Certified Peer Specialist TRAINING COURSE

CERTIFIED PEER SPECIALIST TRAINING COURSE

Participant Guide

P-02884A (08/2023)

Table of Contents Section 1 .....................................................................................................................5 Grounding and Acknowledgments.....................................................................................................9 Introductions ..................................................................................................................................9 Course Overview ...........................................................................................................................10 Practicing Self-Care .......................................................................................................................11 Practicing Self-Care and Community Care .......................................................................................12 Section 2 ...................................................................................................................21 Stigma and Marginalization Connected to Lived Experience ..............................................................25 Culture, Power, Privilege, and Peer Support ....................................................................................27 Culturally Informed Approaches to Trauma .....................................................................................31 The Need for Trauma-Informed Care..............................................................................................34 Section 3 ...................................................................................................................41 Confidentiality ...............................................................................................................................47 Professional Boundaries .................................................................................................................48 Resiliency .....................................................................................................................................49 Understanding Developmental Trauma ...........................................................................................51 Section 4 ...................................................................................................................59 OARS Communication Skills Description ..........................................................................................63 Open Questions (OARS) Skill Description ........................................................................................64 Affirmation (OARS) Skill Description................................................................................................66 Reflection (OARS) Skill Description .................................................................................................69 Summary (OARS) Skill Description..................................................................................................83 Section 5 ...................................................................................................................85 Exploring the Certified Peer Specialist Practice ................................................................................91 Principles of Strengths-Based Recovery ..........................................................................................93 The Connecting Process.................................................................................................................95 Connection for Healing ..................................................................................................................97 Initial Meeting ...............................................................................................................................98 Section 6 .................................................................................................................105 The Exploring Process ................................................................................................................. 109 Sharing Mental Health, Substance Use, and Recovery Challenges with Others................................. 111 Exploring Values.......................................................................................................................... 114 Listening, Revisited ..................................................................................................................... 115 Benefits of Listening Well............................................................................................................. 118 Historical Context for Certified Peer Specialists .............................................................................. 119 Timeline of Systems Transformation and Western Consumer Involvement ...................................... 121 Section 7 .................................................................................................................129 The Supporting Process ............................................................................................................... 133 Sharing Information .................................................................................................................... 135 Self-Disclosure ............................................................................................................................ 139 Setting Boundaries ...................................................................................................................... 142 Understanding Boundaries ........................................................................................................... 143 Setting Healthy Boundaries .......................................................................................................... 144 Gentle Refusal............................................................................................................................. 149 Section 8 .................................................................................................................153 Mental Health and Substance Use Diagnosis Background ............................................................... 157 Defining Recovery ....................................................................................................................... 160 Exploring and Supporting Lived Experience ................................................................................... 162 Lived Experience, Bias, and Stigma .............................................................................................. 164 Multiple Pathways Identified ........................................................................................................ 173 Stages of Change ........................................................................................................................ 179

Section 9 .................................................................................................................187 Exploring and Navigating Emotional Crisis ..................................................................................... 191 Conversations Around Suicide ...................................................................................................... 192 Supporting a Peer Considering Suicide .......................................................................................... 193 Discussing Suicide for Peer Support .............................................................................................. 194 Self-Harm ................................................................................................................................... 196 Section 10 ...............................................................................................................201 Discussing Spirituality and Religion ............................................................................................... 205 What is Anger?............................................................................................................................ 211 Responding to Anger in Peer Support ........................................................................................... 218 Communication Styles ................................................................................................................. 220 Section 11 ...............................................................................................................223 The Planning Process................................................................................................................... 227 Brainstorming ............................................................................................................................. 232 Language Matters ....................................................................................................................... 233 Section 12 ...............................................................................................................239 The Advocating Process ............................................................................................................... 243 Areas for Advocacy...................................................................................................................... 244 Certified Peer Specialists on Integrated Teams.............................................................................. 249 Mental Health and Substance Use Diagnoses ................................................................................ 253 Social Security, Supplemental Security Income, Social Security Disability Insurance, Medicare, and Medicaid ..................................................................................................................................... 265 Section 13 ...............................................................................................................277 Concluding the Peer Relationship ................................................................................................. 282 Best Practices for Concluding the Peer Relationship ....................................................................... 284 Next Steps .................................................................................................................................. 285 Overview of Certified Peer Specialist Practice ................................................................................ 286 Wrap Up and Celebrate Success ................................................................................................... 288

Section 1 This section sets the foundation for the training course. You take part in an introduction exercise and explore community learning considerations to support a sense of safety. A course overview is provided. The section also includes an exploration of the importance of self-care and community care.

