Peer Support Training Curriculum

Preparing Peers to Assist Peers in Preparing for and Recovering From Disasters

Intended Training Audience

• This training is designed for use by organizations interested in organizing and training peers assists other peers preparing for disasters and to provide peer support crisis services to meet the needs of peer survivors, their families and communities following a disaster. 
• It may be used as a stand alone training or incorporated into Forensic Peer Specialist, Peer Specialist and Peer Counselor trainings.

Introductions    

• Trainer/Facilitator
• Sponsoring Program/Agency
• Training Participants

Preparing Yourself

• Before committing yourself to this very challenging and rewarding endeavor, it is important to be sure that you are making the right choice, both for yourself and the people you will assist. 
• You may want to poll trusted family members and friends, as well as care providers, to consider their opinions.
• Most importantly, you need to clarify your own thoughts.

Preparation Exercise

Core Values of the Training
           
Core Values of Training

• Peer Support Principle:  Peers have unique experiences and skills that are particularly valuable in helping other peers cope with and recover from disasters
• Avoid Pathologizing Response:  Normalizing the experiences and responses to disaster
• Peer support services should be integrated into all aspects of disaster planning, implementation and service delivery to assure that the needs of peers are met
• Encourage self-care and mutual support for peers providing these services

Training Goal

• To provide reliable resources and supports to people with mental illness and CODs in the event of an emergency or disaster.

Training Objective

Prepare peers with histories of mental illness, substance abuse and or involvement in the criminal justice systems to assist peers in preparing for disasters and to provide peer crisis support in the aftermath of a disaster

Adaptation of Training

• Peers are the targeted population for the services described in this training.  However, the After the Crisis Project encourages trainers to incorporate information and activities that reflect the unique characteristics and needs of the their communities. 
• This includes but is not limited to incarcerated peers, peers living in institutional settings such as state hospitals and adult homes, peers residing in rural communities, non-English speaking peers and peers with additional disabilities.

Recruitment of Trainees

• Trainees should reflect the communities that they will be working in and the individuals that they will be providing services to.

Learning Objectives

Peers attending this training will:

• Understand the roles that peers can play in assisting in preparing for disasters
• Understand roles that peers can play in providing peer support crisis services following a disaster
• Understand the goals of  peer support crisis services and how to use them to promote recovery
• Understand the different stages of a disaster/emergency and the different needs of survivors, families and communities
• Understand the impact that a disaster or emergency has upon individuals,groups and communities
• Understand the impact that culture has upon an individuals response to traumatic events and how culture can promote recovery
  Learn strategies that promote engagement,trust and resiliency
  Learn basic assessment and referral techniques
  Understand the need for documenting contacts and record
• Learn strategies for self-care and staff support
• Learn strategies for leveraging additional opportunities for peer support services in your community
• Learn strategies for having peer services included in your local and state disaster plans
• Learn strategies for collaborating with local and national disaster relief agencies
• Learn about FEMA Crisis Worker Certification Training and other resources

Training Ice Breaker

• You are are notified that you have five minutes to leave your home due to rising flood waters and you are told that you can only take one personal item with you when you leave, what would you take and why?

Getting Started

What About Your Experiences Make You Uniquely Qualified to Provide These Services?

Getting Started

• What is a disaster or emergency?
• How is a disaster or emergency different from other events or occurrences?
• Who or what decides whether an event is an emergency?
• Why should peers be trained to provide these services?

Challenges Experienced By Peers Following A Disaster

• Lack of Information
• Separation from “family” and friends
• Difficulty accessing mental health services
• Fear of getting “sick again”
• Access to services

Peer Support Disaster Services vs. Traditional Peer Support Services

• Peer Support Disaster Services
• Short term
• Emphasis on quickly assessing needs of survivors for referral to other resources
• Mobilized in response to a disaster
• Traditional Peer Support Services
• No time limits
• No or minimal emphasis on speedy assessments
• Designed to provide ongoing support to peers

Common Ground: Crisis Counseling and Peer Support Disaster Services
Peer Support Disaster Services have a lot in common with Crisis Counseling Model used by traditional disaster relief programs:

