National Association of State Mental Health Program Directors



[Please stand by for realtime captions.] >> [Please stand by for realtime captions.] >> Good afternoon and welcome to our webinar today titled Group Reminiscence for Older Adults with Serious Mental Illness (SMI) by Elder Peers . This is sponsored by SAMHSA developed under the TA coalition contract and presented by the national coalition for mental health recovery. I am Kelle Masten from the national Association of State mental health program directors and I would like to thank you all for joining us today. Before we introduce today's presenters I would like to go over if you housekeeping items. Today's webinar is being recorded in the recording along with the PowerPoint presentation slides will be available on the website nasmhpd audio is through the computer speakers with no need to connect to the phone. If you're having any technical difficulties during this webinar please type your comment in the Q&A pod on the right-hand side of your screen and someone will be able to assist you. Please also type your questions for the presenters in the Q&A pod and at the end of the presentation we will ask as many as we can. The PowerPoint slides are available at the top of the screen where it says PowerPoint presentation for you to download at your convenience. We ask that you take a few months moments to complete the survey at the end of the webinar to give us feedback. Please know that we do not offer CEU credits but we will send you a letter of attendance upon request. My email address will be available at the top of the screen during the evaluation. I would like to thank SAMHSA to allow us to share this information with you today and again thank you for joining us. I will now turn it over to today's moderator, Dr. Daniel Fisher, president of the National Coalition for Mental Health Recovery and a professor at University of Massachusetts, Department of psychiatry who will introduce today's presenters. Thank you very much , Kelle, and welcome everyone who is attending. I will introduce our presenters. The first presenter will be Cynthia Zubritsky and she is the director of policy research for the center for mental health policy and services research at the University of Pennsylvania. With extensive experience in management and organizational services issues in integrating primary care, behavioral healthcare and aging systems and she is a leader in this field and has set up the program that she will talk about, development of peer specialist to work with older adults. I also asked Cindy what motivated her to get involved and she said that she realized when she first started working in the field of mental health that there is very few people working with older adults and she felt that there were a really big needed professionals were not being trained to work with older adults and she could see that peers, people with lived experiences had a good capacity to connect and to meet a lot of the needs of elder adults so she started training peers to work with older adults. Our second presenter is Rob Walker from the same state that I'm in Massachusetts and he is with the Department of mental health office of recovery and empowerment , responsible for providing a bridge from the department to provider agencies, persons receiving services, family members and the community at large. Is a person with lived experience of mental health diagnosis which informs all areas of his work. I also asked Rob and you can get much more details and bayous on our website but I asked Rob what motivated him. He said first of all, he's an older adult himself, although 61 does not sound that old to me and he loved hearing his parents stories and he was motivated by Cynthia's work and why I said why peers and he said, peers have the capacity to meet the need for social connection that often clinics don't have the time for or sometimes even the ability to meet fundamental needs to overcome loneliness and isolation which is a big part of older adults. Cynthia, do you want to take it from here? I will. Thank you for that nice introduction. I am going to talk about two things today. I will talk about group Reminiscence therapy and then I am going to talk about the certified older adult peer specialist program and the reason I will talk about that is this really terrific people to deliver group Reminiscence therapy to older adults. I don't think I need to read the disclaimer, it is there [ Disclaimer ] >> So what is Reminiscence therapy? It is not a therapy if you work with older adults you probably have not heard much about reminiscence therapy. It is one of the nonpharmacological intervention and sometimes you find it listed as a psychosocial intervention but it's a way to work with older adults that improves self-esteem. It gives older adults a sense of fulfillment and comfort and provide a way to maintain intimacy because intimacy is something that most humans seek and with older adults it is difficult and there often living alone and isolated or if they are at a residential facility and have the men shot, they feel separated from those around them because of the dementia. Sometimes reminiscing therapy is called people use it with anyone who has therapy problems. People with Parkinson's disease, with Huntington's disease, sometimes there is memory issues with those two that these as well. Even though it is a reminiscing event in your talking about things that happened in the past, the connection of the current discussion is really helpful for people with dementia , to put themselves in the present time. Reminiscence therapy can be done in a lot of different ways and it can be formal, informal, one-on-one or in a group. It can be done by a CNA, by activity therapists, they can be done by just about anyone who touches older adults on a regular basis in their lives. It should occur at least once a week to have a real effect on older adult but if it does not it can be happening sort of through today by different people were touching the older adult as they help them. Reminiscence therapy is sharing memories from the past and we all know if you're over the age