Training Guide

Peer Delivered Syringe Exchange (PDSE) Toolkit

Module 3: Running Your Program

“You have to respect them. That’s basically what we do. We always speak to them, greet them and they don’t bother us. They know what we’re out there doing, we educate them and let them know what we’re doing and we have no problems.” – Anonymous Peer, speaking about law enforcement

Setting A Peer-delivered Syringe Access Services Schedule

Peer hours will vary depending on the specific needs of your program, the model of PDSS being used, the needs of your peers and any number of other factors.

Some examples of current SSP peer hours:

  1. Peers commit to an agreed upon number of hours per week on-site for activities such as packing kits, conducting outreach, and attend- ing meetings. additionally, they are expected to conduct social network access services at any time they choose.
  2. Peers sign up to do PDSS in a given neighbor- hood every Monday afternoon and Thursday morning. In addition, they are expected, and are paid, to attend educational groups to continue to improve their skills.

It is also important for supervisors to consider whether peers will work independently in the field, with other staff, or with other peers. Each model comes with certain pros and cons. In practice, SSPs handle this in a variety of ways. it is common for peers to go out in pairs. See the table on page 16 for more information on models of staffing your program.

Peer Payment – How Do You Compensate Your Peers?

It is essential that peers are compensated for their work. That said, it is also important to review with your fiscal department the best way to pay for the PDSS program. How your agency decides to compensate peers depends on how much funding you can allocate to the program. For legal, human resources, and accounting reasons, some SSPs have found it important to highlight that peers receive a stipend as opposed to a salary or hourly pay. Peer stipends are defined as monetary incentives for volunteer activities. Most programs provide participants with travel expenses (for example, NYC peers often receive a monthly subway pass, or “Metrocard”, which currently costs $127). Peers receiving stipends are not full-time nor part-time workers regardless of the number of hours worked; because the position is voluntary, peers are not provided benefits given to staff members.

How to use the money allocated to a peer program is a decision with which many programs struggle: Do you use money to extend the number of hours you can pay peers? Do you use the money to pay peers more for the time they are already giving? Do you keep the pay scale and number of hours the same and hire additional peers to expand the scope of your services?

It is also important to consider whether there will be a penalty for missed meetings and workshops. Some SSPs deduct up to $10 from a stipend for each missed meeting, training, or workshop; others might give peers a “bonus” $10 for attending optional networking meetings, trainings, or events. Some possible complications regarding compensation:

  1. Peer absences: It is not uncommon for peers to periodically decrease their hours or take a leave of absence due to health concerns or any number of other issues. This may mean that while a peer is gone, some participants – those who primarily get syringes from this peer – may lose access services to services. What will you do if this happens – will you hold the position open for this peer to return? If so, for how long? You may be able to temporarily reassign the peer’s duties. He or she may have limited mobility and stamina but might be able to stay in your storefront and assemble kits while other peers spend more time doing walkabouts.
  2. Acquiring other employment: Have a conversation about career goals during orientation. A peer may view his or her role within your agency as a permanent job, rather than a step on the path to professional development, and not seek employment elsewhere. A peer might turn down a job offer elsewhere so as not to “let you down”. Let peers know your agency would be supportive of peers achieving permanent employment, even outside of the agency, and that the program will be flexible. Again, making this clear from the outset can help avoid problems or conflicts down the road.
  3. Impact on benefits status: Some of the peers you hire may be recipients of SSI, SSD, Medicare, Medicaid, housing assistance, etc. How monetary compensation affects their status as recipients varies by state and type of benefits. Websites for many benefit programs have an eligibility calculator that can help determine what effect, if any, a peer’s pay could have. Discuss these issues with peers to avoid potential disruptions in benefits.

Sample Compensation Models

Program A: Peers receive $10 an hour for 10 hours per week. Peers also receive four round trip Metrocards weekly.
Program B: Peers receive $120 every two weeks. Peers are required to work 10 hours each week. Each peer also receives a one-month Metrocard.
Program C: Peers receive $200 a month for 4 hours of work each week and a monthly Metrocard.
Program D: Peers receive $100 every two weeks but have no set time commitment to the program. They also receive a monthly Metrocard.
Program E: Peers are on payroll. The number of hours they work varies, but all peers, many of whom started as volunteers, are paid $10 an hour. Peers also receive a weekly Metrocard.
Program F: all peers work on a voluntary basis and do not receive monetary compensation. The peers are able to build skills while making less  of a commitment to the agency. Their work can potentially be a stepping stone to a paid position at the agency.


