Costello, K., Cobus-Kuo, L., . . . Moore, M. (2018). Compendium of the Health and Wellness Coaching Literature. American Journal of Lifestyle Medicine, 12(6), 436-447. doi:10.1177/1559827617708562

 

 

Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, April 13, 2023articles employmentcoaching peer-support psychiatric-rehabilitation
MSER with Matthew J. Smith, PhD (March 31st, 2023) – Virtual Reality Job Interview Training

MAKING SENSE OF EMPLOYMENT RESEARCH. Ever wonder what researchers are finding out about employment for people with mental illnesses/mental health conditions? The Center for Psychiatric Rehabilitation is pleased to present 'Making Sense of Employment Research', a webinar series designed to discuss a recent published research study, in a clear and relevant way, even for those who know little or nothing about research. Presentation: 'Virtual Reality Job Interview Training: An Enhancement to IPS Supported Employment for Adults with Serious Mental Illness' Dr. Smith's presentation will focus on his program of research that develops and evaluates virtual reality job interview training as an enhancement to existing employment services, in particular, the individual placement and support model of supported employment. Join us: Matthew J. Smith, PhD, is a Professor of Social Work at the University of Michigan and a Licensed Clinical Social Worker. Smith is the director of the NIH-Funded Level Up: Employment Skills Simulation Lab. The mission of his lab is to develop and evaluate technology-based interventions to help obtain and sustain employment for people from marginalized and underserved communities. March 31st, 2023 12:00 pm EST Register HERE Or go to: [URL provided] BOSTON UNIVERSITY | NIDILRR This event is supported by funding from The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RT504). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this project do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government. https://bostonu.zoom.us/webinar/register/WN_uDmECYhVRU-UcC4TTYvrxA

This event has passed. View the recording in our archives here.

 

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, March 15, 2023employment eventsmser psychiatric-rehabilitation webinar
AMA Webinar with Peer Support Expert Amy Pierce (Feb. 13th, 2023) – Supervising the Peer Workforce in Behavioral Health Settings

Ask Me Anything: Supervising the Peer Workforce in Behavioral Health Settings 

Ask me anything about employment - interactive Q & A webinars with an expert in employment

You’re invited to ask an expert about another interesting topic related to employment! This free event is not a presentation, but rather an interactive question & answer webinar. And YOU provide the questions.

Save the Date:  Monday, February 13th at 12:00 – 1:00  PM (Eastern)

Ask Me Anything About …

Supervising the Peer Workforce in Behavioral Health Settings with guest expert Amy Pierce

Amy Pierce, MHPS, PSS, ALF 

Amy has been working in the peer movement in the State of Texas for almost two decades and now serves as the Recovery Institute Deputy Director.  Previously, she was the CEO of Resiliency Unleashed, an international training and consulting company focusing on the development and implementation of peer services. She started the first peer support program in the Texas State hospital system, was a peer support worker in a community mental health agency and served as the Program Coordinator for a transitional peer residential housing project funded through the 1115 waiver program. Amy has held supervisory roles within these programs, developing training for providers across Texas and beyond.  Amy is a Mental Health Peer Specialist, a Certified Peer Specialist Supervisor, and trainer/facilitator (Advanced Level Wrap facilitator, ASIST trainer, WHAM facilitator). Amy is a previous chair of the PAIMI council and is a current board member for Disability Rights Texas.

Zoom Registration:  https://bostonu.zoom.us/webinar/register/WN_Tymu99ALReOCUBvV4PFTiA

Submit webinar questions before the webinar to

Lyn Legere, MS at lynleg@bu.edu

Tech Requirements:
The registration and webinar will be conducted through Zoom Conferencing. Once you complete the registration process you will receive an e-mail with the Zoom link for the webinar. If you do not have the Zoom app installed on your computer, tablet, or smartphone, you will be directed through the download process upon registration.

Accommodation Requests: 
Boston University provides reasonable accommodation upon request. Please send an email to lynleg@bu.edu 14 days prior to the event with the specific accommodations you require. If less than 14 days remain until the event, please submit your request the same day you register, or as soon as possible, so we can make every effort to accommodate you.

