This section of the website will describe how you can begin to translate your plans into concrete actions.

It will focus on specific issues that you need to address during this preparation:

  • Selection of peer workers. What are the important skills and characteristics peer workers should have?
  • Involving drug users and ex-users.
  • Recruitment. How do you recruit the ‘right’ people?
  • Regulate the work. How to regulate the work attached to each job function/task, contracts and other technical requirements.
  • Training. How to educate, train and maintain the quality of the work of peer workers.
  • Confidentiality. How to address and handle confidentiality issues.
  • Prepare for monitoring and evaluation. How to document and track your activities and accomplishments.

 

 

Selection of peer workers

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Selecting peer workers is one of the most crucial steps in initiating peer work.
What qualities do we want in peer workers?

There is not one ideal type of peer worker, but a project should have a group of individuals with a good mix of skills, experience, characteristics, insights and roles in the community.

There are five main factors to think about when
recruiting people as peer workers
(further details on each follow):

  1. they people must fit well within the community
  2. they must have insight and knowledge of the culture of the drug-using community
  3. their personality must match well with the role of peer worker (for example, they should be able to communicate well with people)
  4. they must have a good motivation to become and stay involved
  5. if they are drug users, their personal drug use should be sufficiently manageable or stable so that they can meet the responsibilities of their task (be on time, not be high at work, be able to represent the group and be able to communicate well with others).



1.  Peer workers must be accepted by the community
There is not only one sort of peer worker that is accepted by everyone in the community, but in order to work well within the community, some common personal characteristics are valuable:

  • respected by peers, and seen as ‘equal’
  • can approach people without judgement
  • have a wide social network
  • is trustworthy and honest
  • is credible and up-front about their intentions
  • has someone or other friends to turn to for advice/support
  • is interested in meeting new people
  • and is open to suggestions and new ideas.

Other desirable personal skills are:

  • communication skills
  • an innovative and open mind to learning
  • an ability to work independently, as well work in groups or teams
  • good listening skills and empathy
  • emotional stability
  • a genuine respect for other people and for confidentiality
  • flexibility and the ability to work in a very dynamic environment
  • and the ability to build bridges and foster working relationships with other communities and key stakeholders.

Good peer workers should not be so ‘radical’ and different from other peer workers that they will not be listened to or taken seriously.  They should be open to suggestions, constructive criticism and new ideas and practices that are introduced into the peer group.  This type of person is usually called a ‘natural opinion leader’ and is likely to disseminate information, and advocate better than other members of the target group.

 

2.  Insight/knowledge of various drug use cultures
A peer worker should be highly knowledgeable about the culture and the practices (such as the ‘choreography of injecting’ described by Annie Madden  in AIVL’s book on peer work. http://www.aivl.org.au/files/FrameworkforPeerEducation.pdf in order to understand and react to the actual issues, needs and educational opportunities.

 

3.  Personal characteristics
A peer worker should be non-judgmental on drug use matters and be able to understand how the illegality, marginalisation and stigma has shaped/affected the culture and behaviours.

Since proper peer work has a strong focus on self-development, many of these characteristics will grow over time.

To read more on this issue:

  • The Australian Injecting and Illicit Drug Users League (AIVL) has written a good piece on the qualifications of peer workers.  http://www.aivl.org.au/files/FrameworkforPeerEducation.pdf
  • A very useful checklist on skills and characteristics has been developed by the Toronto Harm Reduction Task Force and can be found here. [Apart document, buiten de lopende text openen:]  It can, of course can be adapted as necessary.

 

4. Motivation
It is generally accepted that peer work is valuable, takes time and therefore should be compensated.  In other words, it should be paid.

But some believe that ‘true’ peer education is grassroots’ volunteerism and should not involve monetary reimbursement.

“Experience has shown that peer educators who stay with projects often joined for altruistic reasons and want to inform their peers about HIV and other health issues.  Peer education can offer the opportunity to develop social skills or specific skills in subjects such as media, public speaking and drama. Once a project is running, the friendships among the peer educators and their social activities will be important incentives.  In some projects, being a peer educator brings increased popularity and status.
” European Guidelines on Youth peer education



5.  Involving drug users and ex-users
The issue of the involvement of current or ex-drug users is a recurrent debate among services that want to set up peer involvement programmes:

  • are current drug users able to do the job?
  • what about those receiving substitution treatment?
  • how about former drug users?  Do they have a role in a peer support project?

