ROUGH EDITED COPY APRIL-Cross Disability Services : Serving Consumers with Mental Health, Substance Abuse Disabilites 5/24/18 Captioning/CART Provided By: CLOSED CAPTION PRODUCTIONS, LLC. P.O. BOX 278 LOMBARD, ILLINOIS 60148 * * * * * * This transcript is being provided in a rough-draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication acccessibility and may not be a totally verbatim record of the proceedings. * * * * * * >> Hi, folks. I just wanted to take a check in here. If folks have a hard time hearing, I want to give yourself a check, make sure your speakers are on or that your volume is up, if you're just using computer, feel free to join us in on the conference line. But definitely, the system should be coming through. Can somebody who is on just their computer shoot me a chat message just to say hey, I can hear you if you can? Awesome, thank you guys for that. Why don't we go ahead and just get started. I am so excited for today's call. It is definitely one of my passions. And today we're going to be talking about serving consumers with mental health and substance use disabilities. Today's captions will be provided on the bottom of your screen in the webinar system. If you would prefer to have those full screen options, if you scroll up in your chat box I did place that link to full screen captions and you're welcome to push that and you can pull that up for yourself. We will open the call with some introductions and then our first speaker will give us some information, then we'll move into sharing mode before our next speaker, then we'll open up the floor for participation again. So if you would like to participate in that discussion, you can type your question or comment into that chat feature of the webinar and I'll voice it for you or you can press "*" pound from your phone and that will enter you into our queue and then we can open up your phone line to voice your own comments. Or I know all the options, you can press the little dude with the hand raised at the top of your screen. If you're using computer that will let me know to open up your computer mic. If at any point today you're having trouble, please feel free to email me at Mary.OLSON.MSO.UMT.EDU. I did throw that in the chat box. So today's materials, our speakers have great resources and those will be up on the website following the call along with the recording from today's webinar and the transcripts. Our website again is www.APRIL-rural.OIG. That's in your chat box. So without further adieu I would like to introduce today's speakers for you. We have with us Dee gnash and Kathie Knoble-Iverson. Dee has been involved with and worked in the disabilities field since 1974. Her background in occupational therapy which is provided a strong basis for her work in the independent living field. Dee has served a variety of disability groups during her career including children and youth with disabilities, individuals experiencing psychiatric or substance abuse or excuse me substance use disabilities. Individuals with a traumatic brain injury and many others. These provided services to individuals and groups developed programs and she's been in a management role for the last 23 years. She's currently the executive director of access to independence and serves as the chair for the independent living council of Wisconsin. We also have with us Kathie Knoble-Iverson, she's been director of independent living resources Inc. in la cross, Wisconsin, for 24 years. ILR developed ad great expertise in supporting people who live with MHFUD issues. ILR supports consumer run mental health substance use disability drop in center, a designated homeless program and generated over $300,000 in fees for mental health services. She currently has 22 peer specialists on staff. We are just so lucky to have these two ladies with us today. Again, I want to say we couldn't make this possible without the partnership that we have with the IL-NET. Yeah. I guess without any more further adieu, -- sorry, I apologize. I just wanted to say so that also this proapologetic is supported by -- project is supported bid administration for immunity living and is that -- community living and is that partnership with the IL-NET. Grantees undertaking these projects under government there it is, I'm sorry, taking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not therefore necessarily represent the official administration for community living policy. Now that all that is out of the way I would like to turn it over to our wonderful speakers starting with Dee. >> Thank you, everyone for joining. Hopefully we can enlighten you on a few things we do here in Wisconsin. I was going to ask one thing, if people would be willing to type in the chat box what state you're from and if you're already providing mental health services or substance use services within your ILC. Nice thing to know moving forward. I have broken up my presentation a little bit, I'll set the tone by talking what is recovery and recovery oriented what is that based on. Then I'll talk about what I or my agency does working with Wisconsin department of health services bureau prevention treatment and recovery and then kind of a connection that I have with the other centers to kind of expand the role of certified peer specialist across the state. So that's how I'm going to break my things down so that's how we'll get going. So anyway, we talk about recovery, many states, the federal substance abuse and mental health services administration along with many states including Wisconsin have adopted the recovery oriented behavior health services. And that has caused what I would say is a real dramatic shift in expectations of outcomes for individuals with mental health or substance abuse who are seeking treatment or services. It's now looked at today that in mental or substance abuse disorders, they can actually have the belief that they can recover, they can manage their condition -- their conditions successfully. That's kind of a different change in paradigm from what it used to be even 12 years ago. Again, the value of recovery and recovery oriented services is basically sets a parameter that change is possible with individuals and they can improve their health and their wellness, they can lead self-directed lives and strive to reach their full potential. That was really intriguing because it really fits in with IL philosophy as well. Recovery oriented services and independent living philosophy to me are pretty much the same. Self-empowerment, self-direction, moving forward with your potential and also based on person's strength. So that's kind of the parameter what is recovery. There's four dimensions of recovery that are recognized, one is health. Being able to overcome or manage one's disease or symptoms. For example in you're a person who uses -- has a substance use disability it's really being able to testing for using alcohol or elicit drugs or prescription meds in being able to make informed and healthy choices, that support your physical and emotional well being. So there's a lot of words that come out of SAMHSA but again I think when we talk about peers, and peers providing these kind of things, it really is being able to support another person and share your experiences that might help somebody move forward and see they can move forward in their own lives and recovery. The other thing is, people should be able to have a stable and safe place to live. So often historically many people who were experiencing mental health or substance use disorders, they often have unstable living place,, places to live, they have a hard time maintaining employment and different things so building that stability is so important to help a person work on their recovery. Purpose, having meaningful