 

This event has passed. View the webinar recording in our archives here.

 

 

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, January 5, 2023employment eventsama-employment peer-support psychiatric-rehabilitation webinar
Online Technical Assistance Model: Action as a Precursor to Knowledge

by Joe Marrone, M.S.

The Online Technical Assistance (OTAR) model  was developed as a pilot program, with the goal of assisting organizations (e.g. state agencies, providers, for- and non-profit entities) that want to improve  their employment outcomes for people with psychiatric disabilities by improving their policies, funding, and system design.

Two elements of this are:

Program providers perform an assessment of the need for “technical assistance” (TA) services around a specific group of an organization’s [employment focused] goals for the clients or patients it serves. Once the needs of the organization are identified, the consultant develops a site-specific TA plan based on the organization’s response to this assessment. OTAR clarifies a focus on policy and systemic change within participant organizations more than it focuses on training or product development. The model also emphasizes the importance of assigning a subject matter expert (SME) for each organization. Often, it has been advantageous to pursue candidates new to the consulting field with an opportunity to be part of this team and take on this role.

The second step is the construction of an implementation team which includes supervisory and clinical management staff as well as relevant partner organization personnel. The OTAR implementation team conducts regular Zoom calls to review the steps included in the plan.

 

Typically, sites begin their participation through word-of-mouth and email recruitment.

Once interest is expressed, potential sites are requested to answer the following simple questions:

  • What would you like to get out of OTAR this year?
  • What problems would you like the TA to solve or issues with which the TA might help?
  • What would you hope would be concretely different if the TA were successful?
  • If someone came back 1 year after the process was complete, what would that person see in terms of the system your organization uses to assist people with psychiatric disabilities become successfully employed?

Since the project commenced in 10/19, OTAR has worked with several organizations across the country. They have included:

  • 3 State Behavioral Health systems
  • 1 county Behavioral Health system
  • 2 State public VR systems
  • 2 statewide non-profit employment service providers’offering services to job seekers with psychiatric disabilities
  • 1 county based non-profit employment service provider that aids clients with behavioral health disabilities
  • 1 large city housing provider that serves thousands of people with various barriers to employment including behavioral health problems, homelessness, poverty
  • 1 mental health oriented social service housing and clinical organization in a farm like environment
  • 1 small rural housing provider that serves 20 people who have experienced mental illness
  • 4 CMHCs that offer an array of behavioral health services including employment
  • 1 large behavioral health managed care entity serving a large portion of a state
  • 1 large statewide consumer run organization that provides peer supports, community psychiatric rehabilitation, and housing services.

The specific requests for TA varied by site but most incorporated the importance of employment as a core part of Recovery planning in clinical services instead of as a referral point to an employment unit. These included both micro-level discussions on motivating clinical staff to generate interest in employment with their clients and a broader systems-level focus on creating large scale policy and funding models to increase employment outcomes. A few projects related to how to create a system of financial planning advice early in the process for job seekers with disabilities, albeit one short of the more time-consuming full SSA benefits analysis.

So, what have we learned?

  • Remote technical assistance can be useful to a variety of settings interested in enhancing the role of employment within Recovery oriented systems of care.
  • It is useful to engage potential recipients in a self-assessment to help define the concrete activities that might attend to the needs identified – the more concrete the recipient organization is on stating needs, the easier it is to respond effectively.
  • It is often the case that the first needs organizations identify as those impeding employment are not necessarily the same ones that emerge as the TA continues and other issues are examined.

There are also downsides that have emerged from the online technical assistance model. The initial outreach and engagement with OTAR was presented as a joint priority of each partnering agency with the site’s focus on mental health and employment collaboration. In practice, the commitment to the planned efforts often continued only with some of the participating sites. This most commonly emerges in the context of an employment focused organization getting only intermittent support from the mental health organization (state or local) involved. While the agreement obtained from all sites was to involve at least one of the clinical supervisory and/ or executive level staff, some sites have had only intermittent buy-in from personnel at these levels.

