Using Core Competencies to Support Peer Workers and Improve Services (May 24, 2018)

Using Core Competencies to Support Peer Workers and Improve Services (May 24, 2018)

Well good afternoon everybody and
welcome to Recovery LIVE! This event is brought to you by the Substance Abuse
and Mental Health Services Administration’s Bringing Recovery
Supports to Scale Technical Assistance Center Strategy, otherwise known as BRSS TACS. Our TA center is dedicated to increasing the access to recovery
supports and we achieve this work through a variety of mechanisms
including a lot of TA focused on systems transformation and developing the
capacity of peer-run recovery community and youth led organizations. Now
we’re very fortunate to have three amazing presenters with us today and
they’re going to be talking about using the core competencies to support peer
workers and improve service delivery. I’m very pleased to introduce today’s
presenters. Cheryl Gagne, she’s a senior associate
with the Center for Social Innovation, Ricardo Bowden, executive director of the
Peer 360 Recovery Alliance, and Dan O’Brien-Mazza,
national director of Peer Support Services Office of Mental Health and
Suicide Prevention the US Department of Veterans Affairs. Today’s Recovery LIVE event has a
slightly different format in that I’m going to immediately begin posing some
questions to the presenters to lay out the framework for the discussion, and our
hope is that you’ll be able to benefit right away from a more robust and
inclusive discussion as a result. Now as soon as we’ve completed the introductory
questions to our presenters, we’ll then dive into questions directly
from the audience and we’ll get all started on all of that in about two
minutes, but I’ve got a couple of housekeeping items that I just want to go
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arriving today, we posted a poll question for everybody to answer. Let’s take a
quick look at what those responses were. So as I’m looking at, this is really a
demographics question, and it’s about what is your role. We’ve got a number of
individuals in recovery. Really nice to see a
smattering of recovery coaches. We’ve got a lot of peer support specialists
here. Really nice to see supervisors of peer staff. Same thing with program
supervisors. We’ve even got a couple of executive directors, thank you for coming.
We’ve got a few policymakers, that’s fantastic. Some educators on
the call. A couple of researchers, really nice to see. Great to see some students
here as well. And then we’ve got some folks that are just listed as other and
are here to join in our discussion today. You’re going to see a couple more polls
come up in the room today as we move forward. We
hope you’ll participate and join in. The polls really are
helpful both to you all, to understand who’s here,
and for the presenters to get a sense of who’s actually in the room participating
with them. Today’s session is being recorded, it’s going to last
approximately 1 hour, and if as you are listening you feel your organization
may need or would like some technical assistance around this particular topic
or basically any other topic, please copy the link for our online TA request form from the instructions box, paste it into your browser, and you
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We appreciate you taking just a couple minutes to complete that survey. Your
answers help us better serve you and make Recovery LIVE events better and
better as we move forward. And with that, I’d like to get us started. So without
further ado, presenters, here come those first questions. And the first question
is going to go to Cheryl. Cheryl, could you start us off by explaining the core
competencies for peer workers put forth by SAMHSA and BRSS TACS?
