Drug Abuse

Chapter 2  ORGANISATIONAL ASPECTS

INTRODUCTION

OPTIONS AND CHOICES

Introduction

Autonomy or integration

Paid or unpaid work

Active users, substituted users, ex-users

Exclusively focus on HIV/AIDS prevention or not

GENERAL ORGANISATIONAL ASPECTS

Introduction

Internal affairs

Collecting information

Setting the aims

Selecting the target group(s)

Establishing priorities within a problem area

The reach and limits of present services

Pragmatic criteria

Choosing an approach

The workers

The position of 'peer supporters'

Job description of a 'peer supporter'

Profile of a 'peer supporter'

Training and support for 'peer supporters'

Job description of a trainer/coach

Profile of a trainer/coach

Evaluation for internal purposes

External affairs

Positioning the project

Public relations

Introducing the project

Maintaining good public relations

Co-operation with other organisations

Evaluation for external purposes

PEER SUPPORT BASED IN A SELFORGANISATION

Introduction

Defining the interests

Establishing an organisation

Enlisting and maintaining the involvement of drug users

'Rules of the house'

Choosing an organisational structure

Professional support

What type of support is needed

Where to find this support

PEER SUPPORT BASED IN A PROFESSIONAL ORGANISATION

Introduction

Different models

Organisational prerequisites

Support of 'peer supporters' and professionals

Organisational adaptations

External contacts

Introduction

Basically there are two organisational models of peer support:

Peer support based in a seif-organisation, for example a drug user interest group; or

Peer support based in a professional (or voluntary) organisation, for example a drug aid agency or a health service.

The reality of most peer support projects is that they lie somewhere between these two models. Completely autonomous peer support projects are very rare, and successful peer support projects based solely in a professional organisation are unknown to us. Therefore, most peer support projects have been based on a 'joint venture' of drug users and professionals. However, the basis of these projects is normally by either one of the above mentioned models. These mixed forms can be roughly differentiated into:

peer support by a self-organisation which is supported by professionals or a professional or voluntary organisation; and

peer support by a professional or voluntary organisation leaning on the expertise and the work of drug users.

The purpose of this chapter is to shed some light on the different organisational aspects of peer support. The main issues in this chapter are:

options and choices for establishing the organisational fundament,

general organisational aspects of peer support

relevant organisational aspects and considerations of peer support based primarily in a self-organisation

relevant organisational aspects and considerations for peer support based primarily in a professional organisation.

The material used in this chapter is derived from the experiences of different peer support projects.

The aspects discussed in this chapter are designed to enable the reader to compose his or her own specific organisational plan, adapted to local circumstances.

Options and Choices

INTRODUCTION
Experience has shown that there are different ways to work with the concept of peer support. Before beginning a new project, thorough discussion should take place regarding the basic alternatives of peer support.

AUTONOMY OR INTEGRATION

The first choice which needs to be made even before a project begins, is the choice between:
peer support by a (more or less) autonomous seif-organ isation; or

peer support embedded in a professional or voluntary organisation.

HIV/AIDS prevention is in the interest of both drug users and drug aid agencies who represent the community's interest in health care. This common interest however, does not mean that a joint venture' is the most appropriate approach. Due to distinct local situations and different views, choices have to be made about whether or not to embed peer support in a professional drug aid agency.

To assure the continuity of projects. Most self-organisations of drug users have had problems surviving. The way of life of drug users often appears to interfere with a continual commitment to the job. (A significant part of this is due to the crimination of drugs).

To ensure professional support for the involved drug users on
a professional level (training in knowledge, methods and attitudes, and supervision of workers)
an organisational level (team structure, etc.)
a personal level (personal problems, etc.).

Reasons for embedding peer support in a professional organisation

To make the expertise of drug users (drug use techniques, social values, attitudes, etc.), useful within a professional organisation and understood by professionals. Employing drug users also means acceptance and acknowledgement of them as competent members of society.

To make contacts with drug users who distrust drug aid services.

To ensure workable contacts with other (professional) organisations such as drug aid, health and social services. This is especially important to facilitate referral.

To make contacts and remain on speaking terms with police and justice authorities.
Important conditions for embedding peer support successfully in a professional organisation are:

The work of the organisation is based on the concept of harm reduction, i.e. offering slow threshold' services, without enforcing conditions to stop using drugs etc.
The professionals involved have an accepting, non judgmental attitude towards drug use and drug users.

Reasons for choosing an autonomous organisation

The distrust of many drug users of drug aid services. This distrust cannot simply be taken away by employing drug users. An important reason for this distrust is the sometimes negative attitude of professionals towards the life style and thus, the contribution of drug users. A main issue here can be whether or not drug use is accepted by drug aid workers. HIV/AIDS prevention in the sense of discussing personal matters

such as drug use and sexual behaviour require an element of trust. For an active drug user it might be difficult to talk frankly to a professional about his way of using drugs if the professional finds drug use unacceptable.

In view of this distrust, there is the risk that drug users working for drug aid agencies will not be trusted by their peers because they are seen as 'traitors' etc.

The input of drug users in formulating organisational policies can be quite limited in a professional service This can result in a weakening of the motivation of the employed drug users and again can cause feelings of distrust. There is after all, a certain risk that drug users employed by a professional organisation are (or see themselves), as being used as a 'means to an end' (to reach the 'unreached') or even as an alibi.

Within the framework of a professional organisation the possibilities to criticise the policies of regular aid services can become quite limited.

Professional organisations can be less flexible regarding necessary adaptations of their work to the demands of peer support. To co-operate with drug users it may be essential to work outside of the usual 'business-hours'.

The position of a drug user as an employee of a professional organisation may raise conflicts with clients. i.e. Drug users may see peer supporters enjoying some privileges they don't have.

PAID OR UNPAID WORK

The choice needs to be made about whether or not drug users should receive payment for peer support. Once again there are good arguments for both points of view.

Arguments against payment

Peer support is in the interest of drug users themselves. So, why pay drug users for work, when the work of other interest groups is not paid.

Paying drug users for peer support can have negative effects. It can undermine their credibility in the sense that drug users who are paid for their prevention work are no longer seen as trustworthy by their peers. This is because their position has changed.

Furthermore, payment can mean that a drug user looses their independence. They may have to conform to the dictates of a funding organisation and hence be unable to plea for decriminalisation, etc.

Payment can make a project expensive.

Arguments in favour of payment

The contribution of drug users to HIV/AIDS prevention is in the general interest of public health. Also, because other healthworkers are paid for their work why would you not pay drug users for the same work?

In the case of peer support embedded in a professional organisation, it only seems fair that drug users should be paid for their work. Especially if the organisation has made the choice to employ a drug user to undertake part of the implementation of their HIV/AIDS prevention strategy. The employed drug user(s) is then simply an employee like the rest of the workers in the organisation.

Paying drug users for peer support can have positive effects. Payment can be of importance for the desired continuity and can also be seen as an acknowledgement of the drug user(s) as a competent and professional worker.