of like, 15, short-term memory sometimes goes it's difficult to hold onto but older memories are much easier to access. Reminiscence therapy helps people look towards the past and recall those memories and that behavior in that activity does not happen unless someone usually pursues it. The goal of reminiscence therapy is to help seniors feel valued, contented, and peaceful. It does not stop or reverse dementia but the stress of having dementia and living in a residential facility are being isolated, it does help reduce that stress and it captures and builds on positive dealings. That older adults fields during reminiscence and minimize challenging behavior that can escalate in a group setting. So what are some of the tools? You really need good listening skills and good questioning skills. It can occur and take place anytime during older adults day and I think if someone is in a facility it is so important to work with those who do daily activities like meals, home visits, preparation for bed, bath or shower times and exercise. It's important to work with the folks that deliver those interventions to understand Reminiscence therapy and take advantage of times when it occurs naturally during the day that they spent together with older adults. The keys are to have active listening skills and that's something that peers are taught in their certification program and try to respond positively to the individual and also allow time for silence because sometimes a lot of talking agitates the older adult especially if they have dementia. The bidirectional impact of sharing lived experience in Reminiscence therapy is something that older peers in older adult peers are naturals at so it is that shared lived experience, shared culture that helps or lower older adult feel listened to and more positive. Some examples are open-ended questions about like, how are you getting along today? I enjoy eating lunch. Do you want to have a favorite meal time? A question that has a correct answer that often will agitate someone with dementia they will shut down pretty quickly. Instead of saying what did you have for lunch today? For which there is an expected answer you would say I enjoy eating lunch to , do you have a favorite meal time or a favorite meal? Is important that people train to have these kind of interventions because I'm not sure there's always the natural way of conversing for everyone to be open ended. One of the things to keep in mind is that you really want to know a person's personal history before you begin any Reminiscence therapy because as we all know, a lot of folks have had, in their past and may have some negative memories that you probably do not want to bring to the forefront. It is important to understand what triggers would be for someone to avoid those triggers and we don't want people to avoid Reminiscence therapy because it might have a bad effect on them and you must be able to redirect be able to redirect them when you talk to them and it might elicit unpleasant memories. That's a skill people need to learn before they really begin reminiscence therapy so how is reminiscence different from remembering. It is very different. It is first to the points I just made when you ask someone to remember something specific that very stress inducing. If you say where did you go to high school? What was your favorite subject, who was your best friend? Older adults with dementia awful often cannot come up with those answers and they would shut down. Remembering has to be something that floats up while you're having a conversation with someone. Maybe her eating a meal together and you say I'm really enjoying these cookies for dessert and an older adults with dementia may say you know what, my mom used to make a really good cookies and that's your opportunity to build on that memory and encouraged them to remember or reminisce about their past. Some of the things we should keep in mind that short-term memory goes pretty quickly as we get older. We experience people with dementia really short-term memory is tough for the. Sometimes that's called working memory and the reason it's called working memory is that that short-term memory which is in the frontal lobe of your brain that is the thing that coordinate facts for you and tells you what's happening in the here and now. Those memories are stored amazingly for about one minute so that is not something that you can draw on very easily and in that one minute, your prefrontal lobe can store about seven issues and then it's done. It is maxed out. So while it is good to have those short-term memories, it is not something that three years later you really can access very easily. Moving forward, let's think about -- what are some of the activities that occur when you reminisce. These are activities really was people can talk about pretty easily. We think about things like music, and then we think about visual things like pictures and keepsakes. We can think about smells and tastes and tactile activities. Music is a very very powerful intervention with older adults with dementia and there's lots of videos and there is research that demonstrates that people who may not be conversing at all will respond to music especially music from the past. If any of you have not seen a short video called alive inside I would encourage you to Google that and watch it because it is very moving. It's a man who does not begin pretty much sit still all day and when they play music from his past, he literally comes alive and is able to interact with the person talking and is able to sing. Music is very very important. Pictures and keepsakes that bring back memories are a great way to initiate some Reminiscence therapy. It is helpful if the person is not living in a home with the family or caregiver and it's helpful to ask them to bring in things to a residential facility that you can use the stimulate memories and have people share those memories with you. One of the things to keep in mind is if you have dementia or you have serious mental illness or a combination, you are probably not going to be successful at a lot of your daily activities. This is something that