Pros and Cons of Various PDSS Outreach Staffing Models

This table lists some of the pros and cons comparing peers working independently, with staff and with other peers.

Going out alone

  • Pros
      • A peer can draw on his/her own social network without barriers.
      • Easier for the peer to work with his/her own schedule.
  • Cons
  • Safety issues.
  • Potentially, data could be falsified.

Going out with another peer

  • Pros
  • Peers have reported that they are seen as “more legit” when they approach people in a pair rather than alone.
  • Peers may feel more motivated to approach people they do not know when they have a partner.
  • Good model for building teamwork, camaraderie, motivation.
  • More experienced peers can train newer peers.
  • Another peer is introduced to the social network, thereby creating a “back-up” system.
  • Different peers can learn about different networks and different approaches from each other.
  • Cons
  • Due to stigma, potential participants may not approach a peer if that peer is with someone the person who uses drugs does not know.
  • Personality conflicts among peers. This may simply be a matter of compatibility.
  • Peers may need to adapt their outreach approaches when working with other peers from different social networks.
  • It is necessary to pay two peers rather than one to be at the same location/ network at the same time.

Going out with a staff member

  • Pros
  • Staff may have more training to make referrals.
  • Increases oversight of paperwork/data and prevents inaccuracies.
  • Opportunity for staff to observe/learn peers’ techniques when engaging with networks.
  • increases staff awareness about the realities of participants; helps staff to identify needs and potential resources.
  • Cons
    • Depending on who the staff member is, a peer’s network may not be comfortable talking to them.
    • This can take up a lot of limited staff time.
    • May undermine peer self-efficacy.


The Importance of Having Identification

An identification (ID) card is very important to protect peers if they are stopped by police. An ID card may include a photo, the peer’s name and title (e.g. Peer educator), agency name, logo, address, telephone number, and a supervisor’s name and contact information. Some programs have found it helpful to include an expiration date to cover peer turnover and collect cards if the peer leaves the agency. Talk to new peers directly about when it is proper to use ID cards, why, and consequences for misuse.

There are other ways for peers to identify that they are working with your agency. For example, organizations have used t-shirts, hats, armbands, and buttons. There are pros and cons associated with using strategies that outwardly identify peer status. On one hand, participants who need services are able to easily locate a peer. On the other, it may make participants more hesitant to approach peers for fear of being targeted by the police.

Some programs also give peers a copy of their approval letter (in New York State, a waiver letter from the New York State Department of Health), which explains the regulation allowing them to distribute syringes.


Working with Law Enforcement

Due to the nature of their work and the environments they will be working in, peers may be stopped by the police. For example, they may be operating in highly policed neighborhoods or a police officer may observe syringe access services and assume it is a drug deal. In New York State, it is important for all peers to attend the required New York State Department of Health training on the laws and regulations of syringe access services. It is equally important to plan ahead with peers to minimize the chances of being stopped, and to discuss how to handle a situation should it arise.

It may be helpful to inform local police about what PDSS is, specifically what peers are doing, and in what areas they will be working. Consider talking to police whether you have a pre-existing relationship with the area precinct or not – different officers may come into contact with peers since peers might be going out at different hours and to different locations. Some programs have found it beneficial to present information about the PDSS program to police at local precincts during roll call.

Some peers recommend talking to police the way they would with any participant. On the street, peers may want to offer materials to the police so they can see exactly what information is given out. One program introduces interested peers to the police precinct and undercover drug units so that the peers’ faces are known ahead of time. This may not be possible for your program or it may not be something a peer feels comfortable with, but it is one possibility to consider.

If a peer is stopped, it is helpful for them to have an official card or letter that they can hand to the officer. This card or letter should have a number to your agency that the police can call to verify who the peer is and that they are a peer employed by the agency. Be mindful that interactions with law enforcement may take place outside of normal business hours. Some programs have found it useful to have a cell phone that staff is on-call to answer in case of emergency. It may be possible to put this information directly onto the ID cards.

Peers also need to know that when they are working, they must not engage in any illegal activity. They cannot have drugs or paraphernalia on them. if they carry prescription pills, the medication must be in the correct bottle with the peer’s name on it, with the appropriate amount in the bottle, etc. This should be stressed to peers during orientation so they are aware of all boundaries and expectations.

