Peer Support Standards and Training Guidelines

Introduction

The Peer Support Advisory Board has drafted guidelines establishing a statewide standard of peer support and training that uses best practices, research, and experience from established emergency service profession programs throughout the state of Minnesota.

These guidelines and standards are intended to provide best practices and recommendations for forming and maintaining a peer support structure for sworn and civilian personnel in emergency service programs. The guidelines are not intended to be a rigid protocol, but reflect the commonly accepted and recognized practices of Minnesota organizations they serve.

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Guidelines for practice of peer support

1.1 Purpose

The purpose of a peer support team (PST) is to promote resiliency and recovery by providing supportive interactions from skilled team members to take on the day-to-day demands of the job and following critical incidents.

“Peer support” is emotional and practical support between two people who often share a common experience.

A “peer support member” is a specially trained individual that provides emotional, social, and practical support to their peers when needed.

A “peer counselor” has often lived through that similar experience and is trained to support others.

What peer support provides:

  • A shared experience.
  • Trusted communication.
  • Support and encouragement.
  • Basic psychological first aid.
  • Increased understanding of critical incidents and traumatic events.
  • Resources and a referral to a higher level of support.

1.2 Basic requirements

Effective and successful peer support is peer-driven, while benefiting from the support of command and administrative staff, with advice, insight and guidance from mental health professionals.

1.3 Principles

The following are the principles and qualities required of peer support team (PST) members:

    • Be a peer: A PST member should be viewed as a peer within the organization. They should publicly commit to serving as a peer team member while protecting their coworker’s privacy.
    • Be trustworthy: A PST member should be committed to building and maintaining trust.
    • Be responsive: A PST member should recognize when they are being called to act as a peer, respond earnestly and reflect on and assess their effectiveness.
    • Be skilled and knowledgeable: A PST member should be trained and practiced in core skills and knowledge. This includes knowing the limits of their role, being knowledgeable about organization and regional resources, and referring as appropriate to a higher level of support, intervention, or care.
    • Be healthy: A PST member should possess, prioritize, and attend to their own health and wellbeing.

1.4 Definitions

    • Peer support program (PSP): A peer support program is a worker-centric resource that can augment, but not replace, existing programs such as Employee Assistance Programs (EAPs), and/or internal or external professional psychological services.
    • Peer support team (PST): The peer support team (PST) is made up of specially trained and recognized peer support counselors (see below) and functions as a formal peer-lead support system and resource guide for their fellow first responders. PST为正在经历个人和/或工作压力的同事和邻近的急救人员提供支持. It also provides support during and following critical or traumatic incidents.
    • Peer support counselor (PSC): A peer support counselor is a specially trained coworker, not a professional counselor or therapist. 同伴支持咨询师接受过培训，能够认识到他们角色的局限性，并在适当的时候向同事推荐更高水平的支持, intervention, or care.

There are three levels of non-disclosure of personal information the PSCs must understand and practice:

    • Privacy: 个人期望个人信息的披露仅限于或仅用于PSC.
    • Confidentiality: 服务督导委员会有专业或道德责任，不向接受同侪支援服务的人士披露有关他们的资料.
    • Privilege: The legal protection from being compelled to disclose communications in certain protected relationships, such as between attorney and client, doctor and patient, or priest and confessor. Minnesota emergency service providers are protected under Minn. Stat. § 9731, 181.9732, 13.43 sub 9, and 13.02 sub 12.

1.5 Limits to privacy, confidentiality, and privilege

Peer support counselors should be aware that federal law may supersede state statute for privacy, confidentiality, and privilege.

  1. Organizations should develop clear policies for peer support programs (PSP), 包括为私人服务公司建立符合州和联邦法律的保密准则和报告要求, as well as organization policy. PSCs should advise peers that they are mandated reporters. The policy may provide a procedure for PSCs to report the following exceptions to confidentiality:
    • The PSC reasonably believes the disclosure is necessary to prevent harm to self by the person in receipt of public safety peer counseling or to prevent the person from harming another person, provided the disclosure is only for the purpose of preventing the person from harming self or others and limited to information necessary to prevent such harm;
    • The person receiving public safety peer counseling discloses information that is required to be reported under the mandated reporting laws, including, but not limited to the reporting of maltreatment of minors under section Minn. Stat. 260E.06 and the reporting of maltreatment of vulnerable adults under section Minn. Stat. § 626.557, 但披露的目的仅限于举报虐待行为，且仅限于举报所必需的信息;
    • 接受公共安全同伴咨询的人提供授权披露信息的书面同意;
    • The emergency service provider who received public safety peer counseling is deceased and the surviving spouse or administrator of the estate of the deceased emergency service provider gives written consent authorizing disclosure of the information; or
    • The emergency service provider who received public safety peer counseling voluntarily testifies; in which case the PSC may be compelled to testify on the same subject.
  1. It is the responsibility of each organization’s PST members to educate supervisors and staff on the confidentiality guidelines followed by the PST and set forth in policy. PST members should not be mandated to provide information or 被要求根据政策向主管或同伴支持成员提供通过同伴支持联系获得的信息.
  2. PST members should not keep formal written records of contacts with peers. Anonymous statistical information, such as number of peer-to-peer contacts, may be recorded to support program deliverables, budget justification, and program review.
  3. PSCs must have an understanding of the overlapping principles and limits of privilege, confidentiality and privacy, due to the sensitive information shared during peer-to-peer contacts. 当被问及这些原则并签署保密协议时，同伴咨询师应该能够清晰地表达这些原则, indicating their understanding of these principles and consequences for violation of these principles.
  4. After a large-scale event, 安保公司可就其在事件发生后立即执行的任务提供一般简报. 这些见解应该包含在组织制定的事件汇报或“行动后”报告中. PSC应注意只分享一般信息，以免违反保密和信任原则. 本报告可与参与活动的牧师和心理健康专业人员共同编写.