 


Current drug users
The issue of involvement of current drug users is a recurring issue.

“We think in selecting applicants for peer education positions with drug user organisations, discrimination in favour of current injectors is fair and reasonable, from a practical, if not philosophical, perspective:  there will be situations (largely defined by the network or peers one is working with) where being a current injecting user and openly identifying as a current user will be a required and necessary part of being accepted as a peer; on the other hand, it is hard to think of an instance where being a former user would be required and necessary.”
Annie Madden in ‘A framework for peer education by drug-user organisations’


A couple of significant benefits of involving current drug users are:

  • Current drug users ARE peer work. They are what it is all about, they have been there, and they are the essential bridge-builders.  Current drug users know what is currently going on in the drug community, they know the rules of the street, and they generally have frequent contacts with their peers, etc.  Therefore, they are the most likely people to gain the trust of, and have influence on their peers.
  • As peer workers, current drug users can be seen as role models and sources of inspiration by others.

“Peers can walk the walk, and talk the talk; this can and will help develop the trusting relationship necessary for the most comprehensive service delivery.”
Toronto Harm Reduction Task Force in Peer Manual, A guide for peer workers and agencies

 

Some challenges that need to be mentioned are:

  • Being a current drug user can be like having a full-time job.  There is not much time left to do anything else.  A continuous commitment to a job might be asking too much of a current drug user.  Thus, involving only current drug users in a peer programme might cause problems regarding continuity.

“Our experience show us that an active user often encounters simply too much more personal problems like issues with housing, health, prison, etc. Sometimes this is just too much. No matter how much everybody might want it to happen otherwise.”
APDES

  • The drug-using community might have a trustworthiness issue.  Peer workers who are current drug users might be seen by them as having become ‘one of them’.


Ex-drug users
Former users might be very interested in being involved in a peer programme. They have been on both sides of the fence and programmes can learn and benefit from their experiences.  Their involvement can increase the continuity of the project.  However, there is always a chance of relapse and misinterpretation of the message of the programme.  Former drug users may have difficulty teaching the safe use of drugs and want to recruit drug users to stop use, whereby offending them by not respecting their choice to use.

We cannot say that former drug users’ experiences do not count and do not offer opportunities for current drug users.  Common experiences bind them together - discrimination, abuse, rejection, stigma and health consequences.  Former drug users still live with the same emotional burdens and can very much relate to current users’ struggles and issues.  They have been subjected to the same torment and have engaged in many of the same behaviours.

However, former drug users are not subjected to the same daily struggles and human rights violations that current drug users are subjected to.  Furthermore, many individuals who use drugs may not be comfortable working with ex-users or acknowledging them as peers.  It is for these reasons that we strive to create a safe, non-threatening environment for drug users to improve their health and overall wellbeing and by supporting current drug users’ involvement as peer workers.

Many of the issues relating to ex-drug users also apply to drug users in treatment.  The prescription of substitute drugs such as methadone, buprenorphine or of heroin itself will without doubt contribute to the individual’s stability and his/her engagement in other activities.  Sometimes, it is even seen as a prerequisite for drug users in order to be properly  involved in a peer support project.

What seems to be crucial in the successful involvement of former drug users (and those in treatment) in peer programmes is their acceptance that people are not necessarily ready or willing to follow their path and want to continue using.

The main challenge is that former drug users or users in treatment are sometimes not part of the drug scene anymore and that they might not share the daily life any more with other users.  It takes skills and a mature empathetic attitude from these peers to bridge their current position with those who are using.

Recruitment

How do you find and contact the ‘right’ peer workers?

  • Try to find diversity in peers: men, women, transgendered, older, younger, different sexual orientations, and members of ethnic minorities.
  • Try to recruit from different segments of the population.  Don’t fish in one pond, but recruit in various ways and in different locations.
  • Talk to community members who show some of the qualities you are looking for and ask if they would be interested in peer work, or if they know others with similar qualities who may be interested.
  • Talk to professionals who may know or have clients who could be potential peer workers.
  • Place notices advertising the work in places where potential peer workers spend time, such as drop-in centres, community centres, street corners, etc., thus ensuring lots of different people will see them.

