Core 1: Adult Peer Supporters
Adult Peer Supporters
• The Peer Specialist Service is a structured and scheduled therapeutic activity with an individual client or group, provided by a trained, self-identified consumer of mental health services. A Peer Specialist guides clients toward the identification and achievement of specific goals defined by the client and specified in the Treatment Plan.
https://dbhdid.ky.gov/dbh/ebpi-recovery.aspx
Adult Peer Support
• Peer support in the behavioral health setting is defined officially in Kentucky’s Medicaid State Plan: “Peer support is an emotional support provided by people having a mental health, substance use, or co-occurring mental health and substance use disorder to others sharing a similar mental health, substance use, or co-occurring mental health and substance use disorder”.
• The purpose of providing this type of support is to bring about a desired social or personal change. Peer support services are structured and scheduled non-clinical but therapeutic activities delivered either to individual clients or in groups. Services are provided by a self-identified consumer of mental health, substance use, or co-occurring mental health and substance use disorder who has been trained and certified per state regulations. These services should promote socialization, recovery, self-advocacy, preservation and enhancement of community living skills for the client.
Lived Experience
• In qualitative phenomenological research, lived experience refers to a representation of the experiences and choices of a given person, and the knowledge that they gain from these experiences and choices.
• "Lived Experience" means the experience of an adult in navigating the receipt of services and supports for self that are directly related to mental health, substance use, or co-occurring mental health and substance use disability as defined in the current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).
Peer Supports Role in Hope and Hopelessness
Peer Support is someone who has been where you have been and has found recovery.
Simply being able to relate with empathy to where the client has been gives them hope.
You can be a physical representation of where they want to be and because you have been where they have been it makes it attainable and realistic.
What is Code of Ethics?
A code of ethics is a guide of principles designed to help professionals conduct business honestly and with integrity. A code of ethics document may outline the mission and values of the business or organization, how professionals are supposed to approach problems, the ethical principles based on the organization's core values, and the standards to which the professional is held.
Code of Ethics Example
1. The primary responsibility of Certified Peer Recovery Specialists is to help peers achieve their own needs, wants, and goals.
2. Certified Peer Recovery Specialists will maintain high standards of personal and professional conduct.
3. Certified Peer Recovery Specialists will conduct themselves in a manner that fosters their own recovery.
4. Certified Peer Recovery Specialists will openly share with peers, other CPRS’s and non-peers their recovery stories from mental illness, substance abuse, or co-occurring disorders as appropriate for the situation in order to promote recovery and resiliency.
5. Certified Peer Recovery Specialists at all times will respect the rights and dignity of those they serve.
6. Certified Peer Recovery Specialists will never intimidate, threaten, harass, use undue influence, physical force, verbal abuse, or make unwarranted promises of benefits to the individuals they serve.
7. Certified Peer Recovery Specialists will not practice, condone, facilitate, or collaborate in any form of discrimination or harassment on the basis of ethnicity, race, color, pregnancy, creed, veteran status, sex, sexual orientation, age, religion, national origin, marital status, political belief, mental or physical disability, or any other category protected by state and/or federal civil rights laws .
8. Certified Peer Recovery Specialists will promote self-direction and decision making for those they serve.
9. Certified Peer Recovery Specialists will respect the privacy and confidentiality of those they serve.
10. Certified Peer Recovery Specialists will promote and support services that foster full integration of individuals into the communities of their choice.
11. Certified Peer Recovery Specialists will be directed by the knowledge that all individuals have the right to live and function in the least restrictive and least intrusive environment.
12. Certified Peer Recovery Specialists will not enter into dual relationships or commitments that conflict with the interests of those they serve.
13. Certified Peer Recovery Specialists will never engage in sexual or other inappropriate activities with peers they serve.
14. Certified Peer Recovery Specialists will not use illegal substances or misuse alcohol or other drugs (including prescription medications).
15. Certified Peer Recovery Specialists will keep current with emerging knowledge relevant to recovery and will share this knowledge with other Certified Peer Recovery Specialists.
16. Certified Peer Recovery Specialists will not accept gifts of significant value from those they serve.
17. Certified Peer Recovery Specialists will not provide services, either for employment or on a volunteer basis, without supervision from a behavioral health professional.
There Should Be No Gray Area
It is your responsibility to address questions you have about company policies. Peer support is still relatively new and is being developed as we speak. Agencies are seeing the value in peer support and developing peer support programs. You may be the first peer supporter for your agency. Ask your agency for the peer support code of ethics. Make sure you have a clear understanding and when situations arise that aren’t in your company’s policies be sure to refer to your supervisor and add the situation to the code of ethics as soon as possible.
