Kendrea Young, one of the graduates, shared her experience in the program with UofL News.

UofL News: Tell me about your background and what brought you to the UofL Trager Institute’s Trauma-Informed FlourishCare Paraprofessional Program.

Kendrea Young: I’ve always wanted to do things for my community, but I never knew what I wanted to do, whether it was mental health, physical health, anything like that. I just knew I wanted it to be community-based because I’ve always been about the community. When it comes to my background, growing up – and I’d say I’m still growing – I had some trials and errors. I had things going on with substance abuse and depression. All that stemmed from a lot of trauma.

That’s how it started with the peer support specialist training because that’s how you’ve got to start off. You have to have some sort of experience with substance abuse to get into the program. So, learning all these different things and meeting new people sparked my mind. It shows me that, yes, you could have your bachelor’s or master’s, but being able to earn your certification, like the one I received, can still lead to a career. It lets me know that you don’t have to put yourself in debt to still do the things you want to do, whether that’s doing case management, social work or working in the community in some way. Whether it’s as a paraprofessional or a community health worker (CHW), it all works together. It does get your foot in the door, letting you know that this is something you really want to do.

UofL News: In what ways do you believe this training has contributed to your personal and professional growth?

Young: The incredible support from people I had never even met before has meant a lot for my personal growth. They’ve been so supportive, especially when it comes to continuing with this program and thinking about my future plans. The support, love and information they’ve shown give me hope for pursuing maybe a bachelor’s, maybe a master’s degree. I’m not really sure where I want to go yet, but I know it’s something big.

They’ve also really helped me learn about communicating, understanding what communication looks like, what professionalism looks like and how to present myself in certain environments. We’re advocates for the people we watch over, whether it’s kids, adults or older adults. We advocate for them and make sure we know the tools and can provide the best quality care for our patients. So, in that way, they’ve helped me a lot. I’m never not learning anything when I’m with the group.

UofL News: How would you describe your experience with the program?

Young: I worked with two sites. I started with VOA [Volunteers of America: Determined Health], but I had to stop to finish my dental certification. Trager was nice enough to let me finish and come back, and that’s how I got with Smoketown [Family Wellness Center]. They’re very supportive of my dreams and goals.

First, I started working with health equity with Humana and VOA. Now, with Smoketown, I work with parents and their kids. I always say a healthy child needs a healthy parent, just embedding that in people’s heads. They know that we have a care team, including myself and my other team members, and the doctors – we’re there to help them. When I look back from where I work now and where I used to work, it all starts out in childhood. It begins when they are a kid, and then growing up, knowing that trauma can lead to chronic illnesses. I like that we’re working to stop that, preventing the potential challenges when they’re 30 years old and beyond. So, that’s what I do now.

UofL News: Why do you think community health workers are important?

Young: I’d say that Community Health Workers (CHWs) are so important because we’re real. We’re either in the same boat as the people we’re taking care of or we were in the same boat. So, with this job, you have to have experience of this sort. Everybody’s story is different and everybody’s trauma is different as well. But having someone as a CHW or as a peer support specialist, you know right off the bat that they have been through some things. That’s why the patients we work with are able to open up more.

When they have someone on the team like a CHW, it’s easier for them to share important information with the social worker, therapist and doctors so we can all come together and make a great care plan for this individual to move ahead in life. That’s why the CHW role is so important. It’s because it’s real. We’re meeting people where they are.

UofL News: What unique qualities or advantages of the Trager Institute program do you appreciate?

Young: This is my first time being in something like this, and it’s a real career. I’m not sure about any other programs, but I would say what’s special is that they will go to war with you. Whether that’s finding you a placement and a job, whether that’s making sure you’re successful in the training or making sure you understand what you’re doing and what is being taught. Because when you go out there in the world and you’re trying to do these services and you don’t understand, then there is no point.

So just being on us and holding us accountable and being a great team, I feel like that’s the difference. And they teach us how to be team leaders because, with this job, you have to be an advocate and have to be a leader for the person that you’re working with. Seeing other leaders and other women and other men, it gives you motivation. Whether you want to further your next step in social work or therapy or anything like that, I would most definitely recommend this program. I recommend it to a lot of people all the time. I recommend this to a lot of the parents that I work with because they’re going through so much, and I let them know that the stuff they’re doing doesn’t define them. I’m 22, and I’m young, working with all these different parents, and they’re like, ‘Kendrea, this is great. This is great information. Thank you for everything that you do.’ And I wouldn’t be able to be a good help if it wasn’t for the Trager Institute.

