Strategies for Supervising Peer Support Workers (April 2017)On October 20, 2019 by Raul Dinwiddie
Good afternoon everyone and welcome to Recovery LIVE!. This event is brought to you by the Substance Abuse and Mental Health Services Administration Bringing Recovery Supports to Scale Technical Assistance Center Strategy, otherwise known as BRSS TACS. The TA center is dedicated to increasing access to recovery support and we achieve this work through a variety of mechanisms, including a lot of technical assistance focused on systems transformation and developing the capacity of peer-run recovery community and family and youth led organizations. Peer support workers use their lived experience and specialized training to guide, support, and educate people in or seeking recovery from substance use disorders and/or mental health challenges. Today we will be talking about further defining peer support roles and providing supervision to peer support staff to successfully incorporate peer support services into our organizations. My name is Johanna Bergen and I’m the executive director of Youth Move National and I’m so excited to be with all of you and our fabulous co-presenters today. We’re very fortunate to have on three amazing presenters. I’m pleased to introduce Will Eberle, field director for the Vermont Agency of Human Services, Neil Campbell executive director of the Georgia support, excuse me, the Georgia Council on Substance Abuse, and Jonathan Edwards, a program consultant with the Bureau of Alcohol and Drug Use Prevention Care and Treatment, New York City Department of Health and Mental Hygiene. I’ll be turning things over to them shortly but first we’d like to hear a little bit more about you who are joining us today. As you arrived in the room, we posted a poll question for you all to answer – what is your role – and as you’re answering that, you can select all of the options that apply to you. We’ve received several answers and as I look at them, we’re impressed and excited about the number of you who serve as supervisors of peer roles – over half of us served in that role and this is an ideal conversation for you and as you can see there’s a breath of experience in the room through our lived experience in recovery; we have representatives from youth peer roles and adult peer roles and many of us who work with peers in our workplace. Recovery LIVE! events are very active and include live presenters and audience participation. You’ll see three more polls go up in the room throughout today’s session and we’ll call for your answers to them. You’re also welcome and to submit your questions about supervision of peers. We will have a Q&A session at the end of today’s session. You can also share ideas and comments at any time during this event by typing in the “post your comments and questions here box” which is on the right-hand side of your screen. It may take us a little bit to get to each of your questions but we’re going to do our best. Today’s session is live and is being recorded. It will last approximately one hour. During this event, participants will be in listen-only mode. Please listen in using your computer rather than using the phone line and if you experience audio difficulties there is a phone number available and in the audio instructions pod located in the upper right of your screen or you can request some support through the comments box. Tech support staff are viewing comments and responding to your needs. When we close this room today, a satisfaction survey will automatically open in your internet browser. We will appreciate you taking a few minutes to complete that survey, since your answers help us serve you better in the future. Last but not least, if you listen to the content and feel your organization may need technical assistance around this or any other topic, please visit the BRSS TACS website to request TA. The web link will be posted at the end. Okay, we’re just about ready to get started and I’d like to get another poll up and I’ll leave it to Will Eberle as he begins his presentation so you’ll have time to respond to the question. This poll is asking “do you supervise peers” and we look forward to your response, and with that I’ll turn it over to you Will. Thank you so much your honor. Well it’s really thrilling to see that a tremendous amount of folks in the room in fact do supervise peers, which is great. It’s nice to start with some common language and common framework and, really, you can’t always expect that that’s the case so I’d like to take a minute to really just be sure that we all know what we’re talking about when we talk about peers and peer support. So the way that I like to define this, and it’s certainly controversial, maybe it’s regional, I think there’s different ways to identify and talk about this in different areas, but this is really a strengths-based thing, you’re talking about people who have survived, you know, tremendous forms of adversity for the most part. I count myself among, you know, that community of people who are here demonstrating our resiliency every day despite having travailed, you know, fabulous experiences of adversity. So that could look like mental health challenges, incarceration, substance use disorders, homelessness, living in poverty, all of those types of things, but again it’s a strength to the organization. And so now that we, you know, are familiar with just the very basic term of peer, when we talk about peer support workers themselves, and active peer support, essentially we’re talking about a peer to peer model. You might be in, you know, a veteran’s program with people with a shared experience of having served in the military are sharing their experiences around a particular topic, or people who come out of homelessness are looking at people who are still in homelessness. So we’re really talking about organic grassroots type of exchange that is really the basis that most of the work that we’ll be focusing on today. And a point that I like to make, to people particularly who are new to this work, is that there’s a tremendously high chance that you’ve already hired peers into your organization without even knowing it. You know it’s just a testament to the resilience that the people do have that we can have people operating the highest level
