1. Scope and Direction of workshop: Background
YSGOL GWYDDORAU GOFAL IECHYD / SCHOOL OF HEALTHCARE SCIENCES
Building it together: Peer coaching for people after stroke – a feasibility trial
Scope and Direction of workshop:
Background
‘Why’ - peer-led coaching in a nutshell
Our Project- ‘what’ and ‘who’
Let’s look at the ‘doing’
Issues and moving forward
PRIFYSGOL BANGOR / BANGOR UNIVERSITY
@SHSBangor 

2. Our Study: Collaboration
Bangor, Nottingham and Stirling Universities
Dr Elghenzai, Stroke Physician, Ysbyty Gwynedd
Funded by the Welsh Government’s Health Research Programme (NISCHR)
Feasibility – can we do this?

3. The challenge
Many people find it difficult to carry-on or start new activities that are important to them following stroke:
Hobbies and crafts
Interests
Exercise, sports and activities
Going out with friends and families
Research indicates that those who are able to are less likely to become depressed, and have a better quality of life
Challenge embedded within area of Social and Leisure Activities (SLAs)
Trials on SLAs have been unhelpful!

4. The problem: mapping out gaps in implementation of SLAs
Access to help with these sorts of activities is extremely patchy
The evidence of ‘what works’ for professional support with these sorts of activities (e.g. Physiotherapy and Occupational Therapy) is very limited
What works for who and when and in what circumstances?
We need new solutions such as ‘peer support’

5. Time for adaptation and change…

6. Our Project Three phases over 2 years Completion in March 2016
Phase 1 – Collection of baseline survey data (n = 77)
Phase 2 -participants for interviews (stroke survivors n = 16 and carers n = 10)
Phase 3- focus on intervention of per-led intervention, 6 months post stroke
Overall Aims:
Investigate factors predictive of SLAs six months after stroke;
Explore intentions, beliefs, and experiences of rebuilding SLAs;
Evaluate the feasibility of a prototype peer-led coaching intervention;
Identify requirements for the preparation, support, and supervision of peer-coaches;
Explore implementation issues to be addressed in a subsequent evaluation of effectiveness.

7. Our Project: Who are peers?
People who have experience, and can share this to help others
People who are credible – they have ‘been there, and done that’
People who can provide hope

8. Peer Support Programme
INSPIRES Programme in Calgary, Canada
PEER SUPPORT Programme in Wellington, New Zealand

9. Developing theoretical modelling
Our review of the field and preliminary analysis of evidence and Calgary case exemplar identified a matrix of peer interventions
Our programme theory focus on what we term ‘Peer coaching’.

10. Experiential knowledge
Peer modelling
Supporting the transfer
of experiential knowledge in
rehabilitation services.
e.g. INSPIRES
Peer coaching
Sharing experiential knowledge
and expertise peripheral to
rehabilitation services.
e.g. NISCHR
More embedded
Less embedded
Peer education
Integrating professional
knowledge into patients’ lives
within rehabilitation services.
e.g. peer mentors / educators
Expert patient programmes
Peer support
Accessing both informal and
formal support outside of
formal rehabilitation services.
e.g. stroke clubs / family support
Integrated knowledge

11. Peer coaching (e.g. NISCHR)
Positioned as a lay-led intervention
Defined scope of interaction negotiated within peer-stroke survivor
Peer as structural support but defined as separate from Professional MDT approach, defined as a ‘Peer led programme’
Lay control and professional supervision/support
Focused on supportive and specific lay - intervention framed as guiding stroke survivors to identify biographical led SLA and generate pattern of experiential goal setting behaviour, time limited

12. Peer Screening & Recruitment process
Informal process – 3 strategies evaluated: networks, stroke groups and media
Criteria for selection developed through feasibility work – key step- individual & group work
Peers paid through Bangor University
‘Patients’ screened through 6 month clinic and matched where possible – 3 per peer for feasibility

13. Phase 3: Peer intervention introduces way of thinking … ‘the Doing’
Intervention = Facilitated training + mentoring + development in practice

14. Exploring the ‘Doing’ Part 1: Finding out about the person – Phil
Part 2: Developing what to focus on – Rex & Phil
Part 3: Building a plan – Rex

15. Key steps: Training and Peer-to Peer support
Facilitation and mentoring – 4 spaced sessions and evaluation meetings
THEMED Structure mixed with ‘open’ talk e.g to biography, exploring hopes and fears
Theory and tools
Building material and shaping intervention (co-production of theory and practice)
Shaping / editing handbook & tools
Peer-to-Peer support network