Course Guide: Section 1 (3 hours 30 minutes) 105 minutes

Grounding and Acknowledgements, Introductions, Community Learning Considerations, and Practicing Self-Care and Community Care

15 minutes 15 minutes 65 minutes 10 minutes

Break

Course Overview

Practicing Self-Care and Community Care

Homework Assignment

CERTIFIED PEER SPECIALIST CORE COMPETENCIES COVERED Domain Item Description 1.2 Believes in and respects people's rights to make informed decisions about their lives 1.3 Believes that personal growth and change are possible 1.4 Believes in the importance of empathy and listening to others 1.5 Believes in and respects all forms of diversity 1.6 Believes in the importance of self-awareness and self-care 1.7 Believes in lifelong learning and personal development 1.10 Believes in the healing power of healthy relationships 1.11

Believes and understands there are a range of views regarding mental health and substance use disorders and their treatment, services, supports, and recovery Knowledge that recovery and wellness involves the integration of the whole person including spirituality; physical, vocational, and emotional health; sexuality; gender identity; and community Knowledge of the impact of discrimination, marginalization, and oppression Knowledge of scope of practice of a certified peer specialist Knowledge of ways to encourage safe, trauma-sensitive environments, relationships, and interactions Ability to bring an outlook on peer support that inspires hope and recovery Ability to be self-aware and embrace and support own recovery Ability to listen and understand with accuracy the person’s perspective and experience Knowledge of cultural competency Ability to problem-solve Ability to draw out a person’s perspective, experiences, goals, dreams, and challenges Ability to locate appropriate recovery resources, including basic needs, medical, mental health, and substance use disorder care; supports, including social support and mutual aid groups; and to facilitate referrals Ability to facilitate and support a person to find and utilize resources Ability to foster engagement in recovery Ability to set, communicate, and respect personal boundaries of self and others Ability to utilize own recovery experience and skillfully share to benefit others Ability to balance own recovery while supporting someone else’s

2.5

2.9

3.3 3.5 3.7 4.1 4.2 4.3 4.6

4.8

4.10 4.11

4.12 4.15

4.16

4.17

Grounding and Acknowledgments (Core Competencies: 1.5; 2.5; 3.7)

The State of Wisconsin was founded in 1848 as the 30th state in the United States of America on the land of the Ojibwe, Potawatomi, Oneida, Mohegan, Ho-Chunk, Menominee, and Brothertown. Each of these sovereign nations has their own government, traditions, ceremonies, and culture. They survived with the principles of peer values, including the Grandfather Teachings: humility, honesty, truth, wisdom, respect, bravery, and love. These teachings cross cultural lines and are exhibits of community practices that have mentored several generations. It is in this spirit that we celebrate the diversity of our state and work for the opportunity for all to receive peer support. Introductions (Core Competencies: 1.4; 1.6; 1.10; 3.5; 4.2; 4.8) • Who are you? (If comfortable sharing: What are your pronouns?)

• What does this course mean to you?

• How will participation in this course impact your community?

• What do you like to do in your spare time (interests, activities, hobbies, etc.)?

• Describe a safe environment that would enable you to go beyond your comfort zone. What does the group culture look like?

Course Overview (Core Competencies: 1.7; 1.11; 3.3)

This course introduces you to the profession of peer support, including scope of practice; core competencies; ethics and boundaries; and the processes, key concepts, skills, and tools of the practice. This course provides an introductory, entry-level understanding of peer support as practiced across a wide range of services and programs. Upon completion, many participants will go on to pass the required exam to become a certified peer specialist. Upon gaining employment in the field, an agency may provide training that is more specialized. Drawing upon best practices in adult learning, this course features a wide range of learning activities, such as sharing in pairs; small group and large group discussions; self-reflection and brief writing activities; round-robin readings; demonstrations; and most importantly, activities focused on developing, practicing, and refining the skills of peer support. Fundamental processes and skills are introduced early in the course and then layered continually into subsequent sections for specific application and practice. You are encouraged to take notes. Note taking is useful because it allows you to reference important learning moments later that can inform your practice in the field. Learning also happens outside of the classroom. You are expected to engage in readings, access resources, and complete homework assignments as part of the learning process. Scope of the course Peer support is a broad practice rooted in various communities, settings, and cultures. Peer support is also not a new practice. Peer support has existed as long as humans have been in community with one another, supporting each other through adversity while relating over common experiences. Not every approach to peer support is professional in nature. Some people or communities engaging in peer support seek certification or professionalization of relational ways of being with and supporting others. This course presents the practice of peer support as it is recognized for the purpose of state certification in Wisconsin. It does not seek to invalidate other approaches or forms of peer support, even when those approaches go by other names.

