Training Guide

Peer Delivered Syringe Exchange (PDSE) Toolkit

Module 2: Getting Peers Started

“It’s helpful to be exposed to staff in the field so you get to see a lot of styles in action. This goes beyond classroom training. It’s also important to have a mentor in the beginning. This can be a staff person or another peer (as long as the peer is experienced). Ease new peers into their roles instead of tossing them out.” — Anonymous Peer

Recruitment and Hiring New Peers

The first step in hiring new peers is to consider how they might fit your agency’s needs and goals. For example, if you’re starting to target outreach to transgender clients, you will probably want to recruit a transgender peer with connections to the transgender community in your area. A younger peer would probably have the most success reaching a younger population. Think about how best to recruit a new peer if you are expanding your outreach into a new geographic area. You want someone familiar with the neighborhood and with that specific community. This may require strategically placed recruitment flyers to access services potential peers since you are trying to engage people who may not already be accessing services from your organization.

Peer recruitment varies by program. Often, it occurs organically through a participant’s involvement with the SSP. Some SSPs use their data collection system to find participants who consistently pick up large numbers of syringes and are presumably already doing social network access services on an informal basis. 

Alternatively, peers can be recruited through a traditional listing. Peer position descriptions  should clearly identify and spell out the responsibilities of a peer’s role. Descriptions should also include information about working conditions, such as tools and equipment used, knowledge and skills needed, and relationships with other positions in the organization. Each candidate should be interviewed in a consistent way that works best for that particular SSP. An interviewee may find a large group overwhelming. At the same time, having at least one other peer in the room may set that PWUD at ease. See the Appendix for examples of interview formats and position descriptions.

Peers can also be recruited through referrals from participants within your agency. Case managers, social workers, and outreach workers can publicize the opportunity and provide applications to interested participants. Peers can also be referred to staff by other peers. As with active PWUDs, former users will bring first-hand knowledge of cultural norms and sensitivities of people who use drugs, as well as the experience of making changes to their own drug use. Former users may find that working at a SSP is especially rewarding given their own struggles and a desire to help others. However, it is also possible that former users may be somewhat removed from current drug use trends and communities. In addition, it is important to be mindful that former users may bring certain biases or ideas about the best strategies for making changes to drug use from their own personal experience.

Even before accepting an application from an interested participant, you may want to send the candidate out with an existing peer to make sure he or she understands the responsibilities that being a peer involves. When recruiting new peers, keep in mind that people have varying degrees of stability and access services to resources. These are characteristics of populations you are trying to access services, and it makes sense to apply some of the same flexibility to peers that you apply to participants.

Indicators That Someone Might Make a Good Peer

  • Member of a drug-using community
  • Comfortable approaching and initiating conversation with others
  • Basic literacy (necessary for tracking transactions)
  • Speaks the language of the target community
  • Cultural competency with the target community
  • Willingness to learn: prevention messages, laws regarding PDSS and possession, etc.
  • Eager to educate self and peers
  • A caring or helping personality
  • Trustworthy
  • Does not have any open warrants (this could endanger the operations of both the peer and your SSP)
  • Desire to serve his or her community
  • Knows the “lay of the land”
  • Desire to become involved in health promotion work

Orientation for New Peers

PDSS orientation can cover a wide range of topics and information. Certain information is required based on program regulations, while other information is flexible depending on your specific program needs. Experience has taught us that the more explicitly and directly we cover these topics, the smoother things run for peers as they transition into a new role within our agencies.