of an organization that would identify as peers that we know didn’t necessarily know that. So I think it’s just a good point to start with. We’re going to move on to some more specifics here. So you know the number one point that I like to make about this is that you cannot train for lived experience. It’s a tremendous asset to your organization people that are … bear with me here, I’m having a little bit of a technical glitch of the internet … so essentially we were talking about the value of lived experience and, you know, people that have survived adversity are bringing an experience that you really can’t train for. So, you know, there’s just really absolutely no substitute for the lived experience that people bring to the table and, you know, to really get specific when you sit down with somebody in your peer exchange, you’re talking from a place of knowing that there’s really no substitute for, I like to call it, people’s sort of BS radar. You’re sitting down, you’re doing some peer support and, you know, people know immediately that you’ve actually been through it as well. That you can identify with some iteration of what they’re going through. That, you know, it isn’t contrived and that builds a rapport and just sort of a connection that really is the basis of this healing work that we do. So again, I can’t overstate how important it is that, you know, we hire people in these positions that really do know what it’s like for the people that we’re trying to serve and that said, you know, a person that’s doing work in the world of peer support really acts as a liaison and sometimes even a translator accross communities. So, you know, you’re talking to people that may still be living in a lot of adversity and then your sort of really explaining that at the system’s level sometimes to people that are in systems of care operating to the highest level, acting as a champion at advocate, and, you know, really just a bridge back and forth to ensure that people in need of support are getting that. That are getting, you know, their fair shake in terms of, you know, services and just basic fundamental building blocks that everybody needs to address and, you know, another thing that is really just a beautiful byproduct of this work is that as we continue to grow in these roles and get more training, more experience, more competency over the years, it only strengthens the recovery process of people that are acting as peer support staff. So that’s another thing that’s really important to understand. You think about taking on this work in your own organization. So now that we really are on the same page about, you know, what we’re talking about, what a peer is, what peer support is, I like to always be sure that people that are considering doing recruitment for this type of situation have really taking the time to know that they’re ready to do the best job possible. They really do right by the people that they’re going to hire and I like to call that organizational readiness. So you know you have to ask yourself a series of questions. Do you have an environment where it’s really trauma-informed? Is it safe to talk about that valuable experience that your staff has gone through? Is it comfortable to, you know, share, you know, recovery stories or wellness tools or things that people need on a daily basis to thrive in a work environment and if it’s not, what are some changes that you could make to to get your organization more ready and to really provide an environment that will allow all of your employees to thrive, and when we talk about specifics, I think that in, you know, recent developments in the human services work that I’m working in currently we have a lot of focus on what are called aces in resilience and that generally relates to the topic of being trauma-informed and person-centered and I just can’t overstate how important that is that every iteration of service that we have and every organization sends the message explicitly to everybody that we’re working with that we believe that all people have the ability to thrive and to live out their wildest dreams and we’re sending a message of support and help at all times and so I think that that’s just critical as a building block and remember all the time and, you know, another thing is that you’re going to have people in the organization who don’t identify as peers, and who maybe haven’t had some of the same forms of adversity and, you know, you want to really be sure that there’s comfort around that disparity. Are you able to provide space and room for everybody and all experiences and how are you guided towards, sort of, you know, mitigate some of those awkward situations that might come up where the person might not relate to the same type of experiences but you want to be sure that everybody is feeling comfortable and able to work together well as a good team. So those are some questions that are nice to address in the arena of organizational readiness before really thinking about recruitment. You know, as we move on in the material, some of this stuff is just really operational for an organization, things as simple as are your written policies and procedures really clear, are they, you know, fair. Do you have an opportunity for people who might be new to the workforce to really understand how things work around recruitment, around hiring, benefits, time off, just, just barely work things that maybe are a new experience for some people and are those presented in a way that’s really clear and understandable to folks that you’re hoping to bring in your organization to add value to all you do, and that also goes for things like supervision of peers, we’ll get into a lot more of that down the road, but that it isn’t really just, you know, this process of an employee working in the organization needing to know the ropes, but also you’re supervising peers. What is expected? What are your policies? Are they clear? Do you have the board of directors that you write in in a way that, you know, it needed for this to be the best possible level? So those are some basic questions to ask yourself and one of the things that, in smaller states like Vermont we sometimes run into and I expected is the case in other parts of the country as well, it’s that sometimes you inadvertently create a cohort of one, and basically that’s a situation where you have, you know, a large organization, that maybe is not particularly recovery oriented, that maybe will hire a peer to start a wellness program of some type, and what that can inadvertently do is create a lot of isolation and alienation so that, you know, this employee doesn’t have opportunities to really work with them colleagues. If you like to have a cohort to feel like, they, despite being peer staff, in fact have peers in the organization. So I think it’s really critical that you can hire teams of people whenever possible. That people have those natural supports in the work environment and can help trade tips and learn from each other and just continue to to bring, you know, positive benefits to the organization and all this to you. And, at the end of the day, when we talked about all of this, sometimes it really does come down to time and money. We run