Q&A by Samantha Adams

“The window of time when people are willing to accept behavioral health help is sometimes narrow,” said Kelly Gillooly, M. Ed., LCADC, UofL Health system director of Behavioral Health. “With PeaceNow, the 3-4 month waiting period has been reduced to days and eliminated in some cases. The virtual environment allows us to see many referred patients immediately or on the same day.”

A PeaceNow pilot program began in July 2022, opening first to referrals from UofL Physicians. In its first six months, more than 1,200 patients have been served. Today, referrals are accepted from all providers, mental health therapists, school counselors and social workers in Jefferson County and surrounding Kentucky counties. Future plans include adding Indiana counties, following regulatory approvals.

“Physical health and behavioral health cannot be separated. One influences the other and I see the impact of both with my patients,” said Traci Edwards, M.D., UofL Physicians – Primary Care. “Primary care physicians are ideally suited to refer for behavioral assessments since we know they already have the relationships, know the health history and are located all across the community.”

Referrals to PeaceNow are open to patients age 12 and above with a range of mental and substance use concerns, including:

• Depression
• Anxiety
• ADHD
• Substance use disorders
• Bipolar disorder
• Schizophrenia
• Trauma
• Grief
• Other mental health

“Individuals seeking care for their mental health are often met with long wait times before they receive appropriate treatment. This delay increases the likelihood that their symptoms and condition may worsen before care is provided,” said Nancy Brooks, executive director of the National Alliance on Mental Illness, Louisville chapter. “The access to more immediate professional care that is now being offered through PeaceNow will help many individuals bridge the gap between the onset of mental health concerns and proper diagnosis and treatment.”

Telebehavioral health assessments, through PeaceNow will be performed by a clinical psychologist or a licensed therapist, with additional referrals to the appropriate level of care. Some brief therapy may also occur over the telehealth platform. All care will be supervised by psychiatrists and psychiatric APRN’s, who will also provide clinical services to patients.

“The virtual assessment may not entirely replace the need for in-person therapy, but it is a critical new access point,” said Robert Caudill, M.D., UofL Physicians – Psychiatry and Depression Center and professor of psychiatry at University of Louisville. “By launching PeaceNow, we hope to make behavioral health more accessible and expedite the connection of patients to definitive care.”

Older adults may be referred through PeaceNow to the at the University of Louisville Trager Institute.

“Our focus at the Trager Institute is on older adults. It is estimated that 20% of people age 55 or older experience some type of mental health concern, such as anxiety, severe cognitive impairment, depression or bipolar disorder,” said Anna Faul, Ph.D., executive director of the institute. “Combining the PeaceNow team and the Trager team, we believe that we are filling a void in our community that will lead to better health outcomes in the future.”

More information on PeaceNow is available through your primary care provider, mental health therapist, school counselor, social worker or at: 

The Commission on Accreditation of Rehabilitation Facilities (CARF) has accredited the Behavioral Health Service Organization at Trager for three years for outpatient treatment of adults and older adults. Trager is one of only 10 organizations around the globe accredited by CARF for mental health services for older adults.

“Accreditation is a public statement that our organization strives to ensure that our services are of the highest possible quality,” said Joe D’Ambrosio, the Trager Institute’s director of behavioral health. “At Trager, we are committed to reducing risk, addressing health and safety concerns, respecting cultural and individual preferences and providing the best possible quality of care.”

Mental health is an important aspect of overall health and well-being. Losses that can occur with aging – social activity, identity and physical health – put individuals at higher risk for developing behavioral health issues. However, signs of mental illness in older adults often are overlooked or dismissed as normal symptoms of aging. Without treatment, conditions such as depression and anxiety can lead to further physical decline. Behavioral health services are provided as part of the clinic’s comprehensive care to help individuals maintain health as they age. 

In order to be CARF-accredited, programs and services must demonstrate that they conform to internationally recognized standards for service delivery and are committed to continuous quality improvement and a consumer-driven focus. CARF International is an independent, nonprofit accreditor of health and human services providers in aging services, behavioral health, child and youth services, durable medical equipment, employment and community services, medical rehabilitation, opioid treatment programs and vision rehabilitation services.

“For our Trager team, accreditation demonstrates our belief that all people have the right to be treated with dignity and respect, have access to needed services that achieve optimum outcomes and are empowered to exercise informed choice,” D’Ambrosio said.

