Workshop Summary Report - Best Practices - Treatment and Rehabilitation for Seniors with Substance Use Problems, March 6 and 7, 2003

Peer Co-Leadership In Treatment Groups

a) Presentation by Deb Kostyk

Ms. Kostyk shared her experience drawn from the Elders Health Program in Winnipeg from 1987 to 1993 which offered an age-specific treatment group for older adults with mis-use. A co-leadership model was adopted involving a peer counsellor and a professional therapist. The peer counsellor was someone who was in recovery and not using. The term 'mis-use' is applied because it is considered less threatening to seniors. In the case of prescription drugs for example, seniors are often not intentionally using drugs inappropriately.

Why involve a senior peer as a co-leader?

The peer can serve as a bridge between the older adults and the professional leader and can increase members' sense of belonging and being understood. The peer can also serve as a role model and make helpful observations about how the clients are progressing in their recovery. Finally, the peer can enhance observations and assessments of group process/dynamics and members' progress.

The role of a peer leader

It is important to ensure that the peer and professional leaders in groups share the responsibilities equally. The peer leader's role is to establish relationships with group members and assist with therapeutic interventions. They can also provide much practical support in the form of temporary transportation, supplying reading materials and assisting with the physical needs of clients. Clients are often more receptive to the practical advice offered by peer leaders than by professionals, so peer leaders make an important contribution in this regard.

The role of the professional co-leader

The professional co-leader has ultimate responsibility for the treatment group. He overseas the functioning of the group, provides support and supervision to the peer leader, accesses and organizes sessional materials, delivers presentations about the session topic; conducts intake/evaluation sessions and referrals, and maintains group structure and norms.

Challenges in the co-leadership approach

Sometimes peer leaders have had experience with treatment programs that are run differently and adjusting to a new process can be challenging. Their adaptation to the treatment process can be assisted by careful preparation and debriefing. Peer and professional leaders need to blend their personal styles and different helping techniques. There can be occasional conflict between the peer leader and the group or there may be at times inappropriate reactions on the part of the peer leader, for which the professional leader needs to be prepared. Finally, there can be different theoretical perspectives at play between peer and professional leaders. Integrating these perspectives can be assisted by a third party. The Elder's Health Program always allowed for one session to be facilitated by the peer, and the topic would be left open to the group.

Impact of co-leadership approach

The co-leadership approach helps to establish supportive pairing of group members because they can see someone who shares their experience and who is helping others. Members feel a greater sense of belonging to the group and feel supported in their efforts to change their behaviour. Co-leadership tends to increase the confidence of the leaders in their facilitation skills. The co-leadership approach is also cost-effective for the organization.

Other useful strategies of the Elders Health Program:

• The establishment of group norms was very important, especially for new members.
• The group was open and new people were easily integrated.
• Group meetings were set not too early to allow for home care visits and transit.
• Groups were held on alternating days to allow members to rest on 'off' days.
• Co-leaders were most effective when their age and experience reflected what group members were experiencing.
• Co-leaders were found through Alcoholic Anonymous (AA) programs.
• The program started with mixed groups of men and women but eventually women requested their own group. They wanted to work solely among women and felt safer doing so.
• The program's name "Elders' Health" was carefully chosen to not stigmatize members.

Strategies to achieve collaborative co-leadership

Meetings between co-leaders before and after group sessions helped to ensure good collaboration. Resolving conflict either in the meeting or immediately after was important. Other elements to achieve collaboration included mutual respect of leader differences, professional nurturing of the peer as an equal co-leader, and having the peers maintain their self-help/recovery work. In this case the peers maintained their involvement in AA, which kept their recovery and natural helping skills strong.

Evaluation and outcomes

An evaluation of the program showed positive results. Groups members took better care of themselves and re-established social relationships. Surprisingly though group members did not report an increase in life satisfaction. Expectations about life are different for older people and perhaps life satisfaction is not an adequate outcome measure for them.

About half of the clients abandoned the program. The open structure may have contributed to this, in that it was more difficult to maintain the cohesion of the group.

b) Group Discussion - Challenges

Peer leader training

Many seniors who seek out peer leadership roles or are recruited have never done this kind of work before and may not have a lot of group experience. Whenever possible they should be offered training, particularly in group facilitation skills, group boundaries and power issues, and other professional topics. For example being able to 'read' a group is an important skill in facilitation.

Using volunteers

There are many challenges involved in using volunteers as peer co-leaders. They need to be integrated into programs purposefully and thoughtfully, with adequate selection screening, utilizing job descriptions, and support and supervision. All of this requires resources such as staff time. A certain level of discomfort exists with using unpaid volunteers, but they are present in many other capacities, such as public education, advocacy, treatment programs and after-care groups. Over time more older adults with appropriate skills will want to contribute, and their contribution should enhance programming.

Other considerations involved in using senior volunteers

• Many senior volunteers have health constraints that impede their ability to work.
• They may not have the skill base to co-facilitate groups.
• Some may have rigid approaches to issues.
• They may not have adequately worked through their own issues and this can impede their effectiveness in helping others.

Youth working with seniors

There are examples of initiatives involving youth in recovery co-facilitating seniors' groups. This has been shown to assist youth in their own recovery process.

Balancing directing groups and self-determination by seniors

In the co-leadership approach a balance needs to be maintained between directing the group and having the group determine for themselves how the sessions will proceed. This is partly achieved by not overloading seniors with too many tasks or responsibilities. Another dimension is to recognize that group process may not be what everyone needs.