activities such as a job or volunteering or family caretaking or other creative things really helps a person choose the stay in recovery and move forward with their recovery, to be active participants in the community are really key things. I think oftentimes people with these types of disabilities often end up isolated or do not participate actively in their communities. So again, think a peer kind of support somebody in researching and participating with some of these types of activities. Again, building a community for individuals or with individuals, developing relationships and social networks that can support an individual in their recovery and help them maintain their recovery. So those are kind of some of the core principles under recovery and I think the big key piece in using peer special itselfs and supporting and recovery is that there's hope, you build in hope with these people that they can move forward in recovery, they can build on their strength and their talent and their ability to cope and develop really good strong relationships so those are core principles and really smooth over them but if you want to find some of that information you can go to SAMHSA which is substance abuse and mental health services administration. And they have a wealth of resources, the knowledge is there for anybody who wants to research more and learn more about recovery, recovery principles about the use of peers. So it's a great resource. >> Hi, Dee, this is Mary just to pop in, I was wondering if maybe you can speak up a tiny bit or move closer to your phone. >> Okay. Sorry about that. >> You're great. Thank you. >> Okay. So we're going to move forward now and kind of talk about my experience in Wisconsin. I came to my Senate director position in 2008. In which the center already had a contract with the state department of health services, zero prevention treatment and recovery. With that contract was for was to develop basically peer -- to develop kind of the core principles and practices around peer specialists and the use of peer specialists in service provision for people with mental health and substance use. It's the initial stages we worked a lot with a core group of peers or people who identified with mental health as their lived experience and really develop some core documents to use like code of ethics for a peer specialist. Court documents. Yeah, assets, the competencies that we expect every peer specialist to be able to do in their role as a peer specialist. So the other thing we were asked to do is to develop a certification process. And what that meant was develop a way of training individuals and testing individuals to see if they met the competencies needed to hold certification in Wisconsin. We were able to complete that part of the project in 2010, we started testing certification exams across Wisconsin for peer specialists. And in the beginning we only started with people who were providing services to people with mental health disabilities. As far as peer support program or purchase service through medicaid program. Since that time, we have grown and expanded and done a couple of other things. We have -- I should go back up, we initially started this project based on an employment initiative of people with mental health disabilities as they were highly underemployed population. The state happened to have some medicaid infrastructure funding within Wisconsin that was used a lot to do the development and promotion of the use of peer specialists across the state and in programs that provided services to people with experience in mental health. That's how we got there is really started that employment initiative. In 2010 we started testing individual which time it grew pretty quickly. About, just a little history here, about 2014, we started seeing variability in how people were testing and how many were especially passing the certification exam. We had some theories why that was happening but when we look at the data, we determined that it was flaws in the different curriculums and trainers that we were using. So we developed a new curriculum just based for Wisconsin to train peer specialists for both mental health and substance use and that person was just completed last year. We also looked to the centers to do a couple of things for us, one is they are our exam sites, we have eight center chairs from Wisconsin. We work with the University of Wisconsin Milwaukee to run an online exam for certification. So centers are our proctor sites which people go and take their exams there. We just had an exam yesterday which we tested 140 individual across the eight centers. That's the biggest class we have ever had. The other centers are very much utilized for if they coordinate all of the peer specialists -- I coordinate with the eight centers, all the specialists training that goes on across the state. The centers are integral part of this infrastructure in order to make sure that everybody across the State is going to have access to peer specialists and training. That is how we utilize in hearing, Wisconsin. The other big component for centers, because again I think the vision of peer specialists is not that far off from what we do in independent living. But many centers, in fact, I think all centers right now currently employ peer specialists on staff. Some just use that as a value-added bonus for people they work with. But many in Wisconsin developed fee for service activities around the provision of peer specialists services under medicaid programs here in Wisconsin. So I'm going to stop there, I said a lot, let's see if there's any questions and then we'll move on. >> Thanks, Dee, again, if you have questions, press "*" pound and I can open up your line or go ahead and type them in the box and we'll voice them for you. I see somebody has a question. >> Certification form, is that the one you're see something >> Go ahead please. >> I see the one question, how long is certification? Our certification lasts for two years and then they have to recertify every two years and they have to have at least 20 hours of continuing education, that's very -- but identified what types of -- what categories they need to have continuing and they submit that to the University for recertification. >> Great. Then I also see what areas are they tested in? Did you just answer that? >> Well, the areas they test in, we are curriculum teaches to the core competencies of a peer specialist and there's going to be a website we'll put up later called www.WICTF.org. Where you can find all the core documents about being a peer specialist, the competencies, the ethics, all those kinds of things that you can look up and see all those things that we have developed here in Wisconsin. >> Great. >> Go ahead please, caller. >> Yes, what was your curriculum based on? The peer training certification? >> Our curriculum is based on the competencies that we're develop -- were developed and identified from Wisconsin, that was a core group of peers, people from VHS, department of health services, a variety of some practitioners and we work diligently on identifying competencies needed to be a certified peer specialist, what do you need to know in order to deliver those services. Again, those competencies are identified on that website that I just gave you. >> Could you give me that website one more time. I didn't get Adobe flash player where I'm on the call for some reason it's nots working on my computer. >> I know it's on the back of Kathie's presentation that she's going to put out later. But I can say it one more time. Www.