everyone can be successful at. We know the importance of success in life, it's a really really critical intervention to use for people that are not having many wins in their day. Smell and taste I think all of us when we smell a warm cookie have some pretty good memories. A lot of facilities have methods for older adults to work in the kitchen or to cook and once again, this is an activity that most folks respond very positively to. And then there are tactile activities like painting, pottery, or crafts that people can talk about wants to become involved in doing the activity. What are some of the benefits that we have from Reminiscence therapy? It works well with other therapies so someone could be having other kinds of interventions, behavioral or you can do Reminiscence therapy that fits very well and you can partner with other therapies. We see improved mood and behavior. We see increased cognition so that people, that cognition increase last and has an effect for a couple of hours beyond the Reminiscence therapy so that's really good. We see reduced strain on the caregiver which is really helpful because most caregivers have a lot of stress and deal with a lot of depression and anxieties. Increased confidence in the older adults, reduction in depressive symptoms, we see a better connection to others and we see increased self-worth. That research is all out there and you can find it and it's a therapy that is pretty effective no matter what the setting is. You must always keep in mind like any therapy or intervention that they have the right to refuse and interact with you at this level so if someone is very silent somebody is agitated you need to back off and maybe try again in a few days. So now I want to talk about certified older adult peer specialist in Reminiscence therapy. One of the reasons why we call this COAPS and one of the reasons why COAPS is so good at delivering Reminiscence therapy is that they have shared lived experience. That effective interventions of the mental health nature in recovery coaches who work with people with addiction and it's also really effective in working with older adults with dementia with serious mental illness. COAPS are older adults and you have to be at least 50 to be a certified COAPS so we find COAPS are less likely to seek treatment so this is a nontraditional way to provide treatment for people who also have the same shared lived experience as older adults have. We know that COAPS are more effective and engaging older adults than traditional professionals and we don't that COAPS provide help empowerment choice and connectedness. Isolation is one of the biggest problems for older adults with or without mental illness, addiction issues, just lots of social isolation and it is rampant as people age. So COAPS must be a certified peer specialist and they know how to work with the real health disorders and we use older adults peer specialists to work in many different ways and so far we have seen them more effectively in a crisis situation and we actually have an we have a program in Pennsylvania between the Department of aging and the office of mental health and substance use that if an older adult is in mental health crisis or if it partnered aging and people are going to go out to find out if that older adult needs something, a COAPS person is a member of that team and that's the person that the older adult is probably going to talk to and feel calm by the event the maybe the person is to leave the home or they need to connect them with one of their siblings or their children but we see a reduction in in resistance and better understanding of what have is happening when we use a COAPS on that crisis team. So they helped him develop natural support and they work with the health navigator in the make Dr. visit and they helped him ask questions a need to ask and dealing with medication and work with them to ensure that they're not overmedicating or taking things that they should not be taking at the same time. They also do individual advocacy, self-improvement, and Reminiscence therapy. They also help older adults in improve new networks. That could be a new network of other people in a residential facility in an apartment complex and COAPS are really effective in developing and delivering wellness curricula and developing relationships for older adults in apartments, senior apartments. We have been having a lot of effective programs here in Philadelphia and we call them senior high-rises. Peer support and COAPS is based on the premise with mutuality which is really important with older adults. I just did a training in Mexico with a wonderful group of older adult and we talked about mutuality and why that's important but this group across many different sectors, across older adults, they cross addiction, people with addiction , they cross people who are Native Americans so cultural issues that we can address , these are all pieces of a whole that are sometimes lost in traditional mental health and recovery services. COAPS tend to share their life stories with older adults as part of their recovery intervention which establishes a really nice baseline and affect for asking the older adult to reminisce about their lives as well. COAPS have bidirectional outcomes which means those people who work as COAPS have positive outcomes as a result of being COAPS as well as the people they work with. They share the benefit of the work and they work with older adults including self-esteem and self-awareness are some of the clear outcomes that we see as a result of your services and there are some listed here. These are from COAPS work with older adult and they know they're not alone in the process in recovery and they can see how their uniquely useful to the field and the final one which is really reflecting on the reminiscence intervention. Making connections with people and actively listening to their stories. That has been the foundation of that person's recovery. This is a slide that shows what COAPS like best about their current job . About 90% of COAPS are employed either part-time or full-time and you will see that they indicate things like