How a community college is helping meet growing demand for peer support specialists in Central Oregon

Last month, Central Oregon Community College in Bend launched a four-week-long training course for students to become certified peer support specialists. A peer support specialist is someone with lived experience and formal training to help others with recovery from substance use disorder or mental illness. According to a recent study by researchers at the OHSU-PSU School of Public Health, the number of certified peer support specialists would need to increase by nearly a third to meet the demand for substance use treatment services in Deschutes county alone.

This is the first peer support training course offered in central Oregon, according to COCC, and is aimed at helping to meet a growing need for mental health services and substance use treatment, especially in rural communities. Joining us are Jenny Cruickshank, an assistant professor of health and human performance at Central Oregon Community College; and Terry Rogers, who completed the peer support specialist training course and is the founder of Bible Street Ministry, a faith-based nonprofit helping people experiencing homelessness in Bend.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. As we talked about recently, a new study by researchers at the OHSU-PSU School of Public Health found that counties across Oregon need to greatly increase the number of certified peer support specialists they have if they want to meet the demand for substance use disorder treatment. Peer support specialists have formal training and lived experience with addiction or mental illness that can help them help others. Now, Central Oregon Community College in Bend has a four-week training course, Deschutes County’s first, to help people become certified peer support specialists. Terry Rogers is the founder of Bible Street Ministry, a faith-based nonprofit helping people experiencing homelessness in Bend. He was in the first cohort of students in this program. Jenny Cruickshank is an assistant professor of health and human performance at COCC, and she’s one of the facilitators for the training. They both join me now. Terry Rogers and Jenny Cruickshank, welcome.

Jenny Cruickshank: Thank you so much, I’m so thrilled to be here.

Terry Rogers:  Me, too. Jenny is awesome.

Miller: Jennifer, first. Why did Central Oregon Community College create this program?

Cruickshank: Well, there is such a need, not only just in Central Oregon but the entire state of Oregon. You know, mental health and substance abuse services are critically important across our entire state, and particularly Central Oregon, we’re comprised of primarily rural areas, and lack of access to care is even more prevalent because of that. And we noticed that the need for peers is so vital for supporting those that are going through mental health and substance abuse issues and more certifications, and opportunities for certification, are really needed, not just over on the other side of the state. Having a certification program available here in Central Oregon would really help out so many people that are working as peers currently but maybe do not have the certification.

Miller: Terry Rogers, I I think that describes you, and so we can talk about why you wanted to take part in this course in just a second. But how much of a need do you see day-in, day-out for peer support specialists in your community?

Rogers: I see a huge need. I’m in Central Oregon and to just multiple towns around here … I’ve been doing this for about two years and just meeting people right where they are. After taking this class, it really helped me really identify even better how to communicate and how to speak with people, to self-motivate them. Because in this faith-based organization I’m in, we’ve been going out to meet people where they are, like praying with them, and then giving them resources. But you know that, and I see by taking this class where I was really falling short, and I knew I was before I took the class.

Miller: Well let’s start there. Where did you feel like you were falling short in the work you’ve previously been doing?

Rogers: By doing this, it’s like people were just kind of okay where they’re at, even though they’re not. Even not knowing how to literally communicate in a way to self-motivate someone to do something different, and change their life. So, because the resources are out there, and I got sidetracked on resources, giving people everything they think they need. And then it’s like I didn’t see any progress and you know, they’re still in a tent they’re still in a warming shelter, and they’re not moving forward in their life. And it’s like, you give someone a phone number, but as a peer coming alongside of them – and by me taking this class, I see really with this certification how I can actually work directly now with like, probation and parole, and from inside the jail when they come out of the jail. And because I was literally a guy that was in jail, and I did the same things that I’m seeing right now and as a peer, this is just, it’s so needed.

Miller: So I’m curious, when you were dealing with an active addiction or when you were locked up, would people come to you and offer you versions of help that, either at the time or now, you could look back on and say we’re not helpful?

Rogers: Well, yeah, because even like with probation officers, I work with probation officers. [They] tried to work with me, but I looked at them as they are against me, because they’re the law, or I’m in trouble and it’s not like a peer, you know? I never had anyone to come alongside of me as just a peer – someone that lived the life, that I could trust and talk to. Because in active addiction, and going to jail, and all these things, I didn’t trust police officers. I didn’t trust probation officers tried to help me. I really was – even doctors in mental health, psychiatrist – because I went through all these motions and most of the time the people that were working with me didn’t have any life experience, and I would see that, and I’m like, ‘They don’t even know what I’m going through.’ They can say this. You know, they might have book knowledge, but it’s like they have no clue. And that was my mindset, even if they did know.

Miller:  Jenny Cruickshank, how much evidence is there that peer support is helpful?

Cruickshank: Well, there’s all sorts of evidence that we’re starting to see more – as far as Terry was saying – understanding that peer support specialists, they really do walk alongside people who are in recovery and they’re able to offer those individualized supports and also demonstrate that recovery is possible. And so I think we’re gonna start to see the benefits, more fruitful benefits, as we get more peer support specialists certified for sure, that are able to go to a variety of different communities.

But we also know that when we can have a peer support specialist working in conjunction to complement a clinical support system, then we have an increase in self-motivation and strength, and we see a desire for people to want to move forward when they’re experiencing challenges.