Sure. Absolutely. So this will be just a little review of how we came to
compile and describe these competencies. Back, several years ago, 2015, SAMHSA
engaged BRSS TACS to undertake this process, and it was a lengthy, kind of
multiphasic process, that involved 30 experts across the country to begin to
first compile through a vast literature search, list of competencies, job
description, skills, knowledge, everything required for peer workers, and we cast
our net far and wide and collected thousands of documents that listed what
peer workers were doing currently across the country, and we assembled those,
eliminated redundancy, we polished the language, we put a lot of emphasis
on making these competencies action-oriented, and so you’ll see that
most begin with an active verb of what peer workers actually do in
their daily work. After we assembled these and have them vetted by a group of 25
experts, and by vetted, we did this in a process called a Delphi Process, which
allows for reviewing a body of work getting people’s feedback, but yet
preventing any one person or perspective from dominating the discussion. So it
seems to be a more level playing field that you know we can do with large
groups of people. This final list of competencies had 61
competencies across 12 categories and then we vetted those with real-life peer
workers across the country, 50 peer workers participated in surveys and
interviews to really give us their feedback on these. The motivation for
these competencies were pretty clear. At that time, and then continuing to today,
the number and variety of peer workers in behavioral health care
services is growing. There was a real lack of clarity about what is their role,
what does a peer worker do, what is peer support versus case management versus
community support, where do they, where is there an
overlap in their work? So these competencies describe in detail what
those actions are. Our hope is that these are used primarily
by peer workers themselves to be able to look at “well, if these are the
competencies, where are my strengths, what are my limitations, what do I
want to focus on, what do I want to improve?” It also helps certainly
supervisors, and I noticed many supervisors in the room to again, get
clarity to be able to describe what are the
expectations to fix job description, to fix performance evaluations so that they
align with the actual role of a peer worker. You’re being evaluated on the job
that you’re doing. So these were the motivations really to get clarification
and to create some tools that will support peer workers to perform at their highest level. Now these are called core competencies and I just
want to take a step back and point out that by core here, we mean kind of
the foundational, fundamental, mental competencies. We understand that they’re
not totally comprehensive. That there are peer specialists or peer recovery
coaches that have more specialized competencies. Perhaps they’ve gained
expertise in supported employment or medication assisted treatment, gained
additional expertise, specialty expertise, and there’s also some advanced
competencies that peer workers may develop and those would be some
of the group process skills that many peers are called to do, supervision, some
of the organizational pieces of work that peers may be called to do that
are more advanced. Those aren’t included in this list of competencies. As with any
profession, peer workers, you know, it’s a living, breathing entity, and we
anticipate that there will be changes over time, that these core
competencies aren’t necessarily engraved in stone, but they will be shaped by the
field as we move forward. I do think it marks an opportunity, again, for peer
workers to take a very objective look at their work, being able
to identify their strengths and areas they want to develop, and also helps
programs that employ peer workers, and we’re going to hear from a couple of
those supervisors and administrators today of some of the potential uses of
these competencies. That’s all for me. Cheryl thank you. That was fantastic.
Appreciate that the overview and the historical
context around the creation. Before we jump into the next question, Melissa
could you pull up our second poll for today? I think it’s relevant as we
move into the discussion both with Dan and Ricardo, and before folks jump in,
what you’re looking at on those polls is just your familiarity with the
competencies, but notice that they are split up into “yes, I am a peer worker, yes,
I am a supervisor, administrator, or “yes, I am a policy or other and are
familiar, or, all of the above but I’m not familiar,” and I just wanted
to make sure that I specified that so that folks don’t make a an
error in their selection, and we’ll give everybody a minute to kind of chime in,
but it looks like we’ve got a pretty good lead on the “yes” column with
peer workers, looks like about 36 to 40 percent. The supervisor
administrators on the yes, another big big chunk, about 22 percent. The policy
makers, it looks like for “yes’ that’s around seven folks that are
here. And then it’s also really interesting to see who isn’t familiar, and really thrilled that you folks are here today as part of this
discussion as well, because I think once this is complete, the
familiarity with the core competencies will be complete, but what we have here
is about 10% of the, excuse me about 9% of the peers workers aren’t
familiar, about 21% of the supervisors aren’t, and that’s I think really
common, and same thing for policymakers and others, and the reason I even
share that and say that that’s common, is because it’s the peer worker itself that
it typically would be most I think focused around the core
competencies and want to have an understanding and a bit of
knowledge with that. So fantastic folks. Thank you for responding.
Appreciate it. With that, I’d like to go to Ricardo, and Ricardo, as a direct staff supervisor at a recovery community organization, how
do you use the core competencies? People who work with me
recognizing that from activity to activity, from the work that we do is
dynamic, there are situations that don’t always look the same, and in those circumstances, typically folks don’t think in terms of what core competencies I need
to reach for. They’re looking for trying to figure out how to be the best they
can be in that circumstance. So I try to first
of all role model these competencies. I think that’s really really critical
as a director so that I can continue to be teaching and keeping people’s
awareness. Things like just straightforward things like, “are you
asking open-ended questions,” and when I interact with people and with
them when I want to explore a challenge that maybe we haven’t, I begin with
open-ended question, I began by asking them how they thought
about them, how you think we should go to let them
drive the discussion and and share what strengths they may have and
acknowledged and support the efficacy. So I try to role model that as I teach
folks to continue to do that in work that they do, and I also try
to offer them shortcuts, ways that when you in the middle of a situation where
you don’t quite know what to do, we have been in this territory before, is to
have some shortcuts, like where you do entry level coaching they do a WRAP with a person, ask yourself who’s doing the talking and about
hearing my voice a lot, then it’s not like this is a person-centered
experience. You know, am I fostering hope is circumstance.