Feeling of Powerlessness
The relationship between peer supporter and participant was noted to be a challenge for supporters. In a study of an HIV medication adherence peer support program, supporters were challenged by the resistance of participants who did not wish to change themselves at all. . Similarly, Marino et al. (2007) found supporters to be frustrated with the sense that certain people just could not be helped.
Funding Conflict
• Funding was cited as an additional barrier to success in such programs. Sakwa and Ireys (2006) noted that even with positive evaluation results, securing funding after the study was completed was difficult. Manalo (2008) conducted focus groups with family support staff in a community-based family support program. This study uncovered three major barriers to program implementation. First, inadequate funding was found to lead to unused resources and a smaller breadth of services offered. Confusing, tedious, and difficult funding rules and regulations resulted in extra work for the support workers, which they viewed as inefficient. The funding system often caused a delay in reimbursement that hindered the already stretched budget. These funding issues additionally lead to concerns regarding the program’s stability, with workers fearing program termination.
Effective Communication Tips
Communicate face to face whenever possible.
Provide clear information
Combine verbal and non verbal communication
Don’t just hear, listen
Ask questions
Handle conflicts with diplomacy
Refrain from gossip
Avoid being personal with co workers
Avoid discussing controversial topics
Offer positive feedback
Communicate Face to Face Whenever Possible.
Companies have been relying on email as a primary method of communication for the past several years. Electronic communication can have a detrimental effect on any type of relationship, especially relationships with co-workers. How many times have you sent an email to a co-worker or superior that was misconstrued? Even if you had good intentions, electronic communication is often misinterpreted. Since the majority of meaning during a conversation comes from nonverbal gestures and facial expressions, it is easier to decipher the meaning behind what a person says when communicating face-to-face. When gestures and smiles are taken out of the equation, recipients can get the wrong idea – especially if the person isn’t the most articulate writer. To improve workplace communication, pick up the phone every once in a while, or pay a visit your co-worker when you have something important to say.
Provide Clear Information
Workplace communication involves passing information from one person to the other. If you do not communicate clearly and accurately, it can cause confusion instead of clarity. Plan your communication to ensure that you are passing along the correct information and the right amount so those you are communicating with understand what you are saying. Avoid emails written in haste and always plan what you want to say before speaking to avoid miscommunication.
Combine Verbal and Nonverbal Communication
If you want to become a more effective communicator, you need to understand the importance of nonverbal communication. Be mindful that your verbal and nonverbal messages are in agreement. If you are trying to convey approval of something your co-worker has said, for example, ensure that your nonverbal gestures complement your words. Positive nonverbal feedback, such as head-nodding when the other person is talking accompanied by open body posture help the conversation flow more smoothly.
Don’t Just Hear, Listen
Listening is an important communication skill that many people do not possess. Most conflict is a result of poor listening. In order to share information with another person, you have to hear what is being communicated. If you’re thinking about your next meeting or planning tonight’s dinner during the conversation, you’re not paying attention. To learn how to listen well, paraphrase what was said to show that you are listening and to verify accuracy. This will reduce the likelihood of conflict and will help you become a more effective communicator. Try to keep a mental checklist of all of the important points the person makes.
Ask Questions
Asking questions not only shows you were listening, but also confirms that you understood the other person. You can also use questions to gather additional information and help you understand the conversation. Make sure your questions relate specifically to what is being said. Don’t change the subject by asking a questions about a totally different topic.
Handle Conflicts with Diplomacy
If you feel someone misunderstood something you communicated, talk to him or her about it as soon as possible. Doing so can prevent unnecessary resentment and loss of productivity. To prevent a small misunderstanding from turning into a major crises, handle it right away. When handling a conflict, respond with an open-mind and refrain from personal attacks. Ask questions and listen carefully to the responses so you can understand where the other person is coming from. Doing so will help you reach a resolution that is acceptable to everyone.
Refrain from Gossip
If your co-workers have a habit of gossiping about others in the office, simply listen and smile, and get back to work. Gossiping gives people a negative impression of you and can cause problems down the line. Gossip also gets in the way of effective workplace communication because it has a negative impact on relationships with co-workers. You will earn the respect of your co-workers if you refrain from engaging in gossip and you will be viewed with more credibility.
Avoid Being Personal with Your Co-workers
Be aware of disclosing too much personal information to the people you work with. Aim to be friendly, yet professional. If you become too personal with co-workers, you’ll risk the likelihood of being perceived as less credible when communicating about something important. Controlling your emotions is also very important. Your co-workers don’t need to witness your hysteria over an argument with your significant other; behaving this way will give them a negative impression and cause them to avoid talking to you.
