December 1, 2010

1. Family Peer advocate Training and Credentialing initiativeRuth Fennelly, Wayne M. Gurnick, Anne D. KuppingerNYS coalition for Children’s Mental Health Services Staff Development Training Forum December 1, 2010

3. A Partnership of…. Families Together in New York State Columbia University NYS OMH Division of Children and Families Family and Clinical Partner PEP Training Teams Family Support Programs and Provider Organizations COLUMBIA UNIVERSITY

4. Family Peer Advocacy and Support in NYS • NYS Office of Mental Health - DCF 10 Parent Advisors in 5 OMH Regions • FTNYS - Statewide Family Organization 10 Regional Chapters • Over 100 Family Support Provider Organizations • 400+ Family Peer Advocates in MH System alone • Commitment to Training, Evaluation, and Research • Growing Family Peer Advocacy in all ‘systems’

5. Implemented in a Variety of Settings • Independent Family Run Organizations • Family Support Programs Within Provider Agencies • Family Support Embedded in Residential and Inpatient Programs • Clinics • Wraparound, CCSI, SPOA, HCBS Waiver • Funded System of Care Communities • Schools, Child Welfare, Juvenile Justice

6. FPA Training and Credentialing: A Workforce Development Initiative

7. Principles of Family Support Family-Driven * Youth-Guided * Culturally Competent

8. Evolving Practice of Family Support Services traditionally known as Family Support Services. These might include (but are not limited to): individual advocacy, support groups, skill building, parenting education, respite, home-visiting, warm-line, psycho-education, referral, system navigation support. Very often provided by a peer. Family Peer Advocates work with families is focused on increasing self-efficacy, developing natural supports, modeling self-advocacy skills, engaging the family in the planning process (and in treatment and with the system), system navigation and linkage. Hopefully govern all aspects of service planning and delivery regardless of the provider or system.

9. Family Peer Advocacy, Engagement, Empowerment and Support

10. PEP Training of Trainers New York State PEP Trainers • Behavioral Health Services North • Parsons Child and Family Services • BryLin Hospital • The Resource Center • The Pederson-Krag Center • Nassau County DMH • The Guidance Center • SCO Family of Services • Family Ties of Westchester • Institute for Family Health • Families CAN of Erie County • Families Together in Albany County • Orange County System of Care • Nassau County No Wrong Door • Family Services League/LIFT • Vanderheyden, Inc. • Families Together in New York State • Family Services (Diane Lang) • Montefiore School Health Program • North-Country Regional Center for Independent Living (NRCIL) • Onondaga Case Management

13. Family Peer Advocate: A Unique Role • Empower • Promote resiliency • Navigate • Advocate • Engage • Increase knowledge, skills, and self-efficacy • Promote effective, constructive self-advocacy • Foster partnerships • Achieve positive outcomes as defined by the family, the youth, the system, and the community • Articulate lessons learned from lived experience • Inspire hope

14. Parent Empowerment Training • 100 trained 2003 - 2009 • 175 trained in 2009- 2010 by New York Training Teams • Upcoming trainings: Long Island (March 2011) and Central New York (May/June 2011) • Submit Training Need Form for advocates waiting for training. • In development: PEP Partnership Training for Advocate/Supervisor/Clinical Partner Teams

15. Family Peer Advocate Credentialing • Credentialing Agency: Families Together in New York State • Expected Launch Date: Winter 2011 • Advisory Group: Family Peer Advocate Training and Credentialing Workgroup has representation from OMH, Regional Parent Advisors, Provider Organizations, Family Support Programs, Advocates, NYCDMH, Counties, Columbia University

16. An Attainable, Credible, Evolving Credential • Goal is to develop a Credential that is reasonably attainable yet valuable due to its ‘rigor’. • As the need for new competencies arises, we can address this through adaptation in the training and through continuing education requirements. • Continuing education should be flexible (approved local trainings), right amount, and continue to have statewide aspects.