I had young woman for instance the other day who called me and she received
a call from a lady who was wanted to get was making a choice to withdraw for
methadone without through the temptation process, and so she was
scrambling around potential clinic, didn’t know what to do, decided she would
go to the emergency room, she reached out to the person who worked with for me by
telephone and so she supported important people in the emergency room, all of
that, but she called me there to say Ricardo, I don’t know what to do next,
because there were no structures where she’s able to actually go to the emergency
and be with this person, and so we have to answer excellent questions first of all,
and get her think about it some more, and what we wind up talking about is try
remember from your own experience what it would be like to be in an emergency room
right now if you were her and to fix about how important it would be just to
have somebody out there you know cares, and so being able to sift through all of
the teachings and the learning the new skill set we tell people
people about when they do this work to reach down to the core of being
genuine in your relationships, and so I try to provide those kinds of insights
for people, and also as I develop evaluations around core
competencies, I don’t call them that in terms of the words that I use, but
I evaluate from that context and from that conceptual framework, and
then the other piece, the other thing is that I encourage all of my people,
all my folks, to always be mindful of walking the talk that they do,
and in doing so, it keeps you, keeps them, keeps me, because I have to do the same,
keeps me focused on whether or not I’m doing the work in a way and
I’m representing the work in a way that’s going to be most effective and
come across in a genuine fashion. Ricardo, that was fantastic and thank you for
some real-world examples and diving into a little bit of the
detail around how you, you and your staff both use them. Fantastic. Thank you. Dan,
this next question is directed at you, and on a systems level, how did the
Veterans Administration use core competencies when the VA really
decided to establish a large workforce of peer support specialists?
Hi Steven, everybody out there. A little background first, if I may. Other careers
in mental health have well-established territories already in terms of their
knowledge, skills, competencies, and the acceptable practices. They’ve been around
for years, we think of physicians and psychologists and nursing,
they all have pretty well established career fields. There’s even a theory out
there that mental health treatment is built upon some kind of science, that is
based on emperical data and an established evidence base,
but I think many of us will say the truth is that there isn’t any consistent
measurement system which looks at either organizational or private practice
mental health providers to determine if they are adhering with any fidelity to
any evidence-based practice or scientific model that’s effective. Now in
peer support, we have to remember that in this occupation, which it is now, it was
only formalized in the last 15 to 20 years, before that it was primarily an
informal reciprocal self-help process that has been around for eons. We can go
back to classical scriptures and find verses about one person helping
another through various difficulties, military, certainly in the
VA there’s always been peer support. So the challenge with implementing a new
career field using peer support, is you have to know what it is and what it
does. Where do the people who do it get their knowledge skills and abilities? For
peer support, the expertise rests on very individualized experiences of recovery
that are rather unique, existential, and idiosyncratic. There are some common
themes no doubt shared by many and the impact of those experiences have been
spoken and written about by many talented and intelligent individuals. As
an aside here, some commonly shared experiences of many of those that were
treated for mental illness was abuse, especially in inpatient settings, social
isolation and stigmatization, this resulted in some early iterations of
peer support driven to become a social movement that sought to rectify and
challenge not only the current established system of care, but the
portrayal of individuals who have mental illnesses as being dangerous and not
capable of fully participating in their communities as full members.
