AgrAbility Neighbor-to-Neighbor
Peer Support Training (NNPST):
Be a Best Friend
By Robert J. Fetsch
November 8, 2005
AANNPSTNAP.PPT (Rev. 10.2505a)
AgrAbility Neighbor-to-Neighbor Peer Support Training
(NNPST): Be a Best Friend
By Robert J. Fetsch
Colorado State University
Department of Human Development & Family Studies
970-491-5648
fetsch@cahs.colostate.edu
Our National Goal
To mobilize rural volunteer resources,
including peer counseling among farmers
with disabilities and their families and rural
ingenuity networks promoting cost-effective
methods of accommodating
disabilities in farming and
farm-related activities.
Our National Goal:
New RFP
Priority 2. Networking. Networking will
eventually make AgrAbility sustainable.
Partners include customers, peer
supporters…. Delivery formats include the
donation of goods and services
of direct benefits to AgrAbility
customers.
Our AANNPST
Goals
1. To increase the number of
farmers and ranchers who use
AgrAbility information, education,
and service.
Our AANNPST
Goals
2. To increase the number of
farmers and ranchers who
volunteer to provide peer
support to farmers/ranchers
with newly acquired
disabilities.
Our Training Objectives
1. To learn what effective peer support is and is
not.
2. To learn effective ways to connect well with and
to establish rapport with other farmers/ranchers
who have newly acquired disabilities.
3. To practice and enhance active listening skills.
Our Training Objectives
4. To practice and enhance problem-solving skills.
5. To learn how to spot signs of high stress, anger,
depression, and suicidal thinking.
6. To practice and enhance skills at making
effective referrals to appropriate professionals.
Our Training Objectives
7. To learn how to screen well, to choose
farmers, ranchers, and caregivers who
are ready to provide effective peer
support.
Our Training Objectives
8. To assess the effectiveness of the
AgrAbility Peer Support Volunteer
Training Workshop in helping workshop
participants to accomplish the above 6
objectives via self-reported pretestposttest changes.
3 Keys to Effective AANNPST Training:
1) Screen Well!
2) Teach Well!
3) Assess Well!
to “AgrAbility Neighbor-to-Neighbor
Peer Support Training: Be a Best
Friend.”
What we want to do here is work with
those who are ready to take steps to
become as healthy as you can be
and to take good care of yourself, so
that you can “Be a Best Friend.”
• What does a Best Friend do well?
• What does a Best Friend not do?
Support systems are groups and
individuals who help us meet our
needs (physical, occupational,
intellectual, spiritual,
emotional, and social).
Peer support has been used with:
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Blind people
Women with breast cancer
Expectant mothers
Mothers with newborns
People in conflict
Peer support has been used with:
• Parents of sexually abused children
• Victims of AIDS
• People who have experienced mental,
physical, or sexual abuse.
• Students with disabilities
Peer support has been used with:
• People with alcohol or other drug
problems
• And now with farmers, ranchers, and
caregivers with disabilities
Peer support is beginning to be
used with:
• Farmers, ranchers, and caregivers with
disabilities in CA, CO, DC, IA, IL, IN,
KS, MI, NE, OK, PA, SD, and WI.
What is peer support?
• Being a best friend and providing peer
support are similar.
• Peer support is “a system of giving and
receiving help founded on key principles
of respect, shared responsibility, and
mutual agreement of what is helpful.”
Mead, Hilton, & Curtis, 2001, p. 135.
What is peer support?
• It’s about sharing one’s story with a
good listener.
• It’s having one’s story validated by
another.
McLeod, 1997
What does peer support do?
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It helps individuals improve functioning.
Increases life satisfaction.
Restores self-esteem.
Provides healthy interactions with
others.
Bedard, Felteau, Mazmanian, Fedyk, Klein, Richardson,
Parkinson, & Minthorn-Biggs, 2003
What does peer support do?
• It reduces isolation.
• Increases optimism about the future.
• Helps a person reach personal goals.
Bedard, Felteau, Mazmanian, Fedyk, Klein, Richardson,
Parkinson, & Minthorn-Biggs, 2003
What is peer support?
• It is about listening carefully.
• Encouraging the person to find ways to
solve problems by affirming his or her
ideas and plans of action.
