Advanced Training: Mentoring Peers on the Job

Harry Dohnert, PACT Program Assistant, facilitates a PACT training. Harry conducts the peer preceptorship at Harlem Hospital.

As peers move from training to working with clients, they may experience a moment of panic: the leap from role playing to working with “real-live people” can be overwhelming. A key component to helping peers feel competent in their new role is providing post-training opportunities. This assists them in developing the skills learned in peer training and tailoring their techniques to interactions with clients in the work setting.

Clinicians receive guidance as they begin caring for patients—the AETC (AIDS Education and Training Centers for health care providers) defines this as Level 3 training: “activities where the trainee is actively involved with actual clinical care experiences involving patients.” Peers benefit from this type of training and begin using their newly acquired skills to help clients living with HIV. One strategy to build peers’ understanding of how the skills learned in core training are used on the job is shadowing, in which a new peer observes an experienced peer colleague in routine client interactions. Another approach is a preceptorship, in which an experienced mentor meets regularly one on one with a new peer to discuss the peer’s interactions with clients in detail, exploring the peer’s approaches and strategies to engage and support clients, as well the frustrations and successes of peer work. In this article we explore two recently implemented programs which have applied these approaches to mentoring their peers.

Peer shadowing at Kansas City Free Health Clinic (KCFree)

Peer shadowing is part of the People to People Project’s Level 3 training in which newly hired peers who have completed Level 1 and 2 training travel to the work sites of experienced peers to observe peer work in action. The first peer shadowing took place in fall 2008 when peers from the Truman Medical Center in Kansas City visited the Kansas City Free Health Clinic.

One of the experienced peers who was shadowed during the training is Jerry (second from left), seen here participating in a multidisciplinary team meeting at Kansas City Free Health Clinic. (Learn more about Jerry's work by viewing the video: The Peer Program makes a big difference...

Over the course of one and half days, the visiting peers followed a structured agenda. They observed a one-on-one peer-client interaction (with the permission of the client) following an 8-step plan established by the clinic. (This checklist can be found in Appendix D of the Kansas City Free Health Clinic’s Peer Orientation Agenda and Resource Packet (PDF), a resource in the Building Blocks to Peer Program Success toolkit.) They saw a peer-client interaction in the medication clinic, where the peer worked with the pharmacist to help a client who is beginning or changing medications. They were present at a multidisciplinary team meeting where primary care staff, case managers, social service providers, and peers conferred about client cases (not using any client-identifying attributes), and they observed a substance-abuse support group facilitated by a peer. Finally, they participated in a debrief session with the experienced peers to share experiences, ask questions, and reflect on what they had learned.

Because their programs are new and they are still gaining the trust of their own health care providers, to see a peer valued as an equal member of the health care team is very empowering and significant.

“One thing comes up each time we debrief with the peers,” said Simone Phillips, Community Outreach Specialist at St. Louis Area Chapter American Red Cross, who worked with Alicia Downes, Peer Education Training Site Manager at KC Free, to set up the program. “They [the visiting peers] recognize how valued the peer worker is within the clinic. Because their programs are new and they are still gaining the trust of their own health care providers, to see a peer valued as an equal member of the health care team is very empowering and significant.”

Kansas City Free Health Clinic hosted two more peer shadowings in spring and summer of this year. During these trainings, peers from two St. Louis-based AIDS service organizations, Project ARK and St. Louis Effort for AIDS, and from Madison County AIDS project in Illinois, all relatively new peer programs, had the opportunity to observe an established program in which peers are fully integrated into the clinic services.

After the second peer shadowing, the peers involved were so enthusiastic that their supervisors wanted to learn more about the program and saw great benefits in meeting with their peers as well. So the third peer shadowing included a component for peer supervisors, who learned more about the peer shadowing experience and had the opportunity to meet and compare notes on work issues with other peer supervisors on site at both the Kansas City Free Health Clinic and the Truman Medical Center.

