Peer Support & Recovery

                                 

 

       Peer support & Recovery

 

                           

 

 

Recovery is like a chain of beads, for hope, empowerment, coping skills, community integration and whatever the Veterans need.

 

 

Recovery helps Veterans to attain and maintain their goals through self-awareness and community integration.

 

Veterans can create their own future and become what they always meant to be.

 

 

The Recovery model states that all people can become what they always were meant to be no matter what. Under the appropriate environment recovery is possible for all people. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table of Contents

 

 

1) Message of Hope- Recovery Happens!

2) De-escalating techniques

3) Peer Support approach

4) Cultural awareness

5) Ground rules for group facilitation

6) 5 pathways to recovery

7) Process of development

8) Self-disclosing / personal story vs illness story

9) Self-awareness

10) Self-care

11) ETHICS

12) Boundaries

13) Family engagement

14) Recovery Model

15) Social Skills

16) Stages of addiction

17) Guidelines for empowering people

18) Open-Ended Questions

19) Tips for helping Veterans

20) Cognitive distortions

21) Working with Veterans

22) Anger

 

 

 

 

 

 

 

 

 

Message of Hope- Recovery Happens! 

 

Certified peer specialist and apprentice working in the field are helping both Veterans and other professionals understand that recovery can occur through sharing their experiences. How important to you is it to feel respected? How important to you is it to be in charge of your own choices? Feeling respected and having choices is two major factors in a person's feeling of wellbeing. As peer specialist, we are called upon to treat our peers as we would like to be treated with respect and to respect their right to make choices.

 

De-escalating techniques

 

Anger and agitation sometimes begin as anxiety. Individuals under a great deal of stress may begin to become irrational and angered by what is happening around them. An individual may become angry quickly and then may quickly calm down. There are times when a mental health professional is needed to help calm someone down. There are other times when it may be necessary to contact law enforcement. It is important for certified peer counselors to be familiar with all of the options available to them in addressing this type of situation.

 

For many people, unpredictable situations create anxiety. Humans are hard-wired to physically experience anxiety in an extreme situation. Interacting with someone who appears to be angry, threatening or out of control may be enough to trigger the “fight or flight” reaction. While the sensation may be uncomfortable and/or unfamiliar, it is a normal reaction to an abnormal circumstance. What happens to you when you are around someone who is angry?

 

Crisis intervention and harm reduction strategies are vital in order to enable the safety of the milieu and establish rapport with the Veterans. Recognizing reasons for violent behavior Emotional Distress, fear, anger, shame, TBI, sadness, loneliness, trauma, humiliation and PTSD are some of the reasons why Veterans act in a violent manner and we need to recognize them. Never judge and always remain polite and professional, don’t get an attitude and never seem aggressive.

 

Take steps to keep yourself, staff, and Veterans safe Non Verbal Behavior Personal Space- Proxemics Supportive touch, supportive and silence, take time to listen Supportive Stance Stay on the side of the Veteran and not toe to toe, safer for you and decreases aggression because the Veteran will not feel threatening.

 

Body Language- Kinesics Posture.

 

We need to be aware of our own body language and don’t do any movements which might be seen as threatening. Like putting our hands in our waist, point fingers or rolling our eyes. We need to listen with empathy, try to understand where the Veterans are coming from.

 

Peer Support approach

 

Model, Reflect, Relate, validate strengths. Ask permission, open ended questions Empathy, I statement, recovery language, vet is the expert invite choices ally, describe what occurred after the incident. Often it is the consequences of a behavior that determine the communication road block.

 

Filters can be a physical obstruction such as loud or distracting noises, distance or lack of visibility, or a hearing disability. They can also be emotional or intellectual - feelings, values, beliefs, attitudes, lessons learned from past experiences or opinions. These listening filters cause us to hear certain things, forget others, exaggerate, minimize or expand on what has been said. As a result, we may tend to distort what we hear and interpret it according to our learned assumptions.

 

Cultural awareness.

