Massachusetts Certified Peer Specialist Training Application Packet

Transcription

1 Packet This packet includes everything you will need to apply for the Massachusetts Certified Peer Training Program. There are several steps to this process which are clearly outlined in the Instructions, so be sure to start there! Class Dates: Instructions. Page 2 Self-Assessment Pages 3 & 4 Application Pages 5-13 References Pages 15 & 16 Framingham Classes will be held at Advocates, Inc., 1881 Worcester Road, Framingham. September 19 October 3, 17, 24, and 31, November 7 and 14 (snow date) Lawrence Classes Classes will be held at DMH, 15 Union Street, #13, Lawrence, MA September 21 October 5, 12, 19, and 26, November 2 and 9 (snow date) Joint Retreat for both Classes: 9/26/11 9/28/11 at Wachusetts Village Inn, Westminster, MA Requirements to participate in the CPS Class: 18 Years or older Have a High School Diploma or GED Been actively working on your recovery for at least 12 months. Primary experience in mental health recovery (even though you may also have a substance abuse history/recovery). Steps for Applying: Complete Self Assessment Check calendar to make sure you re available for ALL training days Request an Interview Bring your completed application to the Interview Make sure your references have been submitted, no later than the day of your Interview.

2 INSTRUCTIONS Please Read All the Instructions Carefully Before You Begin 1. Download the application and self-assessment (if you have not done so already) on the Transformation Center website, (If you do not have Internet access, please use your local library, RLC, or ask a friend to download it for you.) 2. Complete the Self-Assessment. The self-assessment tool will help you to decide if participating in the CPS Training course makes sense for you at this time. The self-assessment should not be submitted it is for your selfevaluation. However, it must be completed because the application asks you about your experience. If, based on the self-assessment and a review of the application, you decide to continue with the CPS application process, go on to step #3. 3 Schedule an Interview Meeting. Acceptance will be done on a rolling admission basis. You can complete the application after requesting the Interview. The last day to request an interview is July 29 th, so make your request early. Requests for interviews will begin on July 11, cps@transformation-center.org and let us know your top two choices. We will you a confirmation with your date and interview time, and directions to the Interview. You can interview in either of these locations: In LAWRENCE (15 Union Street, #3) on July 20, August 5 and August 9 In FRAMINGHAM (1881 Worcester Road) on July 23, August 6 and August 11 THE LAST DAY TO REQUEST AN INTERVIEW IS JULY 29 TH!! 4. Ask 2 people to complete a Reference for you. These should be mailed directly from the person offering the reference to the Transformation Center. Your interview date is the deadline date for your references. Reminder: you are responsible for ensuring that the person submits the reference on time. 5. Come to your Interview with your COMPLETED Application We look forward to seeing you!! 2

3 CPS Course Self-Assessment These questions are meant to assist you in deciding about participating in the CPS course. These questions address the knowledge foundation and supports that have contributed to success in the class for past CPS participants. This is for your use alone and does not have to be submitted with your application. However, it MUST be completed, as you will be asked about your experience with the self-assessment in the actual CPS application Circle One 1 I have easy access to transportation to get to and from classes. Yes No 2 I have taken and completed formal schooling, adult education classes, or a GED or High School Equivalency program in the last 5 years. 3 I make the final decisions about my treatment choices. Yes No 4 I have successfully worked in the last 5 years. Yes No 5 I have read articles by Pat Deegan, Judi Chamberlin and other peer leaders. Yes No 6 I am active in my local Recovery Learning Community. Yes No 7 I have completed a Peer Facilitator/Mentor Course. Yes No 8 I get the majority of my support from my friends and family. Yes No 9 I have a personal wellness plan. Yes No 10 I feel ready to be an actively involved in a class that includes individual and group participation. 11 I am able to be away from my home for a three-day retreat. Yes No 12 I have completed WRAP training. Yes No 13 I have taken the Massachusetts Leadership Academy course. Yes No 14 I have worked or volunteered as a peer group facilitator or mentor. Yes No 15 I have attended peer support groups. Yes No 16 I explore options about treatment and/or medications in order to widen my choices. 17 I m comfortable talking about my own story and experience. Yes No 18 I can listen to other people s stories and feel empathy for their experience, even when it parallels painful places from my past. 19 I am able to make my own arrangements (transportation to and from training, lunch, etc.) and organize my needs for a full day of training. 20 I am able to participate for a full 8-hour training day. Yes No Scoring: Enter the number of questions (Q1 Q 10) you marked yes (Score A) Enter the number of questions (Q11 Q 20) you marked yes X 2 = (Score B) Add Score A and Score B to get your Total Score = CONTINUED ON NEXT PAGE Yes Yes Yes Yes Yes No No No No No 3