an organization or business of some type and to really do these things as well as they deserve to be done does take money at does take time and it’s better to do this job very slowly and very well than to rush into it and not give it some, either the time, money, attention, or any of the other things involved as it needs to be done as well as it can. So you really want to ask yourself are you prepared to do that? You know, do you do you have the resources to spend? Are you willing to learn and work on this journey of recovery together? So its really the essence of the organizational readiness that I want to talk about with you all today [pause] and some they’ll have an opportunity to continue with questions throughout the rest of the presentation but at this point it’s my honor to hand the torch over Neil. So go for it Neil. Thanks Will. Great Job. It’s really good to be here everyone. I appreciate being involved in this. I think it’s an amazingly important topic. We’re going to start with another poll question for you. We’re going to pop that up right now. Is that right? Yeah. If you supervise staff, have you ever received formal supervisory training for that purpose? You could go ahead and answer that and I’ll do just a quick introduction of myself. I am a person in long-term recovery and for me that means I haven’t had a drink or a drug for the last 27 years and I speak out about my recovery because I want everybody to have the opportunities that I’ve had to get and to stay well and my organization, we not only hire peers, people in recovery, I have a cohort of nine staff right now, plus we have a bunch of contractors that we do the peer certification training for the state of Georgia for people in addiction recovery. So we also, in our peer training, we have a week-long peer training, where we include supervisors in the last two days of that training and many times what we hear from supervisors is “I wish I could have gone to the whole thing.” So we understand that peers, we hear all the time from supervisors that they would love to have more training about peer support, about how to promote recovery, recovery focus in their organizations. So I want to talk a little bit about organizational readiness and then some qualifications about peers. So what we’re looking like is that people, most people, have received training, formal training supervisor training. That’s great. And there are some that have not, which is, that’s a little frightening but I understand, I get it, I’ve been in that situation before too. So I do appreciate answering honestly to those questions because I think they help us kind of get a big picture of where the field is. I think that that kind of tracks with my experience as well. So see I guess I could forward this, sorry. It’s really really important to clarify essential job responsibilities when you’re doing the hiring. I think that’s, you know, one of the biggest problems we hear from our peers is that, you know, I was hired to do one thing and I’m doing another, or I didn’t know I’d be doing this when I got hired, or they’re not using me, you know, might, they’re not using me for what I thought I was going to be hired for and I think, you know you can get behind that or get around that by actually just having good conversations, open conversations, about the expectations of the job and what all well is expected of someone as they come on, as you’re recruiting and hiring. So many times we hear “well I was hired to do peer recovery groups but I’m only doing intakes” or “I’m filing” and, you know, that’s not going to make for a happy employee and I’ll get to that a little bit later. I think all roles should be supervised as relative to peers and, yeah, so anything I’m saying actually for supervisors and qualities is pretty much for all staff but I think they have to have a fundamental belief in the hope of recovery. I think all staff and supervisors need to believe that were here because the expectation for everyone who comes to us for services, we expect recovery. We know you’ve got everything you need to recover and we’re here to help promote that. So that I think that is critical for peers. I also think, you know, when people ask me, they say to me all the time, I want to come work for you and my question back to them is always, as a supervisor, you know, what do you want to do, and they say whatever you want, and I say that’s not the right answer. Right? So my question back to them is that what do you care about, what are you passionate about, and the belief behind that is people show up for what they care about and what they’re passionate about. So we want people to show up for their jobs. So I constantly, you know, my staff will say what do you want me to do next? I say what do you want me to do, you know, what do you love to do? What is it that you care about and you’re going to get out of bed every day and come running into work and that actually sometimes works. So I think that helps with turnover, when peers really understand and get to do what they’re passionate about and have the training. When we talk about qualities of a strong supervisor, again this can apply to everyone not just working with peers, but someone who’s compassion, supportive, transparent, inclusive, actually, we were in a staff meeting the other day and I asked my staff I said “hey what are some qualities of a strong supervisor” and those were the first four things they said to me so that’s real data if you want to take that. Also someone who empowers, that doesn’t, that makes sure that peers always have a voice. We believe that the conversation is different when there is someone who is openly in recovery at the table and when that gets empowered, I think that’s really really important. We always hear, many times here, we got to have appropriate boundaries, you know, all of that, in terms of sharing. We do a lot of training around effective use of your story. How to tell your story. So it’s not just the ability to have a story, but also use that story to help other people and to set appropriate boundaries. Again all of this is qualities of not just a strong supervisor of peers but a strong supervisor and I think, you know, a quality that stands out for us here and for me if someone who follows up and make sure that, you know, people are taken care of they’re feeling heard, you know, we say, we don’t, we’re not trying to fix anybody, we just wanted to listen, we think we can listen to people and give them a forum, that that’s going to make for a happy employee as well. I’ve got two staff out of the nine right now that are headed down to a regional, it’s a regional NA convention and they’re, I love the fact that they’re taking care of their own recovery and I know, I think