 I think I just said that. So what we'll do to start, and welcome everybody, thank you for being here, and this exciting news. I mean, we're going to open with Invo and Michael. And so if you want to say a few words about it. Welcome, everyone. I feel like my heart would be like, wow. This is all of you here. County, from all around the community. I'll take nails from all around. So many community agencies, community members. If I forgot anyone, just welcome. It's just really amazing. Thank you so much for being here. So as we make a transition into this presentation, we are in Congress, and at Second Story, we've been intervening more and more mindfulness awareness practices to support us to do a better job in everything we do. In the way we are with ourselves, and the way we manage our own stress, in the way we are with the people we serve, in the way we are with the people we partner with. It's very simple. So if you have any anxiety about it, please play it. So we're just making a transition in order to be able to be here, whom it's present, to open our minds and hearts to the experience ahead, and to support each other in this wonderful journey that never comes. So the invitation right now is just to find a comfortable way to be on the chair. Each chair has its own way to make peace with it. And in this episode, and actually hoping for the next couple of hours, if you can put your device on the most disturbing task, at least the same task. If you turn it off all the way, be one little better. And the chair, if you're comfortable for the next two minutes, closing your eyes, if you don't just find a way to bring your gaze inwards, just to allow yourself to check in with how are you doing right now at this moment. Taking a moment, ask yourself, how are we doing physically? Noticing your physical body, because any tension in your world that you can let go. Checking in about what is on your mind right now. You might already have been very busy this morning. Just noticing what is there, the to-do list. Just by just checking in, how are you doing? How is your heart doing right now, emotionally? Taking a moment for, taking your own internal weather report, physically and mentally, emotionally, recognizing, welcoming, the whole of who you are, then gradually bringing the awareness to your breath, hopefully you're embracing this whole thing. Just noticing the very natural rhythm of inhalation and exhalation. Just no need to change. Just noticing the exhale, the inhale. And recognizing for this moment how the rest and as we pay attention to it, can be just a wonderful resource to support your well-being. And as we enter the transition into this presentation, we just like to set the intention, keep listening of community building, of hope and inspiration. And again, expressing such deep gratitude for each one of you for being here, and for this wonderful community of support. So as you hold this intention, gradually opening the eyes, back to the room, wriggling toes, fingers. Taking a moment, kind of looking around, and just with your eyes, welcoming another person that you don't know. Seeing if there is someone around who you haven't seen, with your eyes and heart, expanding the well-being. So with that being said, I'd like to turn it over to Edwin. And so we begin again. Does everybody know what second story is? So our program is a, I was thinking of the greatest one line that could be perfect for trying not to make it apply to the greatest degree as possible. But as I could think about it, the one thing that I say second story is and does is, second story brings sanity back to mental health, right? It brings sanity to the kind of insane dimension. And so we try to find balance in what it means to be peers going through this, and to be able to connect with each other. Everybody that works at second story has gone through their own psychological upheaval. And that myself have been hospitalized quite a number of times, depending on how you find quite a number. And so we all have a lived experience. And please, for the people that work at the house, if I leave something out there to signify you, please. I thought I'd say it at some point later as we go into the discussion. So we were funded by a SAMHSA grant. And the grant is now hanging, and now we're going to be looking into funding with the county. And so we work with all kinds of folks, people that are coming from the hospital, people that are coming from places in the campus, and which is also part of what we work with in slideshows. There's part of the team once we work. And so we're at the forefront of the peer-residence movement, I guess, or at least part of the forefront as much as everybody works together. And so we kind of are working in innovative ways of creating new ways of approaching each other, communication, and connection, and finding the meaning of what it is that we're going through, and being able to articulate the intensities, and be able to receive the same intensity back, and be able to find it, you know, argumentally, that we are people that believe in it. And some of the research will show just how impactful we've been on the community in Santa Cruz Pears. And there's not people here today from within the county and from the campus itself that have also seen and been a part of this process of our own transformation. And it's kind of redefining what it is that we're looking for as a community of health, mental health. And so here we are, and we're all in this group together, and it's not even about mental health, peer movement, it's about a movement towards greater moments. Well, all those great words, but even a health movement, because both of them are out here for each other in some way, and we're doing our best to keep taking steps to create greater and broader visions. So I think that I've left out like probably about 99.957% of what I could say, but I also, in my full time, and better than me rambling and pridling on about how great the program is, I think all that people describe it themselves. And so I want to bring Eric Riera up here, who is the mental health director as a Sam Khrushchevni, he'll say a few words about the program, and then we'll hand it to Involnex and then to Bevin, and then what Bevin's done after about 45 minutes of research, and we'll then move into just a general connection with the rest of us about how the program is impacted each of us. Well, thank you, Adrian. And I guess I have to begin by first saying, congratulations, the second story. I've been with the county for about 18 months now, and this program has been really critically important to the community. And I think what you'll hear today is a lot of the evidence of the impact that this program has made in the community. And I'm very excited to see it moving forward and looking for some opportunities to expand it as well. You know, it's one of the themes that you'll be hearing from the county over the next year is the theme of community impact and how we can work together with all of our organizations and stakeholders, consumers, family members in the community to make the biggest impact for the population that we're serving. And second story has really exemplified that community