Day 2

1
Day 2

• Warm-up Activity
• Lotus Bingo

2
ReviewHomework

• My Plan Worksheet (page 6)

3
Day 2

• A-B-Cs
• of
• Peer Advocacy

4

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

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What are Challenges of Peer Advocacy?
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Challenges of Peer Advocacy

• Have to wear many hats
• Its personal
• Knowing how to take care of ourselves
• Countertransference
• Wanting to do everything
• Working with difficult providers
• Not enough funding for jobs

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4 concepts to Address challenges of Peer Advocacy

• Communication
• Confidentiality
• Countertransferance
• Creating Boundaries

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Barbaras Case Study(page 10-11)

• Barbara Peer Advocate
  Sonya (client) Cindy Social Worker

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Barbaras 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 Sonyas 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 Barbaras personal social
  workerand to this day helps Barbara with some
  matters. Barbara and Cindy are therefore, in two
  different kinds of relationships. Cindy is
  Barbaras social worker, and the two of them are
  also colleagues.

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The Many Hats Barbara Plays

• Peer Advocate
• Client
• Resource provider
• Employee
• Co-worker
• Educator/Teacher

• Listener
• Questioner
• Assures confidentiality
• Supporter
• Health advocate

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FIRST

• Communication

12

• WHAT DO YOU SEE?

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WHAT DID YOU SEE?
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Cash Register Story Page 12

• Read the story with your neighbor.
• Answer the questions together.
• 3 minutes.

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Cash Register Story Answers

• Answers
• 6 True
• 3 False
• The rest are all Dont Know
• We make many assumptions to fill in the blanks.
• Need to communicate to get the story right!

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How Do We Communicate?
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Good Communication

1. Eyes see others facial expressions, make eye
   contact
2. Ears concentrate on what is being said Be
   impartial and don't form an opinion, just listen.
   
3. Mouth reflect back, summarize what has been
   said.
4. Mind- to soak it all in and brainstorm ideas.

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Communication Skills (Pg 13)

• Affirming
• Open ended questions
• Active Listening
• Nonverbal Messages
• Express Thoughts and Feelings
• Communicate Without Making Other Feel Wrong

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Affirming

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

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Affirming Statements

• Thats good.
• Im glad you asked that.
• Youve come to the right place.
• Thats a great question.
• Youre on the right track.
• You really seem to have given this a lot of
  thought.

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Open-ended Questions

• Questions that cannot be answered with a yes or
  no.

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Open-ended Questions

• Stay away from
• Could you
• Would you
• Should I
• Can you
• Do you

• Always ask
• When
• Where
• How
• Who
• Why
• Tell me more

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.

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Nonverbal Messages
Facial expression
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Other Nonverbal Messages

• Posture
• Equal positioning
• Gestures
• Facial expression
• Dont just notice clients nonverbal messages but
  know that they are watching yours too

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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
  ---dont say this.
• Im so pleased youve been taking your meds.
  ---ok to say.
• Many PLWH experience

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Communicate Without Making Others Feel Wrong

• Express concerns non-judgmentally
• "I" statements

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Practicing Communication Activity

• Break into pairs
• Decide who will be 1 and 2

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1 Barbara , 2 Sonya

• 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.

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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

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Next

• Page 14, 15, 16

32
Confidentiality

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

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What to Keep Confidential?

• HIV status
• Housing
• Sexuality
• Housing
• Others????

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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?

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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

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Summary

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

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What Were Confidentiality Issues That Came Up in
Barbaras Case Study?
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Next

• Countertransference
• Page 17, 18

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Countertransference

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

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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 Clients Fear
• Depressed/Suicidal Client

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What Was It For Barbara?

• She was hurt in a domestic violence incident
• She has to be aware that she cant get overly
  afraid for her client.
• She cant 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?

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Last
44
Creating Boundaries

• Page 19

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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.
• Dont feel pressured to share your story each and
  every time
• Being professional
• Putting your personal values aside

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Values

• What are values?
• Where do values come from?

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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.

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Peer Advocates Job

• Provide information and support and dont try to
  change their clients values .

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Personal Stories Worksheet

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

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Working With Grief (page 22)
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When do we Grieve?

• When we have suffered a loss that is somehow
  permanent
• Being diagnosed with a chronic illness (like HIV)
  
• Loss of freedom
• Break up, divorce
• Friend who moved away
• Death
• Loss of a pet
• Child who got married
• Place in our life we had to leave behind
• Aginggetting oldermenopause

52
Early Stages of Grief

• Shock
• Denial/Unreality
• Fear
• Bargaining
• Loneliness
• Anger
• Shame
• Sadness

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Later Stages of Grief

• As peer advocates we help clients move through
  initial crisis to the later stages where there is
  
• Understanding growth positive change.
• Acceptance
• Sense of meaning
• Found purpose
• Wholeness

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Grief vs. Depression

• Depression
• Can be long-term feeling
• Feel only sadness, despair
• Sense of hopelessness
• Feel a lack of purpose
• Only want to be alone
• Needs professional support to work through

• Grief
• Usually temporary
• Range of emotions
• Life will go on
• Sense of purpose for future
• Need time alone and with others
• Many can work it out on their own

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Grief Case ScenariosActivity page 24, 25

1. In your group read your assigned case scenario
2. Answer questions 1-7 together
3. Pick 1 person to report back to larger group

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Those that conceals their grief find no remedy
for it

• There is no grief like the grief that does not
  speak
• The risk of love is loss,
• and the price of loss is grief -But the pain of
  griefIs only a shadow
• When compared with the painof never risking
  love.

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Thing we can do to take care of ourselvesSelf
Care Ideas(pages 26-32)
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Stress

• a physical, chemical, or emotional factor that
  causes bodily or mental tension and may be a
  factor in disease causation.
• problems caused by stress? --heart disease, high
  blood pressure, irritable bowel syndrome
• benefits of stress? --learn coping strategies,
  deal with emergencies, motivates us

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Self Care At HomeWhat Do You Do?
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Self Care Work?

• Take small breaks
• Eat good lunch
• Get support from supervisor, colleague
• Time management

61
Self care can prevent burn out, reenergize you
and keep you motivated. Most importantly, if
you are feeling good, you will be a better peer
advocate to your clients.
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Homework

• Complete the Self Care Contract Page 33
• Do 1 self-care activity tonight
• Write down 2 questions you want to ask the
  providers who are coming for the panel tomorrow.