Practicing Self-Care (Core Competencies: 1.2; 1.6; 1.7; 2.5; 3.5; 3.7; 4.2; 4.6; 4.15; 4.17)

Providing peer support in a professional role can be emotionally complex and stressful. At times, it can be draining and depleting. Practicing self-care or nurturing community connection is critical for those offering peer support. To be effective, you must be able to show up present and attentive to another's need. This means you must recognize your own needs and seek to take care of yourself. This is a solitary writing activity. List ways that you practice self-care or nurture your community connection. How do you take care of yourself or connect with your community on a regular or daily basis? Please be specific. Leaning into discomfort and brave space In this course, real, sensitive, and delicate topics will be explored that can arouse strong emotions or present challenges. Various topics that will be explored include historical and collective trauma, supporting people considering suicide, diagnosis, the effects of stigma, systemic marginalization and oppression, and involuntary commitment. If some of these terms are unfamiliar to you, an excellent glossary of terms related to equity is found at Racial Equity Tools: https://www.racialequitytools.org/glossary. It will be important for participants and facilitators alike to actively lean into uncomfortable conversations and new perspectives. This part of the co-learning process is important in peer support. Earlier in this section, community learning considerations were explored to support a safer learning space. Now, it’s time to ask the question, “Why do we want to support a sense of safety?” A physical sense of safety is vital to supporting participants and facilitators in taking risks, sharing with honesty and vulnerability, speaking up for their own and the group’s collective needs, as well as courageously addressing missteps or conflict. This is called a brave space. What are some ways that you can take care of yourself or intentionally connect with community while remaining actively engaged in learning through full participation?

Practicing Self-Care and Community Care (Core Competencies: 1.3; 1.4; 1.6; 1.10; 2.5; 2.9; 3.5; 3.7; 4.1; 4.2; 4.3; 4.11; 4.12; 4.16; 4.17) For certified peer specialists, self-care and community care help cultivate the ability to bring one’s full presence and strengths to peer relationships in order to deliver highly effective professional services. Self-care and community care is a skill. Like any skill, develops through an ongoing learning process of self-reflection and engagement in community. Part of practicing is developing awareness of both self and others through listening, identifying feelings, and considering needs and unmet needs. Exploring the importance of both self-care and community care Certified peer specialists have long advocated for strengthening self-care in peer support work. All people benefit from taking responsibility for their own well-being in a variety of ways. Self-care can both feel pleasurable and like difficult work, as it is composed of a variety of components as diverse as people. Though self-care is important, the exclusive focus put on the importance of self-care has also contributed to feelings of isolation for certified peer specialists and a sense of alienation for those who are rooted in more collectivist cultures. Self-care alone tends to place the sole responsibility for one’s well-being and resilience on the individual. Oftentimes, self-care is talked about in terms of activities, especially feel-good activities that can be part of the work of self-care. This approach ignores that much of what is described as self-care requires effort, time, and resources. In this context, it is also important to validate that self-care can even feel burdensome. On top of that, many people who are systemically marginalized face barriers to traditional self-care approaches. Many are busy caring for others. People experiencing poverty may not have the resources to participate in self- care rituals. Those working multiple jobs don’t have as much time available. Systemically marginalized communities are inundated with work, news, trauma, and activism. For these reasons, when we consider the central focus and value of full community participation for those with lived experience in peer support history, a shift to community care in certified peer specialist practice becomes necessary. Recovery and meaningful living happen in the context of community. For this reason, the following sections and activities will explore community care, and introduce a variety of skills and practices important for the peer support work ahead. Importance of community Community care recognizes that we don’t all have equal access to time and money, which are the main resources required for care. It reminds us that as human beings, are interdependent. The third level of Maslow’s Hierarchy of Needs is “a sense of belonging and love.” We have a psychological need for intimate relationships and, for many of us, we depend on those relationships to meet our physiological needs. If