After you have hired a peer, it is highly recommended that orientation cover the following topics related to Roles, Expectations and General Program Requirements and Education and Skills-Building:

Roles, Expectations and General Program Requirements

  • The importance of PDSS to the SSP
  • Peer role within the agency
  • State and local rules and laws for PDSS and SSP – these vary by locality
  • Accountability and expectations: consequences for missed meetings, property agreements, etc.
  • Agency rules and use of office resources
  • Compensation and hours
  • Accommodating other commitments
  • Taking care of your own health: sickness, detox
  • Drug use, using on the job and resources for support and drug use management
  • Making schedules and setting areas to serve (if applicable)
  • Paperwork and documenting transactions
  • Confidentiality agreement
  • Safety and emergencies
  • Grounds for termination and disciplinary process
  • Resignation process

Education and Skills-Building

  • Overview of harm reduction philosophy and how it applies to the peer’s role
  • Basics of hiv, hepatitis c, Overdose Prevention, Safer injection
  • “What’s in your Backpack?” (see Module 3)
  • Interacting with police on the job (see Module 3)

If possible, it is helpful to have an area of your office for peers to use – you can designate an area for them to keep their bags and materials and post a white board that lists important and required meetings, deadlines, and workshops for all to see. A designated place for peers to keep training binders and PDSS materials is especially helpful for those who have unstable housing.

“The more education you have, the better it is. That’s how we look at it.” — Anonymous Peer

Sample Models for Peer Program Orientation

New York Harm Reduction Educators (NYHRE): NYHRE’s Peer program, UPRISE (Uniting Peers for the Rights of Injectors and Sex Workers Everywhere) is rooted in social and economic justice and provides the opportunity to educate and empower substance users and sex workers to be the activists and advocates of tomorrow. UPRISE recruits a cohort of 9 to 13 peers twice per year and at the beginning of each cohort, the new peer team attends a series of twenty eight workshops. Once a week, there is a full day of training with one workshop in the morning and another in the afternoon. Peer trainees eat lunch together between the two workshops, providing an opportunity to socialize and get to know one another. Peer trainees are also provided transportation reimbursement to get to and from the training location, but are given no other compensation or incentives for attending workshops. Upon completion of the training cycle, Peer trainees will graduate and become UPRISE Peer educators who will then complete a 6-month paid (stipend) practicum focusing on outreach and group facilitation roles.

FROST’D /Harlem United: FrOST’D/Harlem United doesn’t have a cohort of peers who begin all at once, so a set 2-week orientation is not feasible. Instead, peers are hired as slots open up all year round. Potential peers spend 3-4 weeks going to sites to get oriented on how services are provided in order to determine their fit with the program and the organization. Afterwards, they sit down with the peer supervisor to review the specifics of paperwork, functions of the peer role, supplies, etc. after this point, the peer can begin work officially.

VOCAL: New peers are trained in four half-day sessions as part of their orientation to the agency. The training is provided by staff and includes role-plays on topics such as safe injection and overdose, as well as interacting with or de-escalating interactions with police officers.


Training New Peers

As already mentioned, some training is integrated into the orientation process, but it is important to remember that training, education, and skills-building is an ongoing process. Training topics for new (and continuing) peers might include: HIV, hepatitis, overdose, safer injecting, wound care, pharmacy access services to syringes, local and state regulations on syringe access services, maintaining healthy boundaries, entitlements such as SSI/SSDI and food stamps, sexual health, domestic violence, among others.

If a peer has previous experience, they may be given the opportunity to “opt-out” of a workshop on a case-by-case basis, however, he or she should still be encouraged to participate in any in-house training, if available. This gives peers an opportunity to get to know other peers and staff and to share information and experience.

Regardless of the training structure you choose, it is important to remember that training is as much about career development for peers as it is about improving agency service delivery.

A lot of training will probably occur during supervision in the form of “teachable moments”. Supervisors may notice gaps in peer knowledge or other areas for improvement. Supervisors have also found that, in general, peers will let their supervisors know what they need based on what they are seeing on the job. Examples include: a peer witnesses an increase in abscesses among users in her network which prompts her to ask for more information on wound care; a peer’s friend overdoses and he asks for a refresher on naloxone; or a peer is asked questions about detox programs to which he or she does not know the answers.

Especially for smaller agencies, peer training may occur in tandem with staff training. It is important to remember that adult learners may benefit from varied teaching styles and that each PWUD unique life experiences may inform the meaning of new knowledge; adjust your training to reflect this. Some things to keep in mind when designing a curriculum:

AAdult learners may:

  • Learn best by doing and watching others.
  • Need breaks more frequently.
  • Process information better when we are introduced to one concept at a time.