The argument that there is no reason to pay for peer support work conducted by drug users as it is in their own interest, does not mean that HIV/AIDS prevention work conducted by drug user self-organisations should receive no financial support. Peer support from within the scene can be a very effective way of addressing the HIV/AIDS threat. It is worth considering supporting and encouraging the work of drug user initiatives, at least by financing the requirements for running an organisation. Often, drug user interest groups are in need of financial backing to pay for such things as an office, office materials, telephone, postage, etc.

Although there are some self-organisations receiving financial support to pay for some of the work performed by drug users, it is usually the professional organisations that can afford to pay users for peer support.

ACTIVE USERS, SUBSTITUTED USERS, EX-USERS

Another important decision which needs to be made is: What type of drug users to involve in your activities? The central questions have always been:

Are active drug users able to do the job?

Is substitution/prescription of drugs necessary?

Should and can ex-users play a role in a peer support project?

There are also options, such as:
only active drug users.

only active drug users if substituted,

only ex-users, or a mixture between these groups.

Why involve active users

The main argument for the inclusion of active drug users in peer support, is that most active users are part of the 'drug scene'. They know what is going on, they are aware of the rules and they generally have frequent contact with their peers, etc. Therefore, they are the most likely to be trusted by and have influence on their peers.

Why not involve active users

Being an active drug user can be like having a full-time job. There is not a lot of time left over to do anything else. Continual commitment to a job therefore, might be asking too much. Hence, solely involving active drug users might cause problems with regard to the desired continuity of a project. Furthermore, sometimes it is argued that active drug users might be too involved in the scene to address confronting issues such as habits or rituals involving risky behaviour.

Sometimes, drug users might be seen as untrustworthy by their peers, because they are just 'one of them', or alternatively because they are not 'one of them' anymore.

Why involve substituted users

Prescription of substitute drugs like methadone or heroin itself, can contribute to the desired continuity of a project. Sometimes it is even a prerequisite for drug users involved in peer support to use substitute drugs. However, it can also be argued that substitution lessens the motivation of drug users to assert their interests. Nevertheless, some drug users involved in peer activities would not be able do their jobs without receiving substituted drugs.

Furthermore, substituted drug users can mediate between non-substituted users and drug services.

Why not involve substituted users?

The main argument against not involving substituted users in peer support, is that substituted users sometimes are not part of the 'drug scene' anymore. That means that they might:

not share their daily life with other users. They may have lost contact with drug users (especially newcomers) and they may be unaware of relevant information on 'new' drug use trends, actual problems, etc.

see themselves or alternatively be seen, as 'better human beings'.

be faced with jealousy, especially when they play the role of peer leader.

not be seen as trustworthy anymore.

One thing to keep in mind is that these arguments are more likely to be true in a situation where substituted users are 'out' of the 'drug scene'. It is worth noting that a significant amount of substituted drug users still use some heroin.

Why involve ex-users

They can contribute to the desired continuity of the project.

To some extent ex-users can serve as role models for what drug users can reach, i.e. 'being clean', getting a job, being acknowledged as an expert, etc.

They can draw from their experience to help other ID U's modify their sometimes self-destructive behaviour.

Many former users view providing a service to the community as a way of maintaining their abstinence. In fact, community service can be a fundamental component of many recovery programmes.

Many former drug users have established relationships with the treatment system and may be able to provide referral and facilitate access to treatment.

Why notinvolve ex-users

The arguments against involving ex-users in peer support projects are the same as the ones against involving substituted users. In fact, the risk for ex-users to become alienated from active drug users is even higher than with substituted users. What seems to be crucial is the attitude of the ex-user towards drug use in general: Do they accept or reject it? If they feel they are better human beings than active drug users; or they despise them, (as some ex-users do after therapeutic treatment in trying to protect themselves against a possible relapse). It is evident that they do not fit into the type of self-organisation we are discussing.

An important consideration of involving ex-users in peer support for active drug users is that it may place them in a 'tempting' situation.

Why a mixed group

A mixed group can result in all the advantages of involving the above listed drug users.

Why not a mixed group

Merging different 'sorts' of drug users can also be a source of conflict in a group where there may be differing interests and priorities. Substituted drug users might for instance take substitution for granted, whereas non-substituted users might believe that the first priority of an interest group is to have a more accessible methadone programme.

EXCLUSIVELY FOCUS ON HIV/AIDS PREVENTION OR NOT

Finally, there is the issue about whether or not peer support should exclusively focus on HIV/AIDS prevention. In the case of funding this may be the primary interest of the financing organisation. There are however reasons to doubt that such an exclusive orientation is very effective in the long term. In order to have a project that is functioning well it is obvious that it has to be 'attractive' for drug users to join. Exclusively focusing on HIV/AIDS prevention is not likely to fulfil this requirement. To keep peer support effective the HIV/AIDS prevention message could be better incorporated into a broader framework of drug users subculture. For example, focusing on health in general or (even broader) in the form of a general interest group.

Within the framework of an approach based on the social influence of drug users subculture, it is possible to develop a 'lifestyle' formula. Mainline in Amsterdam have done this. They produce a 'lifestyle' magazine with HIV/AIDS prevention messages and general information on health for drug users.

Involving people with HIV/AIDS can be of value for raising and discussing HIV/AIDS related issues.

General organisational aspects

INTRODUCTION

The focus of this part is on how to organise peer support. The organisational aspects of peer support important for both a self-organisation and a professional organisation will be discussed. For reasons of clarity a distinction has been made between internal affairs and external affairs.

Internal affairs refers to the organisation of the project or group (setting the aims and tasks, team organisation, etc.).

External affairs refers to the link between a peer support project and the field in which one is operating (contacts and/or co-operation with other organisations and drug users, etc.).

INTERNAL AFFAIRS

In this section, the following aspects are dealt with:

collecting information

setting the aims

selecting the target group(s)

choosing an approach

the workers
position of 'peer supporters'
job description of a 'peer supporter'
profile of a 'peer supporter'
training and support for 'peer supporters'
job description of a trainer/coach
profile of a trainer/coach

evaluation

Collecting information

The starting point is completing an inventory of all the necessary information on the target group(s). This should include information on the living situation/lifestyle of the target group(s) and should encompass the aims of the peer support project. This information is necessary to verify assumptions. It also provides the basis to establish priorities for the target group(s).

Important steps are:

collecting and reading written information such as:
statistical material about the characteristics of the target group(s) (number, age, gender, ethnic background, sera-prevalence, etc.)
studies about the living conditions of the target group(s)
reports of service organisations (number and 'sorts' of clients, information on services available, etc.)

identifying key persons (drug users, professionals, police, people living in the neighbourhood, etc.) and collecting information from them. Lastly,

getting on the street, exploring the situation. (Where does the target group(s) meet? When and where are drugs used? What drugs are used? What are the problems? etc.)

