“Reciprocal Peer Support” (RPS): A Decade of Not So Random Acts

137



“Reciprocal Peer Support” (RPS):

A Decade of Not So Random Acts of Kindness

Abstract: A model entitled “Reciprocal Peer Support” (RPS) is introduced in this article to describe

the peer support activity provided at University Behavioral HealthCare – University of Medicine and

Dentistry of New Jersey (UMDNJ) in a variety of peer programs. More than 10 years of peer support have

been developed, reviewed, and assessed by this writer in an attempt to clarify the “lessons learned” and

encourage RPS as an effective approach to peer support service in the future. The Cop 2 Cop , NJ Vet 2

Vet, and several other UBHC peer support programs, which conform to “best practices” criteria, have

been sustained and expanded based on the RSP principles discussed in this article. [International Journal

of Emergency Mental Health, 2012, 14(2)]

Key words: Reciprocal Peer Support , RPS, peer support, crisis intervention

Cherie Castellano, LPC AAETS, is Program Director of Cop 2

Cop, NJ Vet 2 Vet, Mom 2 Mom at University Behavioral Health

Care, University of Medicine and Dentistry of New Jersey. Che-

rie has developed peer support programs recognized as national

models utilizing her expertise in crisis intervention and behavioral

   -

respondence regarding this article should be directed to castelch@

umdnj.edu.

In January 2011 the Department of Defense Centers of





options for the military to develop peer support programs as

a tool to combat the rise in military suicides. To summarize





and preparation, clearly articulated policies, systematic





through structured training. Building on the research options

for actionable items, peer support can address combat and

operational stress, suicide prevention, and recovery-related

issues. According to the DCOE, Heisler (2006) and the

Department of Health and Human services (DHHS, 2007),



      

      -

ation, improve compliance, reduce concerns, and increase

satisfaction with health status. In addition, the DCOE paper



follow the peer to peer support for an extended time period

are components of the best practice in peer support.

At University Behavioral HealthCare we have provided

more than a decade of peer support through the Cop 2 Cop

     



programs. Our UBHC Access Center has sophisticated au-

tomated call distribution capacity and an integrated patient

Cherie Castellano

University Behavioral HealthCare,

University of Medicine and Dentistry

of New Jersey

138 Castellano

management system utilized by clinical staff for a variety of

800 numbers as a single point of entry for service to those



of the access center, combined with the academic excellence

and service provision that is available, have provided a strong

foundation on which to build the UBHC Peer Support pro-

grams. In addition, UBHC historically has employed mental

health peer specialists, the more traditional peers offered

through the mental health systems across the country, for

consumers of mental health and substance abuse services.



support, combined with an historical culture in New Jersey

and at UBHC that values peer support, a peer support best

practice was inevitable.

The peer support services created through the UBHC



-



        

foundations of the success of these peer support programs.

In addition, this writer believes that the two most profound

components for the success of a peer support program that

are absent from the extensive DCOE review are 1) the need



throughout the process, and 2) the provision of resilience

sustainability for peers through events and activities for peer

advocacy, including both the peer staff and the peer popula-

tion being served.

The Reciprocal Peer Support (RPS) model

The decade of service in peer support programs at Uni-



        

    

         



-

tion and praise.

Task One – Connection

A pure presence is at the heart of the engagement and is

necessary for successful peer support. In RPS, the peer sup-

porter is trained and prepared to engage the client without

judgment, avoiding preaching or directing, to cope with the

moments of shared suffering and pain, and to simultaneously

be aware from the initial contact that assessment for suicidal



must be ready to facilitate access to a higher level of care by

having access and liaison connectivity with an appropriately

trained behavioral healthcare professional as his or her part-



partnership is carried throughout RPS but impacts the initial



can be offered the most appropriate care and support.



