Peer Specialist Toolkit - Implementing Peer Support .

4What are some common misperceptionsabout peer support providers?The material in this section is adapted from Mental Health Consumer Providers: A Guide forClinical Staff (Chinman et al., 2008). The full document addresses many important questionsabout integrating peer support providers successfully. It is recommended reading as anintroduction to peer support and can be downloaded for free fromwww.rand.org/pubs/technical reports/2008/RAND TR584.pdf.Misperceptions about Peer Support ProvidersNon-peer staff and other stakeholders often have concerns about employing peer supportproviders. Their attitudes are a key determinant in the success or failure of involving peersupport providers within a health care organization. Below, we will lay out some commonlyexpressed concerns and respond to these misconceptions about VA Peer Specialists (PSs). Peer support providers cannot workfull-time, either because of disabilityinsurance or because of theresponsibility. It should not be assumed thatPSs cannot work full-time. Determination ofthe work schedule and workload should betailored to the individual. Some individualswill be able to work full-time, while othersmay prefer to work part-time. Decisionsabout workload should not be predeterminedbased on peer status. Most VA Peer Specialistpositions are for full-time employment.Often, full-time employment will bring inmore money than the amount that could belost in disability benefits the individualreceives. PSs should be encouraged to seekfinancial benefits counseling before taking aPS job to be fully informed about thefinancial tradeoffs. Peer support providers cannot fulfillvaluable roles in the treatment ofVeterans. The purpose of having PSs is notto have “extra” people who can run errandsand perform tasks others would prefer not todo. However, the roles andresponsibilities of the PS are not exactly thesame as other team members. For example,PSs usually do not have advanced degrees inpsychology (PhD) or psychiatry (MD). They donot conduct formal assessments or diagnoseVeterans. They do not prescribe medicationsor provide psychotherapy. However, they dohave experience as mental health consumers,and this experience makes them uniquelyqualified to serve as recovery role modelsand provide services to Veterans in ways thatare different from non-peer providers. Forexample, PSs can be quite effective in usingtheir lived experiences to engage Veteransinto health care services for the first time.With appropriate training, PSs can effectivelyfacilitate Wellness Recovery Action Plan(WRAP) groups and/or Illness Managementand Recovery (IMR) groups to help Veteranswith serious mental illnesses to develop andattain goals and better manage theirillnesses. PSs are also Veterans themselvesand can be helpful in treatment discussionsabout access to care and challengesVeterans face in navigating the VA healthcare system.page 9

Peer support providers will relapse.Non-peer staff members often believe thatthe stress of the PS’s job will be a likelytrigger for relapse. Relapse among PSs israre. This is mainly because PSs who arehired have already demonstrated that theycan handle job stress. While uncommon,relapse or onset of a new illness ispossible for any employee, not just forPSs. Even if a PS does relapse, he/sheshould be treated just like any otheremployee who has a serious illness thatinterferes with job performance. Just likeother employees, if and when the illnessresolves sufficiently, PSs should beallowed to return to work. The persistentmisconception that PSs will inevitablyrelapse should be addressed anddispelled in continuing educationprograms for mental health staff. Peer support providers cannot handlethe administrative demands of thejob. This has been shown not to be thecase. PSs are capable of appropriatedocumentation and paperwork associatedwith administrative tasks. As with any job,appropriate training will ensure that PSshave competence in this area. PSs whoare hired have demonstrated these skillsor have demonstrated capacity for thedevelopment of these skills.page 10 Given that Peer Specialists are notprofessionals, they will invariablycause harm to clients that the otherstaff members will have to undo. Nonpeer staff members have expressedconcerns that PSs will commit violations ofconfidentiality (e.g., looking up friends’medical records) and demonstrate poorboundaries through making treatmentrecommendations for which they are nottrained (e.g., suggesting that Veteransshould discontinue their medications), anddeveloping dual relationships (e.g.,providing services to a current romanticpartner or friend). While these problemscan occur, they are not unique to PSs,and there are many safeguards in placeto prevent them. First, all of the trainingprograms for PSs cover these issues indetail. Second, the clinical service towhich the PS is assigned should adoptspecific policies to address these issues.These policies, and the consequences forviolating them, should be made clear tothe PS upon hiring. Third, these issuesshould be brought up regularly insupervision. Fourth, if PSs violate any ofthese standards, they should be heldaccountable like any other employee.These safeguards and policies should beapplicable to all staff, not just PSs.