“Drug users tend to have excellent networks. .... Ask your clients and colleagues to recommend potential peers.  Telling a couple of people that your agency is starting this program and asking them to spread the word may be the most effective way of advertising.”
Toronto Harm Reduction Task Force in Peer Manual, A guide for peer workers and agencies


Regulate

When you have found the right people, you should clarify the following in order to avoid any misunderstandings:

Job description, describing the job in detail.
Contract, describing the formal agreements.
Responsibilities, describing the obligations of the agency and the peer workers

 

Each of these are addressed below.

 

Job description
A job description clearly describes the job in detail:

  • what the job consists of
  • the role, tasks and responsibilities of the worker
  • the desired qualifications and requirements
  • the times, days and hours of the job
  • and how to apply for it.


Contract
A contract is a written description and formal agreement of a mutually agreed understanding between the worker and the hiring agency.  A contract describes what is expected from both parties. The contract helps to clarify expectations and avoid misunderstandings on the parts of both the peer and the agency they are working for.


A contract should definitely specify:

  • the work, role and responsibilities
  • the various tasks that are agreed
  • the number of working days and hours
  • compensation:  how much it is and when it will be paid
  • the duration of the contract.

and preferably also include:

  • a code of conduct describing what kind of behaviour is expected LINK HOW/PREPARE/RECRUITMENT/Responsibilities of agencies
  • an agenda for specific issues such as skills, education and training;  supervision;  the probation period;  evaluation;   and how discipline is handled
  • the agency’s mission statement and reporting hierarchy

An example of an agreement or contract comes from the Toronto Harm Reduction Task Force and can be found here.  [LINK naar Apart document, buiten de lopende text openen:] It can, of course, be adapted as necessary. [= naarApart document, buiten de lopende text]


SAMPLE AGREEMENT OR CONTRACT



Responsibilities
Both agencies and peer workers have responsibilities that they must fulfil.

Responsibilities of agencies
Agencies have a responsibility to create an environment where peer workers feel well, supported and are able to develop work-related skills.

The following agency responsibilities have been identified (source:  the Australian Injecting and Illicit Drug Users League / AIVL  http://www.aivl.org.au/files/FrameworkforPeerEducation.pdf:

  • Orientation to the practice of peer work, overview of agency functions/departments, introduction to the networks, communities, other agencies.
  • Education and training on technical knowledge and skills, communication and group work skills, strategies for protecting privacy and confidentiality, setting boundaries for relationships with members of their constituencies.
  • Resources, such as access to publications, references and resources that will give the peer worker an opportunity to improve his/her work.
  • Supervision:  a system of debriefing, support and guidance that will enable the peer worker to assess his/her duties and overall performance.
  • Personal support:  besides professional coaching/training, specific attention should be paid to the personal position of the involved drug users.  Keep in mind where people might come from and if necessary personal support should be given in matters as:
    • practical/material problems (settlement of debts, finding a home, etc.)
    • development of a career perspective by advice and support in the field of training, education and work
    • personal problems (e.g. managing drug use, personal relationships with partner, family and friends).
  • Provide a code of conduct.  Agencies have the responsibility in providing guidance in how they expect peer workers to deal with various situations that might arise, such as:
    • buying and using drugs
    • use and possession of drugs during office hours
    • being high during working hours
    • relations with other community members and clients
    • dealing with conflict
    • accepting favours, lending or borrowing money,


Responsibilities of peer workers
Just like agencies, workers have responsibilities towards the agency and their clients/community.  The following responsibilities have been identified (source:  the Australian Injecting and Illicit Drug Users League). AIVL http://www.aivl.org.au/files/FrameworkforPeerEducation.pdf
Peer workers should:

  • Understand their position as a role model for others in the community
  • Understand equality.  Even if conditions seem to change (e.g. they become trained, paid and respected experts), the concept of equality with the people they are working needs to remain.
  • Respect  the life choices of drug users.
  • Be balanced and skilful in applying the principles of harm reduction to weigh risks, harms and benefits of various behaviours.
  • Encourage and support all kinds of meaningful peer involvement among the community members.
  • Follow workplace policies, codes of conduct and observe the lines of professional boundaries, authority and responsibility.
  • Respect the privacy and confidentiality of all drug users, peer participants and clients, including their HIV status, and that individuals may be members of the agency or peer organisation.