Another downside is that site visits are typically used to expand the pool of informants about the local issues supporting or impeding employment. This activity gets lost with distance-TA-only conditions – those in which the consulting team only has direct involvement with the formal coordinating [on-site] group and captures only a limited view of the local environment. Another downside from the consultant perspective is that it is less satisfying and less fun to be unable to connect with local sites in a more personal relationship and to directly observe the impact of the program. It is conceivable that some form of hybrid model could address these issues in the future.

For more information about  OTAR services contact us at psyrehab@bu.edu.

 

 

Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, December 22, 2022articles employmentconsulting psychiatric-rehabilitation technical-assistance
MSER Webinar with Dr. Wallis E. Adams (Dec. 7th, 2022) – The Peer Support Specialist Workforce During Covid-19: Changes, Challenges, and Opportunities

Ever wonder what researchers are finding out about employment for people with mental illnesses/mental health conditions? BUCPR is pleased to present "Making Sense of Employment Research", a webinar series designed to discuss a recent published research study in a clear and relevant way, even for those who know little or nothing about research. The COVID-19 related lockdowns of 2020 impacted all of us - including Peer Support. This webinar will explore how PSS experienced these changes, including challenges and benefits. Dr. Wallis E. Adams will review major findings from two national surveys of PSS conducted in May and December 2020, and discuss how lessons from this data can inform the future of the Peer Support Workforce. Dr. Wallis E. Adams is an Assistant Professor of Sociology at CSU East Bay in Hayward, CA., where she teaches courses related to the sociology of mental health, medical sociology, and research methods. Prior to this, she was a Postdoctoral Research Fellow at Boston University's Center for Psychiatric Rehabilitation. Her research focuses on recovery-oriented services, peer support, implementation science, stigma, and organizational culture.

This event has passed. View the recording and transcript in our archives here.

 

 

 

Notice: This event is funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The statements made during the event do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, November 26, 2022employment eventsmser peer-support psychiatric-rehabilitation webinar
Two-Part Webinar Series: “The Knowledge to Action Cycle: How Do I Apply it to My Work?” with Dr. Ian Graham (Nov. 16th and Dec. 12th, 2022)

Do you have research findings you want used? Do you want a way of getting findings implemented more effectively? The Knowledge to Action Cycle (KTA) breaks down the implementation process into 7 actionable phases, starting with determining the knowledge-practice/policy gap through to sustaining the change. The webinar series will help you apply the Knowledge to Action Cycle, developed by Dr. Ian Graham, to a project or initiative that you or your group have, for turning research findings into implementation activities. Dr. Graham is a Distinguished Professor in the School of Epidemiology & Public Health and School of Nursing at the University of Ottawa and a Senior Scientist at the Centre for Practice Changing Research at the Ottawa Hospital Research Institute. His areas of research are health services and knowledge translation / implementation science. Dr. Graham studies factors influencing the use of research and evidence in decision making and ways to promote its use. He was Vice President of Knowledge Translation and Public Outreach at the Canadian Institutes of Health Research. Dr. Graham has been inducted as a Fellow of the Canadian Academy of Health Sciences, New York Academy of Medicine and Royal Society of Canada. This webinar is for those working on knowledge translation of research findings related to employment and individuals with disabilities. In addition, anyone interested in the Knowledge to Action Cycle is welcome to participate.

 

These events have passed – view the recordings in our webinar archives.

 

 

, November 9, 2022events othercekter knowledge-translation kt-academy psychiatric-rehabilitation webinar
The Peer Support Specialist Workforce: Where have we been and where are we going?

Brief History 

The Center for Psychiatric Rehabilitation (CPR) at Boston University has partnered with the voices of those with lived experience from its’ earliest days – that is, the voices of those who would eventually populate the peer support specialist workforce.  Luminaries in the field such as Pat Deegan, Judi Chamberlin and Dan Fisher, were among the many people with lived experience who collaborated with Bill Anthony and colleagues in the formative days of the CPR.  Due to the strong parallel in values of the CPR and the consumer/survivor/ex-patient (c/s/x) movement, it was only natural for each to support the work of the other.