collaboration. One of the big challenges that we've faced, as Adrian mentioned, the program was established through a SAMHSA grant, which is actually expiring. And we had to figure out a way, what are we gonna do now? Funding ends, we have a critical program to the community and we want to sustain it. And fortunately, we were able to work out a long-term sustainability plan for the program. That was just finalized last week. And we are able to successfully move this thing forward. And... Thank you, thank you, thank you, thank you. That was a big word for all of us. In-bottles, chuckling in the corner. Perhaps a few sleepless nights. But we're in a great position now where we don't have to be concerned about the funding and we can look at opportunities to really make a bigger impact on the community. So again, congratulations to second story. Lots of opportunities ahead of us, I think. On a state level, for the first time, we're the state's committed to expanding a peer certification process, which for the first time, will bring in Medi-Cal revenues to support programs just like second story. And what does that mean for us? We can look to expand to other parts of our community. Watsonville, for example, love to have a program done in Watsonville similar to what we have here in Santa Cruz. And so we finally have some opportunities to think beyond what we have today. And very, very excited to work with everyone here to make that a reality. So, hope you enjoy your day here today. And I'm very proud of all of you who've accomplished. Just in case you don't know what second story is, because we haven't really defined it. It's a two-week residential care facility, mental health facility of sorts. And it's a place that people can stay up to two weeks and recover or get through any kind of crisis before it turns into a crisis. That's as overview as I think. We can highlight a community-based organization with its encompass to have a peer respite part of our very wide spectrum of programs. And I had the opportunity for almost the last three years to be the person in the compass that worked directly with second story. And before me, it was Betsy. So glad that you're here. And it's been an amazing journey. And if you're not familiar, which took me some time to really immerse myself in the language and the framework around peer-respite program around the country and where do they fit, you know? Because many, so just kind of going through around it and all the experts are seeing right here. They can say, well, you know, there are some similar programs that operate independently. They're just their own program. They're not associated with another big non-profit or small non-profit, they're just on their own. And then when second story was envisioned, as Jona will tell us later on, for many reasons, mostly logistics and really to make it happen, it seemed like a good idea to have second story attached to an existing community-based organization just to support its day-to-day. So this is how it started, which is unusual in some ways. And there were many conversations about does it need to be independent, does it need to be... What does it mean for it to be part of a traditional existing community mental health? So when I came on board, I was very curious about that. And it's been an amazing learning opportunity to really to understand what it means and more than anything, to really... In some ways, I was reflecting on this. Every day, this relationship with second story, this amazing team that works at second story requires me to question, where are we coming from? How am I... What guides my beliefs about the people we work with? What guides my decision-making processes? How am I in the world as part of a community mental health organization? So I'm just so grateful for this push to look at that. Because as we know, many of us looking around the world just from the color of our hair, we've been around for quite some time, have done this work for some time and we have our habitual patterns about that. And our beliefs that we developed over time and what guides our work. And we are all very enlightened and we keep learning and changing our habits and our habits stay the same. So again, with the interaction with second story the questions that are being asked from a peer perspective has been so enlightened to me. And I just want to highlight few of them. It's been a great opportunity. The whole concept of collaboration and what it really means to collaborate with each other has been, oh, I can look at it very differently. How am I being... How is it like for me to sit in the room and really listen to the other person? And am I really taking their world view into consideration? It's something I keep learning. So that's been a great point about that. When it comes to trauma-informed care I really actually want to express my deep gratitude to second story program because in some way it's so second story that I made the big leap into saying, absolutely, we have to be trauma-informed. And there's no way around that. And the way that the peer movement talks about trauma-informed care and the way they define safety, which is so much... It's different because again, as provider, we have all our guidelines around safety and protocols. And then talking to the staff at second story, it's about, oh, just a second. It's about how it's defined by the person you want this. It's not my definition, this person's definition. Just as an example. When it's come to empowerment and collaboration and then it just, in some way, it's very subtle differences but they're so deep in terms of how we are with each other. So it's been an amazing journey. And so what I want to really promote since we are on TV, if you haven't known that, and so on, and this is more the message to the rest of the country that he's been watching second story very closely because it's been a very pioneering program that is doing things very differently. So there's a lot of learning that you'll learn very soon from that and that is being based on the experience of second story is that there is an amazing benefits from having a pre-run program embedded in a community mental health organization. Because I believe that as a result of this collaboration, there's so much amazing learning that if it was separated, it would never happen. So I just want to have it being on record that this is, I think, a really great successful model just for this reason. So with it being said, I'd like to turn it back to you. Thank you. And so now we've had a four-year research component as well and so it's been Bevin Croft that has been kind of the person that we've given all of our data to. And anyway, I think I'm just going to give it to you right now, so I don't have to say too much. Bevin Croft, I'm a research associate at Human Services Research Institute I have from Cambridge, Massachusetts. I'm here visiting for the week. Human Services Research Institute is a non-profit organization, research organization. We have been working with policy makers, providers, stakeholders on local, state, and national levels to do program planning, evaluation, and research to improve human services systems for close to 30 years. I work on the