A Peer Specialist Shares Story of Finding Her Path and Purpose

Finding my way into the peer workforce has been an incredibly rewarding experience. I always felt that my psychiatric diagnosis and my history of hospitalizations, self-injury and extreme states would hold me back. Since I was a child, I thought about working in the mental health field. As someone who survived trauma, I had experience with social workers from a young age and always thought I wanted to help people in that way. As I got older and began experiencing more intense mood swings and suicidal thoughts, I thought that dream (and many others) had passed me by.

Over the years, the mental health system has served me well. It always felt as if there were pieces missing though. I know that in a 12-step model, those who are doing well in their recovery are encouraged to remain a part of things and share their experience, strength and hope. Where was this in mental health services?

As my path of healing grew and I began to look for paid work, I stumbled upon a listing seeking a Peer Support Specialist in a community mental health organization. This was what I didn't even know I could hope for! The main credential necessary for this position was exactly the lived experience I had been through. Being in this role has been incredibly healing for me personally, hopefully for those that my organization serves, and I believe for the system at large.

As a peer specialist, I provide peer support, but also serve as a change agent for the system. I communicate hope to the individuals I work with, but also to coworkers, supervisors, clinicians and doctors. There is hope for recovery for everyone, no matter how difficult things may be right now. My path has brought me to a place where the pain I have experienced can be useful to other people. The fact that this path now exists is proof that the system is shifting already. I feel extremely proud to be a part of that.  

Older Adults and Mental Wellness

by Rob Walker CPS, 

DMH External Consumer Engagement Liaison  

The average life expectancy of citizens of the Commonwealth is just over 80 years, which means many of us can expect to see our 90s. For some, these years may be accompanied by increased happiness, a new career or business, confidence, freedom and time to pursue all kinds of interests. Others may experience loss of health, loss of social connections, depression, anxiety, hoarding, regrets and increased substance use. Many experience loss of freedoms as well-meaning relatives and other guardians make all the important life decisions for them. Because of these factors and loss of previous roles in life, suicide is the highest among older males than among any other age group.

There can be barriers for older adults with mental health challenges. Friends and caretakers may see this as an inevitable part of aging. Physicians may not notice the signs or care is fragmented between many medical providers. There is also self-stigma in seeking mental health treatment, denial that there is an issue or the inability to access the right care.

The Massachusetts Executive Office of Elder Affairs, along with the Massachusetts Home Care Association sponsor the website 800ageinfo.com, a one-stop guide to services for Massachusetts elders and their families. There are also 27 Aging Services Access Points (ASAPs), also funded by the state, in each region of the Commonwealth. ASAPs provide direct services: information and referral; interdisciplinary case management: intake, assessment, development and implementation of service plans; monitoring of service plans; and reassessment of needs; and protective services: investigations of abuse and neglect of elders.

In partnership with staff at CBHI and MassHealth, the Division of Child and Adolescent Services is implementing an early childhood mental health initiative for supervisors in the In-Home Therapy (IHT) component of CBHI.  Goals for the training are to strengthen the services provided for young children and their families zero to five and to provide a foundation in knowledge of early childhood mental health practice including the use of reflective supervision.

In-Home Therapy is a flexible service that allows providers to deliver intensive family therapy to the child in the home, early childhood setting/school, or other community settings. As DMH examined how to achieve effective outcomes for the youngest children and their families, it was clear that most work with this population already takes place within the IHT program. We recognized that the role of IHT supervisors is vital in strengthening and sustaining the capacity and best practices to serve the youngest children effectively, including younger siblings aged zero to five in families already receiving services.

Based on this understanding of the IHT supervisor role, we issued a survey in the early fall of 2014 to IHT supervisors to inform the development of this initiative. We received over 100 responses with the majority indicating an interest in developing further competency and capacity in infant and early childhood mental health at their agencies.

The initiative is being offered within a Learning Collaborative framework which includes a team of senior administrators, program managers, and the supervisors of each agency making a plan as to how to make changes and measure progress to increase agency readiness, capacity, and competencies for their work with very young children and their families.

Eight behavioral health agencies across the state began the Learning Collaborative work in mid-March. Twenty-five IHT supervisors from those agencies will attend eighteen hours of training in April and May and then continue to work with the learning collaborative team of their agency from June through next December. DMH has contracted with Jewish Family and Children's Services (JF&CS) to provide the training and direct the learning collaborative. Dr. Lizzie McEnany, PsyD, an early childhood mental health clinician and consultant, is the lead trainer from JF&CS. DMH will team with Dr. McEnany to provide ongoing coaching and mentoring by phone and in person to the agencies collectively and with individual teams through the rest of the year.

DMH is sponsoring this initiative through funding from a US Department of Education Race to the Top Early Learning Challenge Grant (RTTT) awarded to the Massachusetts Department of Early Education and Care (EEC). All DMH grant activities are focused on strengthening existing infant and early childhood mental health supports within the state's early childhood education and mental health systems.