The CPR was an ally in the advocacy work of movement activists.  Those early days focused on “consumer” voice and participation in mental health policy and practice, under the motto, “Nothing About Us Without Us.”  Simultaneously, the power of peer relationships in peoples’ healing and recovery, called “peer support” today,  was highlighted in Judi Chamberlin’s  seminal book, “On Our Own,” and incorporated into the values and practices of psychiatric rehabilitation.

Prior to Medicaid funding, some headway was made with the creation of a “consumer liaison” role in some states, and other nominal “consumer” roles in services.  However, even the willing were hindered by the usual issue, i.e., funding.

The “Certified Peer Support Specialist”

In 1999, the Georgia Mental Health Consumer Network gained Medicaid approval (i.e. funding) for a new role – “Certified Peer Specialist” By 2005, states across the country began to follow Georgia’s lead and when the Center for Medicare and Medicaid Services (CMS) not only endorsed peer support as an emerging best practice in 2007, but encouraged states to utilize peer support,[1] the flood gates opened.  By 2016, there were at least 25,317 peer support specialists in the US.[2]  The rare “consumer” role of the 1990’s has now become a common role throughout behavioral health.[3]  It should be a time to celebrate all that has been accomplished, right?  Well, maybe….and maybe not.

Unintended Consequences

The word “peer” in “Certified Peer Specialist” is intentional and signifies the mutual relationship between two people with shared experience that was the hallmark of peer relationships in the c/s/x movement communities.  The intent of the “Certified Peer Specialist” role was simply to bring this impactful community role into services to create access for people who couldn’t access and get the benefit of peer-run agencies in the community. Peer support is meant to offer the comfort of “been there, done that” and the hope of “…and I’m not there now.” The peerness of the relationship – that is, no one holds power over the other – is what separates peer support from other roles and is often what opens the door to connection and trust.  There are many more professionals working in mental health, sharing their lived experience..  However, with or without lived experience, the traditional workforce still holds power over people in services.  An authentic peer specialist does not.  They are meant to be “in but not of” the system as a new and different type of provider unconnected to the culture of the medical model.

With hindsight, it’s clear that implementation of the role skipped the vital steps of preparing agencies and their staff for the influx of Certified Peer Specialists, resulting in a clash of cultures. (Byrne et al., 2019.  “The emphasis was initially on bringing the values and principles of peer-developed peer support into paid peer staff roles, but the ability to keep the focus on these values [is]often compromised by clinicians and administrators who do not understand or support the principles (Jones et al, 2020; Stastny & Brown, 2013).

Inevitably, the role has become co-opted, with “mutuality”, the first critical component of peer support to be set on a shelf to get dusty and forgotten. Similarly, “relationship,” is often sacrificed as peer support work often prioritizes the “deliverable” task at the expense of the relationship.   Here’s how one peer provider described their role,

They changed the scope of what peer support really is… Now there’s that movement that kind of makes people, what I like to refer to as mini clinicians. Minus the white coat, they’ve got their clipboard and they’re taking notes, ‘How does that make you feel?’” (Adams, W. 2020)[4]

Changing the Tide

The Center is dedicated to preserving the “peerness” of peer support specialists.  The Recovery Education Center, provides recovery/wellness education classes, many facilitated by people with lived experience who also provide one-to-one support to students in their classes.  Many former students go on to become facilitators and peer support specialists, themselves.

Research projects, in addition to having people with lived experience involved in research project design  have also focused on delivery of authentic peer support in services.  One example is the Vocational Peer Support (VPS) training that was developed and researched at the Center.  Another is a current study developing a way of providing Executive Coaching for peer supporters.

The Center’s Post-Doctoral Fellows have also focused on authentic peer support. The most recent example of this is Wallis Adams who, partnering with the National Association of Peer Supporters (NAPS) performed two studies:  The Impact of Covid on Peer Support Specialists and Barriers and Facilitators of Implementing Peer Support Services for Criminal Justice-Involved Individuals.

Continuing this tradition, the Center will be dedicating a series of webinars ( “Ask Me Anything”) on the peer support specialist workforce in 2023. Announcements will be made when registration is open for these.