16. WHAT THEORY IS BEHIND THIS PROJECT?

17. Introduction to TRANSFORMATIONAL LEADERSHIP THEORY
(Bass, 1985)
“The essence of transformational leadership appears to be inspiring, developing, and empowering followers.” (p.287).
Yukl (2006)

18. Stroke survivor outcomes
Vision - Support – Challenge (adapted to Peer Led project)
What the peer does
Stroke survivor outcomes
Inspirational Motivation
Vision (inspirational vision of the future)
Role Model
Psych Outcomes
(e.g. increased confidence)
Behaviour
(e.g. makes a crumble!)
Support
to achieve ‘vision’
Individual Consideration
Challenge (what needs to be done to achieve vision)
Intellectual Stimulation
Arthur, Hardy & Woodman, 2012

19. Handbook with guidance and tools coloured sections/indexed
Parallels (less detailed) ‘Patient’ handbook
Also Training manual for Peer Trainer developed with transformational leadership material

20. Understanding the Peer Handbook
4. Support and supervision throughout the project
5. What to do in case of an emergency?

21. Understanding the Peer Handbook
3. Rules and ‘setting limits’
GROUND RULES FOR PEER WORK
Respect for each other’s opinion
Provide an opportunity to listen to each other when talking
Agree how long each meeting will last before it starts
The relationship as part of peer coaching is part of a programme and peer work will be done in a supportive and professional manner
The purpose of the peer work and the peer is help identify and shape goals
The peer will only be involved in 6 sessions
The peer cannot be involved in any way with the person having coaching outside these sessions

22. Understanding the Peer Handbook
2. Sessions and rationale
Session
Session Title
Purpose 1
Connecting and sharing
Establish relationship, empathy and a shared story with relevance of personal experience 2
Developing visions/goals
Build on relationship to refine and clarify what might be the focus for a goal and go through evaluating what’s possible – devise a first draft of action plan 3
Planning out activities: Making a start
To review and agree on an action plan that considers ‘what ifs’ and engages in problem solving:
Look at first draft and narrow it down into STEPS to follow.
Review possible barriers – look for solutions
Review facilitators
Fill out the ACTION PLAN 4
Seeing how things are going
To review how ACTION PLAN is progressing since last meeting:
How is the plan being carried out
Review barriers and solutions to them 5
Supporting and learning
To review the ‘ACTION PLAN’ (barriers and facilitators) but also to see if there are opportunities to widen scope of the one activity/plan to build confidence. 6
Evaluating and future directions
To evaluate the ‘ACTION PLAN’
To identify future action plans in this area.
To identify other areas/things mentioned in Session 1-2 that may be developed in the future
To think about what was the overall feeling about what happened

23. Training … A snapshot

24. DAY 2 – Part II
PRINCIPLES OF GOAL SETTING

25. Types of Goals PRINCIPLES OF GOAL SETTING Outcome goal
Comparison with others –
E.g. I want to be better than ….. OR I want to be the best
Better to avoid
Performance Goal
Self-referenced goal –
E.g. I want to improve my mobility by 10% in three weeks
I want to be able to cook one meal independently three times a week
Process Goals
Actions that are required to achieve performance or outcome goals
E.g. I will do 5 minutes of exercise everyday
I will walk to the park by my house and back everyday

26. Starting from being a PEER … and using the tools …
EXAMPLE: Creating the profile of an ‘ideal trainer’

27. EXAMPLE: Creating the profile of an ‘ideal trainer’

28. Case scenarios …

29. Case scenario - Caroline
After your first session with Caroline you find out the following:
Caroline is 54, she is a housewife and lives in Llangefni. She lives with her husband Paul who is a painter decorator, they have no children. Their house is a bungalow that suits her needs quite well. Caroline had a stroke 7 months ago and she has recovered quite well. She can walk quite well with the help of a stick and is independent moving around the house, cooking, cleaning etc. She gets easily tired so her husband shares the workload of the house. Caroline often does too much around the house and ends up so exhausted that she then needs a whole day to recover. Since she hasn’t driven since the stroke and feels she is not ready to do so, Paul does all the food shopping and Caroline doesn’t mind because she hates going to Tesco!
Paul is very supportive but now that it has been sometime since the stroke Paul has returned to work long hours as he used to. Caroline spends a lot of time alone in the house by herself. Before the stroke she used to go out a lot, she loved driving into Bangor and shopping for clothes. Caroline is a bit self-conscious and doesn’t want to go out in case she bumps into people she knows who would want to know how she is and how she is coping. This is one of the main reasons she hasn’t been to church since the stroke although she used to go every Sunday and she misses it. She is also worried about getting too tired when she is out and about.
Caroline used to go to have her nails and her hair done every few weeks to the beauty salon that is a short drive from her house, she hasn’t been since the stroke mainly because she is not that worried about her appearance any more. Caroline used to go to yoga classes and swimming once a week in Llangefni pool. The leisure centre is about a mile away and she used to walk but now she doesn’t feel she could walk that far. Her house is 50m away from a bus stop but she hasn’t really looked up the timetables and routes. A few friends have offered to give her lifts but she doesn’t want to bother them.