It is worth keeping in mind that all these sources have their limitations and biases. It is therefore important to check and compare information to ensure a realistic picture of the situation.

When collecting information it is helpful to make at least a rough plan:

which data is relevant (e.g. how many drug users are HIV-positive, how many inject, how many live on the streets, etc.)

where is this data obtainable (organisations, on the street, etc.)

who is collecting what information and where.

Setting the aims

Firstly, it is important to be clear about what one wants to achieve by peer support. Clearly defining the aims of a project is important for different reasons:

to create common ground for people to join in/apply for a job

to explain to the 'outside' world what you are aiming at. This is not only important to convince policy makers of the need/urgency of financial support but also useful for public relations activities.

to have a standard to measure the results of the project. This is important as you will have to prove the results of the project to external agencies, such as policy makers, funding organisations, etc. It is also important for your own organisation to have a clear insight into the results of your work. This is the basis on which one can learn from successes and/or mistakes and improve (if need be) next time.

It is necessary when establishing the priorities of a project (what is most important and what's not as important) that you keep in mind what could be realistically achieved in the actual situation. Global aims like reducing risk behaviour within the target population are not enough. This is especially important for measuring the results at the end of a project. Peer support in the field of HIV/AIDS prevention could for instance aim at:

increasing knowledge on safer use and safer sex (can be measured by using the information in chapter 3 'Safer behaviour messages')

creating a more positive attitude towards safer use (e.g. towards smoking or chasing the dragon, instead of shooting up) and safer sex (e.g. towards condom use).

raising the general health awareness of the drug using community (taking care for injuries, nutrition, etc.)

changing social norms, attitude and behaviour, etc.

Selecting the target group(s)

A target group(s) can be selected according to:

priorities within a problem area, e.g. based on an AIDS epidemic profile,

the reach and limits of present HIV/AIDS prevention programmes, and/or

pragmatic criteria.

Establishing priorities within a problem area

In the field of HIV/AIDS prevention the target group(s) with the highest sero-prevalence, and the highest incidence of risk behaviour, generally take priority. In order to establish priorities one has to collect information on the current state of the epidemic (an estimate of how many drug users are HIV-positive, or already have AIDS), and on the expected trends of the epidemic. An epidemic profile can be very useful to begin with. Other sources which can be used to obtain this information are:

sero-prevalence studies

HIV counselling and testing programmes

HIV/AIDS service programmes

knowledge, attitudes, beliefs and behaviour surveys

the local blood bank

hospitals, etc.

The reach and limits of present services

In combination with an epidemic profile, data can be collected on which groups of drug users are not successfully reached  by present HIV/AIDS prevention programmes. To be more precise, there are drug users:

who literally are not reached by drug aid services because the main part of HIV/AIDS prevention focuses more or less exclusively on dependent opiate injectors. So-called recreational users, non-dependent drug users, people who are using or injecting substances (other than opiates), and people who are experimenting with injecting drug use, are systematically neglected. Other groups that are sometimes overlooked are women, homosexuals and ethnic minorities.

who do not have contact with a service anymore

who do have contact but are not reached by HIV/AIDS prevention.

who have been exposed to information about HIV/AIDS, and safer use, and safer sex, but without reasonable result. This may be due to:
deficient information
an inadequate approach, e.g. compiling information during a methadone intake
factors or problems on the users side; feelings of distrust, lack of motivation, negative attitude, social norms, lack of resources, etc.

Pragmatic criteria

Experiences with peer support have shown that pragmatic considerations are influential, and moreover useful when selecting the target group(s). It is a fact that the selection of drug users available for peer support (their quality, background etc.) has influence on the target group(s) that can be reached by a project or group.

Although your first option may be to involve drug users who have access to the selected target group(s), you may have to cope with the fact that the number of available and suitable peer supporters is quite limited. However, direct access to the established target group(s) might not be possible. Due to this restriction, the intended reach of a project/group can be limited especially in the beginning. Therefore, existing contacts with available drug users can be extremely useful to establish and initiate access to a network of drug users which can (by a process of snowballing) lead to the establishment of the target group(s).

Choosing an approach

There are two ways of approaching a peer support project; outreach work for the unstructured setting of the street; or training courses for a more structured setting. This manual will concentrate on these two approaches (see also chapter 4 'Methods of delivering').

The choice offered by outreach work or training courses or both, is dependant on different matters such as:

the target group(s). If you are focusing on so-called 'hard to reach' drug users then naturally outreach work is important for making contact and ensuring that HIV/AIDS prevention messages reach them. Discussing personal matters such as drug use and sexual behaviour are sometimes easier in your own familiar surroundings than in somebody else's space, e.g. the premises of a drug service.

the aims of the project. If a snowball effect is a key aim of your project, then training groups of drug users and involved workers to pass messages on about safer use and safer sex can be of great value.

The available workers. The qualifications of the involved drug users and/or professionals (and the availability of professional support) is decisive for what can be done in a project.

The available resources. This is especially true where there is not enough money to do both outreach work and training courses. Outreach work by peers is generally less expensive and time consuming than organising training courses because of the involvement of professionals. Often the choice for outreach work is made on this pragmatic consideration.

HIV/AIDS prevention by outreach work is normally confined to what could be called 'spontaneous counselling' (short, incidental talks about HIV/AIDS). Whereas, HIV/AIDS prevention by training courses offers the opportunity to deal with issues at length and intensively. These two elements in fact complement each other quite well. The combination of these two approaches can be especially effective. An intensive introduction to HIV/AIDS prevention at a training course can make more impact if it is supported by short, incidental talks. These talks serve as reminders and focus attention on the subject at hand.

The workers

The selection criteria for workers in a peer support project is very important. It is critical to clearly define the job description and job profile of a peer supporter. The job of a 'peer supporter' entails two important tasks. One is the job of a trainer, responsible for the training of the 'peer supporters'; the other could best be described as counsellor or coach of the other 'peer supporters'.

Points for consideration are:

the position of 'peer supporters'

the job description of a 'peer supporter'

the profile of a 'peer supporter'

training and support of 'peer supporters'
professional coaching and training
personal support

job description of a trainer/coach

profile of a trainer/coach

Position of a 'peer supporter'

Experiences with other peer support projects have shown that there are different options for peer support. These are:

volunteers (unpaid, possibly receiving reimbursement of expenses)

free-lance workers

employees with a temporary position

employees with a permanent position

The choice of the above options will naturally depend on local conditions and the availability of financial resources. There are however other factors involved, as was outlined in the above section "Paid or unpaid work". Furthermore, a decision needs to be made about what sort of position is most appropriate in view of the abilities and needs of the involved drug users. Permanent employment may be an unrealistic perspective for some drug users because it is asking too much of them. Freelance work might suit them better and it can foster the first step towards a more continual commitment to their work

Positions between workers responsible for peer support (which cannot be explained in terms of differences in working hours or performance) can be a source of conflict. This can occur in a professional organisation employing one or more drug users. Professionals have on occasions undervalued the work of drug users by appointing them as volunteers.

