Certificate IV in Mental Health Peer Work

Foundations of peer work

Day 5

The first step towards getting somewhere

is to decide that you are not going to

stay where you are

Resilience…. tough times don’t last,…

but tough people do!(anon)

Acknowledgement

Speak Out Dual Diagnosis Team art workshops, South Sydney Youth Services, 2010

Welcome and housekeeping

• Acknowledgement of Country• Housekeeping (WHS, bathrooms,

break times)• Assessments review• Group Agreement review

Workshop overview

Today’s workshop will cover• Role 2 –Skills support and coaching• Role 3 –Help individuals & carers to

navigate the system

Role 2:Skills support and

coaching

What is coaching?

Coaching is the art of creating an environment through conversation and a way of being that

facilitates the process by which a person can move toward desired goals in a fulfilling manner.

(Gallwey,1974)

A powerful alliance designed to forward and enhance a life-long process of human learning,

effectiveness and fulfilment (Whitworth et al, 2007)

Coaching is about enabling individuals to make conscious decisions and empowering them to

become leaders in their own lives. (Wise 2010)

7

Coaching and peer work

• Coaching is being considered as an effective way of supporting a person’s mental health recovery (Bora, 2012).

• Coaching is about engaging in conversations that build hope and focus on actions that a person chooses for recovery.

• It is argued that peer workers may be the most qualified coaches for people with lived experience of ‘mental illness’ (Swarbrick, 2011) and carers.

Activity – Coaching & peer work

• Why do you think peer workers would be good coaches?

• What does a coach and peer worker have in common?

GROW coaching

The GROW model opens up conversation in order to uncover what the person wants and how they might get there. GROW focuses on:• Goal - the desired outcome• Reality - the current situation• Options - exploring the options available• Way forward - making a plan of action

• What are the options and choices?

• What is the way forward?

• 'Will' -are you committed to doing this?

• How will you overcome barriers?

• Summarise and wrap up

• Where are you now?• What really is your current

situation?

• Setting direction • What do you want? • Where are you going?

1. Goals

2. Reality

3. Options

4. Way

Forward

GROW coaching

Activity – GROW stages & questions

In a group, as each GROW stage is discussed, take time to discuss and brainstorm additional questions that would also be useful.

Pages 10-12

Morning tea

Activity – Conduct a GROW session• In groups of 3 conduct a coaching session for

approx 15-20 minutes.• Repeat 3 times, changing roles each time. After

each rotation hold a 5 minute birds eye.

1. Coach who facilitates the grow process2. Person seeking to improve their skills in an area

- As the person you need to provide a real issue to work on that is not too big, too emotional or too personal for the role play.

3. Observer to note down good questions for each section, strengths and areas for improvement

Pages 13-14

Role 3:Help individuals &

carers to navigate the system

Navigating the system involves

1. The skills and knowledge needed by peer workers to navigate 'the system' themselves

2. The skills and knowledge of how to help or teach individuals & carers/family to navigate 'the system'

Activity

Brainstorm in small groups all the things you think might contribute to someone’s wellbeing outside of the 'system'

Page 16

Lunch

Beyond the system

Greatest cause of positive change in mental health - Lambert 1992

Relationship with the worker

30%

Tools and techniques

15%

Other things in a person's life

40%

Hope and positive

expectations15%

Activity - Beyond the system

Only one third of people (34.9%) with a mental health disorder used health services for their mental health problem – and two thirds of people with a mental health disorder did not report using services for their mental health disorder. (MHCA 2012 p1)

1. Why do you think this happens?2. What does this mean for your peer work?3. How does your organisation (or other local

services) provide culturally appropriate services with and for Aboriginal people?

Page 16

1. Skills and knowledge needed by peer workers to navigate the system

Activity - Navigating the system

In small groups brainstorm the services you can think of that fit in each column on p16. Include examples of self-help, advocacy and activist services

Activity - A pictorial of the Australian mental health system

• Look at the diagram on page 19 of the mental health system.

• What words would you use to describe the 'mental health system'?

• What else could you add to this diagram? e.g. peaks, alternative healthcare, etc

• Why is it important to know which programs are state funded, and which are federally funded?

Communicating with services

Activity - State & territory funded mental health programs

• List some state/territory funded mental health programs operating in your area, using the table on page 20.

• What parts of 'the system' do you feel most confident about and which do you need to learn more about?

Activity – Speaking the language

• What specialised lingo or jargon words does a new peer worker need to learn? List the words and their meaning in the table on page 21.