mental health team at HSRI and I've been very lucky to have, to be the central person focusing on this evaluation since it began in 2011. Also here's my colleague, Lisa Oskra, who started at HSRI with me and now is a Californian and she and I have collaborated on a lot of work on this evaluation in particular and on studying, understanding, and documenting best practices for peer-respected programs nationwide. So today, if I could give you just a few slides on national context to understand where second story sits in the movement and some people have been talking about it, includes peer-respected exploring community-based alternatives to support people who are experiencing or at risk of experiencing or heading towards crisis. I'll say a bit about second story, but a few people have already offered some definitions, maybe all of them on my own. And then spend the bulk of the time describing the evaluation, which is really a work in progress. So it began in 2011. We have been just wrapped up data collection and finishing up a few interviews with some of you along here this week. And then we'll be one year of the data collection. It's still really synthesizing a large volume of information that we've collected over the years. But I do have some selective results. I'll describe some work that we did recently that's completed looking at the first phase, completed looking at the program's impact on inpatient and emergency services and then provide some fresh results from our survey and interview, particularly focusing on the experience of this program, of free guests for the people who stay there. So peer-response in general, our short-term voluntary home-like environment for people who are experiencing or at risk of experiencing some kind of psychological upheaval, self-defined crisis, intense experiences, really the self-defined part is important. As it is throughout this program. And the premise is offering support by people with lived experience, to people with lived experience to either prevent or overcome crisis. And also with a focus on creating connections within the community rather than taking the person out of the community to deal with whatever's happening. And we can understand peer-response in the context of a larger movement towards health and behavioral health systems change. So if we look at in the 90s, the homesteads of all of the Supreme Court and this focus really led, became a mandate to state and county governments to provide services in the least restricted environment for people with all different types of disabilities and challenges. And so really since then, there's been a mandate to stop locking people away and containing people and to support them in the community. And that's been hard and we're still working on it. But we can see this as the beginning of the movement. The substance abuse and mental health services administration, the federal entity, part of the Health and Human Services Department that funded the first few years of the program has really made a lot of positions that support these ideas of serving people in the community. An emphasis on the value of people with lived experience, working within the system at all levels. And the good and modern being of the health system is a paper that we really like getting to Surai that just sort of lays out a real broad array of services in the community that are needed if we're really going to support people with their diverse challenges and lives. And then in general in health care, I think we can look at the World Care Act and health reform and movements in the health field and understand a shift moving away from a focus on illness and disability to a focus on a whole person and recognizing that people are not just disembodied heads and arms and medical problems that really everything is interrelated and if we really want to support people we need to understand a whole person from the holistic perspective. So you see patient-centered medical homes, you see person-centeredness being an aim for major federal agencies across health care and then you see an integration and a move towards treating a person as a whole person and that includes mental health challenges, behavioral health challenges and physical health challenges starting to boil the lines between those. So I think we can really understand your respites in this context of a movement towards thinking more holistically about health and wellness in general. In the past few years, PRFs have been popping up all over the country. There are currently three in California including Santa Cruz, are there more yet? Just three. There'll be more coming. And others, four more I believe concretely plan. But it's important to understand that Santa Cruz really is one of the first and all of these programs know about second story and know about what's happening here in your community and are watching to see what happens. Okay, so I keep all of them quickly past this slide the second story was funded by SAMHSA. Now it's going to be funded through counting funds, isn't it? It's through this community-based organization and help us and really evaluators. All right, so the evaluation was a condition of the SAMHSA grant and we were hired on through that grant process. And it's a pretty broad evaluation. It uses a mix of quantitative and qualitative research methods and it has a focus on outcomes as well as process. So the outcome questions that we sought to answer back in 2011 when this program started was to what extent has this program met its objectives that were stated in the grant and those objectives were to reduce emergency hospitalizations, their virus and cost of services to foster recovery and we can tease apart what that means. And increase meaningful choices for people in the community. On the process side, we wanted to understand how the program was implemented so that we can capture best practices, lessons learned, things to do, things not to do for future programs since there are more coming every day. We also have been seeking to understand the relationship between second story and the rest of that community and that means the provider community in this room, it means the larger community, it means all different stakeholders. What does it mean for Santa Cruz to have the resources in the community as part of the community? We used a number of data sources for the evaluation. Today, I'll focus on the first three, but Lesha and I have been working on a measure to capture fidelity to the pure respite model. So basically, if we're thinking about a pure respite as an evidence-based practice or becoming an evidence-based practice, what we need to understand. I do that so we're starting to try to lay the groundwork for that. I've also attended a number of meetings, virtually in person, visit every year, we've been looking for documents. But primarily, we have been working with an excellent team of data collectors headed by Linda here, who've been, all of whom have identified having lived experience themselves who surveyed guests. All guests are invited to take a survey at the beginning and at the end of their stay. It's a second story to be part of the research study. And then every six months or so, we collected, we sat