Job description of a 'peer supporter'

A job description for peer support by drug users cannot (and should not) be constructed without consulting available drug users. Often in places with smaller drug user populations the choice of suitable candidates is limited. A job description is influenced by the qualities (expertise, skills, strength, etc.) and the ethnic background of available drug users.

When constructing a job description for a peer supporter, it is best to start with a global job description and profile which gives direction to the selection, but is open to adaptations. After having selected a person to perform the job, the job description should be transformed into a more specific description of the tasks.

Important elements of a job description are:

a clear definition of the tasks, e.g.
making contact with the target group(s)
HIV/AIDS prevention
general counselling
advice (in case of problems in the field of housing, work, justice, etc.)
referral in case of (serious) psycho-social problems,
representing the interests of drug users
contribution to the team/organisation
participating in internal and external meetings
initiating and maintaining contact with other organisations, etc.

how to do this work (outreach, training courses, office hours, etc.)

where to do outreach work

for which target group(s)

specification of working time (total working hours/hours for different tasks, etc.)

participating in counselling/training

Profile of a 'peer supporter'

Not every drug user is suitable to perform the job of a peer  supporter. A user has to meet certain minimal standards in order create a workable relationship and to gain maximum effect. It is preferable to work with peers from different backgrounds (ethnic/age/gender/drug of preference) as these people can cover different communities. Too many differences however, can also lead to conflicts in a group or organisation.

The following points can be relevant when developing a profile:

drug use experience (being an active, substituted or ex-user)

in the case of an organisation employing active drug users, it is important that he/she can control his/her drug use while at work. (Behaviour should be the criteria, not drug use).

positive attitude towards drug users

expressing concern for their peers and willing to work towards ameliorating their living conditions

being able maintain 'professional' distance from the scene

contacts (with special groups) in the scene

high status among peers (peer leader)

position of trust

maturity (in some cases it might be advisable to look for drug users who are older and more experienced)

stability (individuals who lead a relatively stable life are likely to stay around for longer)

having good communication skills, not being afraid to speak his/her mind

have an interest in HIV/AIDS prevention, the concept of peer support, self-organisation, etc.

be open and have no prejudices against drug users

knowledge and skills in the field of outreach work, training courses, etc.

knowledge of HIV/AIDS

Training and support for 'peer supporters'

Drug users involved in peer support activities generally need training and support. Usually this work is done by professionals, however it is also possible for active or ex-users to undertake this task. In some peer support projects, ex-users who have since become professionals have done this job.

The training and support of professionals is generally conducted by official education institutions. One would expect them at least to have knowledge and expertise on the subjects named below.

As was evident from the previous sections on 'job profile' and 'job description' additional training of peer supporters is desirable and necessary. In reality however, there are few training courses in knowledge and skills that are specially oriented to peer support. Most professionals and non-professionals involved in training and support of 'peer supporters' have acquired their knowledge by experience. Coaching and training 'peer supporters' entails two different tasks, professional coaching/training and personal support.

Professional coaching and training

Before beginning work as a 'peer supporter' drug users usually need some training. In most cases they lack necessary knowledge or skills. There are two ways to go about this basic training.

The first way is to specially design tailor-made training courses that meet the needs of a group or individual drug user. The second way to ensure training is to send drug users to an already existing HIV/AIDS prevention training course for drug aid professionals. This second option can be seen as part of a normalising strategy - confirming the capability of drug users to contribute to HIV/AIDS prevention which in turn, fosters their self-esteem.

It is necessary for drug users participating in training courses to be seen as contributors. Previous experience has shown that drug users have valuable expertise and that their presence has a positive impact.

Sending drug users to a training course for professionals does have disadvantages. Firstly, the barrier to join in a training course with professionals might be too high for some drug users. Secondly, there is the chance that the training course will not meet the special needs of specific drug users. The first disadvantage could be addressed by thoroughly preparing drug users for the course (informing them what the training is like, passing on the necessary basic knowledge, etc.). The latter could be addressed by providing individual training in combination with a training course. Individual coaching and supervision aiming at acquiring professional knowledge and skills should be part of a peer support project. The combination of individual training and a training course works well for a peer support project.

Important elements of the initial training course and individual coaching and supervision are:

factual knowledge about HIV/AIDS (and other health problems of drug users), i.e. knowledge on:
infection risks, risk behaviour, etc.
safer use and safer sex
relevant aspects regarding the HIV antibody test (the 'pros' and 'cons' of taking a test, the testing procedure, etc.)
some basic medical information (being HIV-positive without being sick, symptoms which can be an indication of AIDS).
psycho-social consequences of being HIV positive or having AIDS.
referral in case of medical and/or psycho-social problems.

methods (outreach work, counselling, etc.)

professional attitude (e.g. re-defining one's own role from drug user to HIV/AIDS prevention worker, participating in consultations and meetings with workers of other professional services and organisations, being able to work with groups, etc.)

setting realistic aims (not being too ambitious)

preparing correspondence (writing letters, minutes and reports etc.)

Besides the above, attention should also be paid to:

evaluation of work performance and achievements (what has been done, the results, etc.)
developing a work plan, in the short term (per week) and in the long term (for several months).
exchange of information and co-operation between the different workers.

For enhancing a professional attitude it might be useful to develop a list of guidelines, such as:

Do not get involved in trafficking drugs or stolen goods.

Work as much as possible in couples.

Carry some kind of ID or even business card on you which can be presented to police or other individuals.

Becoming intimate friends with members of the targeted population should not be forbidden. However, peer supporters need to be aware that this can cause problems if roles become confused and/or conflicting.

HIV/AIDS prevention workers performing outreach work will be confronted with many day to day problems related to the lifestyle of many compulsive users of illegal drugs. Be clear about referral tasks and possibilities.

It is likely that outreach workers will become involved in drug users personal problems. Discuss with outreach workers to what extent 'clients' can be supported with personal problems.

The role of the outreach worker/representative of an interest group needs to be clearly defined and communicated to everyone involved in the 'drug scene' (from drug dealer to squad officer).

Personal support

Besides professional coaching and training attention should also be paid to the personal well-being of involved drug users. If necessary personal support should be given to matters such as:

practical/material problems (settlement of debts, finding a house, etc.)

development of a personal perspective (by advice and support in the field of training, education and work, i.e. career planning)

personal problems (e.g. in personal relationships with partner, family and friends)

The boundary between personal support and professional coaching and training is not always clear. For example, someone's attitude towards a service is influenced by personal experience with that service. In the case of a drug user this attitude sometimes is quite negative. Therefore, the user has to learn to distance him/herself from their negative experience and modify (if necessary) their attitude.

A similar shift of attitude and behaviour may also be necessary for drug users towards their peers. Again their knowledge is based on their personal experience of being a drug user among other drug users. Although this is an advantage for peer support, it can also be conflicting with a professional attitude. For example, while it may be acceptable 'to beat someone up on the street' this aggressiveness is not acceptable when one is involved in peer support activities.