• What abbreviations does a new peer worker need to learn? List the abbreviation and what it stands for.

Knowing what services are available

• Local councils• Community events• Interagency meetings• Visits to mental health services• Peak bodies, rights agencies, advocacy

and activist groups• Attend conferences• Using the internet• Creating your own resource file

Activity

• What are some ways you can find out about services, programs and who the key workers are, in your local area?

Dealing effectively with other services• Be open to other people’s opinions • Be friendly and authentic• Be clear about your position, what you

have to offer and what you want to say • You are a valuable resource • You don’t have to know all the answers • Consult and find friends • Seek out technical advice and assistance• Try to build capacity and not reinvent the

wheel!

Afternoon tea

2. Skills and knowledge needed to help/teach others

to navigate the system

Supporting others to navigate the system

• To help people to navigate 'the system', peer workers need to employ recovery principles, assist a person to be empowered and build their capacity.

• Rather than just finding information, the peer worker teaches a person to find the information they need

• Peer workers need to communicate that there are many pathways to recovery– by having access to all the information, they are able to make informed choices.

Activity -

Families who navigate the world of mental illness will need to “set aside their confusion, sadness and anger—suspending any feeling of despair—about what’s happening in order to get on with what needs to be done. (Sederer 2013)

• Do you agree with this quote?• Do you think it is the same for people living with a

diagnosis of 'mental illness'?• In your time as a peer worker, what things have people

wanted to know from you or ask you to gather information about? Page 26

Activity - Factsheets

• Factsheets can be an easy source of information and there are a large range available that you can inform a person of so that they can choose from.

• What factsheets and websites would you recommend?

Page 27

Guidelines for navigation

• Analyse behaviour • Remember, it’s not your fault• Trust yourself• Don’t go it alone• Seek help as soon as possible• Don’t get into fights• Learn to bend the mental health system

to your needs• Settle in for a siege and never give up

Activity – Guidelines for navigation

• Do you agree with any or all of these principles? Which ones? Why?

• In small groups develop a set of guidelines of your own

Page 28

Teaching to navigate the system• help a person identify their needs and goals • support collaborative decision making in relation to

services needed• turn jargon and complex processes into plain English• research and find information• break processes into achievable steps and coach each

one• use adult learning principles to demonstrate and teach• advocate and negotiate• access services, eg. crisis, respite services, etc• gather specific information• maintain the emotional energy and resilience to fight

for rights and what is needed

Activity - Barriers to navigating the system

• CALD concerns• Literacy concerns

Questions• What do these barriers mean to you

as a peer worker? • What strategies can you use to

overcome or reduce these two types?

Page 30

Activity – Barriers to navigating the system

• System/service restrictions• Rural and remote challenges

Questions• What other barriers and challenges

(internal or external) do you face as a peer worker in your service or region?

Page 31

Teaching people to navigate the system is the beginning of them

reshaping it and changing it

Reflection on the day

• Key learnings – something you learnt• Best part of the day• One way I can make a difference

Thank you for coming

Certificate IV in Mental Health Peer Work CHC42912

Certificate IV in Mental Health Peer Work

Foundations of peer work

Day 6

Ability is what you’re capable of doingMotivation determines what you doAttitude determines how well you do

it

In this world some people will throw stones in your path.

It is up to you what you make from them… a wall or a bridge! (Anon)

Workshop overview

Today’s workshop will cover• Role 4 – Peer work and the workplace• Dealing with conflict• Collaborative risk management• Duty of care and dignity of risk• Ethical dilemmas

Role 4. Peer work andthe workplace

Activity - Characteristics of a peer workerBrainstorm all the characteristics the world’s worst worker may have (p34)

Activity – Staff qualities checklistComplete the checklist of characteristics of a worker and rate how often you demonstrate these in your work (p35)

Value & benefits of peer work

• Read the quotes about peer work on page 36

• What for you are 3 key messages or facts that you have learnt from the quotes?

Effective qualities of a worker

The watch, listen, wait & act model is a useful model for peer work• Watch• Listen• Wait• Act• Reflect & Review

Activity – Reflect and Review

In small groups or on your own, discuss and complete the table on page 40, which lists a series of questions which encourage reflection on your peer work practice.

Effective participation in meetings

“Good meetings are brief and stay on task – and your participation should support and

reflect this.”

• Peer workers need to attend meetings in their work, to have a say, influence practice, and to promote the value of peer work.

• It is important your participation be positive, dynamic and effective.