Peer shadowing gives new peers an opportunity to apply the skills they have learned in training to a real-life setting. As for the peers being shadowed, they enjoy being a mentor to new peer educators. “It’s invigorating to be acknowledged in the work they are doing,” said Alicia.

Three peers who attended shadowings at Kansas City Free Health Clinic: (from left) Linda Jones, Project ARK, Lionel Biggins, Truman Medical Center and Fred Glick, Truman Medical Center. Click a photo to read the peer’s profile.

Preceptorship at Harlem Hospital

The PACT Project considers Level 3 training an important component in developing peer skills, according to Julie Franks, Program Evaluator at PACT. To help trained peers apply their newly acquired skills in the work environment, PACT has developed a preceptorship program at the treatment adherence peer program at Harlem Hospital in which a new peer attends regularly scheduled 1-1 ½ hour sessions every week for six weeks with an experienced peer mentor to discuss issues and questions that come up as the peer works with clients.

“The goal is to develop the peer worker’s on-the-job capacity to use the knowledge and skills acquired during the PACT core training,” explains Harry Dohnert, PACT program assistant, who conducts the peer mentoring sessions. Harry is uniquely positioned to serve as peer mentor. Over the past decade he has worked as a peer worker, a trainer in PACT peer training programs, a case manager and a peer supervisor at Harlem Hospital. Harry has completed the first preceptorship with one peer and is in the process of conducting two more.

The most important thing is to help them build trusting relationships with the clients.

Prior to the start of the preceptorship, Harry meets with the peer’s supervisor to get a detailed understanding of the program-specific goals and the peer’s roles. In the one-on-one sessions with the peer, Harry explores the peer’s interactions with clients, using fictitious names to protect the privacy of the client.

“I ask them to tell me about a client they are having a difficult time with,” says Harry. "It’s really a continuation of the PACT training. We work on improving the peer-client interaction, sometimes referring back to materials that we’ve used in the PACT core training that might be helpful in a particular situation. The most important thing is to help them build trusting relationships with the clients.” (A description of the PACT training curriculum is included on pg. 32 of the Toolkit Guide (PDF) to the Building Blocks to Peer Success training-of-trainers toolkit.)

The preceptorship is intended to support, not replace, managerial supervision of peers, according to Julie. “It’s a lot like supervision in that Harry leads the peers to reflect on what they are doing with clients. He helps the peers to come up with new ideas about how to approach a client or gain more insight into why they are having certain feelings about a particular client. This process increases the peer’s self-awareness and ability to reflect on what they are bringing to the interaction with the client and how to use the skills that we train them on in their work.”

Harry is familiar with the peer’s training, work setting and managers, yet he is not their supervisor, a fact which frees peers to bring up issues they may not be comfortable discussing with a supervisor. Before beginning the preceptorship, Harry stresses that the sessions are confidential and that the supervisor will receive only a general summary at the end of the preceptorship.

“What’s said between us stays between us,” says Harry.“You have to build in those kinds of safeguards to create a trusting communication about their work.”

Challenges

Both programs agree that getting organizational buy-in to conduct Level 3 training is a challenge. “All programs don’t have enough time to do the things they absolutely need to do, so it’s hard to carve out time for it,” explained Julie. Yet both programs persisted in highlighting the benefits of the program to stakeholders and feel that the resulting programs have been well worth the effort.

“No matter how much role playing they do in training, when they get on the job, they’re on their own. This training responds to a real need for ongoing support for building their own capacity for self awareness and skill development,”said Julie.

Going forward

Both programs are considering options for continuing the mentoring experience beyond the initial training period. Harry would like to continue supporting the peer by scheduling periodic follow-up sessions after the preceptorship is complete. People to People hopes to host a peer retreat in the coming year to build on the shared experiences and new relationships which developed during the peer shadowings. “There are times when a peer needs to speak to another peer, someone who is doing the same work they are,” said Alicia. “We want to encourage the kind of support that peer educators can offer each other.”