Jonathan is going to talk a little bit about self care later. Sn that’s really important. But how do, you know, make sure that people are taking care of their own, whatever their pathway of choices. That you’re giving them opportunities to take care of that, and I think also following up with, you know, making sure that you’re meeting with staff and peers regularly, making sure they’re getting what they need out of the position too, because it really is a two-way street, and we also think it’s very very important to be inclusive of all staff, that you’re not … that you also have some cross perspectives at the table when you’re doing, you know, having staff meetings, we’re talking about roles. We make sure that we have peers at every table. Again, the conversation is different when someone is openly in recovery at the table. We also have a belief that there is a culture of recovery that there are certain things you can do to promote a culture of recovery and that peers should be leading that. If you believe in the peer voice. Are they talking about how they’re getting their needs met and how they’re comfortable in their recovery and promoting the culture that they are comfortable in. So I think that’s really important and again those cross discipline conversations are really important, that we all are in this together, that everybody has a role, you know, when we see a, in a clinical setting, you have a psychiatrist sitting next to a peer sitting next to, you know, family members, those kinds of conversations are really about what recovery is all about. So I think again the qualities of a good supervisor of a peer are the qualities of a good supervisor for anyone and I’m going to turn it over to Jonathan and we can answer any questions in a little bit. Thank you very much Neil. Good afternoon everyone. I’m really excited to be a part of this forum. I was just saying to myself and going over my own experience, I said “well, I guess at this point I have many strengths and I also have some challenges and one might be coordination.” So sort of dealing with the screen and the notes and what to say in the polls and so on, it’s all in the spirit of learning humility, which I think is part of this process. Being a person serving others as well as being a supervisor of those serving others. So that’s just my little plug for an introduction. We have a fourth polling question, that should come up. Right now I’m looking at the previous one. So polling question number four. If you supervise peers, did you receive specialized training for this. Now I think we already asked that. Is that true? Okay. So that’s the question that’s coming up. What I’m going to do is move ahead and look back to see if the question came up that I think I was supposed to read. So good afternoon again. My name is Jonathan Edwards. I’m also a person in long term recovery from substance use and also living with the diagnostic label of clinical depression. So just a little bit about me. I’m a licensed clinical social worker. My experience and recovery allowed me to go back and to pursue some dreams. I’m also a certified peer specialist in the state of New York and I’m also a doctoral candidate in the social welfare program at Hunter School of Social Work and I work with the New York Peer Specialist Certification Board, which really formed in late 2014 and as of October 1st, 2015, we have certified well over 1,000 certified peer specialists to provide Medicaid reimbursable services in the state of New York. So I think that concurs with some of the experience that others have shared on the call. As a former director of peer services at King’s County Hospital Center, which is part of New York City’s Health and Hospitals Health Care System, I’m pleased to take part in today’s Recovery LIVE! Strategies for Supervising Peer Support Workers. I also want to acknowledge Melissa, Will, Neil, and Johanna, for the expertise they bring to the table on this topic. My goal is to contribute to this collective dialogue by presenting a few of the most common challenges that have emerged in supervision and for the purpose of this discussion supervision of peers. I was asked in particular to talk about two things. One, are supervision challenges and solutions. The second being self-care. And they are somewhat related, but also I think a bit fragmented in the sense that I didn’t feel much continuity between the two, but I’m going to try to link them as best as I can. The four challenges and corresponding set of recommendations of each challenge are based on both my experience as a supervisor of as many as 28 peer supporters who went under the title peer counselors in that healthcare system, working in five different service areas of the hospital, inpatient, outpatient, comprehensive psychiatric emergency program, the primary care clinic, and the partial hospitalization program. So I want to talk a little bit about the four challenges and the corresponding set of recommendations of each challenge and I’ll start out by just saying that my initial formal education around the supervision took place as a graduate Social Work student more than ten years ago before I was aware of the great concerns around both the supervision appears and the dearth of supervisors who were deemed qualified to assume this critical role of supervisor. My role in helping to build a visible peer workforce in New York City and subsequent application of supervision principles among peer supporters emanates from the wisdom and work of two experts on supervision, al freaka Duchenne and Eva Kahn kaduche ins work is rather infinite and several of his approaches are embedded into the material I’m presenting. Kahn’s article on the other hand, it’s finite, and it addresses a concept known as the parallel process in supervision. We highlight some of the conflictive issues that come up between supervisors and supervisees and how those often replicate dynamics that occur between supervise and clients. The first point on the grid is the challenge of supervision versus therapy. Sounds very clinical, but it happens in the real world. This can actually happen as it’s often difficult to separate personal emotional investment from the work itself. In my experience employees frequently come to supervision with a host of concerns often beginning with their feelings about the work they are doing and perhaps anticipating the job becoming too stressful, partly because of the stigmatizing attitudes in those environments in which they work. Also resistance from other staff about the involvement of peers. The misunderstandings and lack of information that other staff have about peers and external issues that could potentially impact the ability of peers to do their best even if that’s a perception. So