The change towards a more professional attitude may be more profound for drug users working in a professional organisation than if they worked in a self-organisation. Nevertheless, drug users working in a self-organisation will find it useful and even necessary to be on speaking terms with official agencies, and at the same time be able to maintain some distance from drug users. Peer supporters need to decide upon the priorities of drug users and be able to discern that behaviour such as beating up a user' is detrimental to your position of credibility.

It can be useful to separate professional coaching and training from personal support by having two different people performing these jobs. This will avoid conflicting the interests of employers with the interests of employees. After all, the first is primarily in the interests of the organisation whereas the latter is more concerned with the personal interests of the worker.

Job description of a trainer/coach

Important knowledge and skills for performing the job of a trainer/coach are:   

professional coaching and training of the 'peer supporters' as described above

monitoring the work of the peer supporters, e.g. in the form of supervision, etc.

supporting the development of the approach/methods (outreach work, training courses, etc.)

collecting relevant material for this development

personal support of the 'peer supporters' as described above

Profile of a trainer/Coach

The following points are relevant here:

familiarity with a harm reduction strategy

knowledge of methods (outreach work, training courses, supervision, etc.)

knowledge of HIV/AIDS

interest in HIV/AIDS prevention, the concept of peer support, self-organisation, etc.

maturity

stability

good communication skills, not being afraid to speak his/ her mind.

position of trust

and finally, a positive/accepting attitude towards people using drugs.

Evaluation for internal purposes

There is the need to see what has been done, who has been reached, which steps need to be taken next: If, and how, the chosen approach can or should be developed or modified, etc. This can be done by collecting relevant data about the target group and project. In different peer support projects registration forms have been designed to obtain the necessary information.

Important issues to record can be:

date

gender

age

ethnicity

new/repeat contact

risk assessment, for example
way of using drugs, sharing drugs and drug use equipment (syringe and needle, spoon, filter, water; frontloading, backloading, etc.)
sexual behaviour ( different partners, sex work, etc.)
knowledge
attitude
social norms

who initiated the contact (peer supporter' or drug user)?

how was the contact made (alone, being introduced, etc.)?

where was the contact made (in which part of the city, on the street, in a pub, etc.)?

from what information was the contact made, the place visited, etc.?

what did the contact mean, e.g.
introducing
advice
counselling
handing out condoms/syringes and needles/other
paraphernalia
referral

was the contact important for development of a network

The data collected for internal purposes can also serve as a basis for external evaluation purposes, proving the value of peer support (see page 37). This is especially important for funding organisations.

One problem with collecting the above data is that it can be time consuming. If filling in a form takes more than five minutes it may not be an appropriate way to gather information. If you choose this method of data collection be sure to develop a form which is quick and easy to fill in. A workable suggestion is to split the registration into two parts, the first part could focus on general information about the contacts made and the second part could concentrate on one specific issue.

Part one therefore would include the first five points listed above, plus information on 'what did the contact mean'. This ensures that you have primarily quantitative information on the reach of the project.

The second part of the registration form can be on different issues such as; changes in the ways drugs are being used or changes in sexual behaviour, etc. After having monitored an issue for a while (two or three months) you can change to another issue. This way of registration provides at least a qualitative indication on certain issues. Separating the recording of information results in quick and easy to fill in forms.

It is evident that for reasons of privacy no personal information (name, date of birth, exact address) should be registered. To avoid a mix up of forms on the same person, codes (numbers or nicknames) can be developed by contact people which correspond to a person. Therefore only the code is filled in on the registration form.

It is worthwhile seeking some professional support when developing a registration form or designing an evaluation. This could be an 'expert' from a university or a social science student in practical training.

EXTERNAL AFFAIRS

A peer support initiative should pay attention to external affairs. External affairs are important for a well attuned local/ regional HIV/AIDS prevention and care policy (which is meeting the needs of drug users), and for being able to refer drug uses successfully to other services.

The following issues will be discussed in this section:

positioning the project

public relations

co-operation with other organisations

evaluation

Positioning the project

Before beginning a peer support initiative, the position and function of the project in the field of drug and HIV/AIDS prevention/care services should be clear. Positioning the project is closely related to some of the choices mentioned above, such as:

choosing for peer support either in a self or in a professional organisation

setting the aims

selecting the target group(s), and

choosing an approach.

The position and function of a peer support project needs to reflect the local situation. Therefore, a logical first step would be to make an inventory of:

the needs of drug users

what services are available?

how are these services functioning?

what services are lacking?

are the services co-operating, is there a network of services?

what is the attitude of professionals working at these services towards peer support (supportive or non supportive, etc.)?
This inventory can be completed as part of the above mentioned process of collecting information. Based on this information the position and function of the project should be formulated.

Public relations

Public relations means different things:

introducing the project
attaining and maintaining positive public attention towards the project

Introducing the project

A peer support project needs to be introduced to other organisations 'in the field' as well as to the general public. 'Other organisations' are not only drug and HIV/AIDS services but also general social and medical services, politicians, policy makers, police and justice officials. This provides opportunities for services to attune and prepare for the needs of your project and enables you to seek support and co-operation from important players.

The following points should be noted when designing a public relations (PR) strategy.

It is advisable to inform representatives of the most relevant organisations even before the actual start of the project. The above mentioned inventory will provide information on which organisations should be contacted. Generally a personal talk is more effective than sending written information. In this first contact the aims and the approach of the peer support project can be explained and discussed. This will enable a particular service to prepare themselves for your project.

Directly before the start of the project relevant organisations should receive a letter with all the important information on the project. This should include; the aims and objectives of the project, the approach of the project, the start date and a contact person, etc.

In the starting phase meetings can be organised for the members of these organisations to inform them in detail about your project.

Informing the general public usually means informing the media. Often this is done by sending a press release to the media and organising a press conference. If you have an office the press conference can be held there. One benefit of conducting it in an office is that it shows you have nothing to hide, and satisfies the possible curiosity of what a peer support project might look like. If there are media or particular journalists who are sympathetic to the initiative they could be invited for an 'exclusive' interview.

Be aware of the possible negative effects of publicly 'coming out' as being a drug user and/or being HIV positive. It can have serious implications for the way one is treated by institutions and even family and friends.

If you are starting a project based at a neighbourhood address, it is useful to inform the residents by organising a meeting at your premises. This forum can serve to take away possible feelings of distrust and suspicion. It also provides the opportunity for residents to look around and see what sort of people are involved.

In some cases it might be better not to publicly launch a project at the beginning. There might be good reasons for initially establishing the organisation and then being able to present some results. This is especially true when you expect your project will meet some resistance.
One drawback of not 'going public' is that you loose control of information. One inaccurate and/or negative newspaper article based on second hand information can cause negative publicity and hence big problems. Setting the 'picture straight' again is generally very difficult. Moreover, not 'going public' in the first place can create the impression that you have something to hide.