helping people, sharing experiences, team progress being made by the people they are working with and advocating for peers and with peers are key outcomes for their job. You will see on the left of this slide has your own recovery been impacted? Personal responsibility, sobriety, empowerment, wellness, sense of per is. These are the things that not only the COAPS experiences as a result of working with older adults but these are things that the older adults themselves have also talked about gaining as a result of working with COAPS and peers. This last slide, there is two of them, this is a photo of a COAPS class and this group of folks are currently working which is so interesting -- not all of them -- but they are one of the first experienced using COAPS and skilled nursing care and two of these individuals started providing COAPS services in a nursing home and within two months there were 60 more requests for COAPS services . Clearly we don't have that many COAPS to provide that much service but clearly this is a service that older adults value and would like to have . This is who we are , the COAPS Institute Pennat and you can learn a lot about COAPS at this website. You can learn about how to become a COAPS , who teaches COAPS classes and we have blogs and information about working with older adult behavioral health. With that , I will turn this over to Rob and he is an external consumer liaison . Talking about working with COAPS in the field and in the community. Thank you, Cynthia. That was a great introduction to COAPS and first, I wanted to go over a little bit about the Massachusetts experience . About four years ago I was part of the Massachusetts Elder mental health collaborative and I was thinking that peers would be a great way to work with older adult that a lot of the issues with older adults or many of the issues with older adults are centered around loneliness, and isolation and as Cynthia explained the peers have a real advantage over overcoming that in the ability to do that in their jobs. We contacted and they gave us the technical assistance grant to SAMHSA to hire Cynthia to come and train 20 of us in certified older adult and that really started the ball rolling. Right now there is about 120 COAPS trained in Massachusetts and that number is increasing every year. COAPS are now as of January approved in the home and community based Medicaid waiver for the first time they are covered by Medicaid for people who are nursing home eligible. Interestingly enough , which I think is great for this webinar, most of the COAPS people we've had in the COAPS training class work for mental health providers, regular mental health serving people in the public mental health system and we found that and they found that a lot of the people in or the number of people in the public mental health system are aging and the peer specialist in the group are kind of at a loss on how to especially serve people who are aging in this system. Right now we have a lot of them on our teams and our community services and in the public mental health hospitals. They are trained of COAPS. Cynthia talked about Reminiscence therapy and I have one anecdote. For those of you who have worked in this system or have been served by the system no in-state hospitals one of the tradition is to have a morning check in group and to see how everybody is doing. Mostly a lot of times it's just going through the motions and there is not a lot of participation so one of the nurses at one of our hospitals decided to shake it up a little in the morning check in group and instead of asking people what their names are, she asked people to talk about their favorite pizza and that ended up being an hour-long check-in group which I think is the world record for check in groups. An hour-long check-in group of people talking about their favorite pizza and recalling back their childhood about pizza and where they had their best pizza and a simple question like that really brought people out and people that would not normally connect in that could not participate at all in any of the activities all of a sudden got cute and I think she had to end the group before they were ready because they were running out of time. Reminiscing works on a small scale and a larger scale. One of the coolest applications I heard about and I talked with vets is a program at the VA called my life, my story in the Boston to be a has instituted that program. In some ways it's very simple but it makes a huge difference. It is veterans are interviewed about their life story and about 1000 words first-person narrative is written up based on the interviews . This is 600 stories have been collected in the Boston VA and 3000 nationwide . It's structured interviews but I think they are mostly all it takes is one or two questions to open up the floodgates about people reminiscing about their life and in Boston it has been very advantageous because it has been two way . In Boston there is a lot of medical schools and a lot of other health training and they have a lot of interns coming through the VA. And they are not necessarily veterans and don't know a lot about the veteran experience so one of the two way benefit is that the student interns get to learn about what services and what the life of a veteran is like as well as the veteran getting to tell their story. This is one thing we tried to do with peer specialists as well is that it allows people to get to know the individual as a person or in the case in the mental health system the person has a person rather than a diagnosis. As part of this my life my story the person taking the story which sometimes is a peer specialist writes up the story and gets the veteran to look over the story and once the veteran okays it it gets entered into the clinical records so now any other provider can get to know the person as a person rather than just the standard lab values and I have heard stories that some of this is so powerful that the medical students that go through , one of them interviewed said I always wait until the late afternoon to lead the narrative of the people I'm working with in the VA because that allows me a time to cry without anybody seeing me in there so moved by the stories. And it also helps veterans and people served get in touch with their past and help develop meaning and mission in life and what has been important to them . I can picture this as part of our regular psychiatric care in the system that somebody times in psychiatric care and older adults because of time constraints we are reduced to what are symptoms are and not what the story is and what the experience is so I really see something like my life, my story being part of every regular interview . Another more lighthearted I guess activity that really invokes this Reminiscence therapy helps people get in touch with their own stories. I call them reminiscent balls. This ball is commercially available but you can also make your own so I will tell some stories. If you look on your screen each panel pictured being a soccer ball has a statement like best concert, best place to live, favorite movie actors, best vacation , favorite food , favorite school he went to. What we do is with that ball we get in the group and people toss the ball to each other and whatever question is or whoever catches it whatever question is under your left thumb is one that you need to answer like worst job ever in people who with discuss where caught the ball and they would discuss with the worst job was and as we find this it's a great way to stimulate conversation and unlock the memories of people who work with in the state hospital in other communities settings and in senior centers and sort of an extra added bonus is it stimulates people physical movement as well as their mental acuity and therefore state a little bit of movement with catching and coordination and also helps people with memory reminiscing about those times and usually months somebody catches it and answer the question it usually ends up like a 10 minute answer like I remember my worst job ever I was working at a sandwich place and somebody walked in and it overflowed and we get the longest answers to those questions. When we did this with Cynthia on the great news is you could buy beach balls at the dollar store and sharpie markers and you could make your own reminiscent ball . In other classes I taught on COAPS you can customize it to the generation you're working with or even the [Indiscernible] if you want to get that detailed. I find it very useful and very helpful for reminiscing. Some of the places that we have peers deployed who happened to be COAPS is they use some of these tools things like community based mental health settings, clinics and other community groups. Clubhouses, Massachusetts has a number of clubhouses and they found that there's a number of aging clubhouse numbers with serious emphasis in mental illness that that want more programming besides just the important part of the employment and education and there's also activities that are directed towards older adults. We now have COAPS in a couple of acute-care geriatric inpatient settings where it is a mix of people with dementia related illnesses and with serious and persistent mental illness but these activities work great with both groups. Cynthia mentioned public housing and senior centers and also we have COAPS in nursing homes and I think our next sort of frontier to hopefully push the envelope is getting COAPS involved in the regular medical clinic and medical care . I think that's all part of my conversation and hopefully I can open up this to conversation and questions from the audience. Dan or Kelle ? >> Thank you, Rob. We will ask anyone who has any questions , please contact your question in the Q&A pod and Dr. Dan Fisher will ask the questions out loud. Can you hear me? One question has been raised and we have peer supports that are ready have DIPSS training . Would they also need to do the full COAPS training , that's a question for you, Cynthia but maybe for Ron as well. >> This is Cynthia. Can someone tell me Rob or Dan, do you know what CIPSS training is? Looks like peer specialist training. Intentional. The answer is yes. You have to have some kind of certification as a peer specialist prior to this training and generally we talk with people from different programs to ensure that folks have basic knowledge they need because we don't want to train a basic peer specialist. There's lots of experts out there were doing a great job and we want to focus on older adults. Think the answer is yes. You have to do the whole training? Yes. It is three days long and it's a full 18 hours and yes, you have to do the full training and I do not want to talk too much about COAPS. Actually COAPS is taught and facilitated by peers in the materials we use have been written and reviewed by peers and it's taught by peers so this is the peer effort. Rob, do you want to comment on that? I would just add that in Massachusetts I wish it was five days. It is only three days but there's so much more to learn so we're working on some continuing education efforts because the education does not end after three days but in Massachusetts we encourage both certified peer specialist and certified recovery coaches to join the training because we found there is not a lot of services available for older adult who have substance use disorders. We encourage both recovery coaches and certified peer specialist to apply. >> Is there a train the trainer program? Yes. It's a 2 or 3 day training and we ask that you are trained as a COAPS and have worked for at least one year and then you have to apply to become a facilitator and we usually train 3 to 4 facilitators in a state and then they are able to do COAPS training through their state. Rob is a COAPS facilitator. We have about five or six people trained as COAPS facilitators in Massachusetts. And we are doing a training next week so we still have room if anybody wants to come. There is another question . Heavy had to address issues of liability with COAPS even though they're not medical providers? I cannot speak for Massachusetts. We have not and I think that's because COAPS is within the purview of either the behavioral health system or the aging system. COAPS are