17. Benefits of Credentialing • Respect and recognition of the value of competencies • Potential for advancement • Clarifying role and responsibilities • Assures hiring agencies a foundation level of training • Potential for improving outcomes • Opportunities for continuing education and the development of communities of practice • Basis for the development of a professional association • May open up reimbursement possibilities

18. Proposed New York Family Peer Advocate Credential Requirements • Successful Completion of PEP Training including six months of consultation calls* • High School Diploma, GED or equivalent skills • Lived Experience • Ongoing self-assessment of professional strengths and needs • Work or volunteer experience as a family peer advocate • Three letters of recommendation • Resume • Code of Ethics • Recertification and Continuing Education • Others to be defined by FPA Training and Credentialing Workgroup

19. What about the FFCMH Certification? • The requirements for the FFCMH National Credential have not been finalized. We are working closely with the FFCMH through this process. For more information, go to www.ffcmh.org • Our goal is to align the requirements so that we can achieve reciprocity (ideally) or at a minimum sufficient alignment that advocates credentialed in New York will have fulfilled the majority of requirements for national certification.

20. How Does PEP Training Fit in? • Successful completion of PEP Training will satisfy ONE core credential requirement, but there are additional requirements. • For 8 months following the initiation of the FPA Credential process, applicants may use their Family Development Credential or successful completion of any version of PEP training to satisfy the core training requirement. After this ‘grandfathering’ period, PEP Basic Training will be required.

21. Improving Children’s Mental Health Through Parent Empowerment 21

22. Parent Empowerment Program (PEP) Training 22 A core requirement for the FPA Credential Developed by researchers and family advocates Designed around core competencies for role of family advocate. Teaches specific framework and strategies with an outcomes focus 40 hours plus 12 consultation calls over 6 months Emphasis on promoting parent-professional partnership and parent empowerment Family advocates report that it helps them focus on empowerment vs. ‘fixing’; on listening to families; and, practicing non-adversarial advocacy.

23. Shared Commitment to Equalityand Partnership 23 PEP is based on a paradigm shift that holds that there can be and should be equality and collaboration between family members and providers in the delivery of service and in training. Jim Rodriguez

24. Modules in 40-hour training 24 PEP Conceptual Framework Listening and Engagement Skills Priority setting Boundary Setting Skills Group management skills Mental Health System Working with Schools

26. The PEP Framework: A Model for Working with Families Parents as Agents of Change Model Principles of Family Support Goal: The overarching framework for PEP brings together what we know from the parent support field and behavioral science, and combines them into a strategy for helping parents. 26 26

27. Model of Change 27

28. Principles of Family Support 28 Family-Driven * Youth-Guided * Culturally Competent

31. COMMUNITY PROVIDERS: Lack expertise, resources, already high caseloads, safety concerns OMH: Wants shorter LOS based on research demonstrating positive outcomes 1 p RESIDENTIAL PROVIDER: Can’t do it all by themselves; concern abut recidivism PARENT: Concerned about safety; doesn’t know how to handle child’s behavior POSITIONS CHILD: Just wants to be home, see friends and go to own school POSITIVE OUTCOMES OMH Parent/ Caregiver Provider Child Shorter Lengths of Stay (LOS) 31

32. RESIDENTIAL PROVIDER: • Wants a successful, fully-funded program. 2 • PARENT: • Wants their child to have the skills to be successful. p INTERESTS POSITIVE OUTCOMES Shorter Lengths of Stay (LOS) 32

33. RESIDENTIAL PROVIDER: • Wants a successful, fully-funded program. 3 • PARENT: • Wants their child to have the skills to be successful. INTERESTS Family Peer Advocate Parent Provider POSITIVE OUTCOMES 33

34. Engaging Parents: Objectives Develop an appreciation for obstacles parents face in getting help Provide a framework and strategies for engaging vulnerable families Integrate strategies and practice communication skills to engage families

35. Steps to Engage and Empower Parents 35 Clarify your role What can parents expect? Clarify need What do you think your child needs? What are the benefits of addressing the need? Increase parent investment and efficacy Give them credit for taking the step to come in. Strengthen their sense of self, by showing your belief that they can take the necessary next steps, one by one, and when the time is right

36. Continued…. 36 Identify potential obstacles (e.g. personal and concrete) How do you feel about this? Do you have any concerns? Will child care, time or transportation be a problem? Previous experience with systems of care? What do others think? ADDRESS BARRIERS!!!