down with people, talked with people on the phone and had conversations, sort of more qualitative, open-ended conversations to understand the different research questions. And those have been with guests, providers, with a view, team members, et cetera. And finally, we analyzed some of the data I have here at the county that just captures service utilization and some basic demographics. We'll go through the survey, the source is a little bit. The surveys, as I mentioned, were administered by people with experience who were specially trained in research ethics and how to do survey administration. And the survey was collected at baseline, so within 24 hours of entering the program. So ideally, sort of before people were exposed to the second story environment or a couple hours of exposure. Within two days of leaving the program and then for folks who didn't come back to the program within six months, they were also surveyed six months out to see if there were any longer terms in the past. The surveys that we used focused on these areas, there were a number of questions, it was a fairly lengthy survey that was done. And the data that I'll be presenting today constitute the first ever baseline survey and the last ever discharge survey for 101 of the guests. We'll use the second story in this time period. The stakeholder interview, as I mentioned, we ask people a lot of questions, but the central question that I'll be presenting on today is just what is the impact of the program, the lives of the people who refuse it? We ended up doing over the course of the past four years, 23 interviews with 19 guests, so some folks ended up being interviewed more than once. And the way that we identified people for these interviews, we used different methods each time, but we didn't want to just get the happiest customers of the program, we wanted to get more of a diverse perspective on the program. So we sampled, we tried to over-represent people who were dissatisfied on the survey for the program and we also, when we did the services analysis, we identified some folks who had higher levels of inpatient emergency use and second story, who used second story a lot to talk with them. So, and we also focused on people who are younger, so 18 to 18 to 30 range and tried to focus on that group as well. Because, as you all know, that's a good fit. Is that a point, a particular critical point in their involvement with the system and second story? We may have particular benefits for these individuals. We've also spoken with providers. Before this week, conducted six interviews with nine providers and I've been speaking with some of you in this room this week, so that number will go up. We've done individual interviews with team members over the years and then also, as I mentioned, a number of sort of group interviews with the team members. All of these interviews lasted three minutes to an hour and they were audio recorded and transcribed and then we used qualitative research methods, content analysis or framework analysis to organize the material, which ended up being a lot into themes, sort of ideas and clusters and we're still in the process of that. And then the service utilization data, the third part that I'll be presenting today is the county services data. So we collected data on everybody in the system of care, every single person in the system of care from May, 2001 to June, 2013 and we identified the second story group and then for the rest of the people in that data set we used a statistical method called propensaries for matching, which I can explain to you later if you're interested to create a comparison group. And the idea is the comparison group are people who are similar to the people who used second story along the characteristics that we could measure, so demographics, diagnosis and service use history. And the idea there is to try to compare outcomes to apples, try to compare a population of people who are similar and see if there was a difference in the outcome. And in this case the outcome was total hours of inpatient or emergency service use so anything more acute than a second story after the date of first respite stay and for the comparison group we assigned the date of first respite stay matched with the others. So if we're right into the results of those, data I'll just say a little bit about who we're talking about. So between, and these slides are a little different but samples are a little different depending on the data source and of course they're different. But a total of 209 unique individuals used the respite in the three and a half years that it's been open. And this is awesome, it's December. But a lot of those people use the respite more than once. Actually on minority only 40% use the respite only one time. People see an average of three times. So they went back a number of times. And we have some interviews where people are saying, you know, I come back to second story because it works for me. Just keeping that in mind is interesting. A small number of people use the respite a lot of times over 10 times, over the three and a half years. And those are the folks that we were trying to understand more about and we tried to interview some of those folks. Like the stay also varied. Typically I like to say it is two weeks. The average like the stay was 10 days, seven people. For various reasons there were exceptions made and the range was from one to 52 days. In order to be part of the studying, the person had to stay for more than 24 hours. If a person stayed for less than 24 hours, they weren't included in the study. The average age of respite users, and this is from the county information, so it's a little fewer because it's what we had in the time period that it felt since June of last year. The average is at 44, the majority weren't on Hispanic and white, only a small number were married or employed. More people were employed part-time than the informal employment, but only 5% were employed in the county data. And we didn't see any significant differences between that comparison group that I mentioned and the second story, yes. So like I said, we seem to do a good job creating a comparison group. And of the people who used the respite for the services data, 42% used emergency or inpatient services after using the respite. So by and large, this is pretty frequently used in emergency services. Let's see, a little more about who used the respite. These are from the surveys where we were able to capture some more detailed information. 