Module 4: Trusting, Compassionate, Therapeutic Relationships – Topic F Help individuals identify supports in the community to make choices related to opioid use.

Learning Objectives

By the end of this topic, the student should be able to:

• Differentiate between different kinds of peer support.
• Identify the different supports including those in the community as part of the recovery continuum.
• Explain an Indigenous framework of community support.

Key Concepts

• Community supports are an integral part of the continuum of care.
• Peer support is a key component of support in the community.

What Is a Continuum of Care?

The continuum of care includes a range of diverse and concurrent services that should be available to individuals experiencing or at risk for experiencing harms from opioid use. Visualized below is the range of service available. However, a person’s journey through the continuum of care is not necessarily meant to be linear.

© Course Author(s) and University of Waterloo

How Individuals Move Through the Continuum of Care

Some individuals might use all components of the continuum whereas others might not, and some might revisit different components as needed.

For example, those individuals who are experiencing more or chronic social determinants of health may need to be supported by additional services in the community, such as income and food security and shelter or transportation.

Community Support Imperatives

In order to be effective and accessible, community supports must:

• have low barriers to access,
• have flexible times (evening or weekends; not just traditional working hours),
• be culturally sensitive and knowledgeable,
• be geographically accessible, and
• be run by knowledgeable providers who are trustworthy and nonjudgmental.

As most individuals will require more than a single support in the community, it is helpful to engage a case manager or system navigator to advocate, coordinate, and arrange for seamless delivery of care.

NOTE: Peer support has also been shown to be highly effective in assisting people moving through the continuum of care (Cyr et al., 2016).

Peer Support in the Community

Peer support is defined as “the process of giving and receiving nonprofessional, nonclinical assistance from individuals with similar conditions or circumstances to achieve long-term recovery” (Trace & Wallace, 2016, p.143).

Peer support providers are people who have been successful in the recovery process and help others experiencing similar situations (SAMHSA, 2017). The role of a peer support worker complements but does not duplicate or replace the roles of therapists, case managers, and other members of a treatment team.

“Through shared understanding gained through actual experience, respect, and mutual empowerment, peer support workers help people become and stay engaged in the recovery process and reduce the likelihood of relapse”

Peer support services can effectively extend the reach of treatment beyond the clinical setting into the everyday environment of those seeking a successful, sustained recovery process. Peer support can take the form of:

• groups,
• individual counselling, and
• case management

Peer support has emerged as a highly effective and empowering method to manage the social context of health issues (Trace & Wallace, 2016). Peer support is particularly popular in the substance abuse and mental health fields.

Historically, peer support has been shown to be a key component of many existing addiction treatment and recovery approaches, such as:

• the community reinforcement approach,
• therapeutic communities, and
• 12-step programs.

Many terms have evolved as part of the peer support movement, some of which are shown below.

Types of Peer Support

Within Canada, there is great diversity in what peer support looks like in the community for people using opioids and their significant others.

“The most common types are self-help support groups where peers meet regularly to provide mutual support, without the involvement of professionals, and one-to-one peer support such as co-counselling, mentoring or befriending”

Peer support services can also be specialized, with many being delivered by mainstream providers. Some examples of these specialized services are shown below.

Different Types of Peer Support

(Cyr, McKee, O’Hagan & Priest, 2016)
Nadiinko/iStock (housing); palau83/iStock (recreation); Jo/iStock (hospital); phototechno/iStock (business); GreenTana/iStock (Indigenous); da-vooda/iStock (information); Vladislav Popov/iStock (navigation); ponsuwan/iStock (community); etonie/iStock (food); Blankstock/iStock (advocacy, recovery education, mentoring); matsabe/iStock (artistic)

Principles of Core Competencies

“Core competencies for peer workers reflect certain foundational principles identified by members of the mental health consumer and substance use disorder recovery communities”

Relationship Between the Individual and the Community

A community-based approach that encompasses the spectrum of care of prevention, treatment, and aftercare programs for the individual should be mindful of culture.

Cultural relevance in the community can vary from adding an Indigenous component to the disease model of Alcoholics Anonymous to developing community-based participatory programs with a sociocultural-spiritual model (Mohatt et al., 2004; Robinson et al., 2006).

Services that emphasize the importance of culture and community in the spectrum of care mean that these services take place in the person’s home community. This allows for important connections to be fostered while the individual is in treatment and supports a positive transition back home should the individual be in residential care.

The image below highlights the Indigenous framework that honours the interrelatedness relationship between the individual and the community. This relationship must be supported by distal factors of the environment, political systems, cultural discourse, and the spiritual realm.

Primary Health Care Model

Adopted by Nisnawbe Aski Nation and the Sioux Lookout First Nations health authority.

Three layered circle. The centre circle reads Individual Family Community. The middle circle is divided into 4 sections: Promotive, Curative, Supportive, Rehabilitative, and Preventative. The outer circle has five terms around it. Environmental appears over the Promotive and Curative sections, Context appears over Curative and Supportive, Political appears over Supportive and Rehabilitative, Cultural appears over Rehabilitative and Preventative, and Spiritual appears over Preventative and Promotive.

Sioux Lookout First Nations Health Authority. (2006). The Sioux Lookout Anishnabe District health plan: Building a plan to improve our health. https://www.nodin.on.ca/dhp.htm

Questions

Which of the following are not considered peer support? (Select all that apply.)

a. meeting informally and sharing experiences

b. providing clinical advice

c. dating

d. advocating

e. driving to appointments

Check

Please select an answer.

Correct! While different from professional support, peer support is essential to people in treatment of recovery because of the shared experience. However, like professional relationships, boundaries and ethical behaviours are adhered to.

Incorrect. The correct answers were a, d, and e. While different from professional support, peer support is essential to people in treatment of recovery because of the shared experience. However, like professional relationships, boundaries and ethical behaviours are adhered to.

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Which of the following are core competencies followed by peer support workers?(Select all that apply.)

a. person-centred

b. boundary diffusion

c. recovery oriented

d. mandatory

e. relationship based

Check

Please select an answer.

Correct! Core competencies are strengths based and therefore are voluntary and respect personal boundaries and space.

Incorrect. The correct answers were a, c, and e. Core competencies are strengths based and therefore are voluntary and respect personal boundaries and space.

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Why is considering the community as a partner when working with an Indigenous person who uses opioids important?

a. It is familiar during a time of tremendous change.

b. The person has many friends living in the community that they miss during treatment.

c. The community can provide financial support to the individual.

d. This reflects a cultural component that the individual and their community are interrelated.

Correct! While a, b, and c hold some truth, the correct answer is d. Involving the community as an active member during all phases in the spectrum of care reflects the cultural belief that health must be viewed from the domains of physical, emotional, mental, and spiritual.

Incorrect. While a, b, and c hold some truth, the correct answer is d. Involving the community as an active member during all phases in the spectrum of care reflects the cultural belief that health must be viewed from the domains of physical, emotional, mental, and spiritual.

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References