Train Peer Supporters

Peers for Progress aims to provide training resources for peer support programs around the globe. Below are some training materials that have been provided by our global affiliates and grantees. Underneath these featured resources, please check out the general overview of training and the different training modules.

IDF Peer Leader Manual – A manual by Tricia Tang and Martha Funnell to train peer supporters to provide ongoing diabetes self-management support.

PfP Grantee – ENCOURAGE Project in Alabama, USA: Two 8-hour training sessions

PfP Grantee – Puentes Project in California, USA: 40-hour training sessions

PfP Grantee – Australasian Peers for Progress Project in Australia: 2.5 day training

PfP Grantee – UCSF Health Coach Training in California, USA: 36-hours, 2 weeks

Grantee – PEARL in Hong Kong: 32-hour “train-the-trainer” workshops

Peer Leader Demonstration Project in Nanjing: 7-day training

Quality assurance in peer support programs is a crosscutting issue that affects individual peer supporters, program staff, host organizations, and public policy. In recent years, a popular approach to quality assurance has been the certification of individual peer supporters through approved training agencies. Certification is useful in assuring that individuals are qualified to serve as peer supporters. It can standardize training in core competencies, elevate the social standing of peer supporters, and open up opportunities for better reimbursement.

Accreditation of organizations that host peer support programs is another approach to quality assurance that complements certification of individuals. Accreditation is an evaluation and approval process for organizations to deliver a specific type of services or set of services. In many ways, accreditation is like a “seal of excellence” that an organization can obtain in demonstrating quality, value, and optimal outcomes.

Currently, there are no national standards in place for quality assurance of peer supporters and peer support programs. Instead, standards for training and certification are being established at the state level. The two main tracks in state certification are for mental health peer specialists and community health workers.

In the tables below, you will find a selection of resources on the certification of mental health peer specialists and community health workers. Peers for Progress shares these resources to help readers understand the current regulatory landscape and encourages the development of complementary quality assurance methods.

Overview on Training and Certifying Peer Supporters

CHW Training and Certification

Peer Support Specialist Training and Certification

The figure below summarizes key steps for training peer supporters. This basic outline is drawn from the experiences and lessons learned of other peer support programs, particularly from Peers for Progress Grantees in Alabama, California and Michigan.

This section deals with Step 2: Design training content and approach and Step 3: Develop plans for evaluating training outcomes and ongoing training. Additionally, we provide Examples of training curriculum and agendas. For information on prerequisites and Step 1: Describe peer supporter’s roles and responsibilities, click here.

For more details designing and evaluating training content, please view these seminar slides from the 2011 & 2012 Annual Meeting of the Society of Behavioral Medicine (SBM).

• 2011 SBM Seminar: Recruiting, training, and evaluating peer supporters
• 2012 SBM Seminar: Training, Ensuring Competencies, and Intervention Tracking

You can contact the presenters, who are also Peers for Progress grantees, for more information:

Andrea Cherrington, MD, MPH, Assistant Professor, Department of Medicine, University of Alabama, Birmingham
acherrington@mail.dopm.uab.edu

Tricia Tang, PhD, Associate Professor, Department of Medicine, University of British Columbia
Tricia.Tang@vch.ca

Guadalupe X. Ayala, PhD, MPH, Professor, Graduate School of Public Health, San Diego State University
gayala@projects.sdsu.edu

See the Start a Program page for more details.

General Training Materials Outline

The table below outlines the key components for developing peer support training curriculum and approaches. Resources are broken into two parts: Knowledge & Competencies (5 units), and Training Approaches. The materials for each unit are found underneath. Feel free to adapt and incorporate these units into your peer support training curriculum as you see fit. Depending your unique circumstances, it may not be necessary or feasible to develop a curriculum that addresses all of the topics given here.

General Background of Disease

Understanding the basic foundation of disease is an essential component of an effective peer supporter. A peer supporter’s knowledge base should cover what the disease is, how the disease can impact an individual, and the key behaviors linked to that disease. These key behaviors include self-care behaviors that aid in self-management of an illness, such as healthy eating or physical activity.

General Diabetes Information and AADE Self-Care Behaviors

Stress Management

Stress is a normal part of life that can cause changes to both the emotions and bodies of people with chronic conditions. Too much negative stress can cause harmful changes in blood sugar and blood pressure, so effective coping with stress is very important to feel good and avoid health complications.