(overlapping speakers) >> Also just let you know those are on the slides and also the transcripts from today's call and those slides will also be on our website. So -- but sorry, go ahead, Dee. >> If we are okay with that, I want to move how to do we do systems change within your own state. Any more questions? >> I don't see any other questions at this point. Folks are wondering, is that website active now? >> Should be. >> Great. So again, if you have questions at any point you can press "*" pound and I'll be able to know that you have got that question or type it in the box. Otherwise, go ahead and take it back away, Dee. >> Thank you. So I think couple of things, instead of maybe your seeing -- I know in Wisconsin we saw early on in 2000, maybe we as centers weren't serving people with mental health diagnoses or substance abuse at a level we needed to be. So again, recognizing that and doing something about it is why we do systems advocacy. So I think in your space, one thing is you really need to find out what is going on in your state for delivery of mental health or substance use services. What is their behavior health services they provide, who gets access to services, are they limited, are they peer based. What is going on in your state? You need to find that out. The second thing is there are in most states, I believe in all states, there are mental health councils mental health and substance use committees that your department of health services probably have or the governors counselor that are is helpful to get a seat on those committees because there you find out more about what is going on, who is being served are there opportunities to change the system, are they looking to develop new practices within behavioral health services? And it's also an opportunity for people at that table to learn about independent living and independent living centers. I don't know about you but in Wisconsin many times we continue to be the best kept secret. People don't look at us as working with people with other types of disabilities, other than physical disabilities. Often times they don't recognize that we work with all disabilities in all ages. So again, I think it's an opportunity to educate. Many of those players at the table to share the independent living philosophy which is so close to that peer support piece we do here in Wisconsin and in many other states. And again, those committees have power. They can make recommendations to the state department of health services, they can make recommendations for what they think may be the state budget should be. And maybe initiation of programs, I know those councils here in Wisconsin had a great influence on the development of the peer specialist program. They have had influence on developing peer respite programs. And other types of mental health initiatives here in Wisconsin. I'm assuming those type of structures exist in other states. If you're not where the states seed is getting your local county committees, your counties probably have other advisory committees or other things going on that you can become more informed about what's going on and what is needed in your local regions that you serve. Again, having an idea of what is going on is going to help you shape what you can do moving forward. I think again, because we come from an independent living philosophy and the peer movement in mental health and substance use are so aligned, I think it's been really easy and Kathie will correct me later if I'm wrong but it's been easy for centers here in Wisconsin to embrace the peer specialist movement and to say this is what we do already. For most of the people that we serve, it just has really become an opportunity to develop some fee for services, to take spans in some other realms as Kathie will talk about, they're doing some drop in centers, they have done some work with the lost homeless people and there's a variety of other opportunities that I think can be developed and worked on. Using recovery based services is such a core belief I think within the independent living movement. Other things that I have centers for that I use, I mentioned I was going to give you core things they do. So centers right now with our contract as we have moved out, they are our testing sites. They coordinate a lot or the majority of our trainings for peer specialists. They actually have on staff trainers of the peer specialist curriculum. I'm trying to think. I think those are the core things. And they have also developed fee for -- streams for fee for service they build through medicaid programs or county programs. As they move forward we're also in the process with State of Wisconsin department of health services in peer prevention treatment and recovery as well as children's mental health services in the development of what we call a parent peer specialist certification. Which will run very close to what we're doing as far as curriculum training and testing but the unique role of parent peer specialist is for an individual who is in the parenting role of a child or young adult who is experiencing mental health substance use or other behavior disorders, giving them support and helping them navigate the complicated systems that many Children and Families find themselves in when they're experiencing those types of issues. So that's something that we will be rolling out very soon. Again, I will take questions. >> Great. Thanks, Dee. So again you can join that queue by pressing star pound. And then you can also type it in the chat box for us. And I did just want to let folks know that I did just update the APRIL website and so it also has the website they're speaking of and the resources that folks will be referring to for today. So again, go ahead and press "*" pound or put your question in the box if you have them. Don't see right now, Dee. Why don't we move forward and let folks kind of think about some questions >> Sure. I'm going to use myself, there you go. >> Actually I do have one question. From rolling start. >> I don't see the question. >> I just opened up his mic. You're asking how long does this one last, are you wondering about the conversation? >> It actually -- it's a 90 minute conversation. So we'll be done at 3:00 mountain. Yeah? No, that's -- 2:30 mountain. Sorry. The certification, he's wondering how long the certification lasts. >> As long as you continue to recertify every two years and get your continuing Ed you can last indefinitely. Our certification costs $50 to take the exam and every two years to do the reCERT you have to pay $50. >> Great. Thank you. That's all the questions for now. >> Thanks, I'm going to mute myself. >> All right. So we're going to turn it on over to Ms. Kathie. >> Hi. >> Were you still going to do the slides? Or do you want me to do them? >> Yeah. No, I'll move the slides, they're not up yet. >> Great. There we go. >> All right. Go ahead. >> I do want to respond to Dee talked about the getting the independent living centers involved in working with folks with mental health. I do disagree with her. I think it was it took a long time and I was surprised. I'm very proud of all the centers in Wisconsin now, I think all but one has at least one peer specialist on staff. It took almost ten years for this to happen, I feel like what the heck, it shouldn't happen, it shouldn't have taken this long. In a state that has as much going for it ads Wisconsin does as far as our coalition is concerned. But now I'm past that. And really want to talk about why centers need to figure out if they need to do a better job working with folks with mental health and substance use disorders, and if they want to get involved in the systems change issues that Dee is talking about. From for us in Wisconsin, everybody has to do a 704. So I keep wondering look at your 704. I pulled it out from 20 years ago and we served 11% of the people we served, identified as living with a mental health issue. Our last 