Attachment 1: Core Competency Survey and Demographic Questionnaire
Core Competencies Survey
Category I: Engages peers in collaborative and caring relationships
Initiates contact with peers
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Listens to peers with careful attention to the content and emotion being communicated
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Reaches out to engage peers across the whole continuum of the recovery process
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Demonstrates genuine caring and respect
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Demonstrates understanding of peers’ experiences and feelings
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Comments:
Category II: Provides support
Validates peers’ experiences and feelings
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Encourages the exploration and pursuit of community roles
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Conveys hope to peers about their own recovery
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Celebrates peers’ efforts and accomplishments
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Provides concrete assistance to help peers accomplish tasks and goals
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Comments:
Category III: Shares lived experiences of recovery
Relates their own and others’ personal recovery stories to peers to inspire hope
1-important |
2-of little importance |
3-moderately important
|
4-important |
5-very important |
Discusses ongoing personal efforts to enhance health, wellness, and recovery
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Recognizes when to share experiences and when to listen
1-important |
2-of little importance |
3-moderately important
|
4-important |
5-very important |
Describes personal recovery practices and helps peers discover recovery practices that work for them
1-important |
2-of little importance |
3-moderately important
|
4-important |
5-very important |
Comments:
Category IV: Individualizes peer support
Reflects on his/her personal values and culture and how these influence peer support role and tasks
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Appreciates and respects the cultural and spiritual beliefs and practices of peers and their families
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Recognizes and responds to the complexities and uniqueness of each peer’s process of recovery
1-important |
2-of little importance |
3-moderately important
|
4-important |
5-very important |
Tailors services and support to meet the preferences and unique needs of peers and their families
1-important |
2-of little importance |
3-moderately important
|
4-important |
5-very important |
Comments:
Category V: Recovery planning
Assists and supports peers to set goals and to dream of future possibilities
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Proposes strategies to help a peer accomplish tasks or goals
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Supports peers to use decision-making strategies when choosing services and supports
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Helps peers to function as a member of their treatment/recovery support team
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Researches and identifies credible information and options on the Internet an through other resources
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Comments:
Category VI: Links to resources, services, and supports
Develops and maintains up-to-date information about community resources and services, both indigenous and formal
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Assists peers to investigate, select, and use needed and desired resources and services, both indigenous and formal
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Helps peers to find and use health services and supports
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Accompanies peers to community activities and appointments
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Participates in community activities with peers
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Comments:
Category VII: Teaches information and skills related to health, wellness, and recovery
Educates peers about health, wellness, recovery and recovery supports
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Participates with peers in discovery or co-learning to enhance recovery experiences
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Educates and mentors peers about how to access services and navigate systems of services
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Trains and coaches peers in desired skills and strategies
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Educates family members and other supportive individuals about recovery and recovery supports
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Demonstrates adult learning principles when giving instruction and coaching
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Comments:
Category VIII: Helps peers to manage crises
Recognizes signs of distress and threats to safety amon peers and in their environemnts
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Provides reassurance to peers in distress
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Strives to create safe spaces when meeting with peers
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Takes action to address distress or a crisis by using knowledge of local resources and service and support preferences of individual peers
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
39.