Akridge, Farley, & Rice, 1987
When is peer support effective?
• When we connect well.
• When we have already dealt well with
the stress, pain, and suffering of our
own disability.
• When we model healthy acceptance
and joy of life with our disability.
Byers-Lang & McCall, 1993
When is peer support effective?
• When we model our own good skills at
managing anger, blame, and
depression.
• When we model our own good skills at
dialogue, acceptance, and joy of life.
• When we model our own good skills at
goal-setting, problem-solving, &
listening.
We’re looking for Peer Support
Volunteers who:
• Do not tell other adults what to do.
• Do not provide counseling, therapy, or
technical advice.
• Listen well without judgment.
We’re looking for Peer Support
Volunteers who:
• Connect well with farmers and ranchers
with a newly acquired disability.
• Assist with problem solving.
• Make effective referrals to appropriate
professional resources.
How do we provide effective
peer support?
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Take good care of ourselves.
Be healthy and happy.
Be well balanced.
Affirm their story rather than tell them
what to do.
How do we provide effective
peer support?
• Suspend judgment.
• Be empathic. (Walk a mile in their boots.)
• Listen as they deny, get mad, blame, get
depressed.
• Listen well, accept them, and provide an
environment in which they can grow.
How do we provide effective
peer support?
• Listen to their story. It’s in the telling of
the story to a good listener that they
heal from their pain and loss.
• Eventually they too will come to an
acceptance and joy of life.
• Listen as they blow off steam.
How do we provide effective
peer support?
• If their emotions get too intense, back
off and refer them to professional
counselors.
• If their stress, anger, depression levels
are too high for us to handle, we can
refer them to professional counselors.
How many of us have started
and grown a plant?
• What all did you do to provide a healthy
space for that plant to grow, bloom and
mature?
Feed a person a fish;
s/he eats for a day.
Teach a person to fish;
s/he eats for a lifetime.
Our job is not to keep our child
dependent on us.
It is to provide a growing
environment in which s/he can
bloom and grow into being a
healthy, self-sufficient young
adult.
Our job as Neighbor-to-Neighbor
peer support people is to provide
a growing environment in which
farmers, ranchers, and caregivers
with a newly acquired disability
can grow into being their healthy,
self-sufficient selves again.
Research findings
• People with congenital disabilities adjusted
better.
• People with acquired disabilities are likely to
experience severe psychological trauma from
personal loss and the changes from their
former state.
Li & Moore, 1998
Research findings
• People require greater effort and more time to
adjust to acquired disabilities than people
with congenital disabilities.
• Family and friends may have more difficulty
adjusting to later acquisition, which makes
the adjustment more difficult.
Li & Moore, 1998
It takes time to adjust.
• People need time to adjust.
• They need to feel the sadness, anger, blame,
depression, etc.
• People need others with whom they can talk
and tell their story to heal from their losses.
It takes time to adjust.
• At some point people need to reassess
and reaffirm themselves.
• People need to find new coping
strategies and mobilize themselves.
• They need to dialogue, talk, and
converse.
It takes time to adjust.
• It may take a couple of years to heal
from the emotional wounds.
• It can be as tough or tougher than
coping with a divorce.
Research findings
• The adjustment process has been
described as “Learning to accept the
reality of a condition and then finding
suitable ways to live with that condition.”
Acton, 1976, p. 149.
Research findings
• Adjustment is not linear or hierarchical.
• A phase does not need to be accomplished before an
individual moves on to a new phase.
• People usually experience each phase partially, one
at a time, to be revisited and experienced more fully
during other encounters.
Dover, 1959
Research findings
• We bounce around from anger to depression
to dialogue and back to anger.
• It takes time and conversation with a trusted
family member, friend, peer support, or
therapist.
• It’s like peeling the layers of an onion to get to
the core.
Gomez, 2004
Research findings
• Individuals move through each phase at
different paces.
• Some may stop at a particular phase for
a long time or even remain there the
rest of their lives.
• Often family members experience a
similar adjustment process.
Gomez, 2004
HANDOUT:
Denial-Acceptance Continuum
John Gottman’s Research
How do individuals cope?
How do individuals cope?
• There are tremendous challenges.
• Many different coping strategies.