5How do I build support for Peer Specialistsand integrate them onto my team?Whenever a new idea or program is suggested in a clinical setting, there aremany issues to consider. Several “road maps” have been developed to help us thinkabout how a new idea, like including Peer Specialists, can get started in a clinical setting.One simple guide is called the Simpson Transfer Model. This model has four action stages: Exposure: Provide information andtraining, allow for questions,and look for answers. Implementation: Develop a plan withlocal stakeholders, tailor the program tofit your needs, and pilot the program. Adoption: Find opinion leaders whosupport the new program, and cometo a decision about whether to “adopt”the new program. Practice: Monitor how the new program isgoing, and make improvements orchanges if needed.These steps can work as a guide as you think about adding peers to a clinical setting.Below we provide some tips for each of these stages. It may be helpful to read throughall of them as you get started, so you can be thinking about how your team will handle thenext steps as they occur.page 11

Stage 1: Exposure TipsWith any new idea, the first step is to provide people with lots of information about the idea,and an opportunity to talk about it and ask questions. Helpful ways to build support for PeerSpecialists are: Identify a facility champion or a coordinatorfor peer support. This person should be enthusiasticabout peer support and have aninterest in finding roles for peersupport providers in the facility. Thisperson will be more successful if he/she has time carved out of the workschedule to attend to these duties. The team should be prepared to domultiple informal and formalpresentations to various facilitystakeholders: Facility leadership Human Resources Mental health programs Veterans’ consumer council The coordinator/champion can develop asmall (3-4 people) team to help. Tasks forthe team include: Identify local facility programs wherePeer Specialists’ (PSs) inclusion wouldimprove Veteran care. Provide presentations for thoseprograms’ leadership and staff. Answer questions about PSs’ potentialbenefits, research evidence, andtypical roles. Help staff appreciate the potentialcontribution of Veteran staff living withmental illnesses. We have provided a basic PowerPoint onVA peer support providers available foryour team to use. This presentation isfound in VA Mental Health Services PeerSupport Services h/Peer%20Support%20Services/Forms/AllItems.aspx. At the meeting, you might also hand outthe tri-fold brochure entitledUnderstanding Peer Support Services inVeterans Health Administration. Thisbrochure is found in VA Mental HealthServices Peer Support Services SharePoint(see link above).If you would like help or advice on setting up your meetings, you can contactDan O’Brien-Mazza, the VHA National Director of Peer Support Services,at Daniel.O’Brien-Mazza@va.gov., or The New England MIRECC Peer Education Center.page 12

Stage 2: Adoption TipsAfter discussion and planning, your team may decide to include Peer Specialists (PS) as partof a clinical team. At this point, there are some critical steps that can help the peer supportprogram get off to a great start, including: Offer help with developing a simple written Determine how a PS can contributeto the overall goals of a program, team,proposal to add PSs to a program. This canor facility. It can be helpful to look at placesbe as brief as one page but should includewhere a need exists, or where currentthe contributions the PS(s) will make toprogramming is not achieving desiredspecific goals or outcomes for Veterans.results. Plan and carry out individual discussionswith team leaders and other stakeholders inidentified programs. Some things to discussare: Number of PSs per team needed tomaximize availability to Veterans Training needs for PSs and other staff(see section below for trainingresources) Supervision of the PSs once theybecome part of the team—Identifyresponsible staff who will provideregular supervision of PSs.page 13

Stage 3: Implementation TipsOnce the decision has been made to add PSs to a program, the implementationstage begins. A first, important step is to create a local implementation team.Local Implementation Team: This team is usually made up of the program leader, andtwo or three experienced and interested staff. The team has the following functions: Oversee the hiring of the Peer Specialist.vary based upon the training schedule of thenot-for-profit contract agency providing thecertific

Peer support is one of the 10 fundamental components of recovery according to the National Consensus Statement on Mental Health Recovery (p. 4). “Al Veterans with SM access to peer support services, either on-site or within the community” (p. 28). Staffing models for VHA recovery programs stipulate including peer support providers: