Managing Your Project

Setting Up Peer support meetings

Setting up peer support meetings – the amount you are involved in the logistics of one-to-one meetings depends on where the meetings are taking place.

"In house" meetings

If meetings are being held in your organisation, you will need to make sure a room is booked and that someone is available to check in with the Per Supporter at the end of the meeting. Ideally the meetings should be held in office hours and in some organisations there will be no facility for out of hours meetings. If you are offering out of hours meetings you will need to check your organisation policy regarding out of hours working. You will need to make sure there is a key holder on the premises and your lone working policy will become relevant. You will also need a mechanism for debrief after the meeting.

In community meetings

If meetings are held in the community, it may be that your Peer Supporter arranges the meetings with the person they are supporting and then informs you. You need to know when the meetings are happening for health and safety reasons, and for monitoring purposes.

There are a few more things to consider for meetings that are happening in the community:

  1. If the Peer Supporter is arranging meetings and then informing you, how will they do this? If you have the resource to give your Peer Supporters a mobile phone, this deals with the issue of sharing personal information. If your Peer Supporters are going to share their phone numbers, you need to give them guidelines regarding the management of this.

  2. You need to make sure you know when and where the meetings are taking place, and therefore need to establish a system for your Peer Supporters to communicate this to you.

  3. You need to ensure that Peer Supporters are familiar with your Lone Working Policy and that they check in and out from each meeting with someone – ideally you.

  4. You need a way for Peer Supporters to debrief/feedback to you after each meeting. This can be by email if there is nothing urgent, but you do need a system for this and a way of capturing the content of the meeting.

  5. Your Peer Supporters should not have paperwork or any information with them in community settings that will compromise the confidentiality of them or anyone else. Again, you therefore need a way for Peer Supporters to note the agreed actions from each meeting and goals for next meeting without relying on official paperwork.

The most efficient way for Peer Supporters to feedback is electronically. However, you therefore should ensure that there is a way for all Peer Supporters to be able and willing to do this. If Peer Supporters do not have access to a computer or tablet, you will need to think how you will make this form of feedback possible without it becoming onerous.

Case Study — Supporting people in the community and protecting confidentiality

Paul was matched with someone who he arranged to meet in a café that was suitable for one-to-one meetings. It was big and airy and the seating was such that conversations could not be overheard. Paul and the Coordinator visited the café to do a quick risk assessment, and have an introductory meeting with Dan, who was going to be supported by Paul. The meetings were arranged by the Coordinator and if there were problems, the message would be sent through the Coordinator. Paul was happy to use his laptop to record the meetings. The Coordinator sent him the forms used for recording one-to-one meetings electronically. At the end of each meeting, Dan and Paul would agree together the action points to take away. Paul would then email the notes to the Coordinator at the end of each meeting. No names or information that would disclose any identities was included in the notes, nor was there any logo identifying the nature of the organisation. Initials only were used to identify both Paul and Dan on the forms and in the body of the email.

Supporting Peer Supporters on project

Debrief/Feedback

Debriefing has been mentioned throughout this section. It is not the same as supervision. Debriefing with your Peer Supporters is a way to pick up any issues arising from their one-to-one meetings that you may need simply to note or monitor together, or to follow up. If a session has been particularly intense, it may be that the debrief is just a chance for the Peer Supporter to off load. It may be that your Peer Supporter wants to check that they have followed best practice. You will want to make sure that sessions are running smoothly, that they are working together towards positive outcomes and to pick up any issues that may arise as soon as possible. If the Peer Supporter is meeting mentees in your premises, then getting together at the end of a session is generally straightforward to organise. If they are in the community or meeting at a time that you are not available, debrief can be by phone, or email. Most important is making sure you have checked in.

Debrief sessions can be an opportunity for you to feedback, if it is appropriate. You want your Peer Supporters to be open with you and share their positive and challenging experiences of supporting someone else who is living with HIV. If Peer Supporters ask you for your feedback or thoughts during debrief, then you have an invitation to give your perspective. If they are describing an interaction that you feel is not best practice or raises a feeling of concern, then it is an opportunity to ask further questions and give some guidance. However, unless there is a serious concern arising, or a safeguarding issue that needs an immediate response, be cautious about giving too much unsought guidance. Peer Supporters will stop sharing if, every time they debrief with you, you tell them they should have done something different!

One-to-one meetings with your Peer Supporters

This is not debrief or supervision – one-to-one meetings are an opportunity to check in over a longer period, ideally up to an hour. If the resource and time is available, holding a one-to-one meeting with Peer Supporters bi monthly is a good opportunity to follow up with outcomes from debriefing sessions, check in and iron out issues or concerns that may be arising on either side. These meetings should be noted and a copy of the notes given to the Peer Supporter.

Managing boundaries

Peer Support of any kind – one-to-one, group, distance, face to face, paid or unpaid adds an additional nuance to the management of boundary lines. The delineation is not as clear as it is in any other type of support. The supporter has the same lived experience as the person seeking help and it is the sharing of these experiences that makes peer support such an effective intervention. In Peer Support for people living with HIV this means that both parties may come across each other in clinic, socially or at other support groups. They will be privy to very personal information about each other. Given that boundary lines will shift over the lifetime of the support, this is an area that you need to continually support your Peer Supporters with. Encouraging openness and honesty during debriefing and one-to-one meetings will help you and your Peer Supporters manage the shifting nature of boundaries in Peer Support.