1.6 Selection, onboarding, deselection

A PST member position must be a voluntary, not mandated position. When nominating a PST member, some considerations should be:

  • Nomination: The application and interview process should involve existing PST members. The program clinical director or contracted therapist may be included in the interview process. psc应在其组织中享有良好声誉，并应获得上级和/或同行的推荐. Considerations for selection of PSC candidates include, but are not limited to, previous education and training; resolved traumatic experiences; and desirable personal qualities such as maturity, judgment, personal and professional ethics, and credibility.
  • Interview: Questions for applicants should be standardized; an essay format may be used in place of an interview. 面谈小组可由同伴支持成员和与PST相关的持牌心理健康专业人员组成.
  • Pledge: A pledge or confidentiality agreement may be asked of PST members
  • Integration into the team: Statutory mandatory training, boundaries, and expectations need to be set prior to integration.
  • Deselection: It is beneficial that a procedure be in place that establishes criteria for deselection from the program. Possible criteria include breach of confidentiality, failure to attend training, or loss of one’s good standing with the organization.
  • Personal leave: PSCs may be provided with the option to take a leave of absence and encouraged to exercise this option when personal issues or obligations require it.

1.7 Skills

A peer support team member must possess the following skills:

  • Basic understanding of critical incidents and traumatic events.
  • Basic understanding of the psychological challenges of the job.
  • Basic understanding of psychological first aid.
  • Ability to triage further resources if needed.
  • Knowledge of resources and most effective route to access them.
  • Understand limits to their privilege, 在他们组织的政策和国家规定的范围内，他们如何以及何时提供同伴支持.

A peer support team must be well-versed in the following tools:

  • 一对一:一对一是由一个同伴支持顾问来解决他或她的同事的压力源. It is a one-to-one interaction that is in a private space. This interaction may lead to referral or follow-up.
  • Defusing: Defusing is a small gathering of the first responders (i.e. crew, staff, etc.) who just experienced a critical incident or traumatic event, typically occurring within 8-12 hours of the event. The group is gathered in a private setting and is led through a protocol by a peer support counselor. A mental health professional that is a contracted support for the PST may also be present. Elements of a defusing activity*** are:
    • Introduction (What happened)
    • Exploration (How is everyone doing)
    • Information (Education on self-care)
  • Debriefing: A debriefing is a gathering of first responders who just experienced a critical incident or traumatic event and often includes multiple organizations. Debriefing typical occurs 24-72 hours after a critical incident but can happen much later. Debriefings are led by a PST or a critical incident stress management (CISM) team. Elements of a debriefing are:
    • Pre-meeting (team members)
    • Intro and guidelines
    • 事实/事件描述(让参与者按时间顺序描述他们的角色通常很有帮助)
    • Thoughts/impressions
    • Reactions/feelings (What was the worst part)
    • Signals of distress (What are you experiencing)
    • Information and recovery/teaching
    • Wrapping up/summary
  • Crisis Management Briefing (CMB) is conducted for 3-100+ people at one session, in a private group setting to provide basic information regarding the critical incident, discuss and normalize reactions, thoughts, or feelings related to the incident. The goal is to provide education on stress signs, symptoms, and stress-related coping skills. Resources for follow-up should be available and effectively communicated. Elements of a crisis management briefing are:
    • Pre-meeting
    • Intro and guidelines
    • Fact phase
    • Thoughts phase
    • Emotions phase
    • Education phase
    • Question and answer phase
    • Resources

1.8 Models

There is no universally accepted model for every organization. pst应该投资于持续的教育，以研究和确定其模式的功效，并认识到其他组织模式.