• Recovery is possible
• Services are Person Centered
• Do not pathologize responses to events, “no you are not going crazy or getting sick again”
• Not mental health treatment
• Draws on the resiliency of individuals and communities in developing coping mechanisms
• Services “brought” to people
• Elimination of barriers to accessing counseling services and other support
• Whenever possible, assist individuals and families in returning to their communities

Goals of Peer Support

• Assist peers in understanding that their responses are often “normal” responses to an “abnormal event”
• Crisis often creates opportunities for growth and change (Mead, 2001)

Is your glass half empty or half full?

Goals of Peer Support Continued

• Assist peers in talking about their experiences
• Educate peers about trauma and sources of strength and resiliency
• Assist peers in identifying their needs
• Assist peers in getting their needs met
• Assist peers in establishing or re-establishing contact with “family” and friends
• Assist peers in setting short and long term goals for their recovery

Menu of Peer Support Services

• Individual Crisis Counseling
• Peer Support Groups
• Public Education and Outreach

What other services can peers provide?

Services Funded by FEMA

• FEMA funds the following services, provided that they are provided by a “Certified” Crisis Counselor (more about this later)
• Crisis Counseling
• Support Groups
• Public Outreach and Education

These services are free

Levels of Preparedness

• National
• State
• Local
• Neighborhood/Community
• Self and Family

Preparedness Pyramid

Disaster Preparedness: Before the Crisis

• Studies show that most Americans do not have a “Disaster Plan” and therefore are unprepared when disaster strikes 
• Peers can assist other peers and their families in developing personal “Disaster Plans”
• Effective planning can avoid some of the problems experienced by peers in the aftermath of a disaster

Before the Crisis
Preparedness=Empowerment

Role of Preparedness in Facilitating Rebuilding and Recovery by Individuals and Communities
Individual Preparedness

Peers can assist peers in many activities:

• Creation of personal/family plans
• Storage of emergency items such as food, water, clothing and lighting
• Assembling and retaining personal information in a safe and accessible place

Preparedness:  Keys to Recovery

• We all respond better to difficult situations when we are prepared
• Preparedness can reduce some of the emotional,financial and destabilizing impact of disasters on individuals and communities
• Preparedness can facilitate more timely recovery/rebuilding process

Insert Sample Plan Here

Strategies to Encourage Personal Preparedness

• Convene a special event to complete plans
• Make the development of plans part of routine services provided to all peers in diverse settings, including hospitals, jails and prisons and adult homes

Community Mobilization and Preparedness

• Peer support groups and other activities provide a unique opportunity for peers to work together and develop strategies to support each other in preparing for a disaster

Your “community “ can work together to address issues of:

•           Communication-Multiple means
•           Transportation
•           Temporary Shelter
•           Care of displaced pets
•           Meeting Places

Community Mapping:  Creating Other Partnerships

Disaster preparedness activities also create unique opportunities for peers and peer run programs to build bridges and collaborate with other community based organization in the area.

Community Mapping Exercise

After the Crisis:  Peer Crisis Services

Peers Supporting Peers

Peer Support:  An Emerging Practice in Disaster Crisis Services

• First Responders- Police, Fire Department, Medical Personnel
• Consumers first trained as Crisis Counselors in 1995-1996

            Ventura Fires- 1995
            Oklahoma Bombing-1995
            World Trade Center Tragedy- 2001

What is in the Name:  The Role of Peer Crisis Counselor

• Crisis Counselor is the term used to define counselors specially trained to provide services and support to  survivors and communities impacted by a disaster.
• Peer Crisis Counselors are peers specially trained to provide services and support to peers and their communities. 

Visualization Exercise

• Have you ever been in a disaster?  What are some of the things that you felt or worried about immediately following the event and the days weeks and months and weeks that followed?

Unique Risks Facing Peers

• Relapse
• Attributing normal physical and mental responses to onset of psychiatric symptoms
• Interruption of mental health services

What else?