72% lived independently in that inclusive support and housing, the remainder lived in some sort of housing that was connected to treatment. In some way, 13% reported that they were homeless one or more nights in the past 30 days. There's fairly large number, 83% had completed high school or GC, there's 60 in the surveys. More people reported employment than we saw in the county data. I think a lot of that is probably part-time employment or maybe more informal employment. And this is very interesting to me, 96.7% of people who used the second story reported that they had ever experienced violence in trauma. So when Indole talks about the importance of trauma-informed care, I just want to second that. It's being critical, critical. All right, so getting to the analysis of the county data, look at the math out of the way. We took that comparison group that I mentioned and then we looked at the people who used second story and we looked at the likelihood, first we looked at the likelihood of using inpatient emergency services after going to the rest of it. And we did a logistic regression model for those of you who care that controlled for all the covariates that we could control for. So sort of holding demographics, age, service use, history, constant. We found that respite guests were 70% less likely than non-respite guests who were similar. Who used inpatient emergency services after they went to second story. And then going a little further down, we did also find that the likelihood of subsequent inpatient emergency service use increased with the traditional day of respite stay. So there was something about the folks staying longer in respite that sort of reduced this finding, but still by and large, at a statistically significant level. So we can say with 95% certainty that this is not re-readable to chance. People are quite less likely to use inpatient emergency services when they have used for respite. Then we took out the people who did use inpatient emergency services after respite and we said, well, are they using the services but using them less? So are they falling down and needing to get that extra support, but are they able to pick themselves back again more quickly? And the answer to that is by and large, yes. For those people who did use inpatient emergency services, the ones who had stated the respite used significantly fewer hours of those services than the people who didn't. And again, going a little below, the longer the stay at the respite, there seemed to be diminishing returns to those longer stays. So we saw that this fact sort of wore off the longer people used the respite, so. Interesting finding that I'll discuss a little more and would be happy to discuss later. I think we're hoping to explore some of these questions further, but the takeaways here are people who use that inpatient emergency services less and when they do use them, they use less of them. All right, so the next handful of slides are some newer results that I recently put together just through the compiling information from the in-depth interviews and the surveys because we care about more, we care about other outcomes than just inpatient emergency services. So for these findings in the green arrows, these are the, from the guest service. I guess they could look like houses too. They're from the guest service and there are the percentage of people, the guests were asked if they agreed or disagree with a whole number of statements and these are the percentage of ratings, guests whose ratings increased. So they went from strongly disagree to agree or disagree to undecided. So their ratings increased, they were more likely to endorse these different statements and anything that's presented here is statistically significant at the 95% level. So again, we're comparing the four people who have reused the respite to, after they've used the respite for any length of time that they use the respite. These are changes that we wouldn't see if just deteriorable to change. So, and then the title of the slides are the themes that seem to emerge out of the conversations that we've had over the years with guests, providers, team members, et cetera, what we're wondering about the impact of these programs on people's lives. So the first thing that emerged is a pretty intuitive one, respites refer to rest and a lot of people spoke about how this program was a way for them to take a rest. So 10 guests and four providers really talked about this concept of describing second story as a place to get a break from stressful or toxic life situations. So one guest said, second story is my safe place. I come here and I can breathe. I come here and I have people who love me. It's my safe place. I love here. I don't know why I would use any other place but here. And that quote was really indicative of what a lot of people said of second story was being sort of a sanctuary for them. And in this sense, a few people kind of went further and talked about how being able to stay a second story and get that break before in their lives, they had used the hospital for that break. They had needed to go into the hospital, which one person described as more dramatic and demoralizing than something like second story which really enabled this person to get back on their feet and more quickly attend to her life responsibilities that she had while she was resting as opposed to having to be taken out of all of that. Another theme I mentioned recovery earlier, and as a construct recovery didn't really come up that much. But what did come up was this idea of living the life that you want. So we think of recovery as something that's self-defined and I think people, and second story I really just thought of it being a place for them to, that supported them to live the life that they wanted. So really I think getting to one of the fundamental premises of recovery. So this looked different for every guest. Some guests described having the freedom and flexibility to explore what it was that they really wanted and make improvements in those areas. One person said, you know you were all there for to kind of discover love, I guess, to discover who you are. I think Freud said to working to love and that really is what it is. And we saw this in the data as well, it was so good data. Just some general assertions here. I have a disinquality of life. Significantly more people endorse that statement after staying in second story. Having more good days than bad. This one, the overall hostess, was interesting because we were early and stuck again. It's a smaller percentage, but statistically significant. When asked to rate their overall health, people rated it higher after staying in second story. I gotta get into that sort of connection, mind-body connection piece. Yes. Oh good, thank you. That's a good, I won't be that much longer. So I would say probably the most pronounced theme that came out of the interviews was this one. Connecting to a peer community. It jumped out of the computer at me as I was reading through the interviews. People describe second story as a support network community that is relifting second family, like a commune, a warm-loving place, communal, comfortable, welcoming, and community-loving attendance. The theme was presenting data interviews with 14 of the guests out of 19, five providers, and definitely with numbers of the staff team. It's a gas scope of a positive sense of belonging that they hadn't had before second story. One person said, I say that it gave you a sense of, it gave you a sense of identity. It gave you a sense of belonging. It showed me that there are people whose minds work the way my mind does, who are in control of their minds, don't let their minds control them, who are hugely intelligent and really work their own lives. And this sentiment, this idea of being inspired or feeling more hopeful by seeing people who are sort of living examples of having, you know, living