704 we just did, 44% of the folks that we serve reported that they lived with a mental health issue. In Wisconsin, managed care is the way long term care is provided for folks now. But they did a study in between 65 and 70% of all the participants in long term care have a mental health co-existing mental health issue. And our long term care is only for folks with physical disabilities and for seniors. So it's that co-disability that is often really ignored when a person gets into the system. I also feel like we really need to stress cross disability. When we first became a center, there was a big push about not being a single disability center, there was a lot in the country. And we were lucky, we just started out serving folks with mental health issues and we had some staff that self-reported that they had mental health issues. The other opportunities, is that it's been a great fee for service for our agency ads Mary said in the introduction, this fiscal year we're going to generate about $311,000 in fee for service just for mental health services. Not just for adults. We really took a leap three year, four years ago and decided that if we're going to change how the world looks at mental health, we need to start with kids. So we started working with children. And want to have them be a much better educated adult so they don't have to go into the system as an adult. And the other thing is, it's the right thing to do. There are still really terrible things happening to people, not just in institutions. Happening in the community, happening all over the country and particular in our criminal correction system. Has become the biggest provider of mental health services in the country. So one of the things I think a sender really needs to do is to Oops, wrong way, sorry, Mary. Is to get a sense of what happened historically in this country. I guess in Wisconsin we were -- I was a young adult in the '70s when this happened but peep were institution -- institutions were closed. Some states fought to keep theirs open and particular mental health but in Wisconsin they closed most of them and kept two large state or three large state institutions but a lot of private and small ones were closed. What's this promise that community based services would be provided in people's communities and that never happened. So lots of people were put on the street. And hundreds of thousands of people across the country ended up in a different institution and that's our prison system. Many of them either have passed away in that system or are still there. And now there's not much hope of them being very successful if they would ever be put back in the community. The lack of community based alternatives started to change in the late '80s and there are lots of really wonderful I think creative options out there. I feel like the people are still stigma, I didn't even put that on here, it's something we deal with every day because a lot of staff are folks with that self-identify with mental health substance use issue and the stigma that goes along with that is so different than any state model that is connected to other disabilities. If you had a stroke, you're a person who deserves support and are treated with great compassion. That doesn't necessarily happen with folks who have mental health or substance use issues. The deep talk quite a bit about recovery and IL philosophy. That was sort of the light wept on for us when a long time going I'll get to that, we were asked to get involved in helping consumers be more involved in one of the counties we serve to help them change mental health system. And we just could not believe how compatible recovery and mental health services are. Or recovery and IL philosophy are. And yet again, Dee talked about it. Consumer driven, strength based, one of the things she didn't mention is a lot of centers we are always telling people to tell your story, and I think so many folks with mental health and substance use issues have never been encouraged to tell their story. It's very -- really powerful way to get people to understand what people are going through. I feel like folks really don't have a voice yet. We work a lot on self-advocacy with people that we serve here to make sure they understand they are not their diagnosis and they have a voice. And if they want change in their lives that they can be the driving force to make that change. We also work a lot with folks, the independent living movement, one of the core services is skill training. What has happened for as long as I can remember, in the 60, 70 years I have been around, people looked a folks with mental health issues and felt that their future was hopeless. That they weren't able to learn, that it was a waste to try to give them a skill set, that they couldn't work and they couldn't be parent, they couldn't -- you know, it just went on and on and on. And I believe that in the IL movement one of the things we work a lot with people is to instill hope. That in so many folks that come to us, they're just so smart and have so many skills and no one has ever acknowledged that in them. It makes a difference when you start to do that. So I want to go through, again, Dee went through a lot of this, I won't go through it again but it's really important to understand that recovery is a real personal thing. Recovery doesn't mean the same thing for everybody. It is really about the whole person, that's another connection to the independent living movement, we don't do one thing for a person and then kick them to the curb. If there's other things in their lives, that need -- they need assistance from us, we do it. So recovery is about healing all aspects of a person's life. As much as they can. And learning so many folks don't even know what their personal diagnosis means, how they feel, they know what their symptoms are, but they don't know when you talk to somebody about people say to me I have schizophrenia and I go yeah. Okay. What does that mean to you? And you hear about how that diagnosis has affected their life, not necessarily they have hard time with housing, they have a hard time working, those sorts of the things. Those are all things we help other people with other disabilities work on. So I feel like I sound like the perfect place to team up with folks with disabilities. With mental health disabilities. I really feel strongly that when you start to think about being person centered and strength based, people are just shocked sometimes, or if you ask them what they want, people go what? What are you talking about? I have never ever got to make a decision about anything in my life since I was hospitalized. I feel like that's something again independent living movement could really work on is helping people tell their story and identify people's strengths. So one of the other issues here is to -- this is sort of a touchY one, if we want to take -- ask for questions after this one, I would appreciate that. How many of your ILC staff have self-identify and it's something that I guess -- I guess calls from centers all over the country. About mental health services and when I ask if they have somebody on staff, that have self-identified they go no. And I would bet my paycheck that there's somebody on staff that have a mental health issue or substance use issue and they have just been unwilling to share that. Because of the stigma that goes along with the diagnosis. So we need to take a look, I talked about this a couple of different times, and I think this was one of the hardest things,, our own house here in Wisconsin was what is your agency culture like? Is it accepting and supportive? Does it accept every disability? I have been in centers where I ask about working with folks that have real chronic mental health issues and I get a resounding hell no, there's a place for those folks. We send them down the street. I have heard that if someone comes in and they're homeless and they're dity, and they smell -- dirty and they smell and they might be really hungry and distracted when they come in, and I have asked what centers do for that. And they're like well we send them down to the shelter. And they don't follow-up, they don't see them again. And to me that's just a huge, huge disservice. To the disability community. Because they are our brothers and sisters. No matter whether people want to accept that or not. So taking a loot at your own house -- your own center, what kind of language is used when you talk about mental illness and substance use. Are there accusations about comments about drug use and about people coming to work under the influence. Really detrimental comments about people who are mentally ill. It's not tolerated here at this center. But I have been in other centers where it ice acceptable language. No wonder people don't want to self-identify if that's the case. And then, you know, if I talk to people in your center I keep wondering what would they say to a stranger that they might not disclose in their own center in their own site. I really feel that if people know that their environment, we talk about here when people sometimes don't want to talk about things, and we really make sure they understand that it's a safe place. And what that means here is no one will judge you, you need to tell us how you feel. What's going on here that's making you uncomfortable. Or what can we do to help you be more productive at work if you're easily distracted or something. Those kinds of things need to be conversations that happen at your center. >> Thanks Kathie, you can press "*" pound or little dude with the hand up or chat box question here. I did want to say something from rolling start Inc. in California says a good percentage of their staff identify with some form, they said. >> Excellent. Then you know they're working in a safe and accepting environment. To me that tells you what's going on. If your center has folks who identify, then you need to identify what do I know about peer support? And I just have to tell you when we developed peer support before it was a thing in Wisconsin, in 2006 we brought a trainer from Arizona and trained four or five of my staff, it changed our whole organization. Did somebody have a question? >> Yes, Kristin Williams is wondering, she says, $311,000 in fee for service, what type of services exactly? >> We have several contracts. We have a crisis intervention contract in la cross county for working with families whose children are exhibiting some mental health symptoms and the families don't necessarily think or want to be connected to the county service system. Or they may not qualify because they have their own health insurance. So we go in and do -- we get in that household and help things calm down. Sometimes it's the child, and they are angry and upset and things aren't happening -- are happening to them they don't understand. So we spend lots of time with that child helping them try to figure out what's going on with them. And if indeed they're depressed or have what I consider the new huge disease in this country which is anxiety, a great deal of youth experience. And sometimes it's the family unit, something is not clicking in that family unit. So we get $50,000 a year to do that in one county and that's a fee for service. Then we do what we call CPS comprehensive community services, it's a medicaid reimbursed skill training. Only the skill training has to be based on helping people understand their symptoms, understand their mental illness, develop coping skills. What we train on and we do a lot of other skill training. We do cooking and -- kinds of skill training we have always done, but we do it with mental health in mind. Then we have an advocacy grant called consumer affairs coordinator, to provide advocacy for individuals in the mental health system advocacy for individuals in the mental health system so they understand they have control over their health services and their plan, that's a great one. And trying to think. I think we might have -- and now we do CCS in seven counties. We used to do it just in la cross county and we provide comprehensive community services in seven counties. And we get almost $60 an hour to do that. Some counties pay us because there's not -- we're in a recall rural area once you're out of la cross county. So once -- we might be an hour and a half from a county that doesn't have a provider. And they want the peer specialist provider. So they will pass to travel there also. So it's worked out really, really well for us. >> Great, Kathie. I have a couple more questions if that's okay. >> Sure. >> Let's go to the phone lines. Go ahead please. >> My name is Olivia. I am an independent living specialist here in Illinois. We kind of sort of cover all phases, including people who are -- have mental illness but you know, there's nothing here. We can't even get the howing authorities to even talk -- housing authorities to talk to us so we can get the federal grant money that's there for them and I see a lot of these people that think deeper in to depressed -- they almost become invisible. And I worry constantly every day for these people. And I wonder how we can make it better for here. >> I can hook you up, if you call me after this call, we have a homeless coalition. What we were seeing is about 90% of the folks in our region that were homeless had a mental health aunt or substance use diagnosis. And the homelessness and suicide rate in our community is really, really high. We have two coalitions working really hard. One of the things that we end up doing, sometimes it is difficult to find housing for folks. But people absolutely cannot be denied public housing simply because of their diagnosis. You have to file a complaint. That's what we do. But we have -- we are really passed that because we have a huge homeless coalition here that has opened up the doors to public housing here like never seen before. It's been an amazing change in their attitude about people's rights. There's all sorts of discrimination going on in housing not just in la cross but a lot of counties and we have helped overcome that maybe in half the counties that we serve. we just continue to file complaints, document that people are being discriminated against. Things that people say. And we make sure staff go with them when they apply. Because people are much less willing to say things in fronts of a staff person. We do a lot of housing here, that's with our IL funds and that's probably one of the biggest area of employment for discrimination. >> Thanks, Kathie. That's great. And what I'll do is throw your phone number for your center down in the chat box if you're okay with that. >> I'm fine with that. You won't get an answer today because we have to leave right away. >> Yeah, no that's fine. Moving on to the next question here, Gary Arnold is wondering if the center is displaying evidence against -- displaying evidence against stigma, if they're showing there's a stigma against mental illness at their center, do you have any recommendations for good awareness training? >> I don't know what's available locally. I would have you contact your -- if you have a NAME there or some sort of mental health association, the best thing to do is bring in, folks in your own environment. We do training all the time. We do mental health first aid training a lot to help the public understand better getting folks in to talk about it, hopefully it's someone with lived experience, because they can talk directly about it. So I would go to any consumer