Vaya Health North Carolina Peer Support Specialist Training Program Application What does the training require? Vaya Health s North Carolina Peer Support Specialist Training is a 40-hour program that takes place over five days of instruction. Our training curriculum meets all criteria set forth by the state of North Carolina and includes a brief graduation ceremony on the final day of training. All students must be present and participate in ALL of the scheduled days and hours to receive a completion of training certificate. If you are unable to attend all hours of the training, please do not apply at this time. Students who do not complete all 40 hours will not earn the certificate of completion, which is required for an N.C. Peer Support Specialist Certification. What will I learn? Vaya s Peer Support Specialist Training involves lectures and group activities. In addition to classroom instruction and education, students strengthen their skills through role-play exercises, take-home activities and opportunities to share their personal experiences related to recovery and overcoming mental health and/or addiction challenges. Group activities require mutual respect and support from all participants. Trainers consider class participation, involvement in group activities and general attendance in assessing students readiness to deliver peer support services in a professional setting. PLEASE NOTE: This course provides N.C. state-required training for peer specialist positions. While we anticipate employment opportunities for certified peer specialists throughout the state in the coming years, completing this course provides NO guarantee of employment. You are responsible for applying for available positions and utilizing necessary community supports for job-seeking skills you may need. Am I eligible to participate? Please note that you are required to have a minimum of nine months of demonstrated, sustained recovery to be eligible to participate in this training. Additionally, you are required to have a minimum of one year of demonstrated, sustained recovery to become an N.C. Certified Peer Support Specialist. You must be age 18 or older. If you meet these criteria and would like to attend an upcoming training to prepare you to apply for state certification, complete and submit the form on the following pages. Instructions on submitting the form are listed on page 5. Vaya Health Peer Support Specialist Training Application Page 1 of 5 Community Collaboration Rev. 11.04.2016
TRAINING APPLICATION Date of this application: Which Vaya Health Peer Support Specialist (PSS) training class are you interested in attending? Class date: Class location: Classes fill quickly, and there is often a waiting list. Are you open to attending classes in other locations? Yes (List locations: ) No CONTACT INFORMATION Your first name: Last name: Your mailing address: Street/P.O. Box City State ZIP Code County Email address: (If you do not have an email address, we strongly recommend obtaining one. We will communicate heavily before, during and after training via email.) Phone number: Date of birth: Name and phone number for emergency contact: In which counties are you interested in working as a Peer Support Specialist? PERSONAL EXPERIENCES Your answers to the following questions will help the review committee choose between multiple applicants. Please fully answer all questions. You may attach additional sheets as necessary. 1. How did you hear about this training? 2. Can you identify yourself as a person who has received or is receiving services for mental health and or a substance use disorder? (Note: Having received professional services is not a requirement.) Please explain: Vaya Health Peer Support Specialist Training Application Page 2 of 5 Community Collaboration Rev. 11.04.2016
3. Are you willing to openly share your lived experience with others? Yes No 4. Have you completed a WRAP* class or correspondence course? Yes No (*Wellness Recovery Action Plan) Do you have a personal WRAP for your own use? Yes No 5. Are you self-described as being in recovery? Yes No If so, for how long? 6. Describe what has been helpful in your recovery. What tools do you use in your daily life to sustain recovery? 7. What does recovery mean to you? What factors are important in your own recovery? 8. Would you be able to support someone whose idea or pathway of recovery is different than yours? Explain. 9. Peer specialists are models of recovery for others. In what ways do you demonstrate recovery and goals geared toward a full and meaningful life in the community? Vaya Health Peer Support Specialist Training Application Page 3 of 5 Community Collaboration Rev. 11.04.2016
10. How do you use natural supports (unpaid supports, such as friends, family, etc.) in your recovery? 11. Why you are interested in peer support services and the possibility of working as a Certified Peer Support Specialist? 12. What strengths would you bring to a Peer Support position, and what skills do you feel you need to develop? 13. This training is an intensive course built on interaction and sharing of behavioral health experiences. What will be your greatest challenge in attending the training? How will you address this challenge? Vaya Health Peer Support Specialist Training Application Page 4 of 5 Community Collaboration Rev. 11.04.2016
SIGNATURE By signing below, I certify that I understand the above information and, if selected, plan to be present and actively participate in Vaya Health s Peer Support Specialist Training Program. Further, I give permission for the trainer to contact my references to verify the information provided. Applicant s signature: Date: Printed name: SUBMISSION INSTRUCTIONS Thank you for your application. Program participants will be selected based upon qualifications and availability. Please complete the following steps to finalize and submit your application: Admission to this training program requires two reference letters. See the attached Training Reference form for more information. Please note your relationship to the person providing the reference. Letters may be submitted by former or present employers, teachers, volunteer supervisors, clergy, staff who have provided your treatment services or other individuals who are able to testify to your qualifications. Submit your application in its entirety, including both reference letters and with all questions answered completely. If your application is not complete, you will not be considered for training. Mail your completed application and references to: Vaya Health Attention: Peer Support Training 408-B Spaulding Road Marion, NC 28752 Please note that there is a $30 fee for this training to cover the cost of materials. DO NOT send payment with this application. Applicants who are selected for the training will be asked to send payment upon notification of acceptance to the program. If you have any questions about this application or Vaya Health s Peer Support Specialist Training Program, email PSSTraining@vayahealth.com or call 1-800-893-6246, ext. 5925. Thank you for your interest in peer support! Vaya Health Peer Support Specialist Training Application Page 5 of 5 Community Collaboration Rev. 11.04.2016