4 What your Total Score means: If you scored Below 15 Then you are Well-prepared! You have a solid foundation in place to support your participation in the CPS course. Probably ready to start the CPS course. While not as strong a foundation as possible, you have the basics to support your participation. You may have trouble completing the CPS course without additional support/education. Participation in the CPS course will present you with a significant learning curve, as you may need to learn a variety of skills needed to be successful. You might not be ready to start the CPS course at this time. Participation may require you to learn many new skills while also exploring a whole new framework for your past experiences. While you are still welcome to apply for the CPS course at this time, if you think you are ready, you may want to consider building a stronger foundation and applying for a later class. Suggested ways to strengthen your foundation are listed below. The guide above is only a general guide. This survey has not been tested to determine whether these scores really do predict completion. However, the survey items were selected based on factors that have contributed to the success or difficulties of past CPS course participants. If you would like to strengthen your foundation in order to be better prepared for the CPS course, review the questions where you answered no, and develop a personal plan that will help you change those answers to yes. Here are some specific strategies that may be helpful: Participate in your local Recovery Learning Community (RLC). Information can be found at Learn more about peer work and peer supports on the Internet. Get involved in a peer support group. Read first-person stories of recovery by people such as Pat Deegan, Judi Chamberlin, Dan Fisher and Others. Some helpful links - National Empowerment Center - BU Repository of Recovery Resources: The Copeland Center WRAP Institute for Recovery and Community Integration - SAMHSA Consumer Survivor Information - 4

5 Massachusetts Certified Peer Specialist Training Application, FALL 2011 Name: Date: Address: Street City State Zip Phone: Numbers we can use to contact you Home Work Cell Is there a back-up contact for you if we re unable to reach you with the above contact information? Name: Phone: Training Location Circle your first choice Lawrence Area Framingham Area A. Applicant Requirements: Applicants must have experienced being diagnosed with a mental health condition, and identify themselves as a person who has used, or uses, mental health services in their own recovery process. Applicants must have a high school diploma or a GED certificate and demonstrate strong reading comprehension and written communication skills. Applicants must have demonstrated experience with leadership or advocacy, either from work or volunteer experience as a peer specialist, peer mentor, or community member. Applicants must be well grounded in their own recovery with at least one year of experience working on their own recovery. B. Instructions: This application is an important tool in program acceptance. Please complete thoroughly and completely. The application form must be completed by YOU, the applicant, only. You may type or handwrite the form. If you choose to type your application, do NOT type your name or initials in the places that ask you to initial or sign. You should download and complete the self-assessment form. This is just for you (don t submit), but you will need to discuss the process in your application. Answer each question completely. Due to limited resources, we are not able to contact you to get missing information. As incomplete applications are frequently removed from consideration, be sure to check that you ve completely answered all questions. 5