So for some in the peer support movement, actually joining those systems as
participating staff and becoming professionalized may seem contradictory
to the role of some peer supporters. I believe that corrections in the mental
health systems are necessary and the recovery orientation is transforming
many, and peer support where it is in place is becoming part of the solution
to that end. We could go on and on about that issue, but I digress a little bit. So
in 2007, the VA had about a hundred and thirty peer support staff that were
mistakenly classified as health technicians and very few were being
utilized as agents of recovery to do the work what most of us today would agree
constitutes peer support. Instead, it was assumed that they would be doing the
activities that other health technicians did based on the competencies of that
occupation, which was more along the lines of medical techniques and
behaviors, like taking vital signs, doing drug testing, alcohol sensors. Well, we
assembled a group of individuals at that time, what as Cheryl was talking about,
gathering experts to look at competencies for SAMHSA, and we took
people who were in recovery, some mental health providers, some researchers whose
specialty area was peer support, and we reviewed existing literature,
certification, curriculum to see what it was that those who said someone was
certified to perform peer support provided training on. You see, we couldn’t
go to a college catalog then and look at what peer supporters were being taught.
That didn’t exist then, or at least if it did nobody, knew about it in our group. So
we determined at that time that there were about 35 competencies that were
being taught and tested. These competencies were basically skills that
allowed individuals in recovery to share their own recovery experiences or their
personal recovery stories with others in ways that were respectful, helpful,
effective, and did no harm. We adapted these and put some VA
spin on a few, especially those having to do with culture to ensure that there
was inclusion of military and veteran diversity issues. We then developed our
own training manual for these competencies and used it for a few years
before a federal law was passed requiring VA peer specialists to be
certified by not-for-profit entities approved by the VA or a state mental
health authority. So back in 2012, we wrote our own specifications for
certification training based on our competencies and solicited
not-for-profits to bid on providing the training and testing. At the same time, in
2012, we wrote new position descriptions that were based on these competencies to
change the job classification that the peer supporters had been working in for
five years. The new one allowed us to include the competencies that enabled
veterans who were in recovery to learn how to translate those individualized
lived experiences into active support that was respectful, helpful, and
effective for others who were still early in their recoveries. We awarded our
first certification training contract to DBSA, the Depression Bipolar Support
Alliance in 2013, and in 2015, we reviewed the SAMHSA recommended core competencies
and adopted a version of them that we used in our next contract that was
awarded later that year to Recovery International. So then, our whole system
was impacted by utilizing competencies to define a new career field, develop
certification training requirements, write position descriptions, and inform
ongoing training as well as being the criteria for performance reviews and
evaluations. Let me stop there, thank you. Dan, fantastic, thank you for a great
overview. I’m gonna jump into the next question. This one, Cheryl, I think has
probably likely to take the first stab at. Cheryl, how does lived experience with
mental illness or substance use disorder or both is part of being a peer, but
not the only qualification to be a peer worker? How’s that the
competencies help professionalize the career path of peer workers? Great, thank you. We do know lived experience is kind of a
foundational experience of people who are peers that actually contribute to
their peerness. That they have lived experience of a behavioral health
condition, but we also know that while that’s necessary, it’s probably not
sufficient to make sure, you know that they do a good job in offering peer support
services. So I think the competencies point out specifically what are those
other actions that peer workers do in addition to kind of sharing our story. The other thing I wanted to say that in addition, you’ll see this in the document
when you, the documents in the download box, you can download it after, but this
document that’s up now in the room. We also list the kind of the principles and
values, and that is the spirit in which these competencies are delivered. So
there are many ways to share our experience, but when we do it with
mutuality with the person’s best interest at heart, when we do that, when
we’re truly listening, then we’re doing it in the spirit of peer support. So it’s
not just the competencies what we do, it’s the principles and values that
describe how we do it, that really gives it the kind of the spirit
of peer support, and so together these behaviors or these tasks
activities in addition to kind of the spirit in which they’re delivered form
the core role of peer support workers. Fabulous. Cheryl. Thank you. Ricardo, building on
your last statement, can you talk about the guidance you might have for our
audience to help your workers reflect on whether they are really adhering to core
competencies, particularly when they’re busy working a large caseload. I am a huge proponent and encourager of
people going to trainings after trainings after trainings. The more folks
do that, the more it keeps that slop deepen. My experiences is that a lot of
people will come to trainings, buy into the notion of recovery coaching and all
that entails, the different mindset that that brings to the service
delivery as opposed to personal thoughts for people’s own personal journeys, and
then go back to wherever they’re working and not be and those messages are not