Activity - Effective participation in meetings• Describe the characteristics of a good

meeting?• What meetings do you facilitate and

organise in your work? If you haven’t chaired one yet when might you need to?

• Design an agenda for a regular meeting held in your workplace.

Page 41, 42, 45

Effective participation in teams

• Functional roles refer to the task roles that help a group to work effectively and produce outcomes.

• Maintenance roles support and maintain the group, hold it together and allow it to function well

• Dysfunctional roles disrupt team effectiveness

Activity – Effective participation in teams

• Which functional roles have you performed in teams? (current and past)

Page 46

Providing feedback

• There are times as a peer worker where you need to give feedback

• It is important to feel comfortable doing this

• Carl Rogers identifies 5 ways we can give feedback – evaluative, interpretive, supportive, probing, understanding

Effective feedback should be

• Timely – provided in the moment, or as close as possible to the action or event

• Behaviour-based – focusing on actions or observable behaviour, not assumptions

• Specific – identify specific impacts or effects of the behaviour

• Balanced – include feedback on areas of growth as well as strengths

• Growth focused – supports the person to grow and change, so is not a punishment or unduly critical.

Morning tea

Workplace harassment & bullying

“Workplace bullying is verbal, physical, social or psychological abuse by your employer (or manager), another person or group of people at work.”

(Australian Human Rights Commission 2011)

Impacts of workplace harassment & bullying can include:• Stress, depression, anxiety, panic attacks or trauma

reactions• Memory, concentration, thinking or decision making

problems• Self-esteem, self-confidence or self-assurance• Sleep or eating difficulties• Physical illness or injury• Self-harm or suicidal thoughts• Anger, fear, worry, irritability, short-tempered• Reduced quality of life• Absenteeism, poor morale, reduced productivity and

efficiency• Legal action, Workcover investigation, fines

Activity -

• Have you experienced or observed workplace bullying? What was its impact

• If you notice someone being harassed in the workplace, what can you do?

Page 53

If you are being harassed at work what can you do?• Check the policy and procedure about bullying and

harassment• Keep notes and records of everything that happens• Talk to people you trust who can support you• Talk to the person/s who is harassing you (as long as

you feel safe to do so)• Talk to your supervisor • Follow policy and procedures which may include

contacting the WHS person or HR person • Take it further by contacting the Australian Human

Rights Commission or your local WHS body, a union rep, or in cases of assault, threats or violence contact the police

Effectively dealing with conflict

Solving problems can be easier when you have a good process and approach

• Define the problem• Brainstorm possible solutions• Discuss the possibilities• Select the solution• Plan the solution• Implement the plan

Activity – Dealing with conflict

In small groups, role play the problem solving approach, with a real or imagined issue

Page 55

Negotiation

There are five basic principles to consider when entering negotiations (Conflict Resolution Network):1. Be hard on the problem and soft on

the person2. Focus on needs, not positions3. Emphasise common ground4. Be inventive about options5. Make clear agreements Page 57

Reframing & positive questioning

• When faced with a statement or response that has the potential to create conflict, instead of getting emotional, stay calm and ask open questions to reframe the other person’s resistance or reluctance.

• Explore the difficulties and then re-direct your discussion to focus on positive possibilities.

Activity – Reframing

• Reframing and option-prompting questions useful in conflict resolution are listed on page 57-58.

• Name when you would use each type of question.

Understanding & resolving conflict

• Conflict comes about from differences • Conflict is not a problem in itself - it is

what we do with it, and about it, that counts

• Resolving conflict requires skills• Conflict resolution skills enable us to

bypass personal differences and open up to possibilities

Activity - Understanding & resolving conflict

As a large group discuss• What skills are needed to resolve

conflict?• What are the advantages of conflict?• What are the disadvantages of

conflict?

Page 59

Activity – Conflict quotes

Reflect on the quotes/proverbs on pages 60-63 and select 2 or 3 that you feel drawn to or contain wisdom you need to remember.

Centring assists to:

• Focus our thoughts on desired outcomes

• Feel more balanced and stable• Embrace, rather than resist conflict• Relate to the other person as a partner,

rather than an opponent• Look for the opportunity the conflict

may be presenting us with• Flow with the problem, rather than

against it Page 63

Activity - Centring

What do you do to centre yourself?

Page 64

Different ways to handle conflict

There are 5 conflict handling modes• Avoiding• Accommodation• Competing/forcing• Compromising• Collaborating

Activity – Conflict handling modes

1. Which conflict mode is your preferred style?

2. Why do you think that is?3. How can you become more versatile

in the way you respond to conflict?