 

Training

An essential element in getting a peer worker started in their job is training and education. That’s the case in any job, but in peer work it is critical.  “For some individuals this could be the first time in many years they ever have had any orderly routine.  Chaotic lifestyles can interfere with the ability to conform to set routines.” (Toronto Harm Reduction Task Force:
http://www.harmreductionnetwork.mb.ca/docs/thrtf.pdf
In general, the contents or components of peer training programmes can be divided into the following categories (details of each follow):

  1. Knowledge: technical knowledge on the subject.
  2. Communication skills: skills on how to communicate effectively.
  3. Self-development: to provide greater understanding by peers of themselves and interpersonal relationships, and to improve their social skills.
  4. Technical requirements: job-related issues such as safety and professional boundaries.

chat icon{simplepopup link="video63"}{/simplepopup}{simplepopup link="video64"}{/simplepopup}{simplepopup popup="false" name="video63"}“The training is essential. But not sufficient, it is only the beginning. It is even more important to continue is the peer’s experience and good supervision/coaching”

Joana Marquez, APDES, Portugal

 

 

 

 

 

{/simplepopup}{simplepopup popup="false" name="video64"}“Three issues are of utter importance: good training, decent remuneration.and good mutual support
But first of all practice-based training. And practical support to attent the training workshops. Technical trainings but also on dealing with various situations and issues
Help new people to become creative in solving issues. That’s the best way to address problems. Have team regular team meetings, where people feel welcome, at home.”

Theo van Damm

{/simplepopup}

 

 

1.  Knowledge
The technical knowledge component of training needs to be presented in a way that leads to a personal understanding of the topic.  Peers will need sufficient understanding to correct myths, misinformation and to understand the logic behind them.  After a basic training course, the peer workers will need to be regularly updated and then given the opportunity to have their questions answered by other experts (such as physicians) whenever necessary.

It is most important is they need to know everything on the transmission of blood-borne viruses, classes of drugs and their effects, basic health interventions, legal issues, safer sex and so on.


Resources

  • One of the most elaborate and detailed manuals on drug use is the ‘WHO training guide for HIV prevention outreach to injecting drug users’. It describes a wide range of training sessions and materials:
    • the organisation of training and workshop methods
    • required knowledge and skills
    • drug use, health risks and interventions
    • managing and conducting outreach work
    • and other training programmes, with exercises and handouts.
  • http://www.who.int/hiv/pub/prev_care/trainingguideweb.pdf
  • Another very good and detailed resource, focusing on injecting drug use (from dope splitting to matches, tourniquets to overdose management, and syringe storage) is ‘A safety manual for injecting drug users’, is published by the Harm Reduction Coalition. http://www.harmreduction.org/downloads/idu_manual.pdf
  • A very good and comprehensive resource on drug work is ‘HIV and drug use:  community responses to injecting drug use and HIV’, published by the HIV/AIDS Alliance.  This guide aims to support the scale-up of community-based HIV and harm reduction programmes in developing and transitional countries. http://www.aidsalliance.org/publicationsdetails.aspx?id=454

2.  Communication skills
This involves a combination of specific skills training, assertiveness training, the opportunity for practice and feedback, and increased self-esteem.  Peer workers should become familiar and comfortable with the language of the subjects.  If the peer workers are to give presentations to groups, they need presentation skills, including how to lead group discussions and to handle overtly personal questions.

Resources


3.  Self-development
Training should offer a greater understanding of issues of vulnerability, sexuality, gender, sexual orientation, and the ethics of drug use and health matters on a personal level.  In addition, gaining an understanding and appreciation of human difference, including the dynamics of prejudice and discrimination, should be included.