reinforced in the workplace. So they begin to move very quickly oftentimes,
kind of move back to what they knew best before they came through training in the
first place, and more guided by the traditional treatment service provision
setting if they go back to, because they don’t go back to a place that supports
but has conversations or talks about the principles of recovery coaching. So the
more often people are exposed to trainings to get that reinforcement,
the better. The other thing I’ve been proponent of, I think it
really really helps, is encouraging people to in trainings around
all the issues around recovery coaching
professionalism, ethical considerations, those kind of things, we
do booster trainings on a regular basis or active listening skills and
looking that ethics from a practical way that was really going on in your world
and how you respond to that much ethically perspective to make it very
real that way to the skills building, but importantly though to, for a good self
check, is to be will get as good as you can at using motivational interviewing
skills. That there’s something that that approach to interacting with people
is almost always forces you to be back in that mindset of really trying to
understand what the person is coming from, hearing what motivates them, check
in your own self on when you do conversations and you fall back into I know where this conversations gonna go, I do what they
should do, and if you step back and just ask one more open ended questions, you may
find it was what people have a whole different agenda in mind and where you
thought they were going, and you can keep yourself from erring in those
kind of ways. So I encourage people and that I mentioned before to ask yourself
some questions. Am I fostering
hope and check themselves around
are they interacting with people based on their diagnosis or are they interacting
with people based on their humanity, because we can people get so caught up
and are you using, are you about to use, are you going to relapse, when recovery
coaching embraces the whole person, and so the more folks can check themselves
around that. Then the other piece to is how important that you
look at it from a lens in my interaction with people. Am I helping that individual to feel good about themselves,
and supporting their dignity and their self-worth and perhaps even
helping them to increases their self-esteem. Ricardo, that was fabulous,
and I just want to point out there’s a number of people in the chat
right now who are saying absolutely, great information, so I
think what you were saying really resonated and thank you for that.
Dan, I’m gonna turn to you, and I want to just check in with you around this. Most states have created paths to become certified as a peer worker. Those
certification requirements vary from state to state. Now how has the VA, which basically hires peers in every state, use the core
competencies to help standardize the peer work requirement? You’re correct
Steven that state certification requirements affect us all and perhaps
not all of us equally. For example, some states require only a minimum of 40
hours of formal training to become certified and others demand rigorous,
on-the-job supervised experience as well as formal training to ensure a qualified
workforce. Since the VA, by law, has to accept any state certification for peer
support to make a veteran eligible for VA employment, we thought we needed a way
to ensure that regardless of the individual’s adherence to their state’s
requirements, there was a national standard that was the same for all
veterans who received care, whether in New York, Alabama, or Alaska, for example.
So we require our peer supporters to get 15 hours of continuing education
annually in peer support competencies that are approved by their supervisors
and match our core competencies, which I said earlier, pretty much match the
competencies developed and approved by SAMHSA and had the input of iNAPS, the
the major organization of peer supporters internationally. So indeed, we
have an internalized process for ensuring a high quality of care
throughout our system using core competencies as topics for the
continuing education, and by the way, we provide similar continuing education
based on the same competencies to supervisors of our peer specialists so
that they will be able to supervise the process and effective methods of peer
support that these competencies are meant to ensure. That was great, Dan, thank you, and I think that kind of leads me into another quick question,
and Dan, I’m going to pose this to you first and then I’ll check in with
Ricardo and Cheryl to see if they’ve got a follow up, but are there any specific
core competencies for veteran peer groups or faith-based peer groups? That’s a good
question Steven. When we looked at the 60 or so
competencies that SAMHSA had published, we tried to look at those through the
eyes of veterans, and again, we have veterans on our work groups, and we
specifically address some of the competencies perhaps in a veteran
centric way by seeing if there are cultural specific competencies that we
could add, and indeed, what we did do is we added some specifications to our
contract training that asked the folks who are teaching our veterans about core
competencies to actually address how we would interpret and understand all the
diversity that veterans bring. Now I’m not saying veterans don’t bring this
same breadth of diversity that non veterans do, because they certainly do in
a whole well aura of areas, but when it comes to
being a member of a very rigid militarized group or organization, there
are certain ways that people think and act based upon that experience that we
wanted to make sure people understood, and even within the armed military
services for example, you will find some of our veterans who were members of the
Marine Corps or specialized forces, in the Navy or the Army, all have a sense
of more specific, individualized things that happened with them that didn’t
happen among the other service members. So there is an area of knowledge that
veterans and service members have experienced that non veterans have not.