you’re able to practice self-care, that’s great. Just don’t forget about the people around you. No matter how privileged we are, we still need human connection. We still need to give and receive love. Here are five ways to shift your thinking to community care, considering the needs of your family members, friends, co-workers, neighbors, group members, and others you interact with on a regular basis. • Check-in regularly: In many cultures, it’s a norm to open conversations and even transactions with “How are you?”. It’s a question asked quickly and automatically, often without waiting for an answer. Instead of asking people how they’re doing, clearly state that you’re checking in with them. One way to do this is by saying, “Hi, I wanted to check in with you. How are you feeling?”. If you know the person is particularly overwhelmed or having a difficult time, you may want to be specific. You can say: “Hey, I know you’re working from home and taking care of your grandmother. How are you managing?” You can also ask people if they’re finding time to do anything other than work. If you can’t help, you can show moral support. If you’re able to help, you can make an offer. • Empathize: We sometimes experience similar circumstances. While socioeconomic status and demographics change the way we navigate these circumstances, there are universal elements to every challenge. Working with the same difficult co- worker, having no help with childcare, or being in quarantine, are all frustrating issues you may not be able to change—but you can talk about it. Empathy is not the same as dwelling on an issue, and it’s not about feeling bad for someone. Empathy is understanding and feeling what someone else is feeling. It’s a way to validate someone’s thoughts and feelings and to let them know they’re seen. Part of being in a community is acknowledging difficulties as much as we celebrate achievements. This makes it okay to experience both the ups and downs of being human. • Make a specific offer: We can often intuit when other people are having a difficult time. When we’re able, most of us like to help. One of the failings of self-care is that it’s difficult to pinpoint what you need when you need it the most. When someone says, “Let me know how I can help,” we understand it as a kind gesture. Still, it often ends there because we’re burdened with the self-assessment and solution- building process. A part of community care is assessing what others may need, offering to provide it, and following through when the offer is accepted. Instead of vaguely telling someone you’re willing to help, anticipate their needs and make an offer. Ask if you can deliver a meal for their family, do their grocery shopping, fix the leaking sink, draft the email they’re struggling to send, or create a playlist with feel- good music. If you’re checking in regularly or you’ve spent time empathizing, you’ll know what to do.

• Prioritize rest: It’s easy to glorify busyness and celebrate accomplishments, but this often leads to imbalance. We need to be able to balance work with the rest of our lives and not use work as a distraction or escape from the challenges we face. Some stressed individuals may shift their attention to work, try to increase productivity, and seek a higher sense of self-worth through endless to-do lists. Communities can help prioritize well-being. Productivity, whether at work, in volunteerism, or at home, is often valued more than health and well-being. We unintentionally communicate that productivity is better than, and in competition with, rest. People need permission to take time off. That permission comes from their community. If you know someone is working 60 hours per week and they’re showing up to volunteer for 10 hours, remind them that rest is not only possible, but necessary. Appreciate their commitment but prioritize their well-being. You just might help prevent burnout. Employers can encourage staff to use personal time off, offer mental health days, and implement company-wide days of rest. Take a cue from the Astraea Lesbian Foundation for Justice. In response to the impact of COVID-19, they enacted a 15-day organization-wide pause. Similarly, the Equality Fund took two months of rest. • Socialize: With so much going on in the world, we forget to just relax and enjoy each other’s company. This is separate from checking in, empathizing, or doing acts of service for each other. It’s important to have time together free from thoughts and conversations about the things that aren’t going well. Watch great movies, check out the new restaurant in the neighborhood, choreograph a dance to the latest hip-hop hit, play a raucous game of Taboo, or take a class together. Much of this can be done virtually, too. Do something to keep you from watching or talking about the news. You may find a self-massage is just what you need to combat touch starvation. Use this time to be together as a community that’s not bound together only by the struggles you share, but by your common humanity. Connection itself is reason enough.

We’re responsible for each other Even as we become more attuned to the needs of people in our communities and try to respond to them, self-care will continue to be necessary. We will still need to clean, feed, and clothe ourselves, make dental appointments, organize our kitchen pantries, see therapists (if that is part of our support system), drink water, and try to move our bodies more. Doing these things together and for each other creates a sense of belonging and builds the intimacy that’s one of our basic needs. It reminds us that we weren’t meant to walk these paths alone, but to learn from and care for one another as we find better ways to live together. The challenges will keep coming, but our communities have the resources to get us all through. Work-life balance Finding a balance between the demands of work and personal life can be challenging. Certified peer specialists strive to be empathic people and care deeply for the people they support; leaving work behind may be difficult. However, an important aspect of self-care is finding a way to strike that balance, and self-care can include community spaces to decompress and find safety in. With hopes to show up fully in this work, caring for ourselves and finding people who we can find safety in allows a certified peer specialist to return to work more present, engaged, and effective in providing peer support.