 

Discrimination is not just about deliberately excluding certain people. It is more often about failing to reach far enough to include other ways of thinking. A disconnect can be found between how culture and discrimination are portrayed on television and how they exist in “real life.” For example, on television culture is shown as “other,” special, and obvious. Cultural differences include obvious things such as race, religion and ethnic origin. Cultural differences also include other issues such as gender, class, sexual identity or orientation. In order for a certified peer counselor to successfully communicate with an individual from a different cultural background, the CPS should possess: self-awareness about one’s own attitudes and values self-awareness about one’s beliefs about cultural differences. We need to ensure a milieu of inclusion and recovery for all Veterans.

 

Ground rules for group facilitation

 

To build self-esteem in groups, we can agree on some ideas that build respect for each other as well as for ourselves. Claim Responsibility for Your Own Feelings. "I Feel."

Be Sensitive To Others.

Maintain Confidentiality. What is Said Here, Stays Here. Indefinitely.

Seek Help If You Need It.

Respect The Opinions Of Others.

Share Group Time — Everyone Has the Right to Be Heard.

Ask Questions When You Don't Understand.

 

Group Facilitation It vital for the peer specialist to use the available time slot for the scheduled group. Some standard group facilitation guidelines are form a circle, always discuses policies such as respect, and not to be keep walking out the group. There are a number of different types of groups CPS’s typically may be asked to facilitate. Examples include educational, socialization, and mutual support/self- help groups. Educational groups tend to be focused on a specific topic, such as the recovery process, and the facilitator has the role of educator. These groups are structured and require the facilitator to present information that the Veterans will learn and discuss together.

 

Often the facilitator includes exercises for the group. Socialization groups focus on increasing the social skills of the Veterans. The role of the facilitator with these groups is to assist with the development of the Veterans social skills by helping them to interact and planning events where these opportunities will occur. In all environments established groups are already in place, if the CPS would like to facilitate a new group he/she must confirm that with their supervisor. 

 

5 pathways to recovery

 

HOPE

CHOICE

EMPOWERMENT

ENVIRONMENT

SPIRITUALITY

 

Process of development

 

Knowing our selves.

Recognizing strengths and enhance our confidence.

Goals and dreams

Figure out barriers

Understand what type of support we need from whom

Personal responsibility

 

Self-disclosing / personal story vs illness story

 

When you are thinking about self-disclosing, check yourself by asking this question. “Whose interests are being served or whose needs are being met by this self-disclosure?” Make sure that the answer to that question is “the peer’s” before self-disclosing. If it is not, then it is probably more about your interests being served or your needs being met. If this is the case, avoid the self-disclosure as it may be self-serving or self-indulgent. It is important to remain self-aware of why you are choosing to disclose so that you can avoid being self-indulgent.

 

This is the professional and accepted way of approaching and managing self-disclosure. Sharing Who We Are It is important that certified peer counselors know when, how, and what parts of their stories to tell in different situations and environments. In deciding this, certified peer counselors must first determine the reason for telling their stories. Is your personal story meant to: Build a relationship with the individual or family? Break stigma and biases or change attitudes others may have. Inspire hope, advocate for change and promote recovery oriented services.

 

Self-awareness

 

Means being aware of the predominating thoughts, feelings, values and beliefs from which we operate. By exploring our own issues in this area, we get to know ourselves better and can also discover our own biases or prejudices that might interfere with effective peer support. An increased sense of self- awareness is essential to the success of personal growth and interpersonal relationships.

 

 

 

 

Self-care

 

Peer specialist like other staff must take care themselves in order to be able to be effective in helping the Veterans attain their own recovery. Personal life must stay at home & Work should stay at the office. We need to have a daily routine of relaxation and doing things that we enjoy. Stress and becoming burn-out are possibilities for any staff if they do not take the appropriate measures.

 

We need leisure in our daily life to avoid anything negative from being created. Expressing our feelings and interacting with family and friends will enhance our self-care. Furthermore through debriefing & supervision peer specialist can attain solutions to any issues if needed.