Maintaining good public relations

Public relations is also very important in the later stages of a project. Drug and HIV/AIDS service organisations, as well as media, should receive ongoing information about the project. This could be updates and 'news' about the project and maybe an annual report. 'News' could include developments in your organisation/project; the organising of a training course for drug users; starting a new activity (giving out syringes and needles, organising a meeting for sex workers, disposal of used syringes found in the street); political actions against repressive measures and having new people involved/appointed, etc.

One should take good care to create and maintain a positive image of the project. After all, public acceptance can be supportive for your organisation. The information you provide should not be too radical. Giving convincing examples of harm reduction policies in other areas such as alcohol and tabacco use and car accidents can also be helpful.

Generally it is very effective to have good contacts with one or more journalists who sympathise with your work. They can be helpful not only in times of possible conflict but also for providing positive press coverage of your activities on an ongoing basis. If there is a journalis you can really trust, he or she could even be invited to join a worker performing outreach work. This can be helpful to convince the public of the value of peer support work.

Cooperation with other organisations

Introducing the project to other organisations is the first step towards developing co-operation with them. At this stage suggestions can be incorporated to allow your project to work together with other organisations. Regular consultation could be useful with some organisations for fine tuning policies and creating a basis for satisfactory referral. These consultations should take place on a formal and informal level. Informal talks between individual workers can be very effective for developing or maintaining a local network.

Co-operation with drug and HIV/AIDS service organisations can also be of value to assure necessary professional support. This support can include; the development of methods, supervision of 'peer supporters', lobbying policy makers, politicians, etc.

Co-operation with other organisations is not imperative. If for example, co-operation demands too much conformation, confrontation can sometimes be a better choice. Be aware though, playing the role of 'lonesome hero' can be as ineffective as 'toeing the line'. Therefore, think carefully about which course you choose. Without any co-operation, a peer support project will have minimal chance of surviving. (For more information, see section 'Where to find this support', page 48).

Evaluation for external purposes

Evaluation is important for external purposes. The demand exists to prove to the outside world, i.e. politicians, policy makers, other organisations, etc., the effects of peer support. Evaluation is also important for public relations. An experienced researcher is best to externally evaluate a project. Unfortunately this is often difficult as most peer support projects have financial and human resource limitations.

A workable and efficient solution to this problem is to develop/ use the registration form that was previously outlined. However, this has limitations when measuring the effects of peer support, as it is restricted to the active period of the project. This is a disadvantage for a project of short duration. Using this method makes it impossible to assess the long term effects of your work, for example, the attitude and behaviour of the target group. A combination of an evaluation during the course of the project and a small effect evaluation (e.g. some interviews with people from the target group) at completion of the project is recommended.

It should be kept in mind that the influence of drug users on their peers is hard to value in quantitative terms. Solely conducting quantitative research may not make any sense when attempting to assess this effect. This is especially so for measuring the effects of peer support by 'snow balling' (i.e. drug users reached by the project passing on the information to their peers). More qualitative research (field observation, interviews with drug users, etc.) could provide useful material for drug aid services, self-organisations and authorities who are interested in 'new' ways of HIV/AIDS prevention. Quantitative data is very important for funding organisations, policy makers, etc.

It is also useful to seek some professional support for the development and design of an evaluation for external use. This is especially true if your aim is to acquire some statistical information. Once again this support could come from an `expert' at a university or from a social science student in practical training, etc.

Peer support based in a Self-Organisation

 

INTRODUCTION

Although there are similarities between peer support projects organised by professional and self-organisations, there are also differences. Beginning a peer support initiative as a self-organisation requires clarification of some specific organisational aspects. These aspects will be discussed in this section. As stated in the introduction, self-organisation in this manual refers to an interest group.

Important issues in this chapter are:

defining the interests of one's own group

establishing an organisation

DEFINING THE INTERESTS

Drug users who form an interest group need to clarify what interests and who's interest they will represent. Keep in mind that the individual interests of one drug user are not necessarily representative of a whole group of drug users.

When starting an interest group this clarification is part of the process of collecting information and setting the aims (see page 16). Collecting information on the local/regional situation can be done by completing an inventory of what drug users see as their needs and problems and what they think could be done about them. This inventory can take the form of a questionnaire. Central issues of the questionnaire could reveal what services they usually deal with and what experiences they have had with these services. The following organisations are important for drug users:

the drug aid services (social aid, substitution programmes, syringe distribution, etc.)

other health services (general practitioners, hospitals, etc.)

other social services

police

justice, etc.

Developing an inventory of the experiences of drug users to a particular organisation gauges their feelings of dissatisfaction with the present situation. This for a large part can be attributed to the crimination of drugs. General dissatisfaction is also a motive to begin an interest group. It should be noted that a vague feeling of discontentment is not enough to start and maintain an effective self-organisation.

By using a questionnaire the inventory has a more formal character which is helpful for specifying the actual problems and needs of drug users. As such it can serve as a basis for establishing priorities. It can also have a convincing and motivating effect on the drug users contacted. In that, they can see that something is happening and that someone is taking initiatives to begin an interest group, etc.

HIV/AIDS is an important topic on the agenda of a drug user interest group. Experience in several countries has shown that drug user self-organisations preferably include HIV/AIDS topics in a broader framework of health, living situation and life style. (The training courses performed in order to complete this manual also revealed that this was the case.) When drug users are asked to name their most important problems - HIV/AIDS is often included as one of the issues. Other issues such as police actions, treatment by police offices, receiving no methadone, or housing, etc. are usually brought up first. To ensure a solid base for an interest group it is important to pay attention to these problems as well as safer use and safer sex.

ESTABLISHING AN ORGANISATION

Besides the general organisational aspects mentioned above, a number of other things are important when establishing a self-organisation. These are:

enlisting and maintaining the involvement of drug users

establishing the 'rules of the house'

choosing an organisational structure

professional support

Enlisting and maintaining the involvement of drug users

An inventory of the local problems and needs can be a start to bring people together. Using a questionnaire can interest drug users to join (see the information on outreach work in chapter 4 `Methods of delivering').

In order to enlist the involvement of people, an interest group has to offer them something and be `attractive' for them to join in. It is crucially important to ensure that the individual motivations and interests of one drug user do not get in the way of the 'collective' interests of all drug users. This is not always easy. It is usually a continuous struggle to ensure drug users pay attention to all problems and not only their own personal problems.

Attention should be paid to the following aspects:

Very simple things are important to people. Naturally for people to become involved in a project it is important for them to feel at ease. If it is possible, create a place where people can drop in, have coffee or tea, a chat or a rest, and get the chance to see what is going on, etc. To prevent this place from becoming a room to just hang around in, a motivating approach can be used. For example, after establishing a place for newcomers to meet, you could inform them about the work of the group. It should be made clear to them that people who come along regularly are expected to join in and assist with the work.