So those are things that we changed around. I’d have to actually pull
up the competencies to go through those, but we we will make those available to
folks who have an interest, and by the way, for you peer supporters that are out
there that are not VA employees, whether you’re veterans or not, the VA does have
a training program for individuals who want to know more about how to be more
culturally and military friendly and sensitive to our veterans and there’s an
online course which is very good that you could enroll in and take at your
leisure. It’s computerized, self-paced course, it’s several hours
long, but it does provide a lot of good information that you might be interested
in accessing. Great. Wow, that was great Dan, thank you, and some some really great information. Cheryl or Ricardo, any any thoughts about the core
competencies for veterans or faith-based groups? I think a
lot of the issues that come up to in training are around application of these
issues, kind of going, I know Benjamin had a question like “what’s the difference
peer support one-to-one versus in group facilitation,” and the
competencies are the same, but the application in how you roll them out
may be different. Certainly any peer who’s well trained, highly competent,
will also need additional training that’s specific to their role to their
organization. Every organization has a different culture, a
different way of doing things around, you know, peer workers are in hundreds of
different work environments and so you know core competencies aren’t going
to be able to really discuss all of the applications, but that’s where the peer
worker, the supervisor, the program administrator, can really get to what is
the training that peers needs specific to this organization, and again, they may
be different applications of the core competencies or it might be actually an
additional competency or two depending on the role in the work environment. So yeah, those are the issues with kind of applying these competencies to work
in real life. Ricardo, can you check in before I go on to the next question? Any final thoughts about the
core competencies around veterans or faith-based groups? I don’t have anything more useful to add. Fantastic, thank you. So then let me go
through the next question. There’s a question that says “I’m curious to learn
about the International Association of Peer Specialists. Didn’t they have
some competencies they developed and does Mental Health America have core
competencies for their certification program?” So iNAPS
absolutely has what they call “practice standards.” They were very similar to core
competencies. They articulated certainly the core values and principles of peer
work. We used all of their work, everything they’ve ever written were
part of the foundational first review of documents included
all of the iNAPS stuff. So those have been somewhat included and folded in
to these core competencies, they were not lost. Mental Health America, I’m not sure
where they are with their core competencies. I do know that they’re
rolling out a national certification and have core competencies, but I would
direct people to the website of Mental Health America if they want to learn
more about those competencies. Fantastic Cheryl. Thank you. Let me just check
in with Dan and Ricardo. Any follow up on that? That sounds like a Cheryl question to me. Dan? I concur with Cheryl. I’m sure that Mental Health America has core competencies, but you
would need to address those with that organization. Got it, got it, thank you. So
here’s another question. How have you reconciled possibly duplicated work by
the AA community or the 12-step community and recovery coaches as well
as work through some of the conflicts between those groups? Steven, would you please repeat that question? How have you
reconciled possibly duplicated work by the AA community and recovery coaches
as well as work through some of the conflicts between these groups? Steven, I can take a shot. Sure Dan, go ahead. I don’t really see that there
is a conflict or or duplication between community peer supports, through self
helped groups and formalized peer support, through mental health or
consumer run organizations. I think that we obviously, at least in our
organization, we try to find as many natural supports with an individual so
that they do not have to depend on the VA. I think the VA has had problems in
the past of institutionalizing outpatient care and a long-term
commitment to being a patient. With our work over the past 10 to 15 years in
transforming our mental health system, we really look to finding veterans and, not
we finding, but the veteran finding with our assistance places in the community
where they can have natural supports and we believe that if a veteran chooses