 

We must control our feelings otherwise they will control you. Fatigue, irritability and not having a supportive environment especially in your personal life can affect our recovery. Personal Responsibility As we reveal more of ourselves to the peers we work with, we are role modeling recovery and resiliency. It is important that we continue to work on our own wellness and encourage the same for Veterans. One of the ways we model recovery and resilience is to take personal responsibility for our best health.  

 

Ethics

 

Ethical guidelines help the relationship to remain healthy for both parties and to protect Veterans and staff from harm. Every code of ethics in the mental health field, as well as many laws, require confidentiality on the part of mental health practitioners, and this includes certified peer counselors. Ethics, Boundaries & Confidentiality Ethics are the rules that regulate our actions.

 

Boundaries are the invisible barriers that exist in the various roles with have. Confidentiality is the parameters and constraints we must consider as we carry out our ethical responsibilities. Ethics are the rules that regulate our actions.

 

Every discipline has a Code of Ethics, including Peer Support. Ethical Standards Some ethical standards apply no matter what organization you work for in the role of Peer Support Specialist. Some additional ethical standards are more specific to an organization. The less clarity someone has in their role, the greater the chance is for ethical issues to occur. A Code of Ethics are not merely suggestions, but rather should be used as rules to follow.

 

Boundaries

 

Are the invisible barriers that exist in the various roles with have. Some Possible Boundary Concerns are being a leader in one group and participant in another. Unclear Roles Boundaries and Undefined levels of confidentiality.

Touching and unprofessional demeanor.

Confidentiality is the parameters and constraints we must consider as we carry out our ethical responsibilities. 

 

Family engagement

 

In the updated Uniformed Service Mental health Guide Book family engagement is one of the elements which enable the Veterans recovery. The VA values family engagement and is part of patient oriented services/ recovery model. It is important to know that parents/caregivers, families are the single largest group of care providers to Veterans who receive mental health services. As such, they can be a significant resource and asset to you in providing services. Recognize that most parents/caregivers feel enormous responsibility for their loved one(s) and the accompanying stress in meeting the needs of their loved one(s).

 

Providing support, information, and/or resources will often make a difference to the families. Any discussion about the involvement of families in mental health immediately raises issues about confidentiality. There are myths and truths regarding confidentiality and what may be shared with the families of Veterans. It is important for the certified peer specialist or apprentice to know.

 

Recovery Model

 

The medical model describes the dominant approach to illness in Western medicine. It aims to find medical treatments for diagnosed diseases and treats the human body as a very complex machine. The medical model drives research and theory about physical or mental problems on a basis of cause and cure. For many years, mental health care was driven by the medical model. Clinicians diagnosed and treated the illness. The emphasis was often on the illness and limitations. Medication was often a primary tool as more pharmaceuticals appeared on the market.

 

The recovery movement grew out of the desire of people with disabilities to obtain a better quality of life when it was clear that the medical model was often focused on simply maintaining or coping. A medical approach to mental illness has its place and is not necessarily inconsistent with a recovery approach

 

Social Skills

 

To help the patients to learn methods needed in leading a healthy lifestyle through recovery. To increase patients tolerance, perceptions, and willingness to continue their recovery in the community. In each group I will emphasize and talk about different recovery values which will enable the patients to attain positive community integration. Hope, Individuality, Self- awareness, Self - determination, Respect, Advocacy, Peer Support Community Integration will be focus but not limited in the following areas: Awareness of others, Attention skills, Compliance and direction following, Listening, Rules of Proximity, Dealing with Frustration, Anger and Anxiety.

 

Stages of addiction

 

Pre-contemplation is also often known as the "denial" stage. That is, before accepting that an individual has a problem, she might deny that a problem exists. She is likely to be defensive if others try to convince her to get help.

CONTEMPLATION -A person in the contemplation stage has some awareness of his addiction problem as well as the negative impact that it has on his life, including his mental and physical health as well as his relationships.

PREPARATION -In the preparation stage, the individual is beginning to move toward taking action. She might start to make small changes toward recovery. For instance, a person with an alcohol addiction might begin to limit drinking or start to attend an addiction recovery group.

ACTION -This stage represents a large step forward, as the individual comes to believe he has the ability to make change in his life. The individual starts to take major steps to combat his addiction.