Assists peers in developing advance directives and other crisis
prevention tools
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Comments:
Category IX-Communicates effectively
Uses respectful, person-centered, recovery-oriented language in written and verbal interactions with peers, family members, community members, and others
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Uses active listening skills
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Clarifies their understanding of information when in doubt of the meaning
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Conveys their point of view when working with colleagues
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Documents information as required by program policies and procedures
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Follows laws and rules concerning confidentiality and respects others’ rights for privacy
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Comments:
Category X: Collaboration and teamwork
Works together with other colleagues to enhance the provision of services and supports
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Assertively engages providers from mental health services, addiction services, and physical medicine to meet the needs of peers
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Align efforts with health care providers to enhance the health and wellness of peers
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Coordinates efforts with peers’ family members and other natural supports
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Partners with community members and organizations to strengthen opportunities for peers
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Strives to resolve conflicts in relationships with peers and others in their support network
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Comments:
Category XI: Leadership and advocacy
Uses knowledge of relevant rights and laws (ADA, HIPPA, Olmstead etc.) to determine if there is a violation of a peers’ rights
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Advocates for the needs and desires of peers in treatment team meetings, community services, living situations, and with family
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Uses knowledge of legal resources and advocacy organization to build an advocacy plan
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Participates in efforts to eliminate prejudice and discrimination of people who have behavioral health conditions and their families
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Educations colleagues about the process of recovery and the use of recovery support services
1-important |
2-of little importance |
3-moderately important
|
4-important |
5-very important |
Actively participates in efforts to improve the organization
1-important |
2-of little importance |
3-moderately important
|
4-important |
5-very important |
Maintains a positive reputation in peer/professional communities
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Comments:
Category XII: Growth and development
Recognizes the limits of their knowledge and seeks assistance from others when needed
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Uses supervision (mentoring, reflection) effectively by monitoring self and relationships, preparing for meetings and engaging in problem-solving strategies with the supervisor (mentor, peer)
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Reflects and examines own personal motivations, judgments, and feelings that may be activated by the peer work, recognizing signs of distress, and knowing when to seek support
1-important |
2-of little importance |
3-moderately important
|
4-important |
5-very important |
Seeks opportunities to increase knowledge and skills of peer support
1-important |
2-of little importance |
3-moderately important |
4-important |
5-very important |
Comments:
Demographic Section
Sex/Gender:
____ Female
____ Male
____ Transgender
____ Other
____ Prefer not to respond
Ethnicity: (One or more categories may be selected)
____ No, not of Hispanic, Latino/a, or Spanish origin
____ Yes, Mexican, Mexican American, Chicano/a
____ Yes, Puerto Rican
____ Yes, Cuban
____ Yes, Another Hispanic, Latino, or Spanish origin
Race: (Check all that apply)
____ American Indian or Alaska Native
____ Asian
____ Black or African American
____ Native Hawaiian or Other Pacific Islander
____ White
____ Prefer not to respond
Education: What is the highest degree or level of school you have completed?
_____ Less than high school or GED
_____ High School or GED
_____ Vocational training
_____ Some college credit
_____ Associate’s degree (AA or AS)
_____ Bachelor’s degree (BA, BS, AB)
_____ Master’s degree (MA, MS, MEd, MSW etc.)
_____ Doctorate degree (PhD, EdD, MD, ScD etc.)
What is your age?
25 or under _____
26-29 _____
30-39 _____
40-49 _____
50-59 _____
60 or older _____
____ Prefer not to respond
In which state do you work? _________________________________
To whom do you provide recovery support services? (Check all that apply)
_____ People diagnosed with psychiatric conditions
_____ People diagnosed with substance use disorders
_____ People diagnosed with both a psychiatric condition and substance use disorder
_____ Youth, transition-aged young adults, or young adults (under 30 years old) with behavioral health conditions
_____ Family members of people with behavioral health conditions
Are you certified as a peer worker?
______ No
______ Yes
If yes, what are you certified as?
______ Peer support specialist
______ Peer recovery coach
______ Other Please write what you are certified as __________________________________
Employment: What is your current employment status?
_____ Employed full-time
_____ Employed more than 20 hours per week but less than full-time
_____ Employed between 10-20 hours per week
_____ Employed fewer than 10 hours per week
_____ Volunteer
Wages: What is your hourly wage?
______ Over $20.00/hour
______ Between $15.00 and $20.00/hour
______ Between $10.00 and $15.00/hour
______ Less than $10.00/hour
______ I am a volunteer
Employer: How would you describe the agency or organization that employs you?
______ Community-based mental health service (include residential programs)
______ Community-based addiction service (include residential programs)
______ Inpatient hospital service (mental health)
______ Inpatient addiction treatment service
______ Peer-run organization
______ Recovery community organization
______ Other; please describe ________________________________________
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Cheryl Gagne |
| File Modified | 0000-00-00 |
| File Created | 2021-01-26 |