I’ll start out by just saying in supervision versus therapy, what’s very important, and I learned this from failing miserably at … people said “oh he’s a great supervisor,” but when I really did a self-assessment of my supervisory sessions, what I found was that I was a really good listener, I was empathic, I strove to be balanced, in that, you know, I would do my best to make sure the work got done, including role modeling those tasks, but also, I wanted to meet people where they were at, which is something that we oftentimes hear in, you know, clinical work and engagement in peer work. So I had to learn after a while to develop and agree on a format for supervision and I did that in collaboration with those whom I supervised. I felt it was really important to embed as many recovery principles in the work and actually still be accountable. So developing and agreeing on format supervision really had to do with assessing with the individual how much supervision they felt they needed, how much supervision I felt was needed, and to meet somewhere in the middle with that. And then of course one of the things that I learned in my early supervision as a supervise was to come up with an agenda and present that. One of the other things that oftentimes happens is that people come to supervision with real concerns that should not be ignored. However, you know, the mission of many organizations is to serve those who present for services and so I see that as priorities and therefore when someone comes in with a personal issue, I don’t feel that I want to ignore that, I’ll sweep it under the table, but what I want to do is gently redirect that person to appropriate resources. It could be anything from a person saying, you know, I’m not getting enough sleep and I’m not eating right, to saying “hey, you know, there are some tools” and I usually try to talk about things that I did so that I’m not prescribing and saying “hey have you ever heard of Mary Ellen Copeland’s WRAP, it’s a great thing,” but maybe talking a little bit about some of the tools that work in that for me. I feel that any good supervisor whether you’re supervising peers or non peers should pull on those personal experiences. I think they’re very empowering to share with others that you too are human and you go through challenges as well, but in the final analysis, that someone’s dealing with something that’s ongoing, it’s important to sort of gently redirect, you know, I heard Alex Gitterman, who is a renowned person who does group work in supervision, and he talked about in one of his keynotes that sometimes, maybe, allowing five to ten minutes of a person to kind of dump or unwind, but then gently refocus them on the tasks at hand, and that’s why it’s so important to have an agenda and not let the supervision session become therapy, which I often did in the very beginning and sort of in the middle too. The next thing I want to talk about is role ambiguity and I really appreciate something that Niel said, which had to do with what I was hired to do versus what I’m actually doing, and that something that oftentimes happens if the supervisor does not have a good understanding of what the peer worker should be doing and the peer doesn’t have a clear job description. That oftentimes leads to being a target, being a target because you’re not able to articulate what it is that you’re doing, what your value is, and it’s important for everyone to be able to understand the role, not necessarily be an expert in each other’s role, but, you know, we know what nurses do, we know what social workers do, we know what psychiatrists do, but there’s really a dearth of education around what the peer does, and I think it begins with the peer and supervisor. So it’s important to clarify tasks, competencies required, and also the expectations. Role ambiguity is not the same thing as being a team player and helping out in situations where an interdisciplinary team may be short-staffed, but it’s important for any worker, peer and non peer, to set boundaries, to draw lines in the sand, and to really use every opportunity to articulate the work that they’re doing and how it sort of fits in with the larger picture. I want to talk very briefly about stigma. One of the things that I used to suggest to my supervisors when they would come and say that someone made a disparaging remark or they weren’t sure or, you know, they just felt that there was hostility in the air, it was important to partialize and break those things down. For example really looking at the culture of a particular unit that one was working on, and if the behavior was something that was generalized, then maybe stigma was not necessarily what was actually happening, but more hierarchy and more organizational oppression of one staff member to another, and to not always look at things as stigmatizing, but to know what to do with a stigmatizing comment when it happens, and, you know, for those of you who are really savvy, I’m sure you have experience in identifying those opportunities as teaching moments, and to promote respect and acknowledge the achievements. As a supervisor to sometimes sit with the person coming to your desk or to your office and not denying the disparaging remark but oftentimes stigma assaults our self-esteem, and our capabilities, and our perceptions of ourselves, so it’s really important to, sort of, lead a person back to, you know, their well spring, talents, their contributions, to really help, you know, leverage that moment. So let’s look at what’s going on with the stigma, how can we address it, what can we do. Maybe we need to give an in-service on what peers do. Maybe we need to do more education on the units. And lastly addressing performance. A very very dicey area for all supervisors. One of the other things I found is that I can’t generalize when someone is underperforming or even over performing. Is that I have to be really specific and performance-based and what often times happens with peer workers is that any behavior is pathologized, anything from an absence, to expressing an opinion, to vehemently having a position, and so that ties others, excessive absence, resistance, not well, they’re relapsing, and so oftentimes supervisors, particularly those who don’t have peer experience, may tend to lean on the … err on the side of well, you know, maybe you’re having a hard time on the job, instead of really collecting information and finding out what happened. So it’s important to be specific, it’s important to be performance based, it’s not about symptoms, it’s not about what a person might say their concerns and their worries are, but how they’re performing. And provide feedback, guidance, and support along the way. I think the worst thing one can do