self-help through AA/NA any of the various 12-step programs, faith-based
programs, wherever they might choose, if they have means to hire a recovery coach,
that those are great options to utilize to help maintain their recovery. If there
are any conflicts that emerge in our discussions with our staff, we have found
them to be a minor and easily resolved with
open communication. Sometimes it does require a signed release of information
because of HIPAA, but usually the veteran and the community organization is more
than happy to participate in that process. So I really think that these
should be and are complimentary for the most part. Terrific, thank you. Ricardo or Cheryl, any follow-up? Oh go ahead Ricardo. First of all, a couple of things in out community. The are number of us who are
involved in recovery coaching in a recovery community organization, 50 60
recovery Alliance, who certainly have benefited from being engaged in those
12-step communities for decades, and so we have been able to
leverage some of our personal relationships in a way to engage
with people, let them know what we’re about. Secondly, as we have developed groups, we have sought to find the gaps in our
community. There are sometimes a days where people are over the years is that
wish we had a meeting around here at 5 o’clock for instance, and we don’t and so
we say “okay, well we have what we call our recovery, feel freedom,” we open
up like that. We try to find the niches in our communities and try fill those niches. Also, when we do provide a lot of recovery
community focused socialization events and our outreach
spans across all kinds of pathways, mental health recovery communities,
medication assisted therapy recovery community, AA, NA, and when we do our promotions, fellowships with respect to traditions,
cello chips with respective traditions we don’t take out we we have we have
prostrations hip we can give flyers to, but never in fact that we’re doing a meeting.
Real respectful, it would not trying to be real with responsible about
honoring how they operate. What we have found, and then the other part is that we
just continue to invite them to engage with us, and we continue doing the
programming that we do, and what we have found is we haven’t any bit like an out
of state park for instance and we have all kinds of people coming out to do
tables. People from AA have information table, people from NA have an information table,
suboxone, medications assisted therapy organization have information tables, and
so bit by bit, what we found is a lot of cooperation as we go forward, and
the other part is to we also a high operational recognition that there are
some folks who would not going to be open to what we do. They may, for
whatever kind of the reason, and they have a right to that. So we don’t try to be anything
but what we are, and walk what we talk. You know be who we are and stay our integrity and so we have
found a lot cooperation over time, its taken time, but that approach has been productive for us. That was fabulous Ricardo. I mean that was great. Thank you. Cheryl, did you have any final
thoughts on that? The only thing I was going to say is that one of the
competencies of peer recovery coaches and peer support specialists in
mental health is really accepting and embracing multiple pathways of recovery
and not being too attached to just one way, and I think that that has created
some conflict for people who are passionate believers in their own
pathway to recovery. However, that’s something that through training,
supervision, support, guidance, many people will then open
up and recognize that yes indeed, there are multiple legitimate
pathways to recovery, and we teach that very specifically in most training
programs. There was a question too about what are the differences and the
delineation between what is a peer recovery coach do versus a sponsor. In
general, a sponsor, its primary role is to help the person through the 12-step work
and doing the 12 steps of whether it’s AA or NA, the sponsor is
very active in that. As a peer recovery coach, we wouldn’t work on the steps
together. That would be work for the sponsor to do. However, the peer recovery
coach, I might be talking about career aspirations and possible
jobs or housing and medicine and how do I make a doctor’s appointment,
very daily life challenges that in addition to sort of the the spiritual
healing that AA talks about, includes this getting my feet
back underneath me and leading a meaningful and productive life. Fantastic. I wanted to say I know
Tom Kelly had asked that question about coaches and AA sponsors. There’s a really good article by William White that even
has a table that delineates the the actual path. So I would refer you to that.