group or like I said, NAMI, to see if someone can come and talk about signature stigma. At your own center though, it's really hard. I have got 22 peer specialists so I get called out all too time, if there's comments made, if there's things going on in our environment that they don't think is trauma informed. And then we have a little work group that goes in and corrects it, a lot depends on the hierarchy of your organization. And if it doesn't start at the top I don't know that it's going to be successful. It's going to take longer. That's some of the resistance that I felt in some of the centers here in Wisconsin. Is that the -- the top didn't accept it until they understood it and the staff made a plea for it to happen internally and showing them, it's okay to hire someone that discloses that they have a mental illness. >> Kathie, I through the chat box, it's NAMI the national alliance -- >> The national association for the mentally ill. >> Then I also through in the bottom there, if your area has a youth move program, they're also really great about talking about young people, young people develop. Sometimes if you're more rural your mental health centers might have what they call like a lack, like a local area -- do you know what they stand for? >> No, I don't. Council for mental health programs and they're also with lived experience and sometimes they will do awareness presentation. >> Right. And you get to ask until you find somebody. If we had folks around here who really wanted to tell their story and somebody said oh my God they're going on and on and on and disclosing a lot, we work with them and help them figure how to tell their stories with powerful and effective and how to write about their own stories. So I really think that it's not any different than us encouraging other folks with other disabilities to tell their story. >> Absolutely. I want to say again, Dee, if you have anything to add your mic is still live as well. I have two more questions. One is again from the folks in San Bern diknow, California, they're wondering who would be a good place or where would be a good place to start or who do they need to contact in order to begin looking at working with the county to get fee for service contracts or to start doing some of these mental programs. >> We went right to the mental health department of la cross county human services. That depends, you're in a larger area, might be a little harder to find out who you go to around here. Sometimes one person that you talk to, that would be the director of human services in some of our rural counties. But if you go to the find out what kind of services do they have, you might find out they're already doing something like comprehensive community services. It's a federally funded program. It is funded by medicaid. So I can -- it might be something, do your home work and find out if you're county is interested. In Wisconsin what happened is our governor is picking up the -- there usually is a 60/40 split in Wisconsin for medicaid reimbursed services. And the governor, the legislator passed a bill to pick up 100% of medicaid services for CCS. This is Wisconsin response to a lot of the unfortunately to a lot of the shootings and the mass murders that have been happening around the country. Is to really soup up mental health services. >> The other thing is, I don't know in your state but I know here in Wisconsin, Wisconsin has received a lot of funding with that opioid epidemic that's going on, can't believe that's not happening in other states. >> Yeah. >> The there's a lot of funding out there, a lot of people leading their charge, at least here in Wisconsin is there training both recovery coaches and actually providing peer specialist training so they can actually go to ER and meet with people, that's one of their things but they also might be a good resource in other states how are we serving this population. >> Yeah. >> >> You might want to see what grants your states has and what grants your county has as far as services and maybe having some informal chats with people from your county about what kind of services, how do people access services, are they limited on amount of services, can they only get this much service and then they're done. You really need to understand the system. >> Yeah. Here in la cross, we were a pilot. We were asked to be part of the pilot. Mostly because of our IL philosophy to be a pilot for CCS. And now we spend time educating other counties. We know so much about CCS. We have been doing it for 11 years here. Ten years. >> Extremely progressive. >> Yeah. But other rural counties, we're telling them things we learned here, it's been really nice, it's really opened them up to us is to also then be a provider in their county. Other questions? Otherwise I'll move along here. >> I have one more. Emily Shaw is wondering all disabilities are kind of lumped together, could there be a specific program or group that's for consumers with mental illness? >> I'm going to talk about that, the next is your center ready to provide peer support or other mental health services. We don't have like separate programs. We have fee for service which is CCS and a lot of other -- that also includes -- we provide health services for folks that are part of DBR. We -- division of vocational rehabilitation. We work with children and -- so I guess we could talk about what your center wants to do, what are you good at. That was a -- the thing we needed to find our niche. What we found out is we were really good at skill training. Learning how to make our skill training recovery focused really endeer us to the county and really working hand in hand with counties to make sure you have an open line of communication that you -- we bumped heads with la cross county a lot because we'd hear things like well, we sent person over and here is their goal. It was pretty obvious their outcome or goal wasn't anything they -- they would not say I need to accomplish. They just wouldn't have. So we pushed back a lot, we still do so that when we get a referral and we meet with the consumer and they're not very invested in their outcome because the county social worker decided that's what they needed to work on, then we also provide -- we always tell people you pay us for fee for service but what comes along with that is advocacy. We do a lot of individual advocacy for individuals in the mental health system. I don't know if I answered your question. >> Actually right along with that, is there a title or position someone holds that would be able to help us with fee for service? A county? >> Again, it would -- we contract with the mental health division of the counties, all seven counties, we have a contract with mental health services department. >> This is Dee. We call our mental health service for peer support, it's a comprehensive community services, your state may have it, it might be called something else. >> Yes. >> Programs description, it will tell you what you can bill for and what some of the titling is for different services. >> In Wisconsin for example, if you have a peer -- if you're a peer specialist but you don't have a degree you get a one bill -- the county can bill for one rate, if you have a degree you get a bill for a higher rate if you're have a degree and you're a peer specialist you get a higher rate. I have a couple of staff people here who have their masters degrees. And so the county can bill a really high rate for that. It has to be somewhat connected to mental health services. So if it's social work or therapeutic and those sorts of things, it -- the county really benefits from that. Our independent living specialists, they're the folks who provide all the IL services, provide a of our fee for service, we