Emotional Charting

Phases: Responses to Disaster

• Honeymoon Phase
• Inventory Phase
• Disillusionment Phase
• Rebuilding Phase

Emotional Characteristics of Each Phase

Needs During Honeymoon Phase

Needs During Inventory Phase

Needs During Disillusionment Phase

Needs During Rebuilding Phase

Community Responses Mirror Individual Responses

• Communities exhibit similar responses to disasters.  What behaviors may be observed in communities impacted by a disaster during the following phases:
• Honeymoon
• Inventory
• Disillusionment
• Rebuilding

Caution!!!!

• Not everyone or every community goes through all of the phases
• Not everyone goes through the phases in the order presented
• Let survivors describe how they are feeling and what their immediate concerns are

Trauma Informed Peer Disaster Support Services

• Disasters are traumatic events that cause emotional and physical responses in most survivors
• Survivors with trauma histories such as histories of physical and emotional abuse may be “re-traumatized” by the disaster
• Many peers report histories of prior traumatization and this may impact on engagement strategies used by peers

People respond very differently to disasters

These differences may be due to such things as:

• Previous trauma history
• Current living situation
• Access to resources
• Access to information
• Pre-existing support system
• Gender
• “Culture”

What is “Culture” and How is it Transmitted?

• Expansive definition of culture
• How is culture developed?
• What role does may culture play in how we respond to a crisis?
• How may our views about different cultures impact on our ability to support peers?
• What impact may culture have on the development of particular coping skills?

Impact of Culture on Disaster Responses

Group Exercises

Taking an Observant and Asking Stance

• We all know what happens when we make assumptions!
• Positive assumptions about an individual or group of individuals may be as harmful to them work as having making negative assumptions about an individual or group?  Why?
• What are some popular held assumptions about peers or different groups of peers in your community? 

Taking an Observant and Asking Stance Continued

• Be Proactive! Listen,observe and ask questions
• Be curious, be amazed
• Be a learner and a teacher at all times
• Look and listen for strengths and positive coping strategies
• Meet people where they are and get to know them
• Make sure to familiarize yourself with the community you will be working in

Establishing Rapport

• Mission Not Impossible:  Creating a safe and nurturing environment under difficult circumstances.
• Flexibility:  Adapt to your working environment
• Introduction: Prepare an introduction that you will use     when first meeting a survivor (Don’t assume that people will know who you are or why you are        speaking with them)
• Listen:  Actively listen, listen actively

  Tools of Engagement:  Successful Communication Skills

Active Listening

Non-Verbal Cues

“I” Messages

Active Listening

• Active listening is listening to the speaker with both ears, our mind, our heart and our eyes
• We are not only listening to the speakers words but are also “listening between the line” to hear the feelings behind the words
• When are ready to respond to the speaker, we reflect back the feelings we heard between the lines

Active Listening in Action

• Survivor: I can’t take this anymore.  Every time I need something I have to stand in line and tell my whole story all over again and then tell me that they can’t give me what I need.
• Peer:  Sounds like you are very frustrated!
• You got that right!

Active Listening Exercise

• Think of a time when you had something really important to say and someone listened to you, what did the listener do that made you feel that you were being heard?
• Think of a time when you had something important to say and you did not feel that you were being heard?

Non-Verbal Cues

• Communication can also be non-verbal
• It is important that your non-verbal cues convey your interest in the person, what he/she is saying and your desire to help

Non-Verbal Cues Exercise

• What are some non-verbal cues that promote engagement?
• What are some non-verbal cues that discourage engagement?

“I” Messages

• Statements used to communicate concern
• Helps the listener remain open to hearing you
• Non-judgmental

How can “I” messages be helpful to you in you in your work as a counselor?