Stress Management Resources

• Diabetes Self-Management Magazine contains several blogs and articles on managing stress, including “8 Tips for Managing Diabetes Distress,” “Stress: Finding Peace Amidst the Storm,” and a blog on reducing stress by David Spero.
• “Tips for Coping with Stress” is a resource from the Mayo Clinic.
• The Robert Woods Johnson Foundation’s Diabetes Initiative supported the development of several materials and resources including “Diabetes and Stress Management,” an informational handout from the Take Action Diabetes Self-Management Program; “IN CHARGE: Stress Management,” A course training manual focused on stress management strategies and problem solving and the Take Action Program lesson plans and student materials.
• The Michigan Diabetes Research and Training Center (MDRTC) offers a handout on stress management called, “Coping with Stress.”

Depression

Depression refers to persistent feelings of sadness and hopelessness. Depressive emotions can be a short-term response to stress or a chronic condition. People with diabetes are at greater risk for depression than people living without diabetes.

Depression Resources

• SONRISA, A Curriculum Toolbox for Promotores to Address Mental Health and Diabetes
• Basic information about diabetes and mental health can be obtained from the American Diabetes Association (ADA).
• “Diabetes, Depression, and Stress,” is an article by Carol Watkins, MD provided by the Northern County Psychiatric Associates, Maryland, USA.
• “Depression Screening and Follow-up” is a flowchart handout sponsored by the Robert Woods Johnson Foundation’s Diabetes Initiative.
• The Robert Woods Johnson Foundation’s Diabetes Initiative also sponsored posters on Managing Depression in both English and Spanish.
• “Depression and Steps for Healthy Living” is a handout developed in both English and Spanish by the Migrant Clinicians Network.

Effective Communication Skills

Communication encompasses all ways in which information is relayed to others, and includes fundamental techniques such as active listening, sharing stories, as well as other skills like facilitation and coaching. Being an effective communicator is central to a strong peer support relationship, as well as to effective patient provider communication. These skills help build rapport, understanding, and trust between peers.

Active listening is a fundamental communication technique that involves strategic listening and responses to improve mutual understanding, openness, and honesty.

Active Listening Resources:

• Tip sheet on active listening: “The Art of Active Listening” from the National Aging Information and Referral Support Center.
• Tricia Tang’s Manual for Peer Leaders: pp 18 for active listening

Sharing stories is a fundamental skill that involves sharing experiences and stories from one’s own life. It is a good way to provide support in one-on-one settings and is a particularly important part of some cultures.

Sharing Stories Resources

• NAMI’s Collaborative Training on Telling Your Story and Sharing Cultural Perspective
• The Diabetes Story-Telling Project is an example of a program through Diabetes UK where sharing stories had an impact on behavior change among Bangladeshi women with diabetes.

Facilitation skills are needed to effectively impart information, guide discussion, and encourage dialogue in both one-on-one and group support settings. Effective facilitation skills help peer supporters better serve people by influencing and guiding others toward lasting behavior change.

Facilitation Skills Resources:

• University of Kansas’ community toolbox with resources on facilitating groups: “Techniques for Leading Group Discussions” and “Developing Facilitation Skills.”
• Robert Wood Johnson Foundation provides techniques to promote effective group discussions: Characteristics of an Effective Meeting/Group Visit.

Coaching skills are designed to help people understand and navigate their self-care plan to become a better health consumer. They can alleviate the problems of patients not understanding and/or not agreeing with clinicians’ advice, and can help ensure people are receiving the highest quality of care possible.

Coaching Skills Resources:

• A Training Curriculum for Health Coaches is available from the Center for Excellence in Primary Care at the University of California, San Francisco.
• Coaching Patients for Successful Self-Management is a video for people in a position to encourage people with diabetes toward better self-management, from the California Health Care Foundation.

Support Skills

Providing support is essential to anyone in a peer support role, including peer supporters, health educators, and health care professionals. There are two fundamental forms of support: non-directive and directive. In many cases, a peer supporter would need to use non-directive support. Other support skills that may be useful to peer supporters include motivation building, stage-based advising, and decision-making.

Non-Directive Support involves allowing a person to deal with what is important to them at their own pace, rather than leading or directing them to change. It allows people to identify their own problem behaviors that need to be changed, which can help a person feel more in control of their self-management care routine. Non-directive support can both empower and encourage an individual.