• Maintain normal activities, e.g. going to
work, shopping, and visiting friends.
Lazarus & Folkman, 1984; Williamson, Schulz, Bridges, & Behan, 1994
How do individuals cope?
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Take good care of self.
Take care of others.
Recreate.
Maintain friendships.
Manage depression.
Rybarczyk, Nicholas, & Nyenhuis, 1997
How do families cope?
How do families cope?
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Disability is a family affair.
Revisit family roles.
Adapt leisure activities.
Adjust to financial hardships.
Deal openly with emotional needs.
Spot signs of high stress, anger, and
depression.
Bishop & Evans, 1995
How do families cope?
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Problem solve and communicate.
Resolve feelings of grief and loss.
Create a supportive family environment.
Develop realistic expectations for all family
members.
• Maintain a balance that meets the needs of
all family members.
Marsh & Johnson, 1999
8 main topics that are essential for us
to cover in today’s workshop:
1. Learn what effective peer support is and is
not.
2. Connect well and establish rapport
3. Listen actively.
4. Problem solve
5. Learn how to spot signs of high stress,
anger, depression, and suicidal thinking.
8 main topics that are essential for us
to cover in today’s workshop:
6. Practice and enhance skills at making
effective referrals to appropriate
professionals.
7. Respond to your questions.
8. Where do we go from here? What do you
need next?
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1. Learn what effective peer support is
and is not.
The goal is not to make/keep others
dependent on us.
The goal is to listen well—not to solve the
problem for them.
Don’t tell them what to do.
Don’t blame.
Don’t judge.
1. Learn what effective peer support is
and is not.
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The goal is to empower each individual with
whom we talk and visit to use the strengths and
resilience they have within themselves to solve
their own problems and to figure out where they
want to go.
We provide support for them to re-discover their
own inner strengths.
We don’t do it for them.
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1. Learn what effective peer support is
and is not.
Don’t become so involved that you lose
your perspective and objectivity.
Increase empathy and compassion.
Empathize—more so than sympathize.
Listen actively—don’t advise or tell them
what to do.
Build on strengths—yours and theirs.
2. Connect well and establish rapport.
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Rapport means relations marked by
harmony, conformity, accord, or affinity.
ACTIVITY: Role-play connecting well and
doing everything we can to establish
rapport quickly.
3. Actively listen.
• Listening is hearing the other person
so well that we can repeat back to
the speaker’s satisfaction what they
say, feel, and want.
• The first step is to pay attention to
the content of the speaker—what
s/he says to us.
3. Actively listen.
• The second step is to pay attention
to the feelings/emotions that the
speaker conveys.
• The third step is to pay attention to
what the speaker wants now.
3. Actively listen.
• Feelings are neither good nor bad—
they just are.
• It’s not what people feel that is
harmful to themselves or others. It’s
what they do with their feelings that
can be hurtful.
3. Actively listen.
• Denying feelings does not make
them disappear.
• Feelings always make sense when
we see the other person’s viewpoint.
What are some key
components of effective
listening?
3. Actively listen.
• Some key components of effective
listening include making eye contact.
• Nodding
• Making utterances like, “Um hum,”
“And then what happened?”
• Nonverbal attentiveness
Communication can be
challenging.
• Because ranch and farm families live and
work side-by-side.
• Farming and ranching often involve
several generations.
• Many ranch and farm families are
independent, strong, and resilient.
To communicate well…
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Make good eye contact.
Sit face to face.
Ask for what you want.
Listen well.
To communicate well…
• Be attentive.
• Be open and respect the other person.
• Hear content and sense feelings and
what they want to do next.
• Verify that we heard what they said and
feel.
Neighbor-to-Neighbor Peer
Support Training
• This is an experiment.
• To help you and us know how
you’re doing, your strengths and
growth areas, we ask you to
complete some surveys over lunch.
4. Problem Solving.
4. Problem Solving.
• Having problems with
others is normal.
• It’s what we do with our
conflicts that makes
the difference.
10 problem-solving steps
• Four ingredients are essential:
1) We can find a better way.
2) We can do it together.
3) I intend for us to negotiate so
everybody wins.
4) Let’s create a workable plan.
10 problem-solving steps
1) Define the specific problem.
2) Identify who all is involved with this
problem and invite them to a scheduled
family meeting.