37. PEP in Action in Suffolk County, Long Island

38. Family Advocates: Essential Members of Our Team: • Family Support Services Program • Home & Community Based Services Waiver Program • CIRCLE Family Based Treatment Program • Setauket Community Residence • Dix Hills Community Residence 10 -13 Family Advocates (FTEs) Some Pederson-Krag employees; others contracted

40. Buy-in of Partnership Approach At All Levels • Family • Advocate • Staff • Program Leadership • Administration • Ideally – The System of Care PEP Strategies more powerful if Family Support Principles practiced by all staff at all levels.

41. Mutual Interest = Families remaining together. Children functioning in their homes, schools, and communities. INTERESTS Family Peer Advocate Parent Provider POSITIVE OUTCOMES

42. Key to Success in Achieving Mutual Interests: Families & Providers as Partners in Care • Families, youth and staff share decision making and responsibility for outcomes Collaborative Service Planning • Families and youth share in program development Family Bonds Advisory Board WAVE Youth Leadership Organization • Peer Support Activities Family-Led Support Groups, LI Coalition Events • Cultural Competence/Sensitivity Trainings • New Relationships Project Adventure, Family Bonds Annual Retreat

43. Family Bonds Team

44. Organizational Culture Shift Family Advocates Training of Staff • Family Engagement (McKay) • Family Support Principles/Family Driven Care • Parent Empowerment (Brickman) • Family Development (Cornell Cooperative) Parent Advisory Board Mission Statement “To create a platform for encouragement, healing, and hope for the future while empowering parents (ourselves and others) to collaborate with Pederson Krag on policies and procedures affecting our children” Family Directed Support Groups – Families as Experts

45. Add pictures of camp

46. Family Advocate: A Unique Role • Have walked in similar shoes – empathy and hope • Demonstrate that families have expertise • Address Barriers to access through engagement • Mitigate provider historical perspective of resistance and family dysfunction – focus on strengths • See parent as agent of change: knowledge & skill = power • Active Role throughout all program phases - continuity • Connections to community and larger Family Support Network • Development of families healthy self-reliance

47. PEP Training Provides • Knowledge • Research-based strategies • Strategies to put values into practice • Strategies to get to outcomes • Role definition

48. Transforming Family Support Practice: PEP Skills in Action • Her interactions with the parents are more partnering, empowering, supporting…she is more of an active listener…assisting the parents in coming up with their own ideas or solutions to the challenges at hand. • PEP assisted her in being more mindful of the cultural differences often faced when providing support for families…. • Training has assisted her in providing parents a “cost-benefit” analysis in terms of strategies in managing her child’s behavior. • Principles of Family Support • Active Listening • Priority Setting • Problem-solving • Cultural Competence • Setting Priorities • Developing Action Plan • PAC Model

49. Transforming Family Support Practice • More goal oriented but still provide the emotional support parents need – someone to vent to. • Take a more active role in modeling (through role-play) effective behavior for the parents [with professionals] • Family Support workers have the ability to truly empathize with the parents as well as understand and work through the parents’ concerns…in some cases, parents that were ‘unwilling’ to give up waiver services, fearful at the thought of not having Waiver in their lives are willing to transfer to other services. • Parents as Agents of Change Model • Active Listening • Engagement • Role Rehearsals • Strategies to Empower • Self Advocacy

50. The Smith Family • 9 year old girl in FBT with a diagnosis of mood disorder, NOS, a history of psychosis and ADHD. Five prior hospitalizations in the year prior to admission into FBT. Her 8 year old brother has a diagnosis of Bipolar Disorder. They are cared for by their grandmother who has very few social supports. • She was referred because of aggression toward her grandmother and brother, property destruction, suicidal ideation and gestures and anxiety among other things.