laws involving suicidal, homicidal, and physically abusive

situations. From the RPS perspective, a peer must be a re-

tiree, a veteran, someone who is not actively within the peer

group but in a retired or inactive status to ensure the initial

connection is free of concerns regarding repercussions to



-



and indirect communication. When an initial contact is of

a crisis nature, the intimacy created by the sense of vulner-

ability of all involved expedites the connection of both the

peer in need and peer supporter in RPS, or if handled poorly

impedes the connection, perhaps forever. First responders

and military service members describe that when surviving a

life threatening experience or critical incident they experience

a closeness and bonding that is profound. When the initial







most peer supporters in RPS will describe an intense connec-





encountering resistance, it is important for the peer supporter



they do not interfere with the helping process. Peer supporters

in RPS are directed to recognize a resistant peer at the initial

contact, as well as to recognize their own frustrations and

need to help in the RPS relationship. We reference a focus



peer in need and maintaining a focus on serving that need

as a primary tool to connection. If a peer supporter fails to

establish the connection of a pure presence with the peer in

need the outcome will often result in premature termination of

the contact and therefore the helping relationship. In supervi-

sion, RPS peer supporters are challenged to explore why the

connection was not made. It often involves a contamination

of judgment or personal experiences of the peer supporter

139

that impeded the process. Part of the need for ongoing self

assessment in RPS is to ensure that the peer is aware of his

or her vulnerabilities and strengths in the beginning of the

RPS process, and at all times to ensure that connections are

successful. Not all peer supporters can connect with all peers





on peers’ most appropriate for our shared life experience sets

the stage for effective intervention. RPS tries to match peers

most effectively based upon shared experiences. For example,

although a police peer may be helpful to a corrections peer,



be more effective at establishing the initial helping relation-

ship. Or, a marine matched with a marine versus any other

military peer expedites the connection. Another aspect of

effective matching might be shared life experience, rather

than profession. Shared experiences such as trauma, self-

medication, aggressiveness, etc. can serve as an effective

secondary matching criterion. It is essential, however, that

the peer supporter’s experience is in the past, treated and

resolved. If he or she struggles in relapse or life changes it

is an important component of self awareness to notify the



Task Two - Information Gathering and Risk Assessment



as well as technical support, can drive the effectiveness of this



  

and reactions), as well as the history of a peer in need. This

-



   



-

-

porter must collect certain data to move to the next screen

in completing documentation about a peer contact. Our face

to face peer services follow a standardized training through

the International Critical Incident Stress Foundation (ICISF)

and our outreach and access training utilizes materials and

forms that direct information which should be collected in

every setting for RPS.

Crisis and suicide assessment are infused into every



 

information gathering is an in-depth process, the awareness



information to ensure a safe environment that must be dis-

creetly integrated into all information gathering. The informa-

tion gathering phase, similar to the connection phase in RPS,

   

utilizing the same guidelines and assessment because peers

present differently at different times. Therefore information



RPS occurs in a variety of venues. Each venue has

adapted a protocol or standardized approach to the assess-

ment component of the assessment piece of this phase. For

example, the American Association of Suicidology endorses

-

credited help lines. Therefore we have adapted that model in





intervention services. RPS utilizes the SAFER-R model

of individual crisis intervention as developed by Everly



International Critical Incident Stress Foundation.

It is a legitimate concern, when training peers and men-

tal health professionals to provide RPS, that if a traditional

more formal information gathering or assessment process

    

one and in turn impede the RPS process. A conversational



assessment purposes are needed unless a peer is reporting



peers in those acute moments to build on the connection and

peer relationship to extract genuine experience and accurate

information to ensure a peer is provided all service necessary

to ensure safety.

In RPS we utilize homogenous peer supporter groups

because they have appeared to be more effective than het-

erogeneous groups, based on the effectiveness reports of the

peer supporters themselves.

This prompted the guideline for RPS that programs not

be integrated with a mix of peer cultures but instead be solely

devoted to one peer culture. Cops are peer supporters for



leads us into the next phase.

Task Three - Case Management and Goal Setting



140 Castellano

peer supporter and distressed peer builds. Once a peer sup-





the ongoing peer support and case management for the peer

in need. In RPS, peer supervisors and mental health partners



thoughtful manner, matching the peer supporter to the peer in

need, based on variables such as branch of service, behavioral

healthcare issue, and engagement from initial contact, as well

as other possible factors.







reaching out to a peer support service. Today’s web based

referral options and access to information are so prevalent



as their primary and only need being of a case management

nature, he or she will be receptive to peer support on an ongo-

-



is offered not just through a list of names and numbers but,

more importantly, as part of a solution-oriented approach to

the peer that he or she is not alone and help is viable. Multiple

contacts from the peer supporter throughout the peer support





management can be experienced as a peer supporter truly



As the case management is offered, whether it be be-



oriented, the credibility of the peer supporter is once again

-

rals and services offered through the case management are

attributed to the peer supporter despite the fact that the ser-

vices are all separate entities. A peer in need will rationalize

that the peer supporter is genuine if services offered in case

management go well or is a phony and not truly interested

in helping if the case management referrals go badly. Both



we prepare before hand with case management referrals and



with providers, visiting sites, and outcome measures, in an

attempt to only provide credible resources. This is, however,





emphasize the capacity for change and continuity in this

phase. If a referral or service offered is not ideal, RPS ensures

that the peer supporter will try again, with other resources

and maintain contact with the peer in need throughout. The

sense that the peer supporter and peer are pursuing solutions



trainings, credentialing processes, customer satisfaction sur-

veys, are all tools that have been utilized in RPS to attempt

to maintain credible resources.