  • Size: PST size may vary depending on variables such as organization size, divisions, budget, resources, geographical area, promotions, transfers, and retirements. 每七名工作人员一名方案协调人的比率被认为是可以接受的标准，但可能因现有澳门网络娱乐游戏平台而有所不同.
  • Team composition: Care should be taken to include members from both the sworn and civilian staff. Members should represent a diverse cross-section of the organization. When an organization’s size and resources allow, organization PSCs should cover all divisions, including civilian, sworn, and volunteer. PSCs should be distributed over different shifts, regional areas, precincts, and districts.
  • Resources and support: PSTs are encouraged to combine and share program resources, especially training and mutual support with other teams. 当澳门网络娱乐游戏平台紧张或发生重大人事问题时，建立组织间的关系是有益的. PSCs may also be able to provide mutual support to other PSCs. Departments should consider providing peer support for members at the supervisory and command staff level by training members of the appropriate rank to provide those opportunities to their peers.

1.9 Roles

A peer support team should consider including the following roles:

  • 临床主任:为了使组织在同伴支持项目中达到新的护理标准, it is preferred the department have a clinical advisor for professional psychological consultation with a first responder culturally competent licensed mental health professional. 临床主任的作用和范围应由组织和心理健康专业人员共同确定. This person must avoid any dual relationships and shall not conduct fitness for duty evaluations. Clinical directors should not be a PSC, but should be used as a resource to the PST.
  • Licensed mental health professional provider (LMHP): Trained counselor or therapist who can maintain the highest level of confidentiality and is competent in first responder and organization cultures. This person must avoid any dual relationships and shall not conduct fitness for duty evaluations. 持牌心理健康专业人员的目的不是为员工做出诊断或提供治疗, however, the staff member and LMHP may enter into a private agreement for counseling or therapy. Licensed mental health professionals should not be a PSC, but should be used as a resource to the PST.
  • Peer support team coordinator: The leader and internal champion of the PST that coordinates with the clinical director and oversees training and oversight of peers and the peer support program. Duties may include long-term team planning, program logistics, and development. This leader coordinates peer support activation, makes referrals to mental health professionals, collects utilization data, and coordinates training.
  • Peer support counselor: Often referred to as “peer support team members,理想情况下，这些员工可以代表组织的构成，包括所有级别的员工, non-sworn individuals, and retired staff. They must go through the selection process and certified training. To ensure privacy, confidentiality, and privilege, organizations that have an internal employee assistance program (EAP) run by organization staff shall ensure these staff hold the dual role of peer support counselors.

1.10 Role Conflict

Because peer support teams are built on trust real or perceived role conflict can undermine a program. The following considerations will help eliminate some of these concerns:

  • PSCs are in a unique position and should refrain from relationships that may harm or exploit the peer, such as religious, financial, or sexual engagements.
  • PSCs should be mindful of role/rank differences between the PSC and emergency services provider. Whenever possible, 公共服务提供者只应向在其组织内具有相同级别/角色的紧急服务提供者提供同伴咨询. This should not prohibit PSCs from defusing an emergent need with a ranking emergency services provider. 应鼓励人事编制委员会在实际情况下尽快将该成员转介给另一名职级适当的人事编制委员会.
  • 每个组织都应该评估主管的职责和让主管担任psc的可行性. Supervisors may have additional requirements regarding the reporting of issues such as sexual harassment, racial discrimination, 如果不遵守程序，可能会使主管或组织处于危险之中的工伤.
  • PSCs should recognize role conflicts and conflicts of interest. 如果存在或预见冲突，PSCs应将同伴转介给其他PST成员或心理健康专业人员. psc应谨慎对待在短时间内寻求多次联系的同伴，并应根据需要提供转介.
  • PSCs may not be part of a PST providing services to an emergency service provider if the critical incident stress management team member is a witness to the critical incident for which the person is receiving services, per Minn. Stat. § 181.9731 Subd. 2 and Minn. Stat. § 181.9732 Subd. A PSC may refer the person to another PSC or other appropriate mental health or community support service.

1.11 Peer support operations

  1. Operations recommendations:

Develop recommendations for your organization’s policies based on your organization’s PST model.