Activity: Planning Around Self-Care and Community Care Planning for self-care and community care can look however you want it to, but the point is to name your current or anticipated needs and who can support you in getting your needs met. Be sure to communicate your needs to the people who will support you. If your community is a web-based one, maybe create a private online shareable spreadsheet that folks can contribute to and edit. If your community isn’t online, maybe set up an in-person group meeting, a conference call, or make individual calls or meetings. When folks ask you for support, remember to listen and follow their lead in lifting their own self-determination. This is about the person requesting support, so don’t make it about you. If you feel you can’t meet a need, be clear and honest about that, and help strategize another way to meet that need. Folks experiencing or dealing with their own triggers, crisis, or trauma may or may not be able to support. Ask. Don’t assume anyone is or isn’t able to provide support. If you do commit to supporting the needs of community, you may also need support in meeting those needs, so consider creating a wellness plan for yourself.

FURTHER READING: “Breaking Isolation: Self-Care and Community Care Tools for our People”, The Audre Lorde Project, https://alp.org/breaking-isolation-self-care-and- community-care-tools-our-people)

1. Needs - What are the needs you can anticipate.

2. Who can support these needs? _________________________________________

Body - biological needs, physical needs Mind - emotional needs, needs for your thought process Heart - motivational needs, spiritual needs, how you stay grounded

_________________________________________

Community - needs from your social

_________________________________________

relationships, interpersonal needs, community support

Why peer support? Take a few minutes to reflect on why peer support is important. First, consider the benefits that peers may receive. Then, consider the benefits that you may receive in the certified peer specialist role. In the space below, write out the anticipated benefits from each perspective. Benefits to Peers Benefits to Certified Peer Specialist

Understanding Privilege Privilege is a key element in perpetuating oppressive systems. According to Webster’s Dictionary, privilege is “a right, favor, or immunity, granted to one individual or group and withheld from another.” This homework assignment examines the privileges we hold. Instructions Read each of the privilege statements. If you identify with the statement and feel that it is true, do nothing. If you do not identify with the statement or feel like it is not true, draw one mark signifying that you do not identify with that privilege. There will be a brief large group debrief during homework review. Privilege statements 1. The leader of my country is also a person of my racial group. (RACE) 2. When going shopping, I can easily find clothes that fit my size and shape. (SIZE) 3. In public, I can kiss and hold hands with the person I am dating without fear of name-calling or violence. (SEXUALITY) 4. When I go shopping, I can be fairly certain that sales or security people will not follow me. (RACE/APPEARANCE) 5. Most of the religious and cultural holidays celebrated by my family are recognized with days off from work or school. (RELIGION/CULTURE) 6. When someone is trying to describe me, they do not mention my race. (RACE) 7. When I am angry or emotional, people do not dismiss my opinions as symptoms of “that time of the month.” (GENDER) 8. When expressing my opinion, I am not automatically assumed to be a spokesperson of my race. (RACE) 9. I can easily buy greeting cards that represent my relationship with my significant other. (SEXUALITY) 10. I can easily find hair products and people who know how to style my hair. (RACE) 11. In my family, it is seen as normal to obtain a college degree. (CLASS) 12. If I am going out to dinner with friends, I do not worry if the building will be accessible to me. (ABILITY) 13. I can be certain that when I attend an event, there will be people of my race there. (RACE) 14. People do not make assumptions about my work ethic or intelligence based upon the size of my body. (SIZE) 15. When I strongly state my opinion, people see it as assertive rather than aggressive. (RACE/GENDER)

16. When I am with others of my race, people do not think that we are segregating ourselves. (RACE) 17. I can feel comfortable speaking about my culture without feeling that I will be judged. (RACE/ETHNICITY) 18. I can usually afford (without much hardship) to do the things that my friends want to do for entertainment. (CLASS) 19. When filling out forms for school or work, I easily identify with the box that I must check. (GENDER/RACE) 20. I can choose the style of dress that I feel comfortable in and most reflects my identity, and I know that I will not be stared at in public. (GENDER/APPEARANCE) 21. If pulled over by a police officer, I can be sure that I have not been singled out because of my race. (RACE) 22. My professionalism is never questioned because of my age. (AGE) 23. I do not worry about walking alone at night. (GENDER) 24. People do not make assumptions about my intelligence based upon my style of speech. (RACE) 25. When attending class or other events, I do not have to worry about having an interpreter present to understand or to participate. (ABILITY/LANGUAGE) 26. I can book an airline flight, go to a movie, ride in a car, and not worry about whether there will be a seat that can accommodate me. (SIZE/ABILITY) 27. People assume I was admitted to school or hired based upon my credentials, rather than my race or gender. (RACE/GENDER) 28. As a child, I could use the “flesh-colored” crayons to color my family and have it match our skin color. (RACE) Process questions • How did you feel doing this activity? • How was it to consider the number of tally marks you had on your paper? • How was it to notice the tally marks of others around while you were or were not making marks on your page? • What does it feel like to have or not to have certain privileges? • What is privilege? How would you define it?