30. Please use this tool to identify possible things Caroline would like to do…

31. Which of these activities do you think you should focus on to start with?

32. Example ‘making a crumble’
Think about which things you need to be able to do in order to achieve your goal
How important do you think they are in being able to achieve your goal?  
 I need to be able to walk for half an hour (time that I would need to get all the ingredients I need)
 I need to know the ingredients that I need and make a list
 I need to find someone that can help me do the shopping (in case I get very tired)
 I need to find a way to get to my local supermarket – arrange transport
 I need to have the right utensils and I need to know how to use them in a safe way (e.g. oven, scales, mixing machine)
 I need to be able to follow the recipe (keep time and measure quantities)
I need to make the kitchen comfortable so I can be safe and enjoy making the crumble
  I need to find someone that can help me do the shopping (in case I get very tired)
 I need to be able to walk for half an hour (time that I would need to get all the ingredients I need)
  I need to find a way to get to my local supermarket – arrange transport
 I need to make the kitchen comfortable so I can be safe and enjoy making the crumble
  I need to know the ingredients that I need and make a list
  I need to have the right utensils and I need to know how to use them in a safe way (e.g. oven, scales, mixing machine)
 I need to be able to follow the recipe (keep time and measure quantities)
Extremely
important
Not very important

33. Example ‘making a crumble’
Making an apple crumble
 I need to make the kitchen comfortable so I can be safe and enjoy making the crumble
I need to work on improving my ‘walking’ (or discuss my options with the physio)
  I need to have the right utensils and know how to use them in a safe way (e.g. oven, scales, mixing machine)
I need to make a list of ingredients and quantities
 I need to be able to follow the recipe (keep time and measure quantities)
I need to find a friend that would give me a lift to the supermarket and help me shop
Example ‘making a crumble’

34. Action Plan Goal By when? Final steps? What important to do goal?
Who needed to do goal?

35. My final goal is: ________________________________________________________
THINGS I WANT TO ACHIEVE
(in order to reach my final goal)
Who can help me
Where does it take place
By when do I want to achieve this
What difficulties could I face
How can I solve these difficulties

36. Practical issues …

37. EXERCISE
What would you do if…

38. The participant is asking you a lot of private questions
If during one of the sessions the participant starts crying because they are feeling down (or simply because they are having a bad day)
If the participant is always very late to the sessions although you have both agreed a time and date to meet
The participant is very unrealistic in terms of what they want to get out of their involvement in the project
The participant doesn’t turn up and hasn’t contacted you to explain why
The participant is asking you a lot of private questions
Although the participant was aware that driving is out of the scope of the project that is the only thing he wants to do again

39. You have built a very good relationship with the participant and she/he would really like you to help them out with something (e.g. give them a lift, accompany them to the shop, come to their house)
The participant is always asking ‘am I the same than you were six months after your stroke’?
The participant wants her/his partner to be present during the session and keeps insisting on it
The participant has a difficult sense of humour that you find offensive
The participant tells you they are only involved in the project because they want to please their partner/family

40. Where to meet up with the stroke survivors

41. Workshop: Reflection on ‘doing’ Phil and Rex as Peers

42. Exploring the ‘Doing’ Part 1: Finding out about the person – Phil
Part 2: Developing what to focus on – Rex & Phil
Part 3: Building a plan – Rex

43. Part 1: Finding out about the person – Phil

44. Part 2: Developing what to focus on – Rex & Phil

45. Part 3: Building a plan – Rex

46. Issues and Moving forward

47. Current stage and Challenges
Peer training and facilitation pivotal
Theory and tools important drivers
Role positioning crucial
Case study work: 3 Peers engaged successfully with 4 people
1 withdrew after intervention (‘not for me’)
1 unmatched to date
Co-produced papers – closing the loop
Stroke Association partnership
Emergent challenges
Framing the intervention and dumping SLAs
Lessons learnt - What works for who, when and in what circumstances
Screening peers
Matching peers & mentoring
Physical Geography and
Lay-intervention location

48. Questions and possible answers …