Avoid Discussing Controversial Topics
Try to keep the topic of conversation in the workplace neutral. Refrain from discussing politics or other controversial topics in the office to prevent offending anyone. While it’s a great idea to talk to the people you work with and get to know them, it’s best to avoid controversial subjects.
Offer Positive Feedback
If your co-worker performs a task well, tell him or her. Providing positive feedback is a great way to improve workplace communication. It also helps people view you more favorably and encourages open communication. Having a positive attitude in general at work will open the door for effective communication prompting people to respond more favorably to you.
3 Beliefs That Do Not Promote Effective Communication
• I'm always right
• You have to believe how I believe
• I already know everything about this topic
Possible Scenario Between Adult Peer Support Specialist and Supervisor
Supervisor asks you to clean up after the clinician meeting, including taking out the trash and you have scheduled appointments to attend.
Supervisor meets with you about not keeping appropriate boundaries with your “favorite” client.
Supervisor suggests adding more people to your caseload because of low productivity, causing the company trouble funding the peer support position.
Possible Scenarios Between Adult Peer Support Specialist and Individual Other than a Supervisor.
Co-worker attends peer support training with you and other peer supporters. Coworker starts to nod-off during the training. When introducing themselves co-worker is slurring their words. Peer supporter whispers to you they might have had a little bit too much.
Clients mother follows you outside after client is admitted to inpatient unit. Client’s family member begins to question you on what all you know about client and asks for your personal cellphone number.
Rent-to-Own calls you in reference to fellow co-worker and peer support specialist’s past due payment.
Situations with Good Intentions
Client calls you 20 dollars short on their electric bill and says the electric company is going to turn off the power because they are out of extensions. If they do not come up with the money in an hour the client will be stuck in a house with three kids and no heat. It’s three days until Christmas. Client asks you to pay their electric and they will give it back in two days when they get paid.
Discuss with your table what you would do as a Adult Peer Support Employee
Lets discuss as a group
Situations Because of a Position or Perceived Position of Power
Your client is currently in drug court. Client was told to have a sponsor by Friday at 8am or they would be sanctioned. Client contacts you at 11pm Thursday night stating they have been to “every meeting” for a month searching for a sponsor but no one they have met has “measured up to you.” Client requests to meet for an emergency session at 7am because they are “stressed out” and want you sign their sponsorship paper.
Discuss with your table what you would do as a Adult Peer Support Employee
Let’s discuss as a group
Situation that Could Increase Intimacy
As an adult peer support specialist you have been working with your 18 year old client to prepare for the birth of their baby. The baby’s father was abusive and your client stayed with her baby’s father until two months ago, out of fear of having to do all the “baby things” alone. One of these things she specifically mentioned was the baby shower. Client is currently at a domestic violence shelter who is hosting the baby shower. Client has requested you to be there and help open gifts because “you are all she has.”
Discuss with your table what you would do as a Adult Peer Support Employee
Discuss as a group
Situations that Could Impact Parties Outside of the Peer Support Relationship
Client calls at 5pm crying because court “didn’t go her way.” Client went to court to regain custody of her kids who are currently residing with their father. Client claims the baby’s father “lied about her abusing her daughter because she was dating someone else.” Client stated since he is lying she is going to go to the police and “give him a taste of his own medicine.” Client asks if you would come to the police station with her for support because “you know its not fair.”
Discuss with your table what you would do as a Adult Peer Support Employee
Lets discuss as a group
Core Values
• Credibility- Walk what you talk
• Discretion- Respect Privacy; Don’t gossip
• Advocacy- Challenge injustice; Be the voice for the voiceless; Empower others to speak
• Hope- Offers self and others as living proof; Focus on the positive- strengths, assets, and possibilities rather than problems and pathology.
• Recovery- All service hinges on personal recovery
Ask Yourself this When Faced with an Ethical Dilemma
Why am I questioning myself?
Is there an agency policy regarding this situation?
Is this something I need to discuss with my supervisor?
Does this in any way complicate or negatively impact my relationship with this peer?
Out of all options, why this one?
Mediation Method
1. Agree to Mediate2. Storytelling and Gathering Points of View 3. Focus on Interests and Needs4. Create Win-Win Solutions5. Evaluate Options6. Create an Agreement
Problem Solving Techniques
• PICBA process • Impact• Cost Benefits • Brainstorm
• Actions• White Board Technique
Looking a Little Closer at Brainstorming
The word brainstorming was originally introduced by Alex F. Osborn in 1953 through his book Applied Imagination: Principles and Procedures of Creative Thinking.