Page 66

Lunch

Conflict handling skillsThe following is adapted from the Conflict Resolution Network toolkit of skills for effective conflict resolution www.crnhq.org/

• Win/win approach• Creative response• Empathy• Appropriate assertiveness• Cooperative power• Managing emotions• Willingness to resolve• Mapping the conflict Page 66-72

Activity – Managing emotions

• Consider the questions and goals listed on page 69

• If communication is not appropriate, what other action could you take?

Activity – Mapping conflict

• Identify a recent conflict that has occurred at work.

• In a small group complete a map – inventing any additional details as needed.

• Role play the characters in the conflict map to see if you can develop a win/win solution.

• The group member who provided the scenario should not role themselves, to ensure a new perspective is gained.

Page 72

Supervision definitions

Different people have different views: • ‘A working alliance’ (Kavanagh, et al, 2002)

A trusting and robust relationship

• ‘A disciplined, tutorial process wherein principles are transferred into practical skills” (Powell, 1998)A structured process for development

• Teaching the ‘artistry of practice’ (Holloway, 1995)Engaging the creative and intuitive

78

Why is supervision important?

• To ensure client welfare• To assist in staff skill development • To protect sound & ethical practice• To improve staff job satisfaction

(Bernard & Goodyear, 2004)

• To meet duty of care and accountability requirements

• To improve work practices and professionalism• To offer support to mental health workers, reducing

burnout, job dissatisfaction and job stress

79

5 roles in supervision

Supportive Role

Practice Development

Professional Development

Administrative Role

Evaluative Role

80

Activity – Your experience of supervision• What types of supervision does your organisation

have and how often?• What was your best experience in supervision? • What was your worst?

Activity – Roles of supervision• Rate the roles of supervision from 1 to 5, where 1

is most important to you and 5 is the least valued.

Page 77

Page 74

Activity – Supervision & behaviour styles

People have different behaviour styles, so approach supervision and communication during supervision sessions in their own ways.

• How can you prepare for supervision and identify the type of supervision and approach you feel best for you?

• How will you negotiate this?

Page 78

Behaviour style and supervision

Behaviour Style Supervision Approach

Driver

Expressive

Amiable

Analytical

83

Supervision and behaviour stylesBehaviour

Style Supervision style Potential areas for development

Driver

Goal focusedActive approachHelp exploreOpen, expressive, energeticPractical & realistic

Slow down, allow time for reflectionTalk less, listen moreModerate tendency to challengeTest different approachesGive positive feedback and praise

Expressive

Encourages innovationSpontaneous, flexible, tolerantDeals with present issuesEnjoys exploring new ideas and new waysComfortable providing positive feedback

Focus on detailRegular, structured sessionsChecking you are achieving outcomes

Amiable

Empathic & SupportiveInterpersonal approachReflectiveAllows time to processSkilled 1:1

Address conflictsDevelop logic & analysisDevelop action as well as reflective capacityTalk more – remain open

Analytical

Likes complex problems Logical & methodicalObjective & analyticalGood with details & factsHelpful with planningStructured & organised

Discuss feelings / valuesGive positive feedback and praiseRemaining flexibleFocus on processEncourage use of intuition and imagination (alongside facts)Consider ‘big picture’

84

Collaborative risk and opportunity management

The neglect–overprotect continuumA model for evaluating risk within a recovery-oriented framework. Decisions about risk and providing support are seen within a continuum.

NEGLECT   OVERPROTECT

It’s the consumer’s choice. We are supposed to support choice. We’ve tried everything else. Let’s go with her choice.

  We can get the consumer to do the

right thing. We’ll arrange things so she has to make the right

choice.This is neglect, not empowerment.

  This is overprotection,

and is toxic help.

‘We need to recognize that the people we support are the experts on what they want while we are their partners in helping them get it. We need to have relationships where we share control and continuously support people in gaining as much control as is possible’

Smull 1995 p10

Activity – Neglect & overprotect

Do you ever neglect or overprotect?Provide some examples

Page 79

Duty of care & dignity of risk

• Dignity of risk refers to a person’s right to experience all that life has to offer, even though taking part in an activity may entail a level of risk

• Duty of care and negligence laws ensure that workers have a responsibility to take reasonable care to avoid injury to another

• Fulfilling our duty of care to a person should not shield them from all possible risks, especially if it may actually prevent them enjoying a full and rich life

Activity - Predicting risk

• We expect that risk assessment and management will be based on logic, rationality and good evidence, this is not always the case.