If you just google “peer recovery coach William White,” you’d probably get that
article. It’s a good one. Awesome. Great reference to a resource too, thank
you. Folks I’m just conscious of the time and I
want to make the best out of the remaining time we have. So here’s a
question I’m just going to pitch out to all three of our presenters today. “It is
critical for peer workers to maintain professional boundaries when doing their
work as a form of wellness and self-care.” How does the core competency help with that?” Well I can start and then I’ll let
Dan and Ricardo. One of the explicit directions in the core competencies is
that peer providers follow the ethics of peer workers, the ethical
guidelines, and many states have articulated what are our ethical guidelines, peers must, and again, no exploitation. It’s much
more nuanced than that. We talk about peers because another skill is sharing
your experience, right, and when that is done skillfully, it’s done at the right
time, in the right amount, with the right person. It’s not done indiscriminately
everywhere all the time, right, so if we’re talking about really
in on just two competencies that speak directly to that. In
addition to that, most organizations will have behavioral standards, just, what do they call that,
codes of conduct, and person must follow those as well. So that’s occasionally,
very occasionally, there may be conflicts between the code of conduct and the
peer role and then that would need to be discussed and may be altered, but in
general, peers are held accountable for those ethics and those
codes of conduct. That was awesome. Ricardo, go ahead. Okay, as Cheryl mentioned, the code of conduct at our organization, we have an established code of conduct that we
provide and we talked about and reinforced
in our team meetings and such and in our trainings, and we are very focused on
repeating ethical consideration trainings throughout the year. From that, one of the
other, in my directing of interaction with people and in the
trainings, we talked about thinking through situations based on the kind of
the notion of the possibility of multi-party harm, and so to stop
and think not just as engagement in make this decision or engage the person
in this kind of way, how might it impact me or this individual, but think about
how that might impact our organization, for instance. How it might impact, the
outcome of this might impact the profession of recovery coaching, and to
create a lens to look through in making those decisions. The other piece too, it’s
also, but the boundaries are also about protecting the recovery coaches, and
we also talked a lot about the importance of self-care, and that because
ultimately if you don’t keep what you got, you have nothing to give to
anyone else. And we want that to be, we want people to be focused on being the
better person they can be because the better person they are, the better they
can help someone else. So we talk about my self-care boundary considerations and
conversations are all through all through the notion of self-care. So those are how the core competencies or the way in which I try to make them
practical in our organization come into play. Fantastic. Thanks again. And Dan. Yeah
Steven, I mean just the nature of the question that it is critical
for peer workers to maintain professional boundaries and it affects
wellness and self-care. Around all of the professions, there are
constructs about the relationships between individuals, between the
employees of an organization and those who receive care from them, and
also between the employees that work in that organization. That if you didn’t
have certain competencies, then there wouldn’t be an assurance that
individuals receiving services and the organization itself would be protected
from unethical or illegal practices. So the VA has competencies that again, I
think you’ll recognize came from SAMHSA like recognizing the dynamics of stress,
compassion, fatigue, burnout, seeks appropriate strategies and demonstrates
understanding that self-care is essential to successfully manage one’s
duties. So not to belabor the point, but those aren’t important that we
address through competencies. That was great Dan, thank you. And again, I’m
conscious of the time. It’s 2:57 Eastern time. We did not get to all of the
questions that we wanted to respond to today and I apologize for that. Certainly if you’d like responses to your questions, you can email
Melissa Witham or you can use the Recovery LIVE! address on the screen now
with your questions and we’ll do our best to respond. We are so glad that so
many of you could come and participate today, and if you haven’t done this
already, be sure to grab the resources in the download pod. Before everybody runs
off the back to their daily demands, I’ve got two more things to do really
quick. First, I want to thank Ricardo, Dan, and Cheryl. These guys are rock stars and
they do this work every day and it’s just such a great time to have them come
and share and provide responses to everybody. Thank you all for your time. I
know that you’re all very busy people and we’re just grateful to have you on
our event today. There is going to be a link that’s going to pop up here in
about a minute or so. It is the satisfaction survey and we really want
you to fill that out. It takes about two minutes to complete and we hope that
you’ll give us some feedback because those comments and the suggestions that come from those responses actually are why we have
Recovery LIVE! events today. It’s because of all of you and us responding to
the requests that you’ve all had about how to make these sessions
more engaging and lively and more user friendly. Please give us your
feedback, good, bad, and ugly, because that’s what we learn from, and then if
you’ve got any additional questions, feel free to add them to the satisfaction
survey, and remember folks, there’s a link to apply for BRSS TACS technical assistance. It’s free, use it, and we’ll be in touch with you within
about 48 hours at the latest and we’ll get your support in any way
that we can. I want to thank everybody today for joining us for this Recovery
LIVE! event. Again, Ricardo, Cheryl, and Dan, thank you guys for a great presentation. Have a great day and a fantastic weekend everybody. Bye-bye now.

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