Examples of the plan at one of the agency's includes these components:  

• "Our staff will be empowered to engage in the material from the Early Childhood Initiative training. We will extend the concept of the learning community beyond that of the training by fostering a culture that is curious and creative about approaches to early childhood mental health and reflective supervision. Our staff will not be recipients of our new knowledge, but partners on this experiential journey.

• Our clinicians will infuse new questions into their practice that focus on the youngest children in families. They will be skilled in asking about the young children and pay attention to the children's relationships with their care givers. They will feel confident in their ability to assess and design interventions for young children and their families.

• In an effort to address an area often over looked in our field, we will provide training that teaches supervisors to offer effective supervision. We will teach supervisors to use Reflective Supervision as a tool that can provide a framework for supervision and expand supervisees' skills.

• As we design tools to assess our progress, we will ensure that our approach is sustainable. Instead of riding the burst of current energy to a sudden bout of fatigue or distraction from other priorities, we will focus on initiating change that continues to inspire us and is incorporated into the ongoing structure of our program. We will develop measurable goals that are challenging but possible.

• We will develop an understanding of how new approaches to our work with young children can fit into the performance specifications for In-Home Therapy. We will train our staff to provide services to young children and their families while maintaining the expectations of the Managed Care Entities.

The artwork for the Southeast Breakfast poster pictured was submitted by Tristen who attends the Cape Cod Therapeutic After School Program. Tristen shows the positive effects that attending the TAP program has on his body. "The TAP program makes me feel happy," he says.

View the photos from the Legislative Breakfasts on the DMH Flickr site.

  Watch recovery stories from the above speakers on the DMH Connections YouTube Channel. 

Young Adult Focus Emerges at the Annual Research and Policy Conference on Child, Adolescent and Young Adult Behavioral Health

By Heidi Holland

Director of the DMH STAY Project

The 28^th Annual Research and Policy Conference on Child, Adolescent and Young Adult Behavioral Health is certainly the preeminent venue in the field of children's mental health in terms of cutting edge research and in-depth focus on current trends in policy and practice. As a first-timer to the conference and with a personal and professional focus on young adults, the meeting did not disappoint. Also attending from the Success for Transition Age Youth (STAY) Project team were, Alison Hunt, Statewide Peer Mentor Liaison at Wayside Youth and Family; and Carter Pratt who is part of our evaluation team from the University of Massachusetts Medical School.

The opening plenary, featuring former Congressman Patrick J. Kennedy set the tone for the three-day event with powerful personal stories about his family woven through a comprehensive national policy agenda for mental health and substance abuse that focused on parity with physical health issues. The afternoon plenary that day was a dramatic, multimedia and high energy talk by Dennis Emery, PhD, entitled, Stop the Epidemic! Powerful Universal Protective Prevention AND Potent Yet Simple Treatments for Mental, Emotional, Behavioral & Related Physical Disorders for America's Future. Dr. Emery spoke with powerful eloquence as he compared the national response to polio in the 1950s to the current lack of response to the crisis in mental health disorders, especially among young adults.  

The "Emerging Adult" track offered sessions that spoke to the work that we are doing in the STAY Project here at DMH. Those included some key papers and discussions focusing on themes such as:

• Perceived need for mental health treatment and the disparity among young adults versus other age groups in terms of actually receiving treatment
• Employment and pre-employment activities as key to treatment and recovery
• Presentations on youth peer support models such as, Youth Move
• Participatory Action Research, which engages young adults with lived experience as researchers
• Young adults using lived experience to support systems change
• Youth-guided program planning and evaluation in Systems of Care

One of the themes that cut across many of these sessions was identifying and increasing the level of youth/young adult participation which was presented as a ladder moving from manipulation and decoration to youth/young adult-initiated and directed. As Alison Hunt put it, "it's so inspiring to see that systems are changing and people seem ready to see young adults, taking the lead on what their services should look like and in viewing peer support as such an important role." While not every session had a young adult co-presenter, many did and several featured young adults as lead presenters. 

From the perspective of the Emerging Adult focus, the highlight of the conference was the plenary led by UMass Medical School's Mary Ann Davis, PhD, Investing in the Health and Well-Being of Young Adults: Highlights from an Institute of Medicine/National Research Council Report. The panel included two other prominent researchers and a young adult with lived experience who led the youth advisory panel for the report. The IOM report defines anew this generation of young adults, their unique challenges and their health care and mental health needs. One of the startling findings is that this generation of young adults (age 18-26) is significantly less healthy than younger adolescents or adults in their later twenties. Conditions such as obesity, serious mental health conditions and substance use are some of the key areas disproportionately impacting this cohort. The report calls for innovative solutions on a national level such as greater collaboration between the departments of labor, education and health in addressing the unique needs of the emerging adult population. The full report can be found at the IOM website . 

Our team hopes to attend again next year and to be in position to present on the key outcomes of the STAY Project in Massachusetts in terms of impacting the lives of individual young adults and the systems that serve them.

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