as a supervisor is to wait until performance evaluation and then spring surprises upon a person. Whether those are unfavorable or highly favorable, because sometimes with highly favorable performance, often times we may be really really really good at something and letting something else slip and I think this is just general workforce stuff. So it’s important to help a person calibrate and balance their responsibilities along the way and to also make performance, addressing performance an empowering and dignifying experience, where it’s not punitive, and it’s not disparaging to the individual, but more empowering and informative. So one other thing that Neil said, which I … I lost it, but I may come back to it before I move on. So if I can go to the next slide, I just want to talk very briefly about self-care. So self-care, you know, and the conversations that I’ve had around self-care and peers have gone from anywhere from collaborative to contentious and, you know, I conclude that self-care is universal and it’s not just the peers. However, many of us are working in different organizations. I happen to come from highly restrictive, punitive environments like hospitals and so I often times have to, you know, self assess and and temper down the way that I may operationalize some of these concepts like self-care and maybe every peer should have a WRAP plan. Well actually I think every staff member should have a WRAP plan and, you know, how do we generalize these good practices so that once again we’re not pathologizing well-being, wellness, and health. So I think self-care, first of all it is universal, it should be promoted as a resource, but not in lieu of work because, once again, is a very fine line between, you know, Neil talked about some of her workers going to a regional conference and/or convention and how good it was that they were taking care of themselves, but, you know, like the job might support that or they might be taking their own personal time, but they’re doing it away from work so that they can come back and incorporate, sort of, their learning and, you know, their own renewal into the work, their own energies, but what oftentimes happens is that the system, usually well-meaning clinicians or people in charge, will promote self care as an entitlement in the job place and then what happens is that we lose sight of serving the people who are presenting for services, and this and I think that’s the fear of many people is that well if we have an exercise room are people going to be in there exercising all day long, and that’s why you make accommodations, but you also have policies. You want to get supportive resources but you don’t want people to sort of mistake them as part of their job and that oftentimes happens. Meditation, yoga, aromatherapy, walking, nutrition, time management, are things that I’ve heard, licensed creative arts therapists, psychologists, social workers, talk about needing to do more of. I’ve heard many many peers talk about those things as really being reinvigorating and helping them to get themselves feeling healthier. Planning time off is so fun. I mean, when I went back to work after a few years of Social Security disability, you know, I used to feel like I don’t know if I can get through a whole day, but I desire to and I want to go back to work and I think I have some things to offer and many things to learn. One of the things that my supervisor, sort of, encouraged me to do when I took my first full-time job after a hiatus was to plan time off and she said, you know, start thinking about three months from now, start thinking about four months from now, and I think it’s a good strategy to really, you know, help to create the pot of gold at the end of the trail. Maintaining organization is really important. That’s something that I’m still working on. I may be working on that for the rest of my life. I’m very disorganized and that creates a lot of stress for me, but once again that’s not like a peer thing, that’s personality thing, but I do try to emphasize to people that it’s really really important to be organized, and then creating a culture of recovery, which several of you already spoke about. That happens in many ways. It’s not just the presence of peers in services around what peers do, but it’s about the environment, it’s about representations, it’s about cultural diversity, it’s about the pictures on the wall, you know, all these pictures, sort of, you know, harkening back to days of, you know, good Samaritans, who may have really been oppressors, or are we really showing the dynamics of people on a wellness continuum and contributions of people getting services as well as peers. So I think I’m really yes. I’m going to do a quick time check because we have so many questions to come in if you want to wrap up a final thought for us. Well this is great because I was just finishing up Johanna and thank you very much for that prod. It’s really been a pleasure and so I’m going to look back at the question. Was they’re supposed to be a different question up because I think you guys … You know Jon, there’s just a nuance to this question and it’s if the training you received as a supervisor is specialized to your role as supervising peers rather than general. Okay. So it looks … it looks like in people’s current job, the majority of people have received specialized training to supervise peers, and then, you know, it looks like about fourteen percent received training from a previous job, and 30 percent are saying that they didn’t … they’ve supervised for a few years, but no they haven’t received specialized training, and then about a quarter of the respondents said that they have never received supervision training, I guess that’s at all, and I’m just going over to see if there were any non responses and I don’t see any, but Johanna I’m going to pass on to you now and thank you very much. Yes thank you so much Jonathan. I’m just going to speak briefly to some points that are in a slide deck that will be available for you to download at the end and to some unique considerations for those of you that may be supervising youth peer support specialists, which is an area that I do most of my work in and so all of the things that Neil and Will and Jonathan have said today are very important and should be part of your supervision of youth peers and I would add just a couple of considerations and just the first really is to the uniqueness of youth culture and young people in these peer roles bring that portion of the culture as well as all of the other cultural … pieces of culture they bring with them to their work and we should be ready to and willing to address the needs of a young workforce. Youth peers are also oftentimes serving in their first