6 The application process includes two (2) References that are on pages 11 & 12 of the application package. The References are due by your interview date. It s up to you to ensure that your References are submitted on time. o o If mailed, post-mark must be on or before the due date. If faxed, forms must be received no later than 4 pm on the due date. You are responsible for confirming that the fax was received. All applicants must attend an Interview Meeting where applications are received and applicants are interviewed by members of the CPS training team. Dates for the Interview Meetings will be posted, and all applicants should bring their completed application (excluding references). Please complete all sections fully. C. Answer the Following Questions: Do not write on the back or attach extra pages. If you need more room to complete your answer, use the space provided on page 11, and be sure to identify which question you re completing. 1. Will you need any special accommodations during the training - Physical, dietary, etc.? (All accommodations must be pre-arranged) No Yes What accommodations? 2. Working Status: I am currently (check all that apply): Working as a Peer (paid) (peer specialist, recovery coach, etc.). On a CBFS Team In an ESP program In a RLC Working as a Young Adult Mentor (paid) Volunteering as a Peer (non-paid) Volunteering as a Young Adult Mentor Working in a traditional job in a mental health setting. Working in a job that is NOT in a mental health setting. I am not working If you are working (paid or volunteer), please complete the following: Agency Contact Person Tel No: (for verification) Hours per week: 6

7 3. What does recovery or resiliency mean to you? 4. Describe what you learned about your readiness for the CPS class from completing the self-assessment? What strengths will support you in the class and what areas might need strengthening? 5. If you are currently working in a peer or mentor position (paid or unpaid), please describe the work you are doing and how your work contributes to others peoples recovery or resiliency in their own life. 7

8 6. Have you had any experiences sharing your lived experience in relation to moving beyond a mental health diagnosis? Yes No If yes, please describe the situation(s) and what it was like for you to share your story. If no, how would you feel about sharing your experiences in recovery? 7. Have you ever participated in a a. WRAP training? Yes No b. Peer Facilitator training? Yes No c. Mass. Leadership Academy? Yes No d. Peer support group? Yes No e. Clubhouse Leadership Yes No f. Young Adult Leadership Yes No g. Trainings/Conferences Yes No 8. If yes to any of the above, please describe what you gained from this experience, and how you might use this experience as a Certified Peer Specialist? 9. Why do you want to participate in the CPS training course? How do you envision using your lived experience within the mental health system in your work as a CPS? 8

9 10. Who has played an important role in supporting you to move beyond a mental health diagnosis, and in what ways? (This can include family, peers, therapists, friends, etc.) 11. Please describe any specific leadership roles have you taken to support people receiving services in the mental health system? Briefly describe what you ve done, with whom (groups/agencies), when, and what you ve learned about yourself from these experiences. 12. Please describe any specific advocacy roles have you taken to support people receiving services in the mental health system? Briefly describe what you ve done, with whom (groups/agencies), when, and what you ve learned about yourself from these activities. 9

10 13. Describe what role peer support has played in your own life. 14. What will be your most difficult personal challenge in attending this training? How will you deal with this challenge? 15. The CPS training includes listening to and sharing experiences that may evoke painful feelings for you. What self-care skills and coping strategies will you bring with you to assist in these times? 10

11 16. USE THIS SPACE TO COMPLETE ANY EARLIER ANSWERS. PLEASE IDENTIFY WHICH QUESTIONS YOU ARE CONTINUING. 11

12 The following questions are voluntary. Your acceptance will not be influenced by whether or not you complete this section. We ask this information for two specific reasons. First, we are conducting ongoing research on the CPS training course, including demographic statistics. Second, we are committed to strengthening the learning environment by creating classes that are balanced and diverse. GENDER Male Female Transgender AGE Under and over SEXUAL ORIENTATION LGBTQQA Heterosexual RACE/ETHNICITY African American Asian Caucasian Hispanic Non Hispanic Native American/Alaskan Multiracial Other: EDUCATION High school or GED Some college College degree Postgraduate degree Other: Have you EVER received any services funded by a state Department of Mental Health (inpatient, outpatient, community, case management or any other services?) 12