Review the Racial Equity Tools Glossary found at: https://www.racialequitytools.org/glossary

Section 2 This section continues focusing on self-care and community care and its significance within the peer support process. A self-evaluation is provided. Next, stigma and the role of culture in peer support are addressed, including marginalization and how it is connected to lived experience. Culture, power, and privilege are defined and discussed in relation to peer support. The section also includes information on culturally informed approaches to trauma, as well as trauma-informed care.

Course Guide: Section 2 (3 hours 35 minutes) 45 minutes Homework Review 100 minutes

Stigma and Cultural Competency

15 minutes 50 minutes 5 minutes

Break

Trauma-Informed Peer Support

Homework Assignment

Certified Peer Specialist Core Competencies Covered Domain Item Description 1.1

Believes that recovery is an individual journey with many paths and is possible for all

1.3 1.4 1.5 1.6

Believes that personal growth and change are possible Believes in the importance of empathy and listening to others Believes in and respects all forms of diversity Believes in the importance of self-awareness and self-care Believes in lifelong learning and personal development Believes in the healing power of healthy relationships

1.7 1.10 1.11

Believes and understands there are a range of views regarding mental health and substance use disorders and their treatment, services, supports, and recovery Knowledge of mental health and substance use disorders and their impact on recovery Knowledge that recovery and wellness involves the integrations of the whole person including spirituality; physical, vocational, and emotional health; sexuality; gender identity; and community Knowledge of trauma and its impact on the recovery process Knowledge of the impact of discrimination, marginalization, and oppression Knowledge of the impact of internalized stigma and shame Knowledge of the scope of practice of a certified peer specialist Knowledge of ways to encourage safe, trauma-sensitive environments, relationships, and interaction Knowledge of person-centered care principles Ability to listen and understand with accuracy the person’s perspective and experience Ability to locate appropriate recovery resources, including basic needs, medical, mental health and substance use disorder care; supports, including social support and mutual aid groups; and to facilitate referrals Ability to foster the person’s self-advocacy and provide advocacy when requested by the person Knowledge of cultural competency

2.2

2.5

2.6 2.7 2.9

2.10 3.3 3.5

3.7 4.6

4.11

4.18

Stigma and Marginalization Connected to Lived Experience (Core Competencies: 1.1; 1.5; 1.11; 2.5; 2.6; 2.9; 2.10; 3.7; 4.6; 4.11) The Merriam-Webster Dictionary defines stigma as a mark of shame or discredit. The definition offered for marginalization is to relegate to an unimportant or powerless position within a society or group. Many people with lived experience of mental health or substance use challenges describe the negative and sometimes compounding effects of stigma and marginalization in relation to seeking wellness, recovery, and a sense of safety. The historical causes of such stigma and marginalization are debated widely among those who practice peer support in professional roles. Alongside the lived experiences with stigma and marginalization related to mental health and substance use, the intersectionality of people’s identities can add weight to carry as people navigate through health systems. When more than one part of a person’s identity molds their experiences with obstacles and barriers, the path to recovery must include a wholesome look at all the pieces of a person that are impacted by stigma and marginalization, such as race, ethnicity, gender identity, sexual orientation, socioeconomic status, immigration status, etc. As a certified peer specialist engages in their work and offers peer support, they center the humanity, validity, agency, and autonomy of the people they support. An empathic and compassionate approach, with mindfulness to a person’s intersectional identities, can open a deeper understanding of another and solidify the immense value of sharing and listening to one another’s stories and experiences. This connection can aid a certified peer specialist in addressing the corrosive effects of stigma and marginalization connected to lived experience and the many components that contribute to these experiences. Wisconsin efforts to address stigma • Wisconsin Initiative for Stigma Elimination (WISE) o WISE is a coalition of individuals and organizations promoting inclusion and support for all affected by mental health and substance use challenges that promotes evidence-based practices for stigma reduction efforts. For WISE, stigma reduction is driven by the power of the story of someone’s recovery. Their campaign focuses on individuals strategically sharing their story to educate others on mental health challenges and the reality that recovery is possible. o To learn more about WISE, visit wisewisconsin.org.