It is important to be mindful of how you structure your trainings and deliver material. Remember that some participants may need additional time to adjust to a traditional classroom experience or may have negative associations with these settings. Develop training that draws on the life experience and current expertise of peers while striving to present information that is applicable to real-life situa- tions. Lastly, during the training phase, it is important to balance classroom training with on-the-job skills-building.


Sample Training Structures Used at SSPs

Program A: Peers attend a standard 4-session training series that the SSP offers to all new staff and volunteers on a quarterly basis. Additionally, peers are sent to trainings sponsored by outside groups, such as government funders and non- profit training agencies, on relevant topics, such as preventing needlestick injuries, managing stress, the basics of hepatitis, etc.

Program B: After orientation, peers are encouraged to attend additional internal and external trainings, depending on their interests and availability. Staff may go into the field and observe a peer if concerns arise or provide extra support when requested, but this is discretionary.

Program C: Peers attend a series of in-house training workshops, totaling around 60 hours. Trainings include a broad range of health, political, and social issues, harm reduction, civics and participation, and outreach strategies.

Assessing Peer Performance

Before having peers interact with the community on their own, you want to make sure they have mas- tered certain core competencies such as: what to do when asked questions they do not know the answer to, how to track records, how many syringes they can distribute, and the basics of disease prevention.

Different agencies use different techniques to  assess peer readiness. For topical information where there is a clear, correct answer, many prefer the use of quizzes or pre- and post-tests. To help practice real-life scenarios, many peers find role plays with feedback helpful.

Construct some form of ongoing assessment and establish a system for observation in the field.


Determining Peer Hours and Work Sites

For programs that employ a set schedule with particular hours and routes, orientation is also a good time to talk with new peers about their schedule and the areas they will visit. Be sure to ask questions beyond simple availability. Peers might need to accommodate other commitments, such as shelter curfews, methadone maintenance, etc. Be sure to let them know that you are aware that these are priorities and that they will not be penalized as a result of any time conflicts; that said, peers, like other employees, need to be up-front about these requirements so that the program can schedule around them.

When figuring out routes new peers will cover, you will want to ask them about any areas they may want to avoid. Is there a certain area where they used to cop? Does an ex who is best avoided live near a certain corner? Obviously, if your program is using the social networking model, no schedule or locations will need to be set. However, it is important to discuss any potential barriers or conflicts between and within networks and help peers plan to manage these issues. When peers are working in the field it is also important for them to emphasize with participants alternative ways of accessing injecting equipment and services in the event that the peer is not available.


QUESTIONS TO CONSIDER – Module 2: Getting Peers Started

Recruitment and Hiring

  • Are your recruitment materials bilingual?
  • Can materials be accessed by a range of literacy levels?
  • Are application deadlines flexible, given the often transient lifestyle of potential peers?
  • Does your job listing allow for multiple ways to contact the agency, not just an email address for interested candidates?
  • Do you want to have your PDSS open only to active participants in your program’s caseload?
  • Who will create the application form? Who will review it?
  • Will there be a standardized application form?
  • Who will review applications?
  • Who will conduct interviews – a group of staff or a group of peers?
  • Where will interviews take place?

Peer Orientation

  • Who facilitates the orientation? Is it the head of the peer program?
  • What role can existing peers play at the orientation?

Peer Training

  • What skills do peers need?
  • How does a program ensure that peers continue to develop skills beyond the orientation period?
  • How will you get feedback from peers about the quality and meaningfulness of training provided?
  • How will you continue peer training?
  • How will you get and implement feedback from peers on training they need or want?
  • Does your agency offer in-house training sessions?
  • Do you send peers to trainings at external organizations?
  • How will you support peer attendance to outside trainings? Will you provide compensation for travel and time?
  • Will you help peers maintain a record of trainings attended?