not independent contractors in Massachusetts so their covered under the agency they work for as an umbrella policy. Good question. Do you train people in California? We will come train you in California. Call us. We want to come in the winter though. I missed with COAPS designates. It stands for certified older adult peer specialist. >> The certification actually is or the state of Pennsylvania certification board so it is a real certification and you get a certificate from the University of Pennsylvania because that's where we sit and for the training Institute. >> What steps would you recommend that clinicians or student clinicians take to be able to practice Reminiscence therapy. If you're a student somewhere you need to ask the faculty was going to be teaching that. Secondly, there will be a great continuing education training that we should be offering for CPS as well as students. Rob, what do you think? I also think there is a great book out and I think she has two books now called narrative medicine and it is more generalizable than just with people with psychiatric challenges but if you look it up on Amazon it is there but I cannot multitask right now but there is two grade books written about narrative medicine. Also connections between narrative and narrative therapy and reminiscent therapy . The narrative medicine maybe speaks to more of what we do as a peer specialist. The author is Rita Charon but it's about knowing people as persons and it is joining the patient in their illness recognizing people's journeys and sort of walking with people through their challenges so I think that speaks to what COAPS do. >> Do you offer certification for trainers to provide this training? That was what I was wondering. People to become trainers more than facilitators. We consider a facilitator a trainer and yes, you are certified through the COAPS Institute at Penn. And then you can train others . And you should have that in the state. You need that in-state expertise . You would do a three day training to become a COAPS practitioner and then another three days to be a facilitator and you can also be a trainer. Six days to become a trainer. The facilitator training is two days so COAPS . >> Is there a plan to [Indiscernible] specialist training is larger VA medical facilities? That's a great question. We've had a conversation with the VA programs and we talk about how it will be great to collaborate and it has not happened yet. Not for any particular reason but we would love to do that. We have a lot of veterans that are COAPS and we talked about doing targeted COAPS delivery of group services with Reminiscence therapy and other kinds of therapies for veterans in the community in addition to whatever VA offers and we would really like to do that . If anyone can help us figure out how to move that forward that would be terrific per >> We are working with the local Massachusetts VA to encourage people and peers who are on staff at the VA to attend and in our VA in Bedford , Massachusetts we have a private public partnership for housing so right on the grounds of the VA there is housing for older adults and veterans and we have one COAPS who is a resident and a COAPS there and another veteran who conducts groups at the housing. It is starting off quietly and moving from there. Another interesting venue for COAPS is the district attorney's office here got in touch with me and said we hear you do this thing with older adults in behavioral health and they have people coming out of corrections who have been there maybe 20 years or so and when they went they were 30 amended come out the world looks really really different and they no longer connect to the community and the things they were trained in for jobs are not meaningful anymore so we are trying to figure out a special initiative for COAPS working with seniors in corrections and transitioning back to the community so that's very exciting. In Massachusetts have been a particular agency especially services that have been open to the idea of COAPS and he will be a wonderful resource to have and ones that are not able to meet the consumer patient demands. Not formally but Massachusetts is going through a huge or has gone through a huge change in how Medicaid what we call mass help is offered and is now through accountable care organizations and behavioral health community partners and it is a capitated rate so there is nothing in the rate structure that disallows providers to offer older adult peer support as part of their service are a. I think that's going to be in the near future and we are in the redesign of the patient behavior health system in Massachusetts so I would imagine that will be a recommendation and issues we have with older adults with mental health concerns is they are unwilling or unable to come to clinics or to physically go and see a geriatric psychiatrist so I think COAPS and other methods of telemedicine are the way to go to reach people in their homes were not able to drive to the outpatient clinic. Interestingly the COAPS training with it last week in New Mexico , one of the COAPS that attended does telemedicine in New Mexico so I was really pleased for that connection and he said he works with older adults. We did with one of your colleagues a peer delivered app called peer tech and we tested it with older adult peer specialist and for lack of a better word homebound Elder older adults to see how receptive they would be to using technology which they caught on and it was really a hybrid egg peer guided use of an application where the older adult met with the peer and the older adult peer specialist once a week and then they texted in the meantime between the next visit and there was online tutorials about stress management and management with their physical illness and we had very great results from the. And we are planning some bigger follow-up studies. Rob, you had significant findings and reduction of depression symptoms. And better diabetes control. That's another thing about older adults at the have co-occurring physical and mental health disorders and we found that you really need to attach those at the