The role of people with lived experience, as well as the peer support workforce, will continue to be at the heart of research, training and services at the Center.

[1] CMS Letter dated August 8, 2007 (SMDL #07-011).

[2] Wolf, J. (2018). National trends in peer specialist certification. Psychiatric Services 69 (10), 1049. This number does not include thousands of non-certified peer support workers as well as those employed in forensic, youth, parent partners, substance use and other behavioral, primary and integrated health settings as well as serving specific population groups.

[3] Cronise, R., Teixeira, C., Rogers, E. S., & Harrington, S.(2016) The peer support workforce: Results of a national survey.,  Psychiatric Rehabilitation Journal, 39(3), 211-221.

[4] Adams, W. 2020. Unintended Consequences of Institutionalizing Peer Support Work in Mental Healthcare. Social Science & Medicine, 262.

 

 

Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, September 2, 2022articles employmentpeer-support psychiatric-rehabilitation
What is Psychiatric Rehabilitation?

Welcome to the Center for Psychiatric Rehabilitation official blog! For our inaugural article, we thought we would tackle a basic question that the Center has contributed to answering over the years, i.e. What exactly is “psychiatric rehabilitation”?

 

The Deinstitutionalization Movement

Let’s begin by reviewing one of the most important factors in the historical context of the development of psychiatric rehabilitation: The deinstitutionalization movement in the United States and abroad.

Deinstitutionalization as a movement was motivated by an understanding that the typical incarceration of people with mental health conditions on locked wards in long-stay hospitals, was not necessary. We learned that it was possible to design effective services, in the least restrictive setting, while helping people to keep their personal dignity and self-determination. Following the release of the anti-psychotic, Thorazine and numerous other psychiatric medications, the in-patient census was reduced from approximately 560,000 people in psychiatric institutions in 1955, to approximately 70,000 by 1994. Even though President Kennedy’s Community Mental Health Centers Act of 1963 achieved a breakthrough in developing community services, more than 90% of people – many who spent virtually their entire lives in institutionalized psychiatric settings – moved into communities by the mid 1990’s, often still without sufficient support services in place.

a graph showing the decline in psychiatric institutionalization following the development of first antipsychotic drugs and medicaid/medicare

Marianne Farkas, Director of the Training, Dissemination, and Technical Assistance Division here at the Center, recalls doing a project at an in-patient institution in Maine, helping them to improve their deinstitutionalization efforts.  She encountered residents, such as 58-year-old Betty, who were leery of those efforts. Betty had lived in the institution for more than 25 years and was not eager to leave. It is not terribly difficult to understand such an attitude.  Betty watched other residents separated from their routines, caretakers, and friends as they were simply given a prescription for their medication and ushered out the door. These people were unprepared to choose or pursue valued roles in the community. In many cases, people had been institutionalized for so long that mere identification of a community role – something that requires self-knowledge about one’s values and possible options – was a seemingly monumental task. Marianne’s project focused on the facilitation of services to help Betty and others like her, to live in the community, rather than just get placed there, using psychiatric rehabilitation techniques.

 

Psychiatric Rehabilitation: A Response to the Deinstitutionalization Movement

As the Center’s founder, Bill Anthony once said “If deinstitutionalization was to give freedom to people with psychiatric disabilities, psychiatric rehabilitation would create the space and structure for a meaningful life within that freedom.”

So, what is psychiatric rehabilitation (PR)? The name can be a misleading.  It does not necessarily imply the involvement of a psychiatrist or really of any form of psychiatry. Rather, the term ‘psychiatric’ describes the disability that rehabilitation activities address, just as the term “physical’ rehabilitation describes the kind of condition (i.e., physical disabilities) addressed.  The term ‘rehabilitation’ indicates that the activities are concerned with the performance of a specific role (e.g., worker, student, parent) in specific environments.