The success of the brainstorming process in BBDO quite quickly became popularly known in the American culture at large. It was a trending word in academia and in the business world.
How to Brainstorm Effectively
• Place topic in the center of the page • Record Ideas that come to mind• Draw branches from the main topic • Be concise (single word phrases)
• Draw line between ideas • Look for connections• Have fun
(Brian Idea and Problem, 2014)
https://www.youtube.com/watch?v=YXZamW4-Ysk
Whiteboard Technique (Video)
Group Work
Identify facilitator for your table
At each table write down a problem you are currently having on a post it. (Do not let the others see and make sure it is a problem you will be comfortable discussing with a group)
Reveal your post it to your table and if there are any similar problems that becomes your problem you will brainstorm on. If there are no duplicated problems discuss with your table which problem you want to brainstorm on as a whole.
Using the brainstorming worksheet, utilize the technique discussed in the video.
Don’t be afraid to ask for help
Suicide Prevention
Lets Define
Suicide- the act or an instance of taking one's own life voluntarily and intentionally. (Merriam Webster)
Prevention- the act of preventing or hindering. (Merriam Webster)
Suicide Prevention- Diminishing the risk of suicide. It may not be possible to eliminate entirely the risk of suicide but it is possible to reduce this risk. For example, the suicide rate among US Air Force personnel fell precipitously after the service launched a community-based suicide prevention program. Suicide should not be viewed solely as a medical or mental health problem, since protective factors such as social support and connectedness appear to play significant roles in the prevention of suicide. (MedicineNet)
1.Reluctance to Get Involved
• As a peer support specialist you might feel overwhelmed when approached by a client who is having suicidal ideations. You might think this is a clinician’s job and this isn’t your place. If a client is coming to you this is a sign that they want you involved. Although it is absolutely necessary to get a clinician involved a good way to present that to the client is by saying. “I'm here for you. How about we go talk to your clinician together about what you have confided in me.”
2. Fear and Denial
• The phrase “I just want to die” unfortunately can be used frequently for feeling overwhelmed. Denial can lead us to be easily convinced our client could be using the phrase unjustifiably. We never want to brush off a client making such a statement because they might be one of your “more dramatic clients”. Fear can also be a motivator for not taking evidence of suicidal ideation seriously. Knowing and following protocol is a simple deterrent from fear and denial. Remember this situation is serious and you should follow your agency's suicide protocol.
3. Shock and Anger
• Your client has been doing extraordinarily “well.” She has been achieving and surpassing all goals she has set and has been so excited about how life. You just met with her an hour ago and everything was “great.” Her clinicians have been singing you praises on how “good” you have been for the client. They’ve claimed they would have never established such success without you. Suddenly, the client calls you stating she might need to go to the hospital to be admitted due to some suicidal ideation. She asks if you could notify her clinician to come and be with her. Never take anything personally. The client may simply feel her current situation requires a professional. This is not a reflection of your work or relationship. What’s most important is she reached out for help.
Warning Signs or Clues to Possible Suicide
Giving away prized possessions.
Withdrawing from family and
friends.
Experiencing dramatic mood swings.
Losing interest in most activities.
Kentucky Stats
• Suicide is the second leading cause of death for youth and young adults in Kentucky. According to the Kentucky Youth Risk Behavior Survey, 15 percent of Kentucky high school students (1 in 7) reported having seriously considered suicide within a 12-month period. In addition, 17.4 percent of Kentucky middle school students (nearly 1 in 5) reported that they had seriously considered killing themselves at some point in their lives. However, experts say that
suicide can be preventable. When educators, students and communities learn warning signs and how to take action when a young person might be at risk of a suicidal crisis, lives can be saved.
Older Adults
Suicide is an important problem among older adults. Suicide rates are particularly high among older men, with men ages 85 and older having the highest rate of any group in the country.1 Suicide attempts by older adults are much more likely to result in death than among younger persons. Reasons include:
Older adults plan more carefully and use more deadly methods.
Older adults are less likely to be discovered and rescued.
The physical frailty of older adults means they are less likely to recover from an attempt.