-

cacy



peer supporter, based on their own accounts of their experi-

ence. When self care is emphasized for all peer supporters

and behavioral healthcare professionals in the peer support

model it fosters an environment of openness needed for





RPS, allows peers to model the importance of recognizing

resilience. From the onset of the RPS programs developed at



award, or advocacy occurred within the peer support group.



in the American Foundation for Suicide Prevention suicide



to suicide as part of the mission and group cohesion. Media

have reported the successes of NJ Vet 2 Vet. This prompted

an opportunity to advocate for soldiers by volunteering to be



has created a visual arts project to utilize as an advocacy tool,



peer supporters attend museums when it is shown across

the country, putting a voice to the people served. Many of



memorial events or ceremonies where strength and resilience

were the focus. These activities must be offered regularly to



resilience, translating that experience to the peers in need.

In addition, providing training through RPS within the

communities served in a particular peer program is another



tool for many treatment resistant populations. Stigma is an

impediment to this phase and in the details of the peer sup-





worried they may sound condescending or insensitive by

141



peer supporters is that often there are cues from the peer in

need that he or she is ready for phase four. Perhaps a peer









chapter. Summarizing in a warm and supportive manner with





the end of the RPS experience.

    

return for additional support over time. Our returning peer



experience when they re enter the service. Some peers’ RPS



will not repeat the process. Whether the RPS experience is

part of a continuum or a single episode of support, the RPS







   



remain essential but can be affected by clients’ needs and



changes, all of which can be factors in peers’ vacillation



Most important is the peer supporter’s recognition that







part of a continuum that is not encumbered by a proscribed

number of sessions or period of time. RPS has been offered in





is our constant outreach and sustained contact that supports

the RPS model.

Overall the themes most prevalent in RPS are as fol-

       

RPS service but throughout the program structure because

both peer support and behavioral healthcare must be valued







telephone help lines, face to face individual and group peer

support, crisis intervention services, prevention and training,

and advocacy for peer groups targeted for RPS. Self Care

is emphasized with opportunities for assistance encouraged

within the peer support team and managed through resilience

building activity and advocacy. RPS is an open ended process

that is a continuum. It is most effective with groups who have





-



be recruited and serve as a volunteer or in some provisional



-

ing the RPS services directly can remain volunteers and be

utilized to support the outreach and advocacy as part of the

RPS program. Those that thrive are employed and partnered

with clinicians, then trained and monitored as employees.



clinician approach at the core of RPS, to avoid dividing the

-

nents of the RPS model.

The RPS training curriculum is a composite of models

from national organizations such as American Association of

Suicidology, International Critical Incident Stress Founda-

tion, and mental Health America, and broadly resembles the







cultural competence (not just in diversity but of the peer cul-

-

ing crisis and emergency situations, peer support principals,

 

& stigma, and self care. The RPS Peer Support Curriculum



may be adapted based on the peer support population and the

service delivery system in which the peer support is offered.

Summary

        



the training ideally should be peers and mental health pro-



throughout the RPS process. All RPS training activity is

provided in a variety of modules, initial and annual train-

ing, individual and group training, and peer support service



UBHC Peer programs.

142 Castellano

At UBHC, we have established 10 peer support programs

utilizing the RPS model and employed more than 50 peer



the last decade. The outcomes of these programs appear to

  

groups in need of an additional option to traditional behav-

ioral healthcare services. As the program director of many

of these services, I have witnessed life changing moments

for both the peer supporters and the peers in need. Recipro-

cal Peer Support has been developed initially in response to

suicides and mass disasters, yet over time it has been based

on the data from the peers in need and the peer supporters



been recognizing the moment in time when a peer supporter







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nel



for law enforcement. In Reese, J.T. & Soloman, R. (eds.),

Organizational issues in law enforcement (pp. 183-192).