same time. Not one separately from the other. When mental health gets better and vice versa. One of the participants would like to know how to connect with you and veteran in Alexandria and the contact information , Kelle . Is in the webinar window. Webinar notes window. Can everyone see that Yes. And I would like to say that we have an attendee list after the webinar so I'm happy to share Gregory's information with Cynthia and Robert as well. I'm responsible for peer services in Louisiana. I'm interested in receiving more information on housing as well as the certification of facilitators. Excuse me, on hosting a training as well as the certification of facilitators. Ricardo wants to do a training. Train the trainer. I have a question. A lot of times older adults and people get kind of irritated and they tell the same stories over and over. Seems like part of this is reframing telling the same story over and reframing that is reminiscent in Reminiscence therapy and it has a healing effect. It seems like some of us it may be an attitudinal shift on the part people. Sure. I think what they found at the VA is that people tell the story about until they see it written down or read back to them they don't see a thread. They don't find the meaning until they hear it even though it's written in the first-person and until they hear their own story coming him a third party so I think that really helps people find the purpose and meaning in their mind and what they begin to talk about make my team a random. I think one of the things to remember is that Reminiscence therapy is different from remembering. Remembering is giving the facts about your life and how old you are and where you grew up and where you went to school and there relatively boring part of your life but that's what people keep repeating to clinician and therapists and nurses and they tell them that story that they have. Reminiscing is more evocative. It's reminiscences cookies make me think about my mother when I was in grade school and I was such a happy child and I did well in school and does very different from saying I went to the Philadelphia school number 45. So reminiscing is more evocative and because of that emotions and self-esteem, control , all of those personal dignity issues are elicited as opposed to just telling the facts about your life. That's a good distinction and I imagine in the relationship that is formed between the peer and the person reminiscing is very important in helping the person who is reminiscing go to that deeper level and away. And that interest is shown in the person themselves rather than just their fax of your life. Exactly. One of the important human goals is to be [Indiscernible] in the world and once your past a certain age and you're not out in the world anymore you don't feel like you're very known in Reminiscence therapy really addresses those issues. I was thinking another sort of connection is older adult peer specialist to older adult that people are peers and in many different ways not just a shared mental health diagnoses. Also people can be peers in age and I tell this story about it has a point. Right now I have a therapist psychiatrist is in training so he's about 26 years old and I have to spend half of my therapy time explaining my cultural references with TV and movies and explaining some of my stories like no, I do not have an iPhone when I was in high school but somehow is very helpful to have somebody near your own generation does share stories because the there is a generational understanding . And it affirms you , that affirms your worth as a person. In passing it seems like this lends itself to connecting older adults with other adults in a group so they can start to just be natural peers for each other and that may overcome some of the isolation and some of the loneliness so they might even want to see each other and talk to each other later. This is seen as a helpful effective group. >> Absolutely. I know that for some reason that made me think about the groups we have done in apartment, senior apartments and we would have people in their friend as well as groups so you're not going to the mental health group so no one would come to that group. But I'm thinking personally that's some of that was in her apartment for two years and never left and she was talking because the COAPS went door-to-door and introduced themselves and they come down and we have cookies and she actually came in at the end of the 10 week series where they talked about wellness depression a lot of other things she actually went to the local market and bought flowers and planted them around the apartment building and engaged the other folks were in the group with her to do that activity so she took the activity and build out from there and improved her isolation and improved depression symptoms so that was a lovely success stories. Reminds me of a group I did a cooking group and elderly housing and downtown Boston and we would engage people by taking a meal to the room and luckily those cases like the cooking and it would say come on down and help us cook and people only spoke Chinese and one housing but they sure could cook and they engaged in the activity without being able to really converse verbally so sometimes these activities can really bring people alive. I don't know if there's any more questions that people have. I think I will turn it over to Kelle who I think has feedback from the attendees. I would like to thank Robin Cynthia for presenting and Dan, thank you for moderating and we will switch to screen for a short evaluation now and ask that you all take some time to fill that out for us and we will also add the presenters contact information here as well for you to have in case you would like it and please take a few moments to fill out the evaluation and would like to thank SAMHSA again for allowing us to share this information with you and we are happy to give you back about 20 minutes of your day so thank you for joining us and enjoy the rest of your afternoon.'s back Thank you everyone. [Event concluded] >> ................
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