the life that you want in spite of serious mental health challenges, really resonated with a lot of the guests. And as you can see, we saw very high ratings of belongingness and community, again, sort of finding this community that they didn't connect to before. Having a sense of belonging and even contributing to that community. So another related thing that was very strong is around developing one-to-one relationships, which are obviously supported by that community feeling. So several guests and staff spoke about developing one-to-one friendships through the program. And those relationships included connections between guests. So one guest said, second story, maybe feel comfortable enough to go up to people and talk to people, not just staff, but clients too. I realized that I wasn't alone. There was other people there, quiet too, like me. And so it just helped me out a lot. I just made these steps, and it's easier for me to talk to people now because I've got so many stories. And here we see very high ratings in the 80s of increased endorsement of, I'm happy with the friendships I have. I have people I could do enjoyable things with. And this is pretty important, having the support from other people in a crisis, which might explain some of the reductions that we saw in patient emergency services. Another big piece of the developing relationships was, developing relationships with staff. A lot of interviewees, the majority, spoke about developing one-on-one connections with particular staff members during their states. And I think these particular findings speak to the intentional peer support model that's used at the program, which really focuses on mutual relationships as being the base of where the team members are coming from is really about establishing mutual relationships and connection before doing anything else. So one guest said, I really like that we can have a real serious conversation between each other and exchange information from each other. It's not like a one-way talking. It's a two-way relationship in communication and it's really genuine. We're just really real with each other and they tell them when something's not working for them, they're real. It's like a friendship, instead of a very close, cold-hearted, professional support, there's connection, a real connection that's in store. And as you can see, people are more likely to agree that they have at least one close, mutual relationship and have the trust of people to turn to. A number of people spoke about being treated as an equal. This was also referred to as having more dignity and having more of a sense of humanity through a second story, being treated as a person of a living illness. Several guests sort of compared this to past experiences they've had in the local health system where they felt the opposite of that. So disempowered, treated as an illness, et cetera. One person said, I don't feel less than in this environment. I feel like across the table, we're all equals. Even though I'm not pure staff, still, in traditional crisis services, I may have come out of this feeling somehow I'm defective. You know, if this wasn't around and it was just the hospital crisis house, I would feel in those environments very mentally ill, like labeled that. Like these are mentally ill patients and I'm not a patient, I'm a person and I get treated like a full human being. This could be related to people endorsing the idea of control and controlling important decisions in their lives. So about finding direction through second story in different ways. Half the guests sort of said the program helped them to work towards specific goals. And sometimes the goals were concrete, like going down to school or improving their physical health. Which is interesting because the program doesn't really explicitly push that with all of the guests. But a lot of guests spoke more interesting, more generally about changing their old patterns and habits to work towards the wellness and personal growth, things that they wanted to work towards. So one person said, without second story I wouldn't have as much direction in my life or a sense of hope that I could recover. It's hard to say exactly where I'd be, but I can see how it has changed me or how it would change patterns in my life. I think if I didn't have that, I'd just be stuck in the same old cycle of doing the same thing over and over again and having the exact same thing happen to me. Really being mindful is the word. Being able to see that there is a way to be able to change. Living the life that you want to live basically. And I'm starting to do that. And I accomplished a lot of goals that I didn't think I could accomplish. I'm just coming to second story. Again, endorsing the concept of growing as a person and importantly, hope, being hopeful about the future. And finally, a very strong theme that I struggled with how to conceptualize. I call this flexibility and freedom at one point as well. Now I'm calling it gaining independence. It was about how the program is open and self-directed. People can really make their own choices and the impact that that had on catalyzing change and pushing, motivating people to work towards variables. So one person, when talking about how it's not locked, how you knew where you were, you don't have to go to groups. You don't have to eat at specified times. You don't have to get up at a certain time. This person said, I remember when I first started coming here, I was like a kid. I was like, oh my God, people aren't saying I have to do this and always reminded me about it. It was really a joy, but I matured a lot. So I'm pretty much used to it now. I guess I'll just talk about how the ability led to them taking more responsibility to determine what it was that they needed and asked to change that themselves. Another person said, the second story feels like you're making decisions and people don't take full control of your lives and tell you what to do and eat. Dorsing is both ways. Here we saw people endorsing just a sense of agency, personal, maybe autonomy, believing in positive changes and using personal skills, strengths and talents. You need to do that person. The global flexibility wasn't perfect for all guests too, I should mention. Some guests voiced a desire for more structured activities and more structured policies. Not everybody likes doors when you're both ways all the time. And others complained that the program placed too many institutions on them. So I think that's indicative of the program changing over time and how it approached this flexibility piece and also just people getting different. But by and large, we saw some clear gains. So summing up what we have now and this is really selected by the devaluation, like I said, there are more and we can and will be more pulling out these themes and really finding them and understanding them. But we saw, we observed both quantitatively in the surveys and qualitatively in the conversations that we had significant improvements and things that are pretty important, like quality of life and hope, wellness, self-determination, independence and critically, these personal relationships and community connections for the guests. And for the