• Read through the statistics that highlight the difficulty in predicting risk, provided on page 80-81

• What do these statistics mean to you and your work?

Responding to risk

• The risk factors contributing to a situation do not rest solely within the person, but in the interaction between the environment, peer worker and the person.

• A peer worker brings skills and experience to this interaction which can influence a good outcome

• Start with the person and remember that it is the situation and interaction that is complex, not the person

Activity – Responding to risk

• What do you think of this understanding of complexity?

• How is it different from seeing people as complex?

Page 83

Activity - Categories of riskWhat are 3 risks related to peer work for each of these categories?

• Risk to self• Risk to others• Risk from others• Environmental risks• Service related risks

Page 83

Collaborative risk planning• Enables consumer self-direction and

consumer choice

• Allows a positive risk taking approach where risk is seen as a means to personal growth and recovery

• A planned approach to positive risk taking is the Person-centred Risk Assessment and Management System (PRAMS)

PRAMS

Step 10 Review and reflect.

Step 9 Take action.

Step 8 Monitor the harms and benefits of the action.

Step 7 Take actions to minimise harms and maximise benefits.

Step 6 Consult with everyone who will be affected by the risk plan and reach agreement.

Step 5 Develop a risk plan (explaining how harms will be reduced and benefits maximised).

Step 4 The person makes a decision about what needs to be done

Step 3 Discuss the advantages, disadvantages and boundaries of possible actions.

Step 2 With the consumer, assess the risks of a particular option (possible harms and benefits).

Step 1 Develop an organisational positive risk policy.

(Titterton, 2010).

Activity – Risk & opportunity planning• In pairs, role play a risk and opportunity

planning session. • One person is to discuss an aspect of their

life that is changing or about to change. • The other person is to facilitate the risk

and opportunity planning session using PRAMS steps 2 to 8.

Page 86

Afternoon tea

Managing incidents

• Proactive action – The best way to deal with a crisis is to proactively work to prevent it occurring in the first place.

• Collaboration with the person – Involving a person as an equal in risk planning is essential to reduce levels of distress a person may feel and increase safety for them and others

Activity – Collaborative risk planningIn small groups, look through each of the categories in the crisis plan and respond to the following questions:• How could I introduce the concept of a crisis plan to a

person?• How could I assist a person to identify any triggers?

(emotional, psychological, physical, spiritual)• How could I assist a person to identify their triggers'

early warning signs?• How could I have a discussion in my workplace about

the importance of preventative collaborative crisis planning?

Page 88

De-escalation skills

• De-escalation skills are important to help reduce and prevent distress, aggression, and violence.

• De-escalation skills include both verbal and non-verbal skills.

Principles of de-escalation• Maintain the person’s dignity.• Maintain calm.• Assess risks to the person and to the situation.• Identify stressors and indicators.• Respond as early as possible.• Use a clear tone of voice.• Invest time.• Establish what the person sees as their need.• Maintain plenty of personal space.• Give several options.• Use a non-aggressive posture.• Use verbal and non-verbal de-escalation skills (see

below).• Be assertive, not aggressive.• Assess personal safety

Activity – De-escalation

• In pairs, choose one of the scenarios on page 89-90

• Identify the different verbal and non-verbal de-escalation skills that could be used to calm the situation

• Highlight any potential approaches by the worker that could escalate the situation

Role challenges• peer role ‘devaluation’ and role confusion by other

staff• tensions between maintaining ‘peerness’ and being

a professional worker• lack of access to peer-specific training• lack of, or inappropriate, supervision and debriefing• lack of opportunities for career progression• tokenistic use of peer workers at services• in recruitment, imbalance of benefits for individual

peer workers with the importance of providing quality peer services

• little or no real succession planning

Activity – role challenges

Provide an example or possible situation from your workplace where you might have experienced each of the following.• Role strain• Role conflict• Role confusion

Page 92

Ethical dilemmas

• Select 3 scenarios to read on pages 93-96 and answer questions for each

Reflection on learning

To ensure your learning is transferred to your peer work practice, reflect on the topics covered in training and any areas that you would like to grow in and build knowledge and skill. Record your reflections on page 97.

Reflection on the day

• Key learnings – something you learnt• Best part of the day• One way I can make a difference

Thank you for coming

Certificate IV in Mental Health Peer Work CHC42912