MAINTENANCE -The maintenance phase involves finding strategies to ensure that the actions set forth in the action phase are kept in place for the long run. The individual works to maintain these new patterns of behavior and avoid situations that might lead to relapse.

TERMINATION- The person is ok with relapse just needs to maintain.

 

 

 

Guidelines for empowering people

 

Listen, wait, validate, check in, and never assume, open ended questions, Empowering interaction Good listener, be fully present, validate reinforce, honor choices, promote self- advocacy Recovery environment Point out positive strengths, conflict resolution, and honesty not defensive, no gossiping, assume the best for all people, are we helping the solution or helping the problem Spirituality is a connection with our inner self

 

Open-Ended Questions

 

One way we get to know the peers we work with and what they would like to accomplish is by asking open-ended questions. These questions cannot be answered with a simple “yes” or “no.” Here are a few examples: Who is important to you? Tell me a little more about them. Why are they important to you? What is your typical day like? Is there anything you’d like to change about your daily routine? What was/is your favorite thing about school (work)? If you had your choice of any one thing to do right now, what would it be? What do you like about yourself? What activities or things help you relax? What new activities would you like to try? Some people have great difficulty in responding to questions, they answer “I don’t know” and appear overburdened with having to give a response.

 

In this case one can try forming questions as comments that invite a response but don’t demand one, for instance: I bet you have some people in your life that are important to you and could tell me stories about them.

 

Tips for helping Veterans

 

Listen,

Believe in them,

Create a rapport,

Open ended questions,

Validate,

Recognize each recovery as unique,

No assumptions and judgments,

Allow person to take the lead,

Honor choices,

Don’t give up on people celebrate the small steps.

 

Peer support is about being an expert at not being an expert and that takes a lot of expertise. We are not supposed to give them the answer, but allow them opportunities to find the solution themselves.

 

Cognitive distortions

 

Self-blame- blaming self for everything

Filtering- only letting in certain information

Over generalizing- taking facts and making them a general thing

Global labeling- placing labels on everything

Mind reading- everyone is like you

 

Control fallacies

 

You can do everything better than others.

You can’t do anything

Polarizing- all or nothing

Emotional reasoning- rely on how you feel

Personalization- everything it’s about you

 

Working with Veterans

 

Talk with Veterans in a manner that they will understand (when appropriate) Always try to communicate, interact and engage.

Group facilitation along with activities.

Peer specialists are part of the team.

A bridge among the Veterans and the staff.

Understand what is needed and try to help.

Never go at it alone It’s a team effort to deescalate Veterans.

Being the hero is dangerous.

Personal experience enables us to talk with the Veterans.

Work with all team members to de-escalate any potential crisis.

Reality check Self-talk

When Veterans start believing in their abilities they will become active participants in their own recovery.

Asset based approach vs Deficit based   

 

Anger

 

Anger Control Plan will help you remember what triggers to avoid, which warning signs to watch out for, and what strategies you can use to control your anger. Will enable you to improve relationships with family members. Get along better with friends and neighbors

Avoid problems at work. Stay out of legal trouble.

Feel more in control of my emotions.

 

High-Risk Triggers

 

People asking rude questions or being nosy

People joking about important subjects

Places that bring up bad memories

Waiting a long time for an appointment

 

Anger Warning Signs

 

Physical

Racing heart rate

Tightness in the chest

Sweating/shaking

Clenched jaw

Fast breathing

Headache

 

Anger Warning Signs Behavioral

 

Clenched fists

Yelling

Pacing

Slamming doors

Pounding or banging on things

 

Anger Warning Signs Emotional

 

Feeling abandoned or afraid

Feeling disrespected or humiliated

Feeling guilty

Feeling insecure

Feeling jealous or rejected

 

Anger Warning Signs Cognitive

 

Thinking of hurting someone

Thinking of teaching someone a lesson

Thinking someone is rude on purpose

 

Behavioral Tools

 

Timeout

Deep Breathing

Muscle Relaxation

 

Cognitive Tools

Thought Stopping

Self-Talk

Conflict Resolution