“Assessment” and Referral
Assessment and Referral

• Caution:  This is not a mental health assessment
• The purpose of this assessment is to help survivors effectively communicate to you what their needs are and to assist them in having these needs met
• Mental health services may be one of these needs
• The agency that you work with will have established policies and practices regarding these types of referrals  

Referral Strategies

• Work with other peers to create a resource handbook of community resources

Handbook should include but not be limited to the following information:

• Emergency Housing Information
• Food pantries
• Peer Support groups
• 12 Step-Programs
• Pharmacies
• Places of Worship

Additional Referral Strategies

• Local benefits offices
• Post Offices

FEMA, the Red Cross and other disaster relief agencies also have resource manuals and directories

Making the Match

• Collaborate with survivor in locating resources that meet their needs, are culturally and linguistically competent and are accessible ways call to confirm hours of operation and what documentation is need to receive services or support

Each Contact is an Opportunity to Educate Peers About Wellness and Recovery Tools

• In some communities, survivors may be unfamiliar with wellness and recovery tools whose value may extend beyond their recovery from the immediate disaster

Some suggested tools are:

• Disaster Preparedness Kits
• WRAP Plan
• Advance Directives
• “Personal Medicine” Forms

Documentation Requirements

• You will be required to document your contacts and provide basic demographic and referral information
• Generally speaking, different forms may be used to document different types of services
• Follow all confidentiality rules regarding the listing of names and other personal identifiers
• Become familiar with the forms you will be using
• In most cases these forms document services rendered for payment
• If you don’t record it, it didn’t happen

Self-Care

Disaster support work is very demanding and challenging

Tips to assist you in maintaining your own recovery and to avoid the “burnout” that is frequently experienced by workers:

• Don’t over do it, stick to your assigned work schedule
• Maintain your personal wellness routine
• Eat healthy and get plenty of rest
• Have regularly scheduled debriefing sessions with your supervisors and peers
• Ask for help when you need it
• Create opportunities to joy and pleasure

Wellness tip:  Create your own Wellness and Recovery Action Plan

Self-Care Exercise

Strategies for Systems Change in Disaster Planning and Preparedness
Integrating Peers in Disaster Planning, Preparedness and Disaster Service Delivery Activities

Strategies for Inclusion in Your Local and State Disaster Plans

• Your state and local government are required to have disaster/emergency plans
• Do not wait until a disaster to advocate for the inclusion of these services into state and local disaster plans
• Inclusion in your local and state plans creates a formal process assuring the utilization of peers
• Be proactive and organize!

FEMA Funded Services

• The Federal Emergency Management Administration funds two types of crisis counseling initiatives and crisis counseling training when the President officially declares a disaster.

Immediate Services Program

• FEMA program allowing the state or local agency to respond to immediate mental health needs with crisis counselors, outreach and community networking services.

Regular Services Program

• Provides up to 9 months of crisis counseling, community outreach and education services.  State can request an extension of this time limitation.
• State must submit a proposal to FEMA and peer crisis services must be included as part of this submission.
• Programs and agencies are strongly encouraged to review previously successful applications submitted for peer crisis services (don’t reinvent the wheel).

Other Peer Services Funded by FEMA

• Peers have successfully received funding for such services as:

                        Warm Lines- Oklahoma and New York City

Crisis Counselor Certification Program

• FEMA also offers a Crisis Counselor Certification Training Program
• Counselors must be certified for costs to be reimbursed
• States must formally request services and certification training

FEMA Certification Training

Benefits of FEMA Certification

• Strengthens your argument for inclusion state and local disaster plans
• Increases likelihood that you will be permitted to provide services in disaster relief shelters run by traditional relief agencies
• Eligible for payment for services

Roadmap for Inclusion and Integration    

Speak with Peer groups with previous experience developing, implementing and evaluating peer disaster relief initiatives and develop strategic plan addressing:

• Statement of Need
• Services provided
• Proposed outcomes-targeted community, numbers served
• Management of program
• Program Evaluation
• Training Outline and schedule
• Identify key players and schedule meetings
• Practice Your Presentation
• Advocate, Advocate and Advocate

Leveraging Your Peer Crisis Counselor Program

Peers have successfully leveraged the opportunities created during disasters to:

• Organize our communities and establish mutually beneficial relationships with other new organizations
• Develop peer workforce
• Introduce concepts of peer support and recovery