Encourage peers to report any incidents they have with law enforcement recording as many details as possible such as date, location, time, persons involved and officer badge number or name (if possible). If you are unable to attain the badge number or name of the officer, documenting the other details will still be sufficient to file an official incident report. If there are witnesses to the event, it is important to collect and record their testimony also. Report all incidents (see the Appendix for sample incident report forms) and inform peers of the outcome of the report. Agencies should make legal consultation available to peers.


TIPS FROM THE FIELD: Tips for Doing Peer-Delivered Syringe access services Safely

Peers at the 2010 Peer-Delivered Syringe access services Conference in New York City developed the following list of safety precautions and recommendations for doing syringe access services.

    • Carry ID: Have a SSP membership card and an ID card from your agency that identifies you as a peer syringe access servicer. An ID card that says you are a “peer” carries more weight than an ID card that says “volunteer”.
    • Don’t go out by yourself: Always do peer syringe access services with at least one other person.
    • Know the area you’re going to: Is the area a known hot spot? Have a relationship with people in the area that you go to, so that they can tell you what is going on.
    • Carry a cell phone: Cell phones should be carried at all times, and make sure you have the phone number for your supervisor or site. Call in regularly to check in and let your supervisor or team leader know where you are and how things are going.
    • Know the peer-delivered syringe access services rules and regulations: Know where you can  and cannot go. Know what you can and cannot do. (This information is available as part of the New York State required training on laws and regulations.)
    • Dress appropriately: Do not draw unnecessary attention to yourself. Do not wear tight clothing or otherwise dress provocatively. Do not wear a lot of jewelry or an expensive watch. Wear light-colored clothing to differentiate yourself from people “in the game”.
    • Dress for the weather: Be prepared for cold temperatures, rain, snow, heat, etc.
    • Know your teammates: Be able to read your partner to know if and when something is going on. Have some code words and an exit plan in case you need to communicate under pressure or to leave suddenly.
    • Prevent needlestick: Do not take used syringes from clients if you do not have a proper sharps container. Do not pick up used syringes off the street if you do not have tongs and gloves. Do not wear open-toed shoes. Go to the needlestick training at the AIDS Institute.
    • Get vaccinated: Make sure you have been vaccinated for hepatitis A and B and get a tetanus shot.
    • Get trained in overdose prevention: After you’ve completed training, always carry your Overdose Response Kit with narcan (naloxone) on you.
  • Don’t carry any weapons.
    • Don’t carry any illicit drugs on you: This includes pills, cannabis, everything.
    • Don’t steer [tell people where they can get drugs]: it is a misdemeanor. you are a peer syringe access servicer, not a runner. remember who you work for.
    • Be wary of drug sellers using you as a cover: Do not give out syringes too close to people selling drugs. Police might think you are working together with them.
    • Have a relationship with local cops: Make sure your program has a relationship with the local precinct, so that if you are stopped by police, you can tell them you are with the syringe access services program.
    • Act professional: Do not respond to unwelcome or negative comments. Keep it professional. you are on the job.
  • Get certified in CPR and First Aid.
  • If you’re on medications, be prepared: Be properly medicated for your shift, and be mindful of your schedule. If you need to take meds during your shift, have the medications with you (insulin, blood pressure medications, HIV meds, etc.). Make sure you carry the prescription with your name on it.
  • Don’t let your own drug use interfere with the job: if you are too high and you cannot function, do not do the shift. Call in sick. Be real with yourself about your abilities.
  • Don’t carry a lot of money on you: if you are carrying incentives (Metrocards, gift cards), do not let everyone know you have them. Keep them in a safe place.
  • Don’t give out change or cigarettes: If you start this practice, it may become expected of you.
  • Don’t get caught up in the local rumors: gossip, small talk. if people ask you if you have seen someone, do not engage with them. Use discretion.
  • Night outreach: Be hyper-aware of your surroundings at night. go out with at least one other person, preferably two or more people if possible. Do not carry lots of supplies; just carry as many supplies as you need, probably only a few sets. Do shorter shifts at night—maybe only 1 or 2 hours.
  • If you are driving, drive safely: Wear a seatbelt. Keep your driver’s license and vehicle registration handy. Do not drive under the influence. Follow all traffic rules.
  • Be consistent: if you have a scheduled route, do the same route every time and go at the same days and times. (This may not apply to social network syringe access services.)