• Wisconsin Voices for Recovery o Wisconsin Voices for Recovery has developed a training to help people understand what stigma is and how it can affect a person in or seeking recovery, understand what recovery messaging is, learn how to share their recovery story in a way that is not stigmatizing, and learn ways to advocate and reduce stigma. The “Ending Stigma with Recovery Messaging: How to Share Your Story to Reduce the Stigma of Addiction and Recovery” training module is part of the Wisconsin Voices for Recovery online RecoveryU resources. o To learn more about Wisconsin Voices for Recovery, visit wisconsinvoicesforrecovery.org. Peer-based efforts to address stigma and marginalization connected to lived experience The resources listed below are some examples of peer-based organizations that address stigma and marginalization connected to lived experience. • Project LETS o Project LETS builds peer support collectives; leads political education; develops new knowledge and language around mental distress; organizes and advocates for the liberation of people with lived experience globally; and create innovative,

peer-led alternatives to the current mental health system. o To learn more about Project LETS, visit projectlets.org. • Wildflower Alliance

o The Wildflower Alliance supports healing and empowerment for people and communities impacted by psychiatric diagnosis, trauma, extreme states, homelessness, problems with substances, and other life-interrupting challenges. o To learn more about Wildflower Alliance, visit wildfloweralliance.org

Culture, Power, Privilege, and Peer Support (Core Competencies: 1.3; 1.5; 1.6; 1.11; 2.6; 2.9; 2.10; 3.5; 3.7; 4.6; 4.18) What is culture? Culture may be defined as the behaviors, values, and beliefs shared by a group of people, such as an ethnic, racial, geographical, religious, gender, class, or age group. Everyone belongs to multiple cultural groups. Each person is a blend of many influences. Culture affects every aspect of a person’s life, including how mental health and substance use challenges are experienced, understood, and expressed. What is power? Power is often understood as the ability to affect change and control or direct others. What is privilege? Privilege is a type of inherent power that affords people benefits, access, and support, frequently without realizing it and often without having earned it. How do culture, power, and privilege intersect with peer support? Certified peer specialists have a variety of roles to play when it comes to the intersection of culture, power, privilege, and peer support. Some are related to the people they are supporting, and others are related to their own experiences. These roles include intentionality with unpacking personal implicit biases and advocating for culturally relevant resources. When certified peer specialists provide peer support, they must recognize that each person’s intersectional identities are unique to themselves, even among people who may come from similar backgrounds. The assumption that people of similar backgrounds are a monolith is harmful, and the intention to educate oneself of this experience is critical to reducing harm in the peer relationship. Additionally, education on the systemic barriers a peer experiences is needed to fully grasp the hindrance a peer has endured when receiving resources or individualized support. This deeper understanding provides a certified peer specialist an awareness to truly meet a peer where they are at in their journey. An effective certified peer specialist will approach each person they support with as much education as empathy to create true mutuality. Taking this into consideration, any information shared by the peer must be reflected in the adjustments made to the support provided.

Exploring culture Certified peer specialists will support people who have different cultural identities, worldviews, norms, beliefs, and values. The mental health and substance use services system, including certified peer specialists, are working toward providing services in a manner that take everyone’s own culture into account. This is advocacy and accountability. Certified peer specialists must be familiar with how areas in the cultural iceberg (below) interact within and among individuals. CULTURAL Surface culture

Food Flags Festivals Fashion Music Art Games Dance Crafts Performances Literature Celebrations Language

Communication styles and rules facial expressions gestures eye contact touching personal space tone of voice body language handling and displaying of emotion conversational patterns in different social situations Approaches to...

Notions of… courtesy and manners friendship leadership cleanliness modesty beauty

religion courtship marriage raising children decision-making problem-solving Attitudes toward...

elders adolescents dependents rule expectations work authority cooperation vs. competition Relationships with animals age sin death

Concepts of… self time past and future fairness and justice roles related to age, class, family, etc.