also hired what we call community based skill trainers and they are they are all peer specialists. We have six or seven of those. Six I think. >> I want to clarify one thing. At least in Wisconsin, I think this holds true across other states, a peer specialist or peer support person whatever they call them in different states, must be a person who identifies with lived experience of mental health or substance use. Co-occurring. I want to be clear about that. Having a degree in mental health doesn't qualify you to be a peer specialist. >> no. Have to be a person with lived experience. That's, this next slide that I have, we have developed a self-assessment tool. -- hello. >> I was get act tiny bit of feedback from -- getting a tiny bit of feedback from you, Kathie. Actually that assessment tool is up on the APRIL website now. I will drop that link one more time on the chat box. >> Okay. That -- this is all about whether you're ready to start this process, if a center is already got folks on staff and you want to figure how to get them trained, to me we weren't even thinking about charging anybody when we started training folks. We train people because consumers coming to us, that's whey they wanted. They wanted someone who was a peer with the same lived experience as them. So we had five or six trained before the state of Wisconsin even started training people. So again, it made us a much better center. It made us much more aware of I think what was really going on in our center. We had to change a lot of policies and we had to be what's called trauma informed. As an organization, because they're finding trauma is at the base of about 80% of not only mental health but a lot of substance use. So we don't want people to come to us as a consumer or staff member and be retraumatized at work. That's probably one of the things that is really hard to maintain, we work at it. I probably have to work at it the hardest here. Because I'm loud. And I I'm a touch feeling kind of person and a lot of times that's not what people want. I have to be on high alert to make sure I'm not offending somebody. Then you have to decide as an agency again, we're back to this issue of starting at the top. . Is your center willing to make changes? If you're answering the questions honestly, and you're -- if you're administration is answering questions and then you get down and there's three different sections to the assessment tool, if your staff are saying oh my God, I hear people saying this and that, why would I ever tell people that I, you know, live with major anxiety. Instead I just take sick days and don't tell people what's wrong. If that is going on, then it needs to be noted. Somehow you have to get people at the top of your administrative system to listen. Then back to role of trauma. I didn't realize sometimes I was traumatizing people because I'm loud and can come off being really aggressive. So that's not what I want to do with folks at all. And so I am on alert constantly and checking, I do a lot of self-checking with people to make sure I haven't offensed somebody or caused them any anxiety in their interactions with me. I think that's something I have had to learn to do. Not just me, other folks in our organization. So is it's like our -- is your organization willing to make those kinds of changes? The next thing that I think is so important and believe me it's probably the most important thing next to center being ready is to have excellent supervision of the folks that are peer specialists. I don't care -- I have -- my system director is a peer specialist. We have coordinator who supervises the staff, is a peer specialist. We have independent living centers staff that are peer specialists and we have skill trainers that are peer specialists. We run a drop in center and the staff there are peer specialists. Having folks who really get it who understand. It doesn't mean people aren't supposed to do their jobs. We do that dance every day here. Making sure people understand that we understand what they're going through but that then we need to either have them take time off if having a difficult time or help find some sort of accommodation for them so that they can do their job. I feel though like a good supervisor is compassionate and they allow people to be who they are. They help people find their strength and use their strengths. One of the hardest thing I think, and this is something if you have ever had -- I can't think of -- Dee, can you think of the name of the training where you really -- micro aggression. Where people really need to identify what their own personal biases are. We do around mental health but we have also center on race and gender issues to really help make sure that your organization is really accepting and supporting everybody that comes to you. One huge crisis we have been having in -- around our area is the number of suicides that we're having. Unfortunately a lot of that happens with youth who are having a tough time with gender identification. Or if they're transitioning, those kids are so at risk. It's just breaks my heart because there's wonderful, wonderful children that are taking their own lives because they couldn't figure stuff out. And weren't connected. It's one of the things the county is putting some pressure on us, they want us to get even more involved with the folks that were not connected with. Because a lot of folks who commit suicide in our region are not part of the service system. And they want to do it for free. We are just so busy unless we get money to hire more staff there's no way we can do it. Then are you providing a safe supportive and inclusive environment for your staff in watch what language you use. We try not to use the C word which is crazy but it happens. It's part of our American culture. , used to identify a lot of different things. So we're we work hard to finds alternative language when we talk about things that going on in the world. There is always the chance things aren't going to work. If you -- we have hired the wrong peer specialists, we have hired folks that we were willing to give a chance, though they didn't have much work experience. Some worked some flourished, some didn't. It's the risk you take with any staff person. To me it's making sure that you have the best support system in your organization that you can. And I just have some information up here about just a few of the services we do comprehensive community services, and we learn so much from people we serve. We have a mental health drop in center and it was there people were frustrated about the lack of centers for people that are homeless. They had mental health and substance use issues. It got us, we listened, and we got -- wrote a grant, we wrote a grant, working with youth and we wrote a grant working with folks who are homeless. We're a big player in the homeless -- there's a coalition of homeless providers in the community that is phenomenal. We're just kicking butt. In the city of la cross. And we're really benefit as an organization because we learn so much from them about how to approach different systems that are keeping people from being housed permanently housed. So we learned a lot. The thing is, those systems are really difficult. You can get really frustrated trying to deal with public housing that might be archaic this in their thought an process, we found out here in la cross, it wasn't just folks with mental illness but boy, if you weren't white, there's a really good chance you weren't going to get housing. We broke that barrier, but for me it's taken us 24 years to brake break that barrier -- break that barrier with the housing authority here in la cross. And then homeless folks have huge -- mental health is way down the list, we need