Idaho Peer Support Specialist Training Application

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1 Idaho Peer Support Specialist Training Application This application must be received no later than July 31, 2015 Before completing this application, please first review the minimum requirements for applicants to be considered for the training: Minimum Requirements to Apply Be at least 18 years of age Have lived experience as someone who has a mental health diagnosis or co-occurring diagnosis Have at least one (1) ongoing and continuous year of recovery Be willing to share with staff and clients at your employment site your experience with mental illness and recovery Have a strong desire and commitment to help others with their own recovery Have a high school diploma, GED, or higher education Feel comfortable reading and writing Be able to use a computer, basic software, and Be willing to work productively as a team member with other mental health service provider staff Be able to access reliable transportation for traveling to work and possibly clients homes Read and understand the Peer Support Specialist Training Readiness Guide on the OCAFA website Read and agree to abide by the Idaho Peer Support Specialist Ethics and Guidelines Demographic Information Please provide the following optional information. This information will be used only for statistical data by Jannus, Inc. and Peer Support Specialist Training objectives. Gender Veteran Age Male Female Physical Disability Yes Ethnicity No Asian/Pacific Islander American Indian Black (not of Hispanic origin) Hispanic White (not of Hispanic origin) Other Supply two letters of recommendation from individuals supporting your recovery process This completed form, along with your two letters of recommendation from individuals who know you in your recovery process may be submitted by mail, fax, or in-person to: Bobbi Matkin Fax: Peer Support Specialist Training Director Phone: West Jefferson Street Boise, ID 83702

2 Idaho Peer Support Specialist Training Application This application must be received no later than July 31, Date of application: 2. Name: First Last 3. Address: Street Apt. # City State Zip Code 4. Contact Information: Primary Phone Address REQUIRED 5. Employment Status: Unemployed Employed Part-time Employed Full-time Student Volunteer If employed, please provide: Job Title Name of Employer 6. Educational Level (please check highest level achieved): GED High School Diploma Technical School Some College Associate Degree Bachelor s Degree Master s Degree If degreed, certified or licensed, please list specific field of study: Please submit two letters of recommendation from individuals who know you in your recovery process

3 Your name: Please answer the questions below. They must be your own answers, and in your own handwriting. Please use complete sentences and make sure your writing can be read. There are no right or wrong answers to these questions. Your answers will be used to learn about your interest in working as a Peer Support Specialist and assess your reading and writing skills. Again, please respond using your own handwriting. 1. Why do you want to become a Peer Support Specialist? 2. What makes you a good candidate to work with adults who have a mental illness? 3. What does working as a Peer Support Specialist mean to you?

4 4. Please discuss your diagnosis of mental illness including when you were diagnosed and the services you have received. 5. What does recovery mean to you? 6. Describe how grounded you are in your recovery. 7. What were some of the important factors in your own recovery?

5 8. Peer Support Specialists tell their own recovery stories when assisting others in recovery. Why do think this is important? 9. How effectively can you tell your recovery story? 10. What types of advocacy have you done for consumers of mental health services? Please describe any public speaking, letter writing, board or committee membership, special events, leadership in consumer services, or other work. 11. Describe your experience working as a member of a professional team.

6 12. Describe the strength of your reading, writing, computer, and skills. 13. What type of access do you have to reliable transportation? 14. Describe your current employment, volunteer, or school situation. If you are not working, volunteering, or going to school, how do you spend your time? 15. The Peer Support Specialist Training will be held Monday-Friday from 9am-5pm and may be in a different town from where you reside. The training will cover many aspects of recovery and working with mental health consumers and some of the material may feel sensitive. What will be your most difficult challenge in attending this training? How will you deal with this challenge?