Racial and Ethnic Groups
• Suicide risk varies among different racial and ethnic groups. In the United States, suicide death rates are much higher among whites and American Indians/Alaska Natives than among other populations (see our Racial and Ethnic Disparities page).1 Suicidal thoughts and behaviors can vary across racial and ethnic groups, as well as within subgroups, such as people of different ages.
https://www.sprc.org/populations/racial-ethnic-groups
LGBT
• Like other minority groups, people who are lesbian, gay, bisexual, and/or transgender (LGBT) may experience prejudice and discrimination. Research indicates that mental health problems, misuse of alcohol and other drugs, and suicidal thoughts and behaviors are more common in this group than in the general population.1
https://www.sprc.org/populations/lgbt
Military Service Members and Veterans
Suicide is an important problem affecting military service members and veterans. The military services include an Active Component (Air Force, Army, Marine Corps, and Navy) and a Reserve Component. Estimates from the U.S. Department of Defense suggest that although suicide rates vary across these groups, they remain higher than they were in 2003.1
Among veterans, the suicide rate appears to have stabilized in recent years.2 But this rate remains unacceptably high. Recent estimates suggest that 22 veterans may die by suicide each day.2
To address this serious problem, the U.S. Department of Defense and the U.S. Department of Veterans Affairs have put into place comprehensive suicide prevention programs.
Men
• Men are much more likely than women to die by suicide (see Scope of the Problem section). Among the reasons for this are that they are more likely than women to use firearms in attempting suicide and less likely than women to access behavioral health care. They are also subject to a variety of cultural expectations that can contribute to risk.
Research indicates that asking someone if they're suicidal doesn't make them more likely to attempt suicide. Still, starting that conversation can feel intimidating for people worried about offending or embarrassing a loved one.
How to Ask Others About Possible Suicidal Ideation
"Sometimes when people go through a breakup, they may have thoughts of ending their life. I want to check in, have you had any of these thoughts?"
“With all of your sadness about the breakup, I just want to check in about your safety. Have you had any thoughts about death or dying?”
3 Questions to Ask Someone You Suspect May Be Experiencing Suicidal Ideation
1) How are you feeling right now?
2) Are you having thoughts about hurting yourself, or killing yourself?
3) Do you have a plan
How NOT to Ask Others About Potential Suicide
• Your not thinking of suicide right?
• Are you seriously thinking of suicide right now?
• You wouldn’t do anything crazy would you?
“Do’s” of Suicide Prevention
Be aware. Learn the warning signs.
Get involved. Become available. Show interest and support.
Ask if she or he is thinking about suicide
Be direct. Talk openly and freely about suicide.
Be willing to listen. Allow expressions of feelings. Accept the feelings.
Be non-judgmental. Don’t debate whether suicide is right or wrong, or feelings are good or bad. Don’t lecture on the value of life.
https://www.psychalive.org/the-dos-and-donts-of-suicide-prevention/
Things to Refrain from in Suicide Prevention
• Don’t dare him or her to do it.• Don’t ask why. This encourages defensiveness• Offer empathy, not sympathy.• Don’t act shocked. This will put distance between you.• Don’t be sworn to secrecy. Seek support.• Offer hope that alternatives are available and Take Action
https://www.psychalive.org/the-dos-and-donts-of-suicide-prevention/
Protocol for Working with Someone Who is Possibly Having Suicidal Thoughts/Actions
Ask
• How – Asking the question “Are you thinking about suicide?” communicates that you’re open to speaking about suicide in a non-judgmental and supportive way. Asking in this direct, unbiased manner, can open the door for effective dialogue about their emotional pain and can allow everyone involved to see what next steps need to be taken.
Keep them Safe
• How – First of all, it’s good for everyone to be on the same page. After the “Ask” step, and you’ve determined suicide is indeed being talked about, it’s important to find out a few things to establish immediate safety. Have they already done anything to try to kill themselves before talking with you? Does the person experiencing thoughts of suicide know how they would kill themselves? Do they have a specific detailed plan? What's the timing for their plan?
Be There
• How – This could mean being physically present for someone, speaking with them on the phone when you can, or any other way that shows support for the person at risk. An important aspect of this step is to make sure you follow through with the ways in which you say youll be able to support the person- do not commit to anything you are not willing or able to accomplish.
Help them Connect
• How – Helping someone with thoughts of suicide connect with ongoing supports (like the Lifeline, 800-273-8255) can help them establish a safety net for those moments they find themselves in a crisis. Additional components of a safety net might be connecting them with supports and resources in their communities. As a peer supporter referring to clinician or asking client if they would like to be there when talking to the clinician. At this point a clinician should be involved and depending on your companies protocol may need to be contacted.
Follow Up
• How – After your initial contact with a person experiencing thoughts of suicide, and after you’ve connected them with the immediate support systems they need, make sure to follow-up with them to see how they’re doing. Leave a message, send a text, or give a call. As peer supporters we have a unique ability to follow a client when they have been admitted and continue providing peer support services. Consistency is one of the biggest components to peer support. Here we can help with after plan and goal setting.