staff too, I think I would add. And then on the administrative data side, we saw these significant reductions in innovation and emergency service use, which has implications for cost and for the system as a whole. In the future, we have more planned, doing more work to understand the program's implementation and really starting to develop resources for other programs around the country and this program continues to grow on best practices and guidance for how programs like this can have the same kind of impact the second story has had across the country. And also the question of the organizational structure, how the leadership was structured in the house was something that the team has really wrestled with over the years and is quite fascinating from an organizational studies perspective. So we hope to do some work to understand that in the context of the peer movements and social movements in general. In terms of the outcomes evaluation, digging down further into the survey and county data that I described, linking up the survey data and the county data to really understand what are the characteristics that we're seeing in the surveys that may be indicative of the reductions in inpatient and emergency service use. So who's reducing my service use and why? And we also will be doing a round two service use analysis with a larger sample size. So that'll happen this year before or after my maternity leave. I promise anything. But we'll have a larger sample size. So we'll be able to detect results with more sensitivity and get at this question of what's going on with those folks who are using a higher amount of services. What's the story? And looking more at sort of characteristics and understanding that and maybe informing how the perpetrator respond and maybe meet some needs, what is meeting needs, et cetera, we'll see. And then this question of what the impact is on the system as a whole, I think is really salient. Second story is mission, I think, is certainly to be a space of community for people and just for people, but I think it goes beyond that and it's about system change and about social justice. And so what does it mean for programs like these to be situated within a mental health system? How does it change the worldview of folks like you who have been working in this system a long time to maybe do things differently in your processes in your life? So I have some references here. There are a few copies of the size of people like them and then they'll be available a little kindly. And I don't know how much time I have to talk about. Yeah, if folks have questions about the evaluation or any of the findings now or later, I'm happy to answer them. Second. My question was in the rightful state or longer-day state within diminishing return, is that based upon the baseline average length of stay of 13 days? And was there any type of metric for days state longer than the state and the, in front of us, the regression back to three seconds first? And is there analysis on why is that? I'll answer the first part of your question and I may have to ask the other question on the second. So in a regression model, you have an outcome and an intervention. So in this case, inpatient emergency service use and stay at second story or just stay at second story and then put other things into the models and control for them. And the one thing that we can control for them for was total days of stay in respite. So that's, we also put number of respite states to see if there was a difference and there wasn't, we used total days of respite. So these findings are based on that. So we found that around, I'll have to look it up, but it was around nine or 10 days we started to see the diminishing returns kicking. So that's really the finding for now. What was the second part of your question? We wanted to, do we know why that is? No, we don't know why. We tried to find out with some qualitative interviews and we talked about it, we have some ideas. One issue might be related to housing. So we did have measures of housing stability in this, just kind of rough measures from the county so like where they homeless or not. But I don't know how accurate that information is and how is it a complicated issue. So one issue might be other people who are using both of these kinds of programs as defacto house, which given the circumstances of a lot of folks that you work with I think might be possible. Other things too might be lack of social connections in the community, just more challenges that you know, even a second story wasn't gonna make a dent in Stephen Webb. Those are ideas that hopefully we'll figure out we'll understand that more about the time system. Hi. I can't start young, I'm gonna say in their early 20s they're more in denial with a mental illness. And unless somebody calls the police and feels like they're like some major, they get taken to the mental. So is second story an alternative to these kids where they can go into second story instead of getting no doubt in the mental board? I think a lot of people in this room just about this question, I'll offer one observation that we've seen. For people, I mean for this and for several different folks, for younger folks, one issue might be coming to terms with what's happening and not wanting to be labeled, not wanting to be somebody who's in the system. And you know, for years and years and years we've understood serious mental illness is a chronic disease that you never recover from and you're never gonna work and you're never gonna get married. And so that's a pretty damning sentence to receive in your young person. Second story is very powerful and it offers an alternative to that. And folks come to second story and they see all kinds of great adults, grownups of all different ages who are living very full, meaningful lives who've been labeled with serious mental illnesses who've been through the system. As opposed to maybe going to a law facility and seeing the folks who have really been through the system and are in a pretty bad shape from being in the system for years and years and years and it can really be scary or hard for folks. That's one observation. Yeah, but is it an alternative? Because they get taken away, they get put in the facility for 24 hours or a couple of days, doped up with the generic or the general, oh, we're gonna get this and everybody gets the same thing or whatever. Then they come out, they're coming off of all of those drugs and you're about to square one in a month or two. So second story, do they offer an alternative to going into the psych ward because they are having an episode? Yes. I think so. Wow, that's a good question. I just really wanted to make it. So we don't offer like cures, right? There's no such thing as a cure in all of medical health practices. There's no cure, but what we do offer, especially with young people with this, it extended time that they're connected with the county and they're part of the team, transition stages program. Then we offer extended stays with them so that we can kind of bring through some of that, some of the mental illness model type of existence. So we definitely, and we've had incredible success. So we don't, with people that come in