13 Read each of the following statements thoroughly!! Initial each statement that you agree with. Reference Form Process (Reference Forms are on pages 14 and 15) I understand that reference forms may not be completed by family members. Peers, employers, volunteer supervisors, educators, or other individuals that have a good understanding of my characteristics and skills may complete reference forms. I understand that it is my responsibility to ensure that the Reference Forms are submitted on time. I also understand that the Reference Form deadline is the same day as my interview. I have known at least one person providing a reference for at least one year. I understand that the people filling out the references will mail them directly to CPS program staff. (If FAXED, you must confirm that it was received) I understand that I can decide to waive or not waive the confidentiality of the reference forms, and the choice will not impact my acceptance to the class. I have read and signed the designated area on the reference form myself. Agreements for Participation (DO NOT TYPE). Initial each statement that you agree with. I completed this application on my own. I understand that the Mass. CPS program is not a job placement program. Yes, I agree to share my recovery experiences as part of my job/work as a CPS. I intend to seek paid employment as a CPS. I have a high school diploma or hold a GED certificate. (If requested, I can provide documentation) I have been involved in recovery for less than one year. No, I do not wish to disclose my recovery experiences in my work as a CPS. I have read the schedule for classes and can fully commit to each class day and the overnight retreat. I ve never really had the experience of receiving a mental health diagnosis or facing extreme emotional states, but am in recovery from substance abuse/addiction. I understand that the training program has been funded for the purpose of enhancing the peer work force in Massachusetts. If accepted, I agree to take the certification exam following completion of the training. If accepted, I understand that I am responsible for all travel expenses and arrangements* and that the CPS program staff will not provide assistance in making these arrangements or covering related costs. *If you are traveling by bus or train, we will try to arrange to pick you up at the nearest station provided that you make such arrangements in advance. Signature: Print your name: 13

14 Massachusetts Certified Peer Specialist Training Reference Form Confidential TO BE COMPLETED BY APPLICANT WAIVER: I WAIVE or I DO NOT WAIVE (please circle) my right to see my Reference Form after it is completed and submitted for consideration. This decision will not affect consideration of your application in any way. Both the referrer and I understand that this form must be faxed or post-marked by the Reference Deadline, and that late submission may disqualify me from acceptance to the training. APPLICANT NAME & SIGNATURE: DATE: TO BE COMPLETED BY REFERRING INDIVIDUAL Please Mail to: The Transformation Center, 98 Magazine St, Roxbury MA OR Fax to by the Reference Due Date (ask applicant what their due date is). Call w/questions Phone/Contact Number The CPS Training Course is a rigorous training for people working or hoping to work as Certified Peer Specialist. It includes an Orientation Day, three-day two-night retreat, followed by 5 full-day classes. There is homework between classes, and people are required to participate in class activities, etc. There is also a written and oral exam four weeks after the end of class. 1. How long have you known the applicant and in what capacity? 2. What strengths have you observed that will support this person s success in the class? 3. What have you observed that might be considered challenging for this person with respect to the CPS class? Print Name: Signature: Date: 14

15 Massachusetts Certified Peer Specialist Training Reference Form Confidential TO BE COMPLETED BY APPLICANT WAIVER: I WAIVE or I DO NOT WAIVE (please circle) my right to see my Reference Form after it is completed and submitted for consideration. This decision will not affect consideration of your application in any way. Both the referrer and I understand that this form must be faxed or post-marked by the Reference Deadline, and that late submission may disqualify me from acceptance to the training. APPLICANT NAME & SIGNATURE: DATE: TO BE COMPLETED BY REFERRING INDIVIDUAL Please Mail to: The Transformation Center, 98 Magazine St, Roxbury MA OR Fax to by the Reference Due Date (see applicant for their due date). Call w/questions Phone/Contact Number The CPS Training Course is a rigorous training for people working or hoping to work as Certified Peer Specialist. It includes an Orientation Day, three-day two-night retreat, followed by 5 full-day classes. There is homework between classes, and people are required to participate in class activities, etc. There is also a written and oral exam four weeks after the end of class. 1. How long have you known the applicant and in what capacity? 2. What strengths have you observed that will support this person s success in the class? 3. What have you observed that might be considered challenging for this person with respect to the CPS class? Print Name: Signature: Date: 15