3) Establish a positive atmosphere that is
free from interruptions.
10 problem-solving steps
4) Determine what each stakeholder
really wants or needs related to the
specific problem.
5) Brainstorm and write down as many
possible solutions as possible to the
specific problem without evaluating any
of them.
10 problem-solving steps
6) Clarify and evaluate the consequences of
solutions or combinations of them.
7) Together choose the “best” solution.
8) Plan who will do what, where, and when.
9) Put your plan into action on a trial basis.
10) Schedule a follow-up family meeting in a
month or so to figure out what worked and
what did not.
5. Learn how to spot signs of high
stress, anger, depression, and suicidal
thinking.
HANDOUT:
Farm and Ranch Family Stress
and Depression: A Checklist and
Guide for Making Referrals
5. Learn how to spot signs of high
stress, anger, depression, and suicidal
thinking.
•Anger is OK—It’s what we do with our anger that
can hurt others and ourselves.
•How do you know when someone has a high level
of anger?
•What signs do you look for?
How do you feel?
Annoyed?… Enraged?
Enraged?
Furious?
Angry?
Frustrated?
Irritated?
Aggravated?
Annoyed?
RETHINK
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Recognize
Empathize
Think
Hear
Integrate
Notice
Keep
What do you think the leading external
causes of death on Colorado ranches
and farms have been?
What do you think the leading external
causes of death on Colorado
ranches/farms have been?
1) Suicide
2) Animals
3) Tractors
• Middle-aged men (35-44 years old)
account for the largest number of
suicides.
Source: Retrieved April 27,2004, from the World Wide Web:
http://webapp.cdc.gov/sasweb/ncipc/mortrate.html
Western Mountain States have
the highest suicide death rates.
• The risk of suicide death increases
among older men and is especially high
for 75 years plus.
• Most are white and not married.
5. Learn how to spot signs of high
stress, anger, depression, and suicidal
thinking.
•How do you know when a rancher/farmer/friend is
depressed?
•What signs do you watch for?
•What words/phrases do you listen for?
5. Learn how to spot signs of high
stress, anger, depression, and suicidal
thinking.
•Depression is a serious, life-threatening condition.
•An estimated 19 million Americans are depressed.
•Mind Health Tracker may help people figure out how
serious their symptoms are.
http://www.mediconsult.com/defeatdepression
•An estimated 1 in 5 of us could be suffering from
depression.
5. Learn how to spot signs of high
stress, anger, depression, and suicidal
thinking.
•Depression is a biochemical imbalance.
•The latest research indicates that the best treatment
for people who are clinically depressed is a
combination of medication and talking therapy.
•What are some healthy ways you know of to
manage depression?
5. Learn how to spot signs of high
stress, anger, depression, and suicidal
thinking.
•How many of us know of someone who has died
from suicide?
•What are some signs that a person may be suicidal?
HANDOUT:
Farm and Ranch Family Stress
and Depression: A Checklist and
Guide for Making Referrals
6. Practice and enhance skills at
making effective referrals to
appropriate professionals.
Activity
• For professional consultants in our area, we
can look in our telephone book yellow pages
under “Counselors” for marriage and family
therapists, psychologists, social workers,
pastoral counselors, physicians, etc.
• Open communication is important for farm
and ranch families.
HANDOUT:
Farm and Ranch Family Stress
and Depression: A Checklist and
Guide for Making Referrals
How do I find resources for
depression?
• Call 1-800-SUICIDE 24 x 7 for a live
trained person to talk with and to find
local resources.
Overall Summary: What
responsibilities will you have?
• To be available to the person needing help,
whenever possible.
• To listen actively.
• To keep confidentiality.
• To help the person solve his/r own problems.
Sturkie & Gibson (1998), pp. 1-2
Overall Summary: What
responsibilities will you have?
• To refer the person to a professional
when warranted.
Sturkie & Gibson (1998), pp. 1-2
7. Respond to your questions.
7. Where do we go from here? What
do you need next?
•
Review—What is the telephone number
for the U.S./Colorado Hot Line Suicide
Number?
3 Keys to Effective AANNPST Training:
1) Screen Well!
2) Teach Well!
3) Assess Well!
Thank you
very much!