that are young are saying, I have schizophrenia, well, where is it? Because I don't, so it just becomes a conversation about the human and the person that is expressing a very difficult time in their lives and being able to, and from our framework, it's not illness, and as a result of really speaking to it and finding strength and sympathy and community with each other and providing a different way of being so alternative, yes, we can use a rich alternative, but it's, it doesn't solve everything with young people and come through the program that will reap the rewards and no longer seem to themselves as a bit ill and broken, but they still have to explore those kind of difficult spaces anyway. So that's kind of how it is. We've had a lot of these kids who know they have poor eating habits and it just, it, mm-hmm. So they're older adults. Well, I'm talking about the younger kids, like, you know, our children, some of our children, that, you know, they're going to become adults so why not live it in the bud? And so, we've been doing a lot of research on this and realizing how important nutrition is. So I'm just wondering, I don't, can everybody hear me? So I'm just wondering, like, when they get into this second story, are there some, you know, better habits also offered with, you know, with nutrition and not just pills? Well, I'm sitting right next to you. Can I answer that question? Yeah, yeah, yeah, yeah. You know, yesterday I was at MHCAN and I was there as a young man in that age group who came up to me and, ma'am, ma'am, I just want to tell you something. When you say hello to everybody at Second Story, he said, I just want you to know that Matt is programmed for drugs and alcohol, so he died most. This kid has come to us several times. He is psychotic, drug addict, meth user, you know, and so he comes and then he leaves and then he comes and then he leaves and he says, I just want you to know that this time I'm really going to do it for 90 days. I know, and he looks so good and so clear, and so, you know, I don't know if he will or not, but it's just, it's that feeling of community, of feeling, of belief, you know, we listen to his story about why he uses drugs and why he, and how that helps him with his magic. So, that's an example, you know. And yes, it's continual conversations about nutrition and exercising, you know, and sleep and just the basics of self-care, basically. So, is there a difference in that going to the psych ward? Yes. I just want to highlight something that is related to this, and I think just, I really hope everyone comes away with this concept. The idea of flexibility and freedom, the idea of self-determining the program experience is critical in Second Story. Is eating well important? Yes, especially for young people, probably yes. But, Second Story team members are never going to tell anybody what they should and shouldn't eat. Because the program is about creating support that goes deeper, and setting the stage for people to develop their own independence and their own sense of self-force, and their own intrinsic motivation to be well in ways that they define for themselves. And I just want to highlight that as what I see as a critical ingredient that makes this program unique among any other program I've experienced and seen in the mental health system. There's a crisis situation, and the police are called and immediately here they take up to telecare. Now, that's not much of a choice. I'm wondering whether or not there could be the choice already situated to where they can say, I want to go to Second Story. Because it's just going to be a cycle going in to telecare if something isn't set up to where there's a choice. And a lot of times it doesn't need to be to hospitalize something, the crisis is like that, critical, and avoid the trauma of going into hospitalization that stays with a child for life. So we can be that, it's a matter of coordination, it's a matter of the person if they want to be there, it's really their choice, is if they want to be there. If they say I want to go to Second Story, then that's realistic or plausible according to, like once we get kind of hooked into the, the way that whether it's accordion or whether it's somebody in the system that is grappling with us right now and we're trying to figure out what to do next. If somebody's saying I want to go to Second Story, it's by the before going to the hospital or something extended decision that it gets difficult to make, but if we're a part of that process, if we're able to, if we're able to be a part of the decision. We won't be a part of the decision as much as receptive, offering, maybe a fit for us, we're open to talking about it. And so in that said, once a person gets into a hospital, there's also people that the hospital, the PHF now is working with us, the telecare is now working with us to send people to us. And again, if they feel it's appropriate, the part of our model is mutual, like we want it to be on the equal terms. And so trying to break sort of those barriers, well, of how do we communicate with each other in ways that we know we're called, we need to be fulfilling the needs of society and our expectations in it. So yes, yes, and then once we get people from telecare, then it becomes another conversation of breaking people out of the document of e-mailings. And so that's kind of where we're at right there, but it's complicated to have the people in the new networks. But I just want to really quickly, I just want to say we've got 45 minutes left and I want to make sure that we have time for story time just because it's, I've seen heads nodding and so we do want to move in that direction. So really quickly, do you want to start, Rich? No. I just still feel like this gal here, I still feel like the question was just how to answer it because when you have a child, a young person, he's not an adult or an adult and it's not an assistant care who wants to come to the house, but there's, this is the first time crisis for them. How do you bridge that gap to allow them to come to the house? It seems like it's going to have, it seems like they're going to have to go to the club, they're going to have to do all the things you were mentioning until they can get into the system and how can we have something for people who are just having their first crisis or having their, whether or not all into the system yet. We get calls from parents or to directors. Did you better answer that? In both directions. So now that we know that the funding for the program is sustainable for the next few years, this is actually one of the areas that Eric and Pam and Cali Mental Health's leadership with collaboration with Second Story and us at the Compass are looking at how we can expand services. Like one, you know, is there a way to have peer support, you know, with the sheriff as they go to the house? Is there a way to really intervene in the first contact? So it's in the work coming soon. And so now if we can, we do want to start the story, right? Yeah. And so who wants to start? And who's been impacted by Second Story? And who wants to say what it's been for them? And if there's people who identify as providers, think of questions that have been.