to make sure they're getting nutrition they need, they're in a safe place, if we can find a temporary place to look and they need healthcare. And then we start to talk about their whether substance issue or mental health issue, once we have gotten the basics taken care of. We run the drop in center that's my favorite place in the world to be. If I can sit there ever day I would be there. We have 510 people, this is in a town of 50,000, about 510 folks used the drop in center last year, we're open Monday through Friday 9 to 5. Three nights we're open for groups and every other Saturday. We're open for half a day. And if people give us more money we would be open seven days a week. And it would be used. But right now we can't do that financially. People that use the drop in center pretty much run the drop in center. They give us their priorities, they identify what they want for services there, what we need to provide. And it's so busy there we have to have two staff on every shift. We do two, four-hour shifts for two folks on each shift every day. >> Another thing that you do where the entire -- for the entire State of Wisconsin working with centers. >> Yes. The PRO contract? >> Yes. >> Yes. We also (overlapping speakers) >> You're starting to cut out. Can you guys hear me? We also provide state-wide contracts where we support other peer run organizations, other mental health drop in centers. That's a state contract that we secured six years ago. And again, we just learned so much from folks, it's amazing. And a lot of those sites didn't start using peer specialists, that's what -- that is our focus to get peer specialists and their regions trained and have them be on the staff, whether volunteers or paid. >> I just wanted to let you guys know, we are getting close here. We are having -- we have seven minutes left before we close. So for folks on the line, if you want to start pressing star pound if you have any last questions, we can see you in the queue or typing them in the boxes here. Otherwise I'll let you guys kind of start finishing out while we gather our last session of questions. >> Kathie, you can talk about and I didn't either but on the website is also what we call employer tool kit. >> That's right. >> There's stuff you can start looking at this was developed not just for ILPs but for kind of the core tool started but we use that for other agencies that might be on boarding peer specialists. And kind of what you can do and safeguards and also talks supervision and support and a whole bunch of different things, I think if you ear looking at adding this type of component, there's good information in there. >> It's really good. This is the second version of it we have gone through it a couple of different times and upgraded it and it's a good tool. I guess my biggest issue is I sometimes have higher standards for centers than I do other organizations. I'm sorry. That I would expect of a lot of what some sense of what other organizations don't think about is that centers really already have it in place. >> Again I think -- (overlapping speakers) >> I said it's a starting point. >> Yes. Absolutely. And along with that, I just have one question from rose Mary who is wondering do y'all know if this peer specialist certification is available in -- is it available remotely? Or do other states do it as well? Besides Wisconsin? >> I can talk to that. >> Can go ahead Dee, some other states do. >> This is different in every state. For example, in Georgia, which was one of the early onset peer specialist or peer supporters, started training and they're all actually employees of the state. >> Right. >> Employed by state. >> Arizona has done it for a long time. But I don't think they have a state certification, do they? >> I don't think so. They may now -- but I think the big thing is to just go into your Google search and say peer support or peer specialist and do your state and see what you come up with. There is a lot of resources and things out there or just contact what kind of services are provided in your state and in your county. That will tell you a lot of information, they may not call them certified peer specialists, it maybe mental health peer support or they can have a variety of names. >> Peer mentors. I have heard. >> Most states their billing medicaid, I think they're asking for certification process. At least in CCS. That's the one program in Wisconsin that requires a certification. It all depends on administrative rule around those programs. >> Great. I just have one more question from the line. For some reason it's not letting me open them up here. Let me see if that's other ones, finish up, Kathie, and Dee, I try to get this participant line open. It logged out on me for some reason. >> Yeah. Yeah. I -- if anybody wants to call and talk about what we do here, it would be fine. I'll give Mary my number. And be patient, we're just incredibly busy here. It's one of the things that we are having a terrible time finding employees in Wisconsin, our unemployment rate is under -- what is it, Dee, under 2.6 percent or something. And then in la cross, in our county we're housed in, is under 2%. So we're having a tough time finding employees. >> Mary, you are posting our contact information, are you not? >> Absolutely especially, so I actually have not added that to our website just yet but I will definitely throw that up there next. We do have all those other resources up there in currently available. >> Great. >> Anybody who wants to call for me as well, I will try and help them find out what's going on in their state. I can make possibly some emails and difference things to find out what's going on peer wise. >> Dee, another state that I was thinking about, Minnesota has a certification. >> It's different than ours. >> Different than ours. But they do a lot of servicing of individuals with mental health and substance use as well and they actually have a very unique, they actually train that peer specialist, they actually have help for the deaf community. >> I think I was able to unmute our question from the floor. Can you go ahead? >> This is BobBY walker from Montana. Can you hear me okay? >> I sure can. >> Hi, Kathie, it's been a long time. >> >> Yes it has. >> I work for (inaudible) and I'm an independent living specialist and Montana is also moving forward with the certified behavioral support specialist which is exciting. That we will get to help people because we live with our mental illness substance use disorder, Montana is on its way. >> Good. Do you have a question? >> I don't. I just wanted to let people know there was one question about the LACs. In Montana we have local advisory councils which is reports who are service area authority and work our way up to the mental health oversight advisory, when we work with the state to provide input and priorities for on the housing and all the issues that we're dealing with here in Montana. >> Great. >> You have unique challenges just with distance in Montana. >> We do. We're the fourth largest state and we're very rural. >> Awesome. Well thank you. And I apologize, I just want to make sure that I'm kind of starting to wrap up so folks know we're reaching the 2:30 mountain mark. I wantedded to say while we still have folks on the line how much I appreciate Kathie and Dee joining with us today. This is again, one of my favorite topics and so I really would like for us to continue the conversation. Again, this was sponsored by the IL-NET and all the follow-up from this call will be on the APRIL website as well as the IL RU website. We'll for sure get the contact and full out for you amazingly intelligently, even Wisconsin. So that's our show. >> Great. >> Thank you. >> Thank you so much. >> Bye-bye. >> Thank you.