Deep culture

An important aspect of understanding how these cultural elements may impact providing peer support is for certified peer specialists to understand their own views on these topics and their own biases, implicit or otherwise. By continually checking in with themselves regarding bias, certified peer specialists set themselves up to mitigate potential harm they may cause when working with people from different cultures or who hold different values or beliefs. Systemic oppression Systemic oppression, also known as systemic racism, refers to the systems in place that create and maintain racial inequality. VIDEO: “Feeling Critically to Understand Social Justice” – Suthakaran Veerasamy, TEDxUWLaCrosse https://www.youtube.com/watch?v=dHxUb2oXtEo According to the National Equity Project, the lens of systemic oppression assumes that: • All negative forms of prejudice and/or bias are learned and therefore can be unlearned. • Oppression and injustice are human creations and phenomena, and therefore can be undone. • Systemic oppression exists at the level of institutions (harmful policies and practices) and across structures (education, health, transportation, economy, etc.) that are interconnected and reinforcing over time. • Oppression and systematic mistreatment (such as racism, classism, sexism, or homophobia) is more than just the sum of individual prejudices. • Systemic oppression is systematic and has historical antecedents; it is the intentional disadvantaging of groups of people based on their identity while advantaging members of the dominant group (gender, race, class, sexual orientation, language, etc.). • Systemic oppression manifests in economic, social, political, and cultural systems. • Systemic oppression and its effects can be undone through recognition of inequitable patterns and intentional action to interrupt inequity and create more democratic processes and systems supported by multiethnic, multicultural, and multilingual alliances and partnerships. • Discussing and addressing oppression and bias will usually be accompanied by strong emotions. FURTHER READING: “Healing Ethno-Racial Trauma in Latinx Immigrant

Communities: Cultivating Hope, Resistance, and Action” https://psycnet.apa.org/fulltext/2019-01033-005.html

Systemic oppression in mental health and substance use services In addition to understanding culture and the ability to explore the lived experiences of the people who certified peer specialists support, they must also be able to recognize the connection between a person’s culture and background and the role that plays in deciding which supports they would like to connect with. All systemically marginalized communities have experienced oppression due to the design of the mental health and substance use services system and the population for which they were created. This is not to say that each individual member of a systemically marginalized community has been personally harmed by service systems. The systems have led to oppression of communities at large. When working with people who are members of systemically marginalized communities, certified peer specialists must recognize and understand how this oppression comes into play when navigating through the service systems. The systemic oppression at play in the mental health and substance use services system can have an impact on systemically marginalized community members in many ways, for example: • Invalidation and denial of the accuracy of one’s insight and lived experience in service systems to a higher degree than their counterparts, also known as gaslighting. • Misdiagnoses occur 3-4 times more in Black, Indigenous and People of Color (BIPOC) communities. • People who are incarcerated have limited access to services of any kind, including proven effective approaches to care and treatment. • The expectation that transgender people will thrive in therapeutic environments when sorted into services for a gender with which they do not identify. • Indigenous communities being denied equal access to culturally specific and relevant supports. • Lack of accessibility of services for communities experiencing disability, resulting in far fewer support and treatment options due to disability. • The real and sometimes perceived threat of being deported if attempting to access services while undocumented.

Culturally Informed Approaches to Trauma (Core Competencies: 1.4; 1.5; 1.7; 1.11; 2.2; 2.6; 2.7; 2.9; 2.10; 3.5; 3.7; 4.6; 4.11; 4.18) The original adverse childhood experiences study relies on data predominantly collected from white people classified as middle class or upper middle class, with a focus on experiences within the home. It falls short in understanding the depth and breadth of the impact of trauma on communities of people who experience various levels of systemic marginalization. According to the Behavioral Risk Factor Surveillance System, individuals of different races in Wisconsin experienced adverse childhood experiences from 2011 to 2016 as follows: • 77% of Indigenous communities have experienced an adverse childhood experience. • 76% of multiracial and Black individuals have experienced an adverse childhood experience. • 66% of Hispanic and Latino individuals experienced an adverse childhood experience. • 55% of white individuals experienced an adverse childhood experience. • 39% of Asian individuals experienced an adverse childhood experience. The 2019 Wisconsin Behavioral Health System Gaps Report, a report compiled by the UW Population Health Institute at the request of the Wisconsin Department of Health Services, identified the impact of historical and emergent community-level trauma on those who live at the intersection of many systemically marginalized identities in addition to the barriers that individuals face when engaging in mental health or substance use treatment. “As one respondent articulated, “People fear the system. They fear losing their jobs, children, and their integrity. They fear the ‘state’ or the ‘system’ will lock them up, or chapter them for using services. They may have always been involved within the system therefore will not seek help for treatment due to retaliation from law enforcement/court systems.” The 2019 Wisconsin Behavioral Health System Gaps Report is available on the UW Population Health Institute’s website.

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