D’Ambrosio said that during Trager’s accreditation survey, the CARF surveyor commended the institute’s FlourishCare^TM service, an integrated lifelong wellness care approach focused on lifestyle and preventative medicine for adults of all ages, as well as the use of student interns and telehealth, increasing accessibility to services.

Trager’s aging services include the FlourishCare^TM assessment, care coordination, family support, medication management and education, organized education programs, end-of-life care and grief support, all available in a nationally recognized, age-friendly clinic.

“Events of 2020 represent a public demand for change, and the process of healing requires re-conceptualizing public safety and emergency response systems in a way that honors the needs and wishes of the community and maximizes use of already limited resources,” said Susan Buchino, assistant professor, . “One such way is to provide social and clinical support services as an alternative or auxiliary to police and EMS.”

Buchino, who also serves as assistant director of the , says the Louisville Metro alternative responder program hopes to reduce incidents of confrontation and demands on the Louisville Metro Police Department, as well as create a positive health impact and fiscal savings. The team will investigate national best practices and analyze local data to create a model designed specifically for Louisville. 

Tony Zipple, SPHIS executive-in-residence, along with other are working with Buchino. The region’s community mental health center, is partnering with the SPHIS team in planning Louisville’s model, offering mental health and substance abuse treatment expertise. The also is collaborating on the project.

The planning process includes seeking the input of community members, as well as leaders from multiple government agencies, behavioral health and social service providers, and representatives from advocacy organizations.

“Transparency and community engagement around the planning process is crucial,” said Buchino. “We are including multiple partners to understand how they perceive this project and how it fits into our community and their organization’s other ongoing work.”

The team is consulting with officials in Eugene, Oregon, who implemented an evidence-based model for deflection called . In this model, the Eugene Police Department partnered with White Bird Clinic, a local Federally Qualified Health Center that offers a full range of medical, dental and behavioral health services, as well as drug and alcohol treatment.

Researchers expect to complete a final report later this summer which will include:

• Louisville alternative model design, including an operating model for services
• Comprehensive training materials
• Implementation and evaluation plans
• Budget and sustainability plan
• Cost-benefit forecast

Behavioral Health Service Organizations fall under a license category created by the Kentucky Cabinet for Health and Family Services. The designation was established to increase the number of entities in Kentucky that provide behavioral health services to Medicaid recipients in community-based programs.

“This classification allows our team to provide behavioral health services to a broader spectrum of our community, as many vulnerable individuals rely on these programs to receive mental health care,” said Anna Faul, executive director of the UofL Trager Institute. 

Faul says the change means the institute can hire more providers and scale services to their already existing statewide network established through the Geriatric Workforce Enhancement Program (GWEP) and Behavioral Health Workforce Enhancement Program (BHWEP).

The UofL Trager Institute grant-supported GWEP and BHWEP programs provide health care and behavioral care training, care coordination and health resources through a partnership network that includes all 15 Area Development Districts covering 120 counties in Kentucky.

The institute philosophy integrates behavioral health and primary care, as reflected in their  – a care coordination approach to health and well-being that addresses six comprehensive determinants of a patient’s health. 

“Mental health is deeply connected to our overall health and well-being as we age,” said Joe D’Ambrosio, director of wellness at the UofL Trager Institute. “The greater emotional strain of loss, mobility restrictions and physical changes can cause older adults to be at greater risk of developing serious, chronic mental health issues, such as depression or anxiety. In our practice, we are finding that both depression and anxiety are on an increase across all ages.”

Approximately 20% of adults in the United States age 18 and older are affected by . For older adults, but least recognized disorders.

D’Ambrosio says, “In addition to the emotional and psychological toll, untreated mental health issues can cause greater physical distress through increased inflammation and stress on the body. Untreated mental health issues can, therefore, lead to further negative physical decline, especially for those who may have multiple chronic conditions such as diabetes, heart disease or COPD.”

The importance of expanding accessible and affordable behavioral health services to all individuals, and especially older adults, is underscored by data showing 30-to-80% of all primary care visits are driven in part by behavioral health conditions. Evidence equally suggests that integrating a comprehensive behavioral health approach to primary care can improve emotional and mental well-being while increasing adherence to chronic disease treatment protocols.

The UofL Trager Institute provides a variety of behavioral health service options and modalities at its Republic Bank Foundation Optimal Aging Clinic, including individual and group therapy, couples and marriage counseling and  for addressing depression in older adults. All services are available virtually.

To learn more about the behavioral health and tele-health offerings, visit .