Non-Directive Support Resources:

• The Lay Health Educator Manual of the Move More Diabetes Project has slides on Directive and Nondirective Support on pages 25-33 of the manual.
• Empowerment is when an individual feels they have the power and self-confidence to make changes and take control of their illness.Empowered individuals are able to manage their illness better and often experience a better quality of life.
  • Patient Empowerment Training Manual is produced by the National partnership for Women and Families
• Encouragement includes words and actions that may motivate people toward behavior change or overcome fears, challenges, and burnout related to self-management of an illness.
  • The Human Performance Applications (HPA) website lists 6 Skills of Encouragement and 6 more Skills of Encouragement.

Building Motivation is the ability to first recognize where a person may be in terms of behavioral change, and then provide encouragement and guidance to individual decision-making in order to strengthen their motivation for change. Building motivation is often person-centered and collaborative, and can help people with a chronic disease make lasting behavioral changes. This set of skills is often based on common counseling techniques such as Motivational Interviewing and Stage-based advising derived from the Transtheoretical Model.

• Motivational Interviewing
  • “Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency” is a motivational interviewing toolkit/training resource from the Mid-Atlantic Addiction Technology Transfer Center.
  • The Clinical Diabetes journal includes an article on practical pointers for using motivational interviewing in clinical diabetes care.
• Stage-based advising
  • The North Carolina Breast Cancer Screening Program produced a training manual for lay health advisors, having one particular session on stage-based advising.
  • The Robert Wood Johnson Foundation’s Diabetes Initiative supported the development of a resource called, “Effective Strategies to Motivate and Encourage Healthy Lifestyle Changes.” This resource provides information on using the Stages of Change on page 15.
• Counseling skills
  • Counseling for Behavior Change is a presentation by the American College of Physicians that illustrates counseling skills based on the stages of change.
• Decision-making
  • The California Healthcare Foundation provides a resource for collaborative decision-making

Individual Assessment

Involves collecting, reviewing, interpreting, and using information for the purpose of setting goals and developing an action plan. Assessment helps health care providers, health educators, and peer supporters understand the self-management status of a person with chronic illness, and helps set appropriate behavioral goals for improved self-management.

Individual Assessment Resources

• Michigan Diabetes Research and Training Center (MDRTC) developed several assessment instruments. The website includes explanations and information about the surveys and downloadable versions of all instruments.
• The Robert Woods Johnson Foundation’s Diabetes Initiative offers several assessment materials, forms, and instruments used by multiple diabetes self-management programs.
• Knowledge, Attitudes, and Beliefs Assessment Instruments:
  • Attitudes Survey
  • Health Belief Questionnaire English/Spanish
  • Patient Diabetes Knowledge Questionnaire English
  • Patient Diabetes Knowledge Questionnaire Spanish
  • Self Efficacy Assessment Tool
• Self-Management Behavior Questionnaires:
  • Are You Ready? Brochure
  • Building Community Support Patient Questionnaire
  • Behavioral Health Assessment Tool
  • Behavioral Health Assessment Tool Spanish
  • Case Management Assessment Form

Setting SMART Goals

Involves choosing something Specific, Measurable, Attainable, Realistic, and Timely (SMART) to change or achieve. For people with chronic illness, goals can be both short and long term. Goal setting is important for people to live longer and healthier lives with their condition.

SMART Goals Resources

• Louisiana Public Health Institute (LPHI) has an online article about developing how quality self management goals that are patient-centered and behaviorally specific.
• The Robert Wood Johnson Foundation’s Diabetes Initiative offers many materials, instruments, and forms to assist in goal setting.

• Goal Follow Up Form
• Goal Setting Assessment Tool
• Goal Setting Form and Tips English/Spanish
• Goal Setting Support Tool
• Nutrition Goal Setting Form
• Ready for Change Worksheet
• Self Management Goal Follow Up Form
• Self Management Goal Form
• Self Management Goal Form English
• Self Management Goal Form Spanish

• The California Health Care Foundation offers handouts in English and Spanish called “My Diabetes Plan” that can be used by peer supporters in assisting with goal setting.

Making an Action Plan

Refers to day-to-day plans, goals, and activities that help achieve long-term goals. Action planning can help people with chronic illness change unhealthy behaviors and better manage their condition.

Action Planning Resources

• The Robert Wood Johnson Foundation’s Diabetes Initiative offers many materials, instruments, and forms to assist in creating an action plan.
  • Action Plan Card English
  • Action Plan Card Spanish
  • Action Plan Form English
  • Action Plan Form Spanish
  • Weekly Action Plan Form

• Action planning forms are available from The Center for Excellence in Primary Care at the University of California, San Francisco.
• The California Health Care Foundation offers handouts in English and Spanish called “My Diabetes Plan” that can be used by peer supporters in assisting with creating an action plan.