7 16. What did you learn by reading the Peer Support Specialist Training Readiness Guide? 17. What does the Code of Ethics found at the end of this application mean to you? 18. Please let us know if you live in a rural and/or underserved location and plan to work in this community, and tell us about the benefits that peer support services would bring to the area. 19. Is there anything else you would like us to know in considering you as a trainee? 20. Are you able to pass a criminal background check? This is not a requirement for admission into the training, but it will be for obtaining employment as a Peer Support Specialist. 21. Are you currently enrolled in mental health court, drug court, or a problem solving court? 22. Are you currently on probation or parole?

8 This application must be received no later than July 31, 2015 Please sign your initials ONLY to the items below that apply to you: I am at least 18 years of age. I have lived experience as someone who has a mental health or co-occurring diagnosis It has been at least one year since I was diagnosed with a mental illness. I have at least one (1) ongoing and continuous year of recovery. Yes, if employed as a Peer Support Specialist, I agree to disclose my experience with mental illness and recovery to staff and clients as appropriate. No, if employed as a Peer Support Specialist, I do not wish to disclose my history with mental illness. I understand that completion of the Idaho Peer Support Specialist Training does not guarantee me employment as a Peer Support Specialist. I understand that completing the Peer Support Specialist Training does not guarantee me certification as a Peer Support Specialist and I will need to learn about the certification process. I have a high school diploma or GED certificate. I am able to use computer and basic software. I feel comfortable reading and writing. I have access to reliable transportation. I completed all of the questions on this application on my own. I understand that clearing a criminal background check is required in order to work with vulnerable adults and most likely will be a condition of employment with employers in Idaho. I have read the Idaho Peer Support Specialist Code of Ethics and I agree to adhere to them. I have read and understand the Peer Support Specialist Training Readiness Guide. How did you hear about the Idaho Peer Support Specialist Training? Your completed application along with 2 letters of recommendation from individuals who know you in your recovery process may be submitted to: Bobbi Matkin Fax: Peer Support Specialist Training Director Phone: West Jefferson Street Boise, ID 83702

9 Idaho Peer Support Specialist Code of Ethics & Professional Conduct Peer Support is a helping relationship between mental health clients and Certified Peer Support Specialists. The primary responsibility of the Peer Support Specialist is to help those they serve achieve self-directed recovery. As such they are committed to providing and advocating for effective recovery-based services for the people they serve in order for them to meet their own needs, desires, and goals. 1. Peer Support Specialists believe that every individual has strengths and the ability to learn and grow. 2. Peer Support Specialists will advocate for the full integration of individuals into communities of their choice. 3. Peer Support Specialists respect the rights and dignity of those they serve. 4. Peer Support Specialists respect the privacy and confidentiality of those they serve. 5. Peer Support Specialists never intimidate, threaten, or harass those they serve; never use undue influence, physical force, or verbal abuse with those they serve; and never make unwarranted promises of benefits to those they serve. 6. Peer Support Specialists do not practice, condone, facilitate, or collaborate in any form of discrimination on the basis of ethnicity, race, gender, sexual orientation, age, religion, national origin, marital status, political belief, or mental or physical disability. 7. Peer Support Specialists never engage in sexual/intimate activities with colleagues or those they serve. 8. Peer Support Specialists do not accept gifts of significant value from those they serve. 9. Peer Support Specialists do not enter into dual relationships or commitments that conflict with the interests of those they serve. 10. Peer Support Specialists maintain high standards of personal conduct. 11. Peer Support Specialists role model recovery. 12. Peer Support Specialists openly share their personal recovery stories with colleagues and those they serve. 13. Peer Support Specialists conduct themselves in a manner that fosters their own recovery and maintain healthy behaviors. 14. Peer Support Specialists ensure that all information and documentation provided is true and accurate to the best of their knowledge. 15. Peer Support Specialists keep current with emerging knowledge relevant to recovery, and openly share this knowledge with their colleagues and those they serve. 16. Peer Support Specialists remain aware of their skills and limitations, and do not provide services or represent themselves as expert in areas for which they do not have sufficient knowledge or expertise.

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