PR helps people consider, research, choose and achieve a major role in a specific environment, that is personally meaningful.  These “role goals” may involve, for example, working part-time as cashier at McDonald’s or completing a Community College certificate in Addictions Counseling. The Center’s materials can help providers learn how to use PR techniques to facilitate a person identifying such goals ( e.g., rehabilitation readiness, setting an overall rehabilitation goal).

a word cloud of psychiatric, goal, mental health, and employment related content

 

Psychiatric Rehabilitation vs. Physical Rehabilitation

Different “role goals” make unique demands on an individual in order to succeed, regardless of the source of their challenges. Rehabilitation, of any kind, aims to restore functioning in people’s lives by teaching skills and modifying the environment in order to maximize independence. For example, being able to transfer from bed-to-chair might be a skill necessary for an individual with a spinal cord injury. Railings or other supports might, together with this skill, help that person to perform the tasks needed to succeed in their role as parent at home. In a work role, skills such as accepting negative feedback from a supervisor or improving job-specific skills might be critical for the individual. However, beyond skills, that same individual might need their workspace to conform to wheelchair accessibility guidelines, to support their ability to succeed at work. This combination of skill and environmental support allows the individual, regardless of their type of disability, to perform well in their preferred valued roles.

 

Psychiatric Rehabilitation Techniques Developed at the Center

Techniques developed at the Center transfer these ideas from the realm of physical rehabilitation to psychiatric services (e.g.. PR Functional Assessment and Skill Teaching) and help people in mental health recovery figure out and develop the skills they need  for their specific selected role goal. Young adults who live with mental health and/or substance use conditions who’ve experienced an interruption to their pursuit of higher education, develop critical skills and supports in the NITEO program, one of many College Mental Health Education Programs at the Center. NITEO supports young adults prepare for a successful re-entry to college. Beyond college, people who want to consider or succeed in work may struggle specifically with cognitive difficulties. Participating in Thinking Skills for Work, developed by the Center’s faculty (Susan McGurk and  Kim Mueser), has been demonstrated to improve employment outcomes when TSW is delivered together with Supported Employment. Thinking Skills for Work (TSW) trains people in core cognitive skills important to the work goal they may have (e.g., paying attention, planning, organizing etc.), as well as self-management skills. For example, one TSW self-management strategy is the use of a “memory spot”, a place selected to regularly keep important personal items like keys or a wallet, to address problems associated with memory problems that interfere with work functioning.

a jigsaw puzzle in the shape of a human head

 

The Importance of the Environment

PR is about the person in the environment. I can be very good at my job and not doing terrifically as a parent. Beyond my parenting skills, I might need environmental modifications and supports. I may need a babysitter to cover time between the end of the school day and when I get home from work. No matter how skilled I am, that support is critical to my success.   Most of us are dependent on some support to succeed in the many roles we juggle in our lives. For example, common supports like public transportation, an alarm set to wake up, having a doctor, friends or recreational facilities can help the average person to succeed, including a person in mental health recovery. The Center’s focus on the importance of such support and strategies to modify the environment-rather than only focusing on changing the person, was a breakthrough in the realm of psychiatric services.  New Center interventions such as Bridging Community Gaps, using Photovoice, help people make better use of what the community has to offer.  Interventions such as PR case management help people to develop and link with needed supports.

a group of individuals holding up a connecting gears

The belief that every human being has the right to live a personally defined, meaningful life is a cornerstone of Psychiatric Rehabilitation. Its processes are based on a belief in our common humanity, regardless of the challenges we must face. PR recognizes the importance of supporting people with psychiatric disabilities in identifying and thriving in their preferred valued role.  Consistent with the broader field of rehabilitation science, PR accomplishes its aims with a combination of skill development and environmental accommodation and may encompass a wide range of modalities, depending on the specific roles selected by the person. To learn more about the PR process and approach, check out our Primer on the Psychiatric Rehabilitation Process or, for a deeper dive, consider our textbook: Psychiatric Rehabilitation, Second Edition.

We hope you enjoyed our first post! Please let us know what you think in the comments section, below, and subscribe in the sidebar on the right!

 

 

Notice: The contents of this post were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTEM0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this post do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

, March 11, 2022articles employmentdeinstitutionalization psychiatric-rehabilitation serious-mental-illness
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February 25, 2022events

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