Problem Solving

Is an important step to active self-management of chronic illness. Obstacles in chronic care management are encountered every day, so it is very important to know how to find solutions for unexpected problems. Solving problems, no matter how large or small they are, involves clear-headed thinking and determination.

Problem Solving Resources

• Solving the Problems of a Chronic Illness from University of Michigan.
• An article by Felicia Hill-Briggs and Leigh Gemmell reviews the literature about Problem Solving in Diabetes Self-management and Control.
• MyDiabetesPartner.org is an online resource for family, friends, and diabetes educators of people with diabetes that includes videos on problem solving.
• The Michigan Diabetes Research and Training Center (MDRTC) offers a handout called, “Balancing Better,” about solving problems in order to keep blood sugar levels normal.

Linking to Health Care Resources

Linking to Health Care is an important role of peer supporters in aiding an individual’s management of chronic disease. Regular visits with a health care provider can help monitor an individual’s condition and find and treat problems based on an assessment of their health. Furthermore, routine health care can help outline steps for reaching self-management goals. The role of peer supporters is distinct and does not replace the role of professional health care providers in care. Peer support complements and supplements primary care services to a person with chronic disease. By linking an individual to regular health care, a peer supporter can help a person with chronic illness work with an expert provider to improve their health.

Linking to Health Care Resources

• The Living with Diabetes guide to doctor visits is a resource for people with diabetes sponsored by the Robert Woods Johnson Foundation’s Diabetes Initiative.
• Importance of Doctor Visits is a handout for people with diabetes in both English and Spanish from the Migrant Clinicians Network.
• Patient-provider communication is essential to effective care of chronic illness and accurate identification of any problems that may arise.
  • Active listening and other communication skills discussed previously (LINK) help establish and strengthen relationships between doctors and patients.
  • Increasing the Public’s Awareness is a commentary about the importance of patient-provider communication found in the North Carolina Medical Journal.
  • This 2007 research article provides a qualitative overview of communication issues important to people with diabetes when interacting with their physician.
  • The Partnership for Clear Health Communication created Askme3: the three most important questions a patient should ask their health provider at every visit.

Linking to Community Resources

Linking to Community Resources, such as agencies, organizations, and other services that assist people with chronic illness, can help individuals manage their conditions and meet their goals. People with chronic disease may not be aware of the resources available to them in the community and elsewhere, and a peer supporter can help fulfill this need.

Linking to Community Resources

• MyDiabetesConnect was launched by Cities for Life to connect people with diabetes to community resources in Birmingham, AL.

Ethical Considerations

Ethical Considerations refers to basic standards of right and wrong. For a peer supporter, ethical considerations include, but are not limited to, respecting others’ rights, confidentiality, doing no harm, and maintaining boundaries. Ethical considerations are important so that no one is harmed, physically or emotionally. Peer supporters should be trained in basic ethical principles so they may understand the limits of their power, influence, and care, and how to deal with difficult people and situations.

• The American Association of Diabetes Educators has a Code of Ethics for all certified diabetes educators.
• The Arizona Department of Health Services created a workbook on ethics and boundaries for peer supporters.
• The University of Kansas’ Community Toolbox contains resources on influencing people.

What is it?
Role playing is a training technique that allows people to act out hypothetical situations they may encounter in working with people with diabetes.

Why is it important?
Role playing allows participants to practice and become comfortable with dialogue, listening, and how to handle potentially difficult situations or people.

Learn more about role playing from the following resources:

•  Role Playing and Simulation Games is an article from Community Empowerment on how to use role playing in trainings.

Evaluating Training Outcomes

An evaluation of training outcomes focuses on the impact of training on the training participants. Such an evaluation is important for examining the preparation of peer supporters to carry out peer support.  It is also important for identifying ways to inform and improve future and ongoing training activities.

Evaluation of training outcomes involves:

• Identify outcomes that the training intends to achieve
• Select approaches to assess them

For example, if a peer support training

• If a peer support training  information uses information education to teach disease specific information (e.g., basic diabetes-related knowledge)   then written tests may be useful for evaluating training outcomes
• If a peer support training program emphasizes skills building and role plays to enhance communication, facilitation and other support skills a  then  simulation through standardized patient cases to observe participants’ responses may be useful for evaluating training outcomes.

A peer support program needs to determine any “minimum requirements” for meeting or passing the training expectations, and also how to deal with those who may fail to demonstrate the intended training outcomes.  In many cases, programs may offer additional sessions to address noted areas needing further attention and thereby “re-train” the training participants.

