Day 2

1. Day 2 Warm-up Activity Lotus Bingo

2. ReviewHomework My Plan Worksheet (page 6)

3. Day 2 A-B-C’s of Peer Advocacy

4. A = advocacy B = believing in what you do C = concepts to address the challenges of peer advocacy

5. What are Challenges of Peer Advocacy?

6. Have to wear many hats It’s personal Knowing how to take care of ourselves Countertransference Wanting to do everything Working with difficult providers Not enough funding for jobs Challenges of Peer Advocacy

7. 4 concepts to Address challenges of Peer Advocacy • Communication • Confidentiality • Countertransferance • Creating Boundaries

8. Barbara’s Case Study(page 10-11) Barbara – Peer Advocate Sonya (client) Cindy – Social Worker

9. Barbara’s Case Study • Barbara is a peer advocate living with HIV. • Sonya has recently tested positive for HIV (not an AIDS diagnosis) and was referred to Barbara by a social worker at a local medical clinic. • Cindy, the social worker is Sonya’s social worker and refers her clients to Barbara when they need a peer advocate and the two of them sometimes coordinate care for their mutual clients. Cindy is also Barbara’s personal social worker—and to this day helps Barbara with some matters. Barbara and Cindy are therefore, in two different kinds of relationships. Cindy is Barbara’s social worker, and the two of them are also colleagues.

10. Peer Advocate Client Resource provider Employee Co-worker Educator/Teacher Listener Questioner Assures confidentiality Supporter Health advocate The Many Hats Barbara Plays

11. FIRST Communication

12. WHAT DO YOU SEE?

13. WHAT DID YOU SEE?

14. Cash Register Story Page 12 Read the story with your neighbor. Answer the questions together. 3 minutes.

15. Cash Register Story Answers • Answers: • #6 True • #3 False • The rest are all Don’t Know • We make many assumptions to fill in the blanks. • Need to communicate to get the story right!

16. How Do We Communicate?

17. Good Communication • Eyes – see other’s facial expressions, make eye contact • Ears –concentrate on what is being said; Be impartial and don't form an opinion, just listen. • Mouth – reflect back, summarize what has been said. • Mind- to soak it all in and brainstorm ideas.

18. Communication Skills (Pg 13) • Affirming • Open ended questions • Active Listening • Nonverbal Messages • Express Thoughts and Feelings • Communicate Without Making Other Feel “Wrong”

19. Affirming A positive confirmation. Providing support and encouragement. What is an example???

20. Affirming Statements “That’s good.” “I’m glad you asked that.”’ “You’ve come to the right place.” “That’s a great question.” “You’re on the right track.” “You really seem to have given this a lot of thought.”

21. Open-ended Questions Questions that cannot be answered with a yes or no.

22. Always ask… When Where How Who Why Tell me more Stay away from: Could you Would you Should I Can you Do you Open-ended Questions

23. Active Listening • Using your eyes, ears, mouth, and body language to listen. • Name the feeling the client is having… “you seem ______ (upset/frustrated/sad)” etc. • We let the person know its okay to have feelings; permission to express and let feeling go, so she can hear the information we are giving.

24. Nonverbal Messages Facial expression

25. Other Nonverbal Messages Posture Equal positioning Gestures Facial expression Don’t just notice client’s nonverbal messages but know that they are watching yours too…

26. Express Thoughts and Feelings Be open and honest Speak clearly Make the distinction between facts, beliefs, and feelings. “The best medical regimen for all clients is …” ---don’t say this. “I’m so pleased you’ve been taking your meds.” ---ok to say. “Many PLWH experience …”

27. Communicate Without Making Others Feel “Wrong” • Express concerns non-judgmentally • "I" statements

28. Practicing Communication Activity Break into pairs Decide who will be #1 and #2

29. Barbara will: Ask Open-ended questions to Sonya Respond with affirming statements Reflect back what Sonya is saying and feeling Sonya will: - give feedback to Barbara about her use of communication skills. #1 Barbara , #2 Sonya

30. So Why Is Good Communication Important Between Peer and Client? • Can get the most information about situation • Clear up myths vs. facts • Better understanding • Builds trust • So you can do your job well

31. Next Page 14, 15, 16

32. Confidentiality Shared information that is kept private between two or more people.

33. What to Keep Confidential? • HIV status • Housing • Sexuality • Housing • Others????

34. Why Should Peers Maintain Confidentiality? • Build trust • Code of Ethics • Rule of organization you work with • You have been there and know how important it is… • Others?

35. Breaking Confidentiality If the client is: • suicidal • QPR (question, persuade, refer) • assistance from supervisor • Call 911 • 1-800-273-TALK – National 24hour hotline • threatens homicide • assistance from supervisor • physically abusing a child or dependant adult • assistance from supervisor

36. Summary • Confidentiality is an important part of a peer-client relationship • Many reasons why a peer advocate must do all she can to maintain a client’s confidentiality including building trust, to provide support, etc. • A client may have several things she wants kept confidential and peer should be mindful about them. • A client’s confidentiality may have to be broken for her own safety or the safety of others.

37. What Were Confidentiality Issues That Came Up in Barbara’s Case Study?

38. Next Countertransference Page 17, 18

39. Countertransference Any thought, feeling, wish, hope or fear that might come up for a peer advocate, that is directed towards the client.

40. What Pushes Your Buttons? People, Places, and Things: • Domestic Violence • Substance Abuse/Use • Co-infection With Hepatitis • Pregnant Client Not Wanting To Take Meds • Newly Diagnosed Client’s Fear • Depressed/Suicidal Client

41. What Was It For Barbara? • She was hurt in a domestic violence incident • She has to be aware that she can’t get overly afraid for her client. • She can’t fear that client might get hurt in the same way, or to the same degree that she did.

42. Strategies to Manage Countertranference • Talk to colleague, supervisor, therapist • Stress reduction activities- journal, exercise • Re-assess your boundaries with client(s). Do you need to spend more or less energy on this person?

43. Last

44. Creating Boundaries Page 19

45. Create Boundaries By: Open communication with clients Follow through with your promises in a timely manner Address your limitations Seek support from your supervisor Refer, refer, refer It is ok to not know. Don’t feel pressured to share your story each and every time Being professional Putting your personal values aside

46. Values What are values? Where do values come from?

47. Value Activity – Page 21 • Discuss with your group whether you agree or disagree with the value statements on page 21 and why you feel that way. (Remember it is not about who is right or wrong but sharing various view points and listening to each other.) • Discuss the question on the bottom of page 21.

48. Peer Advocates’ Job… Provide information and support and don’t try to change their client’s values .

49. Personal Stories Worksheet Page 20- for you to review. Worksheet will help peer advocates tell their stories in an effective way, without burning out.

50. Working With Grief (page 22)