It is important to give people personal attention. Sometimes this can be forgotten with all the work that has to be done. Personal attention can be given in the form of asking how things are, listening to personal stories, showing concern for personal problems, etc. Personal attention is also important as an acknowledgement of someone's work and expertise.

In order to motivate drug users to participate actively in a group or a project it is important for them to have influence on the policy of the organisation. This point has sometimes been a problem in self-organisations, as initiators of these groups are usually people with strong personalities who find it hard to accept the majority's point of view. Thus, a strong 'leader' is not always an advantage in a drug user group.

The final crucial step to ensuring the involvement of drug users in a self-organisation is their participation in concrete political actions. Drug users will then see that it is worthwhile to stand up for their own interests. What action should be taken depends on the actual situation, the aims and needs, etc. Essential features for achieving successful political actions are that they are innovative and carried out co-operatively. (Think bigger than, demonstrating in the streets, or corresponding to politicians, journalists etc.).

A good choice of objectives is vitally important. Our experience has found that it is difficult to find a middle course between long term and short term objectives. It is not enough to concentrate on the political struggle alone. Pursuing long term aims such as `normalisation' or even 'legalisation' are too abstract and too far removed from the daily life of many drug users.

'Rules of the house'

Self organisations can either have a formal (legally registered) structure or an informal structure. In both cases it is important to clarify the 'rules' of the structure. Written rules and regulations are important for two reasons; to define the rights and responsibilities of the people involved, and to prevent and/or resolve any possible conflicts.

Important points to consider when forming rules and regulations are:

the goals (see 'Setting the aims', page 16)

the tasks (see 'Selecting the target group(s)', page 17 and 'Choosing an approach', page 19)

the organisation
the workers, (besides the aspects listed in the section 'The workers', page 20), attention should be paid to the selection procedure of drug users
the board, in the case of a legally registered organisation. The following have to be defined here:
tasks and responsibilities
how many board members
who can/should be a member of the board
an election procedure for board membership
maximum period of membership
the structure of the organisation (see page 44)

how to deal with conflicts (e.g. how to install a committee to mediate in case of a conflict)

If you choose to become a legally registered organisation (a foundation or an association) these rules and regulations can be the formal statutes. To fully understand the specific legal provisions and rules it is wise to consult an expert, i.e. a lawyer.

One important advantage of being a legally registered organisation is that it is easier to raise funds. Usually only registered organisations receive financial support from government and private organisations.

Being officially registered can also help make your organisation more trustworthy to other people and organisations. Official statutes make clear who you are and what you want.

It might be helpful to ask non drug users to join the board. One important criteria for their selection is that they should be able to provide relevant support for the organisation. This support could either be professional expertise (e.g. a lawyer, a medical doctor, etc.) or political influence (e.g. a politician, a priest, etc.). (See also the section "Professional support", page 47). Another necessary criteria for selection to the board is that the person sympathises with the idea of an interest group of drug users.

Choosing an organisational structure

Most organisations have either a horizontal or vertical structure. In a horizontal, i.e. completely democratic organisation, everybody involved has the same say; in a vertical, hierarchical organisation there are distinct levels or positions differing in power, e.g. board/co-ordinator/team. Usually, an organisation is positioned somewhere between these two poles.

If there are different levels or positions it is important to clearly define the following:

the responsibilities of these different levels (e.g. the board as employer, the co-ordinator and the members of the team as employees)

the tasks of these different levels (tasks of the employer, tasks of the employees, etc.)

the influence of these different levels on organisational policy and how this influence is guaranteed (e.g. election procedures, policy discussions, etc.)

As stated earlier (see page 42), it is important that everyone involved in an organisation has influence on the policy. This will motivate people to participate and contribute to the work of an organisation. The organisational structure of the MDHG (an Amsterdam interest group of drug users), provides a good illustration of how everyone involved can have input into decisions about organisational policy. (The MDHG is an association of drug users.).

The following levels can de distinguished in the organisation of the MDHG:

the members

the board

the team

sporadically involved drug users

visitors

Besides a number of registered members, all the people involved in the daily activities of the MDHG are counted as members, although some of them are not registered as such.

The board formally is the employer. By including drug users and some professionals it also serves as a basis for professional support. Once a year the board is elected by the members of the association.

The team includes some paid workers (permanent or part-time) and some volunteers (unpaid, receiving a weekly award and reimbursement of expenses). For both, there is a well defined selection procedure. The paid workers are appointed by a selection panel consisting of members of the board and the team. Volunteers are selected by the team from the sporadically involved drug users who are interested in more commitment.

Sporadically involved drug users are regular visitors to the office drop-in centre of the MDHG and sometimes assist with the work.

Visitors who just come along for a chat, advice, etc.

To assure that these different groups can exercise influence on the MDHG's policy, different platforms have been established for drug users to have their say.

an annual meeting of the members for a comprehensive discussion of the MDHG policy

monthly board meetings which are accessible for all members, where the focus is on the extensive line of MDHG work

a weekly team meeting, where the following topics are discussed:
what occurred and what has been completed in the last week?
what went well. Why?
what went wrong. Why?
what can/should be done next week e.g. setting priorities?

a so-called 'open evening' for anyone interested in the MDHG. After a round in which everybody has shared the 'most important' drug related event of the week an agenda is made up to discuss the most important issues. The result of this discussion is noted and placed on the agenda of the next weekly team meeting.

a written record of complaints/remarks. Frequent complaints are placed on the agenda of the team meetings as well.

This structure ensures that even drug users not regularly involved in the work of the MDHG have influence on setting priorities.

PROFESSIONAL SUPPORT

In order to provide professional support, two questions need to be answered:

what type of support is needed? and,

where to find this support?

What type of support is needed?

Support can either be provided at a material or at an immaterial level.

At a material level:
a meeting room can play an important role
to allow drug users to drop in
to talk with people in a more relaxed atmosphere than on street
to prepare some work/actions
a separate office can be of value, especially if the meeting or drop-in room is becoming too crowded to do office and organisational work
furniture for the meeting room and the office
office material such as a type-writer or computer, a telephone, a photocopier, etc.
money for office expenses (stamps, stationary, pens etc.), travelling expenses, etc.

At the immaterial level professional support could mean:
expert advice on
factual details such as infection risks, safer use and safer sex, treatments and services, legal provisions concerning the organisation etc.
the approach (questionnaire, outreach work, counselling, etc.)
development of the organisation's policy (e.g. the choice between a confrontation or compromise policy)
co-operation with professional organisations (e.g. HIV/ AIDS prevention, exchange of expertise, etc.)
moral support (positive public relations, defending your initiative, etc.)

Where to find this support

There are different organisations and/or professions who can support and even serve as allies for a self-organisation. These are:

HIV/AIDS and drug aid services (and other social services).