Ending the one-to-one relationship and next steps

Ending the one-to-one relationship can be difficult for both parties in a peer support relationship. As part of the matching and assessment process you should have been clear about the number of sessions you will be offering. However, given the mutual understanding that can develop in a peer support relationship, letting go can be difficult for both parties. This is part of moving on and your Peer Supporters may need support with this. Ideally, by setting and reviewing goals and working together towards ultimately moving on, the end of the relationship will be a feeling of success and optimism for what comes next. The times that you may need to give extra support will be when things do not go so smoothly:

Peer Support relationship breaks down

Sometimes the peer relationship does not work. In this case you may need to intervene to help both parties come away from the experience feeling ok. Depending on the reason for the break down, you may decide to try and re-match so that support can be ongoing. You need to monitor this scenario. If a pattern emerges where either a Peer Supporter or someone being supported continuously asks for a new person to work with, it may be that the Peer Supporter is not suitable to offer support or the person to receive it.

Peer Supporter and person supported become friends

It is not unusual or surprising that if a peer support relationship works well it is because there is a certain chemistry. This can mean that both parties feel like a friendship is forming. You need to encourage your Peer Supporters to be open and honest about this. If they decide they are friends – or even something more than friends, they must tell you before they are using their one-to-one sessions to conduct some sort of personal relationship. Once you know, you can end the peer support relationship with no harm to either party.

Person stops engaging with support

This situation can be difficult for Peer Supporters to be objective about. Sometimes people will simply stop engaging. This can be for a variety of reasons; the time might not be right, other issues may take over, they may have got what they need and don’t want any more support, they may simply not like it. You may never find out why someone stops engaging with your programme but most important is that the Peer Supporter does not internalise and blame themselves.

Talking through next steps

Talking through next steps is part of ending the relationship. Peer Supporters should be discussing with the person they have been supporting what they will do with what they have worked on during the sessions they have had. Putting together an action plan for the 3-6 months after the end of the sessions will help the supported person think about how they can continue to benefit from the peer support they have received. Signposting people is an important part of moving on, not necessarily to other HIV services but also to organisations, projects, training etc. that may be of benefit depending on the goals that they have set. Talking about the next steps can form part of the final sessions that the Peer Supporter and person being supported have together. Both parties need to be active in this conversation, and it may be that part of their final meeting is to research together what the supported person can do to continue to work towards the goals that they have set.

Working with Groups

Peer Support Groups tend to be run as drop ins, and do not have a start and end point in the same way as one-to-one relationships do. Sometimes people may start attending a group and move on to one-to-one support – or vice versa. Attending a group may be part of the step down from a one-to-one peer support relationship, or it may be that a group meets the need better than individualised support.

Peer Supporters who are suited to group facilitation may be interested in this type of support. Most groups will include semi structured activity – for example a guided discussion or discussion and informal, open discussion. Given the more fluid nature of a group, facilitators need to be happy to work with the uncertainty that having a group of people together can bring.

Considerations for Peer Support Groups include:

Peer Supporter Facilitators

Best practice is for two people to facilitate a group. For practical and safety reasons, having two facilitators means that the group will run more smoothly. Facilitators need to be able to commit to arriving before the group starts to set up, keep the group on topic and to time and to tidy up at the end. They need to ensure that they are prepared with all the resources they need. Just as for one-to-one, they need to debrief with you at the end of the group highlighting what went well, any concerns and what they want to do next time. You will also rely on them to gather information about the number of people attending and any comments/feedback that will help with evaluation of the group.

Referral to groups

You will be likely to promote your group in much the same way that you promote one-to-one support. However, accessing group support would not require the assessment or referral process in the way one-to-one support would. You will need a way to check someone qualifies for group support, but you will not take them through the same individual assessment as you would for one-to-one support.

Group agreements

Just as for one-to-one support, participants must sign a confidentiality agreement and adhere to ground rules when they first join a group. Although it can feel a bit laboured for the facilitators, it is really important to re visit ground rules at every meeting and ensure that everyone is signed up to the same standard of group behaviour.

Safe space

If the group will be meeting in a space outside your organisation, just as for one-to-one support, a risk assessment should be carried out that includes checking the insurance, health and safety and rules of the premises. It is also important that signage to the group does not undermine confidentiality i.e. does not reveal that the group is an HIV Peer Support Group. Participants need clear information, with the name of the group in any communication they receive so that they feel reassured that they are coming to a safe environment.

Paperwork

This is important to be kept to a minimum and as for one to one, should not disclose any personal information about the people attending. If the group is running off site, there will need to be a mechanism for ensuring that any paperwork is returned to you at the end of session.

Debriefing with facilitators

Ideally facilitators should spend some time at the end of a group meeting to debrief together and share thoughts on the session. This can then be fed back to you with any issues or concerns.

Troubleshooting

People attending the group need to have details of who they can contact in the event that they have a complaint or query about the group. You need to be willing to help the facilitators if they have problems in the group that they are struggling to deal with, or they feel is beyond their remit. This could include dealing with a participant that is causing disruption to the extent that it is not safe for them to continue attending, or handling issues arising relating to the organisation that they feel you should address.