job in their role of peer and keeping that in mind as we help build the skill set in their job and also in the holding of a job. We also, as supporters of young people in peer roles, need to consider that there are developmentally appropriate transitions occurring because of their age and this includes coming into education environments, graduating from education environments, moving away from family support and into independent living, our friends and peers are moving and transitioning into the community and away from our community, and all of these we will bring into our workplace in one way or another and to have the support of a supervisor in those transitions is vital, and then for those of you that are lucky enough to work on an environment where there are both parent peers as well as youth peers that can support a single family unit knowing that the role clarification becomes even more important to determine how peers work together, especially in a team environment where they’re present at the same table. You guys have been asking so many amazing questions in the chatbox already. We’re going to transition in and pose some of these questions to our presenters and we’ll do a little bit of our round-robin here but Will, I’m wondering if you would be willing to speak to the question many folks are looking for policies – specifically to support peers or are in development process, and do you have any guidance for them. Thank you Johanna. It’s a critical question and yes, I do. One of the points I like to make on this topic is that there are regional approaches that maybe are different, but when you’re in the process of creating policy it’s really great to have the opportunity to compare what you’re doing to other states and even international work, and for that reason the thing that I recommend the high is a set of core competencies emerging through work of the Intentional Peer Support Cohort, and a person that works for that organization called Chris Hanson is always happy to share the work that they’ve done to compare policies and procedures internationally, places like New Zealand, and all of them work, it takes them overseas, compared to things happening here in the States, and it does sound like shameless self-promotion, but it will say that there’s some really good work coming out of Vermont around policies and procedures that again are anchored to things happening all around the world. So a second person to connect to it would be Gloria van den Berg, the executive director of the Peer Respite Center in Montana, Vermont, and I’d be happy to connect folks with both of those individuals and their emails and I’m sure they’ll both be happy to share policies, manuals, things that can really act as a template or a point of context for people in the process of building this. Thanks so much Will. Neil or Jonathan, anything to add or we will move on to another question. No. I can think about P and P all day long but that’s a great question. I would say also, yeah, for peer-run organizations specifically can also go to the Association of Recovery Community Organizations ARCO and they have some good stuff there. Patty McCarthy Metcalf and the folks at Faces and Voices of Recovery can lead you to – as well as the certification for … the Council on Accreditation for Peer Recovery Support Services if you’re talking about again about peer run organization. So another question that’s coming up very commonly in the chat box is how we can support peers during a relapse or a transition in their recovery journey. Neil can we start with you, everyone will probably want to chime in on this one. Again, I’d like to yeah, we should we had a whole hour just to talk about this, but of course the time to talk about these issues is before someone has a setback in their recovery, so I think having conversations about that. I ask my people that work with me or for me “hey, you know, how can I support you when things get tough” and we have those conversations ahead of time and “what helps in your recovery so I know how to help you.” So we don’t call it relapse, we actually, we’re very mindful of our language around all of this and we call them setback in our recovery, we don’t, we think relapse is … there’s a lot of different problems with that language, it’s the only health condition I know of where you talk about relapse. You don’t say people relapse in their diabetes, we talk about setbacks in their recovery. So I think it is it’s just really important first and foremost to be proactive and to have these discussions ahead of time and because people will tell you if you say, if you ask, say if you get into trouble or if you’re having a, you’re thinking about using again, specifically if it’s for addiction recovery, you know, how can I help without, how can I support you. It just basically good peer work and then I take out a good policies, you know, it’s not that you … you don’t want someone who is ill working for you, right, and everything but you also … and you want to maintain wellness and health, and so I just think having those discussions getting staff especially supervisors comfortable with the language of setbacks and the language of returning to youth is really important. If I could just jump in for one second. I love what you just said Neil. That’s wonderful. One other thing I could throw in on that topic is that I’ve found in the process of doing a lot of direct service and supervising a lot of peer students, is saying that the work is incredibly triggering and it’s incredibly helpful to let people know that from the very beginning that it’s important to understand what those things you might encounter on a daily basis are that could lead to a setback or to some difficulties in their own life and concurrently to really from the very beginning identify the self-care strategies that can allow a person to do the work for the long haul. I just want to add those two cents. And I really appreciate what Neil and Will said and I’ll just say that in, when people were newly hired, I don’t know that I put a lot of emphasis on the relapse or even put that out there. What I tended to do was to acknowledge the stress and complexities of the job and also, this being a critical stage for people as they were moving from, you know, typically not working to working as was the case with most of the peers, and I would try to sort of frame it as a wellness thing, you know, as opposed to like what if you relapse, possibly saying that, you know, we all have different triggers or activators and different things happen. I just did not want to, and I appreciate Neil what you said about the language and we have to be mindful of that term relapse, I don’t know that I ever used that, I think I would talk about setbacks