These services are valuable because they provide expert advice, training, supervision and personal support. They also can offer some support on the material level, for instance by offering office facilities, second-hand office material, etc. Services who have adopted a harm reduction model and who have a positive attitude towards drug user self-organisations are naturally the best to consult for support.

medical doctors
Can supply necessary medical information on such things as methadone and HIV/AIDS related aspects. They can also be of value for public relations support e.g. to support your organisation's views by 'facts', etc.

lawyers
Can provide legal information about beginning an organisation. They are also very useful for legal advice and public relations support.

scientists or researchers
Can support by helping to develop questionnaires, and project evaluations, and for conducting research. They can also 'scientifically' back your organisation's views.

politicians/policy makers

The support of political parties and policy makers is important for two reasons; firstly for obtaining financial support for running an organisation and secondly, for backing your organisations policy. However, be weary about aligning yourself too closely with one party. Among other things this may cause problems when trying to get a majority vote on relevant issues. Keep in mind that political parties always have their own agenda and can sometimes use a self-organisation to promote their own profile.

interest groups/human rights organisation

Can be valuable allies but often need to be convinced of the human rights implications of crimination and drug users. Their interests are generally too far removed from the specific interests of drug users. Sometimes they are working on quite abstract, political and ideological levels. Besides moral support they can offer support in setting up an organisation and maybe even office facilities.

press/media

As discussed in the section "Public relations" (see page 34), positive media coverage can be very valuable in convincing the public, politicians, and policy makers, that the work of a self-organisation is worthwhile. Standing up for your own interests demonstrates that people who use drugs are not necessarily 'junkies'.

church organisations

Can be important for some support in the field of finances and facilities. They can also be important for publicity, as they are generally seen as respectable and trustworthy.

police/justice

Confrontations with police and justice authorities are sometimes unavoidable. For drug users, the police are seen as a natural enemy. However, this is not necessarily so. There are examples of individual police who care about drug users and who are in favour of less repressive policing policies. Sometimes even police authorities are in favour of harm reduction measures. Furthermore, there are police measures which are in favour of drug users. For example, the Amsterdam and Rotterdam police forces are exchanging the used syringes of an arrested drug user when released. It is also important for drug users to examine and think over their sometimes stereotypical picture of the police. Although this picture is understandable, it need not always be true. After all, police are employed `to police'. It is worthwhile to try to find allies, at least on some issues. Police and justice officials, if well informed can provide support in the case of problems in a neighbourhood, critics on syringe exchange activities, etc.

The above listed organisations and people can be allies as well as adversaries. An important condition for support is that the basics of a harm reduction strategy are accepted by the individual or organisation. Public relations work is therefore very important. One should keep in mind that a negative, critical and confronting approach should only be used only when appropriate. In general a positive approach with some convincing developments and highlights in the right direction is more effective. Making compliments and being co-operative is also very worthwhile. Critics and confrontations can be more easily dealt with if you have adopted a positive approach.

When building up external contacts (see page 48) attention should be paid to where material and immaterial support is available. It is important to explain at length the aims and objectives of the self-organisation and why you have chosen for an approach which involves drug users, etc.

One possible problem with involving yourself in a network of professional organisations is that they tend to be very institutionalised. Hence, alignment and involvement may result in losing an insiders' trust and contact with drug users.

 

Peer support based in a professional organisation

 

INTRODUCTION

Peer support based in a professional organisation is usually developed and embedded in an already existing organisation. Often a professional drug aid service will choose this approach, to reach the 'unreached' because professional drug aid workers have not succeeded in doing so. This situation is quite different from the usual starting point of a self-organisation. Although one will not encounter the same problems a self-organisation has with having to build up from nothing, it can often be harder to change or adapt an already existing organisation to suit a peer support approach.

In this section we will focus on some important characteristics of peer support based in a professional organisation. They include:

different models, and

organisational prerequisites

DIFFERENT MODELS

With peer support based in a professional organisation, drug users (active, substituted and/or ex-drug users) are employees of a professional drug aid agency. Their incorporation in a professional organisation can and does vary.

One could choose for reasons of efficiency and organisational support (less expensive overheads, etc.) to base a relatively autonomous project within a professional organisation. This means that the peer support team operates more or less independently from the organisation and decisions about the team policy are made by the members of the team. Another option is to add one or more 'peer supporters' to an already existing team. This would mean that they are then integrated as colleagues in a professional drug aid team.

The actual choice within this range will depend on different factors as both approaches have their drawbacks. Choosing for the second option can result in a better integration of peer support in the work of the organisation and a professional drug aid network. However, this approach limits the influence of drug users on organisational policy more than the first alternative. The `pros' and `cons' listed under the heading "Autonomy or integration" (see page 5) can be useful when trying to make a decision about which option to choose.

Furthermore, the choice depends on the local situation. In a small city or region with a small drug using population, employing one or two 'peer supporters' is obviously more adequate (and feasible) than creating a team. The same is true in the case of a small professional organisation.

ORGANISATIONAL PREREQUISITES

Employing drug users within a professional organisation generally requires some adaptations in order to offer them a fair chance to succeed. This is especially true when one is choosing for active drug users as they may need some time and support to get used to working in a professional organisation. Bear in mind that professionals may also need some time and support to accept a drug user as their colleague. This means that the organisation must create conditions for both sides to become acquainted with the changed situation and appreciate the advantages of involving drug users.

In this respect, there are different points which deserve attention:

support of `peer supporters' and professionals

organisational adaptations

external contacts

Support of 'peer supporters' and professionals

As discussed earlier in the section on 'general organisational aspects' (see page 14), 'peer supporters' tend to need professional coaching and training and personal support. It is advisable to have a fixed arrangement, for example one hour on a specific day every week.

It is especially advisable for peer support embedded in a professional organisation to separate professional coaching and training from personal support. This can be done by having two different people performing these tasks. This will also avoid possible conflicting interests. After all, professional coaching and training of employees is in the interests of the organisation, whereas personal support is important for the individual worker.

An organisation should not expect that professionals will immediately accept involved drug users as their colleagues. Therefore, it is advisable to integrate professional supervision into professional support.

Organisational adaptations

To co-operate with drug users it may be essential to work outside the usual 'business-hours'. This is important if you want to reach the 'unreached'.

To assure the influence and motivation of drug users their position should be equal to the professionals in the organisation. This equality is especially important when deciding organisational policies. Drug users 'say' should have the same weight as that of their professional colleagues.

One problem with assuring this equality is that 'peer supporters' will generally be outnumbered by professionals in an organisation. It is therefore recommended to institutionalise an exchange of expertise on both sides (e.g. a meeting once a fortnight). This would mean that professionals are obliged to take note of the drug users' expertise and vice versa. Institutionalising this process ensures that this exchange of expertise is in fact occurring.

External contacts

It is useful to inform other co-operating organisations about  your peer support activities and 'peer supporters' (see "Introducing the project"). This makes the work of 'peer supporters' easier and more effective (e.g. in the case of refferal, expertise knowledge etc.).

Embedding peer support activities in a local or regional network can mean that other orgaisations can utilise the expertise of drug users.