The eventual aim is peer workers’ greater understanding of themselves and interpersonal relationships, and improved social skills.  One of many ripple effects of such training is building self-confidence and personal satisfaction in completing something of interest.

Resources:
The ‘WHO training guide for HIV prevention outreach to injecting drug users’ provides detailed examples of training sessions and materials to increase personal development. http://www.who.int/hiv/pub/prev_care/trainingguideweb.pdf

4.  Technical requirements
This training part will focus on job-related issues such as:

  • Safety protocols: the first priority in any job.
  • Occupational health: How to avoid health risks in your daily work.
  • Boundaries: guidelines, riles or limits that a person and/or agency set to create a safe working environment.
  • Legal issues and law enforcement, including how to deal with the police.
  • Referral networks and procedures.
  • Conflict resolution.
  • Dealing with stigma and discrimination.
  • Reporting procedures: how to document daily work activities.


Other general, useful resources on training include:

  • ‘Peer education, outreach, communication and  negotiation’ published by HIV/AIDS  Alliance.This training manual describes ways in which NGOs may design, deliver and manage training programmes for peer workers. http://www.aidsalliance.org/includes/Publication/Peer_education_manual.pdf

  • ‘Peer educators’ manual’, published by the European Network for HIV/STI Prevention and Health Promotion among Migrant Sex Workers (TAMPEP). This manual is developed for (agencies working with) sex workers. EXTERNAL LINK www.tampep.eu

  • A useful guide on peer work with younger people is: ‘A practical guideline to outreach, peer work and early intervention with a young target group’, written by the Competence Centre City of Oslo (CC-AADAS, Norway) for the Correlation programme see: Correlation

Confidentiality

Peers workers ‘wear different hats’ at different times during their work.  The agency may view them as being part of the organisation and yet, as members of the community, also as being outside it.  The community members may see them as members of the community, yet also outside it because they are working for an agency.  Whichever hat they are wearing, however, confidentiality is paramount.

A confidentiality protocol must be in place to specify exactly what peer workers can and cannot reveal – to community members, to other peer workers, to the agency, or to any other person/agency.

A good example of a protocol on confidentiality Sample Confidentiality Agreement

 

 

Prepare for monitoring and evaluation

If anyone asks what a peer support project is doing, what information is available to tell them?  For instance:

  • those who fund the project (or those who are thinking of funding it) want to know what their money is paying for;
  • those who are thinking of becoming peer supporters want to know how worthwhile or successful the project is;
  • the project’s workers want to see how their individual work and concerns fit into the whole project;  and
  • the project itself needs to know whether or not it is meeting its goals and whether there needs to be any improvements.



“Thoughtful and attentive supervision is especially important .... given the complex dynamics between the intensity of the work, potential for drug use and recovery issues among staff, high turnover common in social service jobs and burnout associated with direct service and social justice work.”
Harm Reduction Coalition,Guide to Developing and Managing Syringe Access Programs


Harm Reduction Coalition, Guide to developing and managing Syringe Access Programs

 

 

Monitoring and evaluation means you will be able to answer these questions.

Monitoring and evaluation are closely related but not the same.

The main goal of monitoring is to assess whether or not things are going as planned and whether any change is necessary.

Evaluation goes further and deeper than monitoring:  it is a more formal, systematic assessment of whether the project’s goals have been met, how and why certain outcomes were achieved (or not), and what has been the value and significance of the project.  An evaluation may also identify additional and unanticipated outcomes of the project

When starting a programme or an initiative, think of monitoring and of ways to collect information (data) to see if things are on track and if any changes will be required.

It is important to create a clear and simple plan for collecting data and monitoring any type of activity, especially if you are working in a sensitive area like the drugs field, with discussions, controversy, different policy priorities and budget cuts around the corner.  Prepare to document how your work works.

For monitoring and evaluation to be successful, they need to be designed at the earliest stages of the project and continued as a parallel process.  Make it easy.  Don’t overdo it.  Make the collection of valuable data something that is part of workers’ routine tasks.  Although reminding workers to fill in the forms can be helpful, it still is important to develop a form that can be easily and quickly completed.

More information on monitoring and evaluation for grassroots initiatives.
Monitoring and evaluating your peer support project:  a simple guide