It is also recommended to conduct process evaluation in terms of evaluating training program satisfaction. This can help understand if the training content and approaches enable the participants to obtain the knowledge and skills that the training intends to provide. The assessment can be quantitative and/or qualitative.

To learn more, please view

• Part 4 of 2011 SBM Seminar: Recruiting, training, and evaluating peer supporters
• Part 3 of 2012 SBM Seminar: Training, Ensuring Competencies, and Intervention

However, in addition to conduct and evaluate training, having plans for ongoing training and support for peer supporters such as periodic booster sessions on certain topics is just important.  You can learn more about how to provide ongoing support for peer supporters in Manage Peer Support.

Here you can find Examples of Peer Support Training Curricula and Examples of Peer Support Training Agendas. While the target audiences and topics of these resources vary, they do illustrate how to bundle important competencies and skills together to create a comprehensive approach to training peer supporters. Users would need to tailor sample curricula and agendas to best meet the needs of your specific setting or population.

• IDF Peer Leader Manual – A manual by Tricia Tang and Martha Funnell to train peer supporters to provide ongoing diabetes self-management support.
• UCSF Health Coach Training – A curriculum developed by Thomas Bodenheimer and David Thom at the Center for Excellence in Primary Care
• Diabetes Self Management Education Manual – A manual developed by the Montana-Wyoming Tribal Leaders Council to help trainers to teach diabetes educational sessions to a group.
• SONRISA – A Curriculum Toolbox for Promotores to Address Mental Health and Diabetes
• Peer Supporter Training Curriculum – Rapid training course originally developed for the Lions Club of North Carolina

• Peer Support Training Manual – This training manual was developed by the Canadian Mental Health Association as a guideline for peer support training in the Okanagan (British Columbia) Health Service Area.
• Peer Mentor Support System – This Peer Mentor Support System addressing mental health provides a series of peer support training modules, guidance documents, other resources, and exercises in various chapters.
• Peer Support Training Manual – This training manual was written for Trinity College’s Peer Support Project. The manual is a result of years of experience with building a peer support program through the college’s student counseling services. This training manual contains 10 workshops focused on building skills and competencies of peer supporters.
• Washington State Certified Peer Counselor Training Manual – 40 hour course
• Ohio Advocates for Mental Health Peer Support Training – This collection of materials comprises a short course for consumers to further peer support among individuals, to gain skills for use as Peer Support Specialists, to advance the use of warm lines and partnering activities, and to form and sustain peer support groups. The expectation is that people giving and taking this course will have heightened awareness of effective communication skills and resources to assist them as they provide peer support.
• SAMHSA Training Teleconference Archives – The Substance Abuse & Mental Health Services Administration teleconference archives offer many helpful presentations on peer support for mental health. Presentation slides typically include dozens of links to additional resources.

• Lay Health Advisor Manual – This manual from the NC Breast Cancer Screening Program prepare older African American women working within their local communities to encourage friends, families, and others they meet to have regular mammograms and pap smears.

• Peer education: training manual – This training manual describes ways in which non-governmental organizations (NGOs) may design, deliver and manage training programs for peer educators. Its purpose is to assist NGOs to design and implement strategies and work-plans for peer education, as part of comprehensive sexual health interventions.
• Training of Trainers Manual – This peer education in HIV prevention manual was used extensively for two years in 27 countries across Eastern Europe and Central Asia and was translated into 15 languages, including Arabic. In particular, Section 2 provides Guidelines for Training of Trainers, and provides general team building and communication exercises.

• Lay Health Educator Manual – This is a guide for implementing lay health educator interventions and training educators for settings and program models similar to Maine’s Move More project. The manual includes policies and procedures, change models of particular importance, sample forms, and information about exercise.

Peer supporter trainings vary in duration based on the time, money, and resources available to each individual organization. The following examples are organized by the duration of training:

• Short ( less than 18 hours)
• Medium (18-30 hours)
• Long (Over 40 hours)

Short Duration Trainings (less than 18 hours)

• Target Audience: People with Brain Injuries
  One 4 or 6 hour session (sample training agenda beings on pg. 35)
• Target Audience: People with Diabetes
  12 hours over 2 days

Medium Duration Trainings (18 to 30 hours)

• Target Audience: Peer Supporters for People with Disabilities
  3 day training agenda

Longer Duration Trainings (over 30 hours)

• Target Audience: Community Health Workers
  6 day training, each day with multiple sessions on HIV/AIDS Prevention