1. Certificate IV in Mental Health Peer Work Foundations of peer work Day 5

2. 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)

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

4. Welcome and housekeeping Acknowledgement of Country Housekeeping (WHS, bathrooms, break times) Assessments review Group Agreement review

5. Workshop overview Today’s workshop will cover Role 2 –Skills support and coaching Role 3 –Help individuals & carers to navigate the system

6. Role 2: Skills support and coaching

7. 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

8. 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.

9. Activity – Coaching & peer work Why do you think peer workers would be good coaches? What does a coach and peer worker have in common?

10. 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: G oal - the desired outcome R eality - the current situation O ptions - exploring the options available W ay forward - making a plan of action

11. 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

12. 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

13. Morning tea

14. 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 process 2. 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

15. Role 3: Help individuals & carers to navigate the system

16. 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'

17. Activity Brainstorm in small groups all the things you think might contribute to someone’s wellbeing outside of the 'system' Page 16

18. Lunch

19. Beyond the system

20. 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

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

22. 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

23. 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?

24. Communicating with services

25. 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?

26. 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.

27. 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

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

29. 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!

30. Afternoon tea

31. 2. Skills and knowledge needed to help/teach others to navigate the system

32. 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.

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. Teaching people to navigate the system is the beginning of them reshaping it and changing it

41. Reflection on the day Key learnings – something you learnt Best part of the day One way I can make a difference

42. Thank you for coming Certificate IV in Mental Health Peer Work CHC42912

43. Certificate IV in Mental Health Peer Work Foundations of peer work Day 6

44. Ability is what you’re capable of doing Motivation determines what you do Attitude 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)

45. 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

46. Role 4. Peer work and the workplace

47. Activity - Characteristics of a peer worker Brainstorm all the characteristics the world’s worst worker may have (p34) Activity – Staff qualities checklist Complete the checklist of characteristics of a worker and rate how often you demonstrate these in your work (p35)

48. 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?

49. Effective qualities of a worker The watch, listen, wait & act model is a useful model for peer work Watch Listen Wait Act Reflect & Review

50. 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.

51. 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.

52. 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

53. 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

54. Activity – Effective participation in teams Which functional roles have you performed in teams? (current and past) Page 46

55. 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

56. 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.

57. Morning tea

58. 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)

59. 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

60. 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

61. 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

62. 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

63. Activity – Dealing with conflict In small groups, role play the problem solving approach, with a real or imagined issue Page 55

64. Negotiation There are five basic principles to consider when entering negotiations (Conflict Resolution Network): 1.Be hard on the problem and soft on the person 2.Focus on needs, not positions 3.Emphasise common ground 4.Be inventive about options 5.Make clear agreements Page 57

65. 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.

66. 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.

67. 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

68. 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

69. 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.

70. 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

71. Activity - Centring What do you do to centre yourself? Page 64

72. Different ways to handle conflict There are 5 conflict handling modes Avoiding Accommodation Competing/forcing Compromising Collaborating

73. 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

74. Lunch

75. Conflict handling skills The following is adapted from the Conflict Resolution Network toolkit of skills for effective conflict resolution www.crnhq.org/www.crnhq.org/ Win/win approach Creative response Empathy Appropriate assertiveness Cooperative power Managing emotions Willingness to resolve Mapping the conflict Page 66-72

76. Activity – Managing emotions Consider the questions and goals listed on page 69 If communication is not appropriate, what other action could you take?

77. 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

78. 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

79. 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

80. 5 roles in supervision Supportive Role Practice Development Professional Development Administrative Role Evaluative Role 80

81. 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

82. 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

83. Behaviour style and supervision Behaviour StyleSupervision Approach Driver Expressive Amiable Analytical 83

84. Supervision and behaviour styles Behaviour Style Supervision stylePotential areas for development Driver Goal focused Active approach Help explore Open, expressive, energetic Practical & realistic Slow down, allow time for reflection Talk less, listen more Moderate tendency to challenge Test different approaches Give positive feedback and praise Expressive Encourages innovation Spontaneous, flexible, tolerant Deals with present issues Enjoys exploring new ideas and new ways Comfortable providing positive feedback Focus on detail Regular, structured sessions Checking you are achieving outcomes Amiable Empathic & Supportive Interpersonal approach Reflective Allows time to process Skilled 1:1 Address conflicts Develop logic & analysis Develop action as well as reflective capacity Talk more – remain open Analytical Likes complex problems Logical & methodical Objective & analytical Good with details & facts Helpful with planning Structured & organised Discuss feelings / values Give positive feedback and praise Remaining flexible Focus on process Encourage use of intuition and imagination (alongside facts) Consider ‘big picture’ 84

85. Collaborative risk and opportunity management The neglect–overprotect continuum A 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.

86. ‘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

87. Activity – Neglect & overprotect Do you ever neglect or overprotect? Provide some examples Page 79

88. 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

89. 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?

90. 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

91. Activity – Responding to risk What do you think of this understanding of complexity? How is it different from seeing people as complex? Page 83

92. Activity - Categories of risk What 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

93. 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)

94. 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).

95. 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

96. Afternoon tea

97. 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

98. Activity – Collaborative risk planning In 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

99. 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.

100. 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

101. 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

102. 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

103. 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

104. Ethical dilemmas Select 3 scenarios to read on pages 93-96 and answer questions for each

105. 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.

106. Reflection on the day Key learnings – something you learnt Best part of the day One way I can make a difference

107. Thank you for coming Certificate IV in Mental Health Peer Work CHC42912