TIPS FROM THE FIELD: Staff Orientation and Support for the PDSS Program

There are several things you can do to integrate peers into your organization as a whole. respectively, there are also important things for staff to keep in mind when working with peers. here are some things that we have found helpful:

Consider making a presentation at a staff meeting about the peer program

  • Explaining the potential of a good peer program, how it fits in with the agency’s goals, and how the agency can benefit from PDSS, can generate buy- in and enthusiasm among staff.

Involve staff from other parts of your organization in the peer program

  • Peers help staff meet deliverables and bring in new participants. Ask staff  to help recruit and interview potential new peer hires. Consult staff about the selection of peers or the peer training curriculum subjects. If you know a staff person has a particular strength or area of expertise, invite them to facilitate a training for peers on that subject, and vice-versa for peers. Involve staff in peer celebrations, like their graduation party if you have one.

Invite staff to act as mentors to peers

  • Staff mentors alleviate some of your supervisory responsibilities, give frontline staff a chance to teach their skills (which they often may not get to do), and give peers an alternative confidante if they ever have an issue they do not feel comfortable bringing to their supervisor, or if their supervisor is not around in a moment when they need advice.

Remind staff not to express their grievances with a particular peer within earshot of any other peers, participants, or staff

  • It is important for staff to communicate about peers’ professional development and job performance; staff should be reminded that these conversations should be constructive. Peers may talk amongst themselves about who is working hard, who is not, and why, just as staff do, but staff are not to talk to peers about other peers and their performance. even if peers are doing similar work as staff, it is important to treat them with the same confidentiality guidelines as participants. While it may be constructive to share information about a peer’s work habits among staff, staff must also evaluate whether that information is constructive or gossip – just as when we share sensitive health information about a participant with another staff person, we only would do so to try to coordinate better care for the participant.

Remind staff to be encouraging but not to make false promises or to make statements that may induce false hopes

  • Staff who are enthusiastic about the peer program and the work of the peers may share the goal to transition peers into stable employment with the organization. That said, they may not be as acutely aware of the limited funding of the peer program or may not be thinking through the implications of saying things like, “hey, pretty soon you’ll be staff!” to a peer. it is encouraging, and it may make someone feel good in the moment, but it should be avoided (unless, of course, it has been established the person will soon secure employment with your organization); down the road, the peer may feel strung along or taken advantage of if they are not hired by your organization.

Remind staff  to respect peers’ time and commitment

  • Peers are in a tricky position. Often motivated and eager to help, their time and efforts can also be exploited. if a peer’s role is to help with outreach only, staff should know that they cannot delegate office tasks to the peer. As the coordinator of a peer program, you may find yourself in a position of reminding peers they are allowed to say “no.” Staff who are used to wearing many hats may ask peers to do the same, forgetting that the hours peers are paid for are limited, and monetary compensation is usually quite small. Peers may feel obligated to volunteer their time above and beyond their paid shifts and can then experience burnout or feel underappreciated and underpaid. Staff should be reminded that the organization only has a limited budget to pay peers, and beyond that, the peers should not be pressured to volunteer extra time.

QUESTIONS TO CONSIDER – Module 3: Running Your Program

Peer Compensation

  • Will peers be paid an hourly rate?
  • Will peers be placed on payroll or given a stipend?
  • How will you help peers understand any potential impact their payment as a peer will have on public benefits (such as SSI/SSD)?
  • Will there be opportunities for pay increases and promotions?
  • How will you manage transitions between unpaid or volunteer peer positions to paid peer and staff positions?
  • Will peers be provided with additional benefits such as health care?
  • Will transportation be compensated (public transportation, gas, mileage, repairs, etc.)?
  • How will you remain accountable to differences in pay scales and benefits between staff and peers? Are peers doing the same jobs as staff for lower wages?

Interactions with Law Enforcement

  • What will you do if a peer is arrested while doing peer-delivered syringe access services?
  • What resources can the agency provide to peers who are arrested or have ongoing legal issues for a PDSS-related arrest?
  • How will PDSS peers identify themselves to law enforcement or other community members?
  • How will you prepare PDSS peers for potential interactions with law enforcements?
  • How will you document interactions with law enforcement?
  • How will your agency outreach to local law enforcement to prevent negative interactions with local police?