and challenges. So, yeah, I think it’s important to address and we all have different ways of doing it. Awesome, great, and another question that we’re hearing about is how we, how do we grow the workforce and recruit new peers into the work and we’ve heard references to stigma come up and I’m wondering, Will if you could start us off in thinking about recruiting and growing the workforce. I’d love to. The topic that’s really dear to me. I’ve actually made a professional shift from running a peer run program to being a state bureaucrat, so I very much believe in this tactic. So I think that this relates explicitly to this concept of stigma and getting the message across in a very diplomatic way that it isn’t a scary deterrence for an organization to hire somebody that’s been through forms of adversity. So that’s a tremendous strength that can only help the organization and all the work that they do and I think that fundamentally is the message that we would navigate to find a place of balance to improve the scope and reach of what can be done within the peer workforce. I think that there are a number of opportunities that are emerging with funding and billing codes that we’re seeing particularly in the realm of reentry for incarceration, but some of the sort of mentoring peer reentry work that we’re seeing on this are definitely burgeoning sectors, but again I think that there’s this liaison ship in translation and talked about data points in that material today, where a person in these roles is really acting as an ambassador data conduit between large organizations that can sometimes be bureaucratic and faceless and very real people really who depend on them to get through the day. So in these roles, all of us, I think, have a duty to be champions and advocate and to have a cohesive voice in stating that, you know, to experience that people bring to the table, who have survived adversity, who are now demonstrating resilience, who are thriving, can only improve our ability to serve everybody in every sector. So they’ll be the biggest plug I would say, and in addition to that, I would also encourage people, regardless of where they might be working in an organization at what level, to think about their own professional development and things that would be required to get to the point of having systemic influence and ability to sort of think about not just getting grants, but being in a position to disseminate them, not just adhering to policy, but making it, things of that nature. So I think there are many opportunities for us to ascend to those positions that can really be tide changers. I’m going to not weigh in on that because I think that Neil and Will said a lot of good stuff. I don’t know to have anything to add to that. Okay, great, and now the questions just started coming in. We are hearing questions and a lot of excitement Neil about that positive strength based language you were using. Can you speak a little bit more to recovery language and how that can be supportive of peers in the workforce. Yeah. Absolutely. So we we talk a lot about, again, about wellness, we don’t, we get rid of them, we call them the killer D’s, the diagnosis, the disability, the disease, you know, we don’t talk about those. More about how we stay well, right. I think it’s really important to, you know, if we, that we have the expectation of recovery, that’s a recovery-oriented system, so many times in treatment programs per se you hear people say “hey, only two out of ten of you are going to make it.” Here, right, we see, we say that to our peers who are coming in to us for services. We change that around and say “hey, we expect everybody to recover.” We have the expectation of recovery here and become a very strength base. We don’t ask what’s wrong with you today or, you know, what’s the matter. We say, you know, what’s right with you today. What’s going well. Think that kind of language is really, can help promote recovery too – we don’t talk about people hitting bottom. We think that language is not strength based because the elevator gets off at every floor. Now you can do this you don’t have to go out and hit bottom. That kind of language and that, it’s sort of the social norms around addiction anyway. We’re trying to bust all of those wide open. Hopefully that’s helpful and turn it over to you guys if you have anything else to add. Well I just add a dimension around language that, in addition to everything that’s been said, you know, also the cultural aspect of how we engage and how we’re very tempted to define people in their experiences and so, if we’re dealing in settings on a multicultural, I think it’s important for us to be curious to ask people, you know, how they prefer to be referred to, because it’s not just the illness lexicon or health lexicon, but it’s also how people are made to feel about, you know, their culture, themselves, their sexuality, their religion, their height, their weight, so we have to be really careful in how we give language or put language to people’s experiences and really, you know, sort of check in with them about how they like to be referred to. Yeah it was actually our peers who came up with the setback language. They said they didn’t like relapse, they wanted to call it a setback. We are constantly asking peers how they prefer to be referred to and we have, not only that, we’re having our peers who have had setbacks develop a setback policy so they can tell us what helped them and that to us is, of course, they know, they’ve come back from the setback, of course they should be setting our policy. That’s amazing, it’s amazing. That’s a really good example Neil of all of the values and many ways that peers can support and improve our work or workplace I love that. Neil, Jonathan, Will, thank you so much for this hour that you have sparked a serious number of questions that continue to come on. Thank you everyone for joining us today. We’re glad that you will be able to be here. As our session wraps up today, you will be able to download the slides from today and there will be a link to a satisfaction survey that will pop up as you leave this meeting room it takes less than three minutes to complete and so we really hope you’ll give us feedback on our presentation today and your comments and suggestions are important to us. If you have additional questions, please go ahead and put them in a satisfaction survey. You’re also welcome to visit the BRSS TACS website to learn more where there is a link to an online TA request form. In the handout spot of the webinar today there is a request form for TA that you can download if that form works better for you and we want to thank everyone for joining us in this session today and have a great rest of your day.