    • 积极主动:应该有一个过程来建立和保持同行支持临床主任之间的沟通和联系, team coordinator, peers, officers, and staff. Open communication between roles needs to be communicated with all participants in peer support programs.
    • 及时响应:应该有一个适当的流程，以及时有效的方式响应同伴的支持请求, keeping in mind the personal preferences of the individual making the request.
    • Be Timely: The response to a peer support request should have an expectation of timeliness that needs to be operationalized and universally understood by PST members.
  1. Initiation of request for peer support
    • 自我转诊:需要建立一个障碍最少的自我转诊机制.
    • Peer referral: There needs to be a referral mechanism in place for Peer-referral that maintains a high level of confidentiality but also does not allow referrals to be left unattended.
    • A need for referral is not always from one incident of trauma at work. Sometimes it is a combination of many work incidents, or a combination of work and an individual’s personal circumstances and experiences.
    • Supervisor-referral: There should be a referral mechanism to allow an organization supervisor to initiate a connection request on behalf of another member that would benefit from having support. This is to maintain a lateral model while also providing a mechanism for due diligence. Peer support is not to be utilized in lieu of discipline, as part of discipline, coaching or work improvement plan, as this creates role and trust issues, whether real or perceived.
  1. Peer support management system
    • Communication around Individual’s information, especially mental health, must not be stored in the system. Information that cannot be protected should not be stored or used.
    • Any software utilized must meet relevant security, encryption, user authentication, data-storage requirements and should be data practices compliant.
  • A system should be established that allows the organization to manage proactive connections and provide proof of coverage through reporting and anonymous tracking that is based on the PST’s needs.
    1. Organization protocols and procedures must be accommodated, along with Union or Federation concerns.
    2. 可能会记录有关同伴支持计划使用情况的匿名和去识别统计信息. Information that could identify staff members, staff member’s number of interactions with the peer support program or information that could violate the trust of a program should not be collected. This statistical information may be used as a guide to amend peer support services and programs, change training focus or justify a program. Organization administrators and Peer Support Team Coordinators should recognize that results of peer-to-peer interactions are not always quantifiable.

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Guidelines for peer support training

2.1 Training programs

Initial peer support training programs must comply with Minn. Stat. § 181.9731, in order to allow for an acceptable level of privileged communication within a PST.

2.2 Training requirements

Continuing education may be via an accredited trainer or vendor, may be focused around a support industry or specialty group, and may comply with Minnesota Peace Officers Standards and Training (POST) Board education standards.

Training should be at a minimum of 16 hours initially. Continuing education training is also suggested quarterly, at a minimum of four hours per quarter. Peer support training should focus on skill development, resource education, networking, and problem solving.

A PST must be trained in specific knowledge areas, including how each directly applies to peer support. Initial and annual training should cover, at minimum, the following topics:

  • Confidentiality/ privacy/ privilege.
  • Suicide.
  • Chemical dependency.
  • Post-traumatic stress disorder (PTSD).
  • Concept of psychological first aid.
  • Relationships.
  • Basic wellness.
  • Behavioral health.

2.3 Training model

Training programs should utilize the “Teach – Demonstrate /Practice – Process” model when applicable. Some education will not fit this model.

  1. Teaching a topic, skill or tool.
  2. Demonstrate or practice utilizing the topic, skill or tool as a PST.
  3. Processing as a team after the demonstration.

2.4 Initial training/ vendor selection

Initial Peer Support training providers should:

  • Be accredited as defined in Minn. Stat. 181.9731.
  • Be recognized by the commissioner of public safety.
  • Have emergency service professional cultural competency training.
  • Have a history of working with emergency service groups
  • Meet MN POST Board standards with educational curriculum.

2.5 Continuing education

Continuing education training vendors should:

  • Have emergency service cultural competency training.
  • Have a history of working with emergency service groups.
  • Strive to meet MN POST Board standards with educational curriculum.
  • Be applicable to emergency service wellness and mental health with an emphasis on peer support.

2.6 Training topics/ sub-topics

The following are topic ideas that PSTs can use for continued education:

Be a Peer
When to seek licensed mental health consultation
Referral information
Organizational stress
Cultural competence, diversity, and bias awareness
Roles and responsibilities

Trustworthy
Culture and trust
Confidentiality, Privacy and Privilege
Role Conflict
Role and boundaries
Limits and Liabilities
Ethics

Responsive
Communication
Active listening skills
Problem Assessment
Critical incident stress management
Dependency and abuse (alcohol, substance, gambling, etc.)
Relationship and family issues
Local state and national resources
Organizational stress
Wellness and self-care

Skilled
Communication
Active Listening skills
Problem Assessment
Problem solving/ scenarios
Psychological Symptoms
Medical conditions vs psychiatric disorders
Stress management
Resiliency
Burnout
Grief Management
Domestic Violence
Medical issues with psychological or lifestyle impact
Crisis management intervention
Critical incident stress management
Dependency and abuse (alcohol, substance, gambling, etc.)
When to seek licensed mental health consultation
Referral information
Relationship and family issues
Local, state and national resources
Veteran and military support
Organizational stress
Wellness and self-care
Physical wellness
Financial wellness
Spiritual wellness
Social Health and relationships
Chaplaincy and peer support

Personal Wellness
Stress Management
Resiliency
Burnout
Compassion Fatigue
Critical incident stress management
Relationship and family issues
Organizational stress
Wellness and self care

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