Some research also is showing that they’re more apt to stay in a recovery program with having a peer support specialist by their side. They are adding more to their community. They’re following recovery protocols. So really getting this behavioral health team network out there is going to be such a wonderful complement for health treatment plans. So I like to say, more peers in the system equates to a broader net cast to provide services and resources and that’s what makes me so excited to be a part of this. And also to hear Terry commenting about how much he’s already learned about the communication side of it.

Miller: The whole idea of peer support as you’re both describing it as we’ve talked about in the past, is that people who have experienced something and somehow come out the other side in a better position, that they’re more able to meet people where they are who haven’t gotten to that better side yet. But the fact that there is this course implies that, in addition to that lived experience, that peer support specialists also need to learn or could benefit from learning certain specific skills. Jennifer Cruikshank first, what are some of those skills?

Cruickshank: Well, a lot of these skills are really just being a good human, I like to say. But understanding what the roles are of a peer support specialist, and that covers ethics and boundaries, understanding trauma and the trauma process, and then also promoting health and wellness. So the importance of solid nutrition and physical activity and stress management and being able to promote that within the patients’ and clients’ community that you work with, but also promoting it within yourself, because we need to remember that peers are also within their own recovery. So we’re walking side by side with those that we work with, which means that we are also within our own recovery, and what Terry was alluding to also was our communicating – we do a lot of motivational interviewing, skill practice, and so that really helps build that foundation for the peer and the community member to be honest and open about what their goals are, how to work through maybe some fears or obstacles that they have within, moving forward with goal sets, and so motivational interviewing is a skill that we spend a lot of time doing.

Miller: What does motivational interviewing sound like?

Cruickshank: Well, motivational interviewing, it sounds like a collaboration. So I’m collaborating, let’s say with you, on maybe some goals that you have. The focus is listening in for maybe changed language that I hear from you; ‘Maybe my life would be different if I did the following,’ or, ‘How could I feel better about the following’ . I then start to use open-ended questioning and affirming what I’m hearing from you. I reflect with my listening to make sure that I’m hearing you clearly, and that really builds a sense of trust. That’s very much needed when we’re working with a population that is in recovery. And then summarizing the needs and moving forward with a plan. So, it really is based on accepting you where you’re at, having compassion, and then instilling that hope that we can get there by working together.

Miller: What’s the opposite of motivational interviewing? Or what’s a style of trying to help or trying to extract information that you think is less productive?

Cruickshank: Well I think we hear that a lot when we look at traditional medicine, but it’s the expert role. I’m not saying that there is not a time for us to use our expert hat, but a lot of times people will be stuck in the expert role of not really listening to what you need or what you want, but telling you what I think would be best for you – freely giving advice that might not be pertinent to your goals. Not listening to what you really need and having my own agenda versus listening to what is something that you’re ready to work through.

Miller: Terry Rogers, what did you learn about this style of talking to people, of interviewing them, from the course?

Rogers: Okay, we were just talking about motivational interviewing, you know, and it’s changing the way I was speaking to people. They would tell me what was going on in their life, and I lived that life, and I would start telling them about my life and how I made it through it. But through the motivational interviewing skills here, the skillset that we’re learning and I’m still learning – but it’s already working in my life with men I’m working with, like with adult teen challenge – and I go there and literally to give them self confidence and to not tell them what to do, but asking them so what do you, when you turn around for open ended question, and you answer a question with a question instead of just telling him what to do – and I helped the kid, adult and teen challenge, and he spoke with me, and he was really in a bind, didn’t know what to do. And so I asked him, ‘What do you feel like you need to do?’ And I let him answer his own questions. And the next day, when I seen him, I walked in, he was so excited and he said he was gonna write a letter and he came up with a way to address the problem with his family and he was so happy, the self confidence he got out of that. I mean, not giving him the answer, it  was just … I was still in the class when this happened, and I was just using what I was learning literally that day, I used it that evening, and with the motivation, and it changed the whole directory of what I would normally say.

Miller: It seems like it takes a little bit more humility on your part. I mean, you’re in this position because you are a kind of expert in your own recovery and you’re doing this because you want to help other people, but it seems like sometimes you have to now take a little bit more of a backseat and let people take the lead?

Rogers: Yes, even in the effective listening, when someone is speaking to you and just tell them the exact moment – like am I hearing you right – is this, what you’re going through, is the problem? And then it gets them thinking about it even more – and also myself – to where the person realized, ‘Wow, he’s really listening,’ because I just repeated what he said and it’s like these are the kind of things I’ve learned in there so far.

And actually even, we do a oral health certification in there too about teeth and the things that are going on with mental health with someone with their self-esteem and stuff because their teeth are bad, and you see someone holding their hand over their mouth. I was just talking to the guy literally the day before  yesterday, I noticed he put his hand over his mouth. He’s got bad teeth and how that really affects a person. So well in this class we actually learn about that too, and get them help with their hygiene on their teeth because it’s a big self confidence builder. I worked with a guy already with his teeth and literally the dentist, pro bono, fixed all his teeth and now this guy’s smile is so big and the confidence he got from that is just … I didn’t realize before I took this class how much a difference that makes in a person, you know, just with his teeth.

Cruickshank: Yeah.

Miller:  And Jenny Cruickshank, we just have about a minute and a half left, but…

Cruickshank: Oh, man, I could talk about this, all day…

Miller: Well, let’s squeeze this in. What has this experience overall been like for you?

Cruickshank: Oh, it has been beyond my wildest dreams. I, we had so much help to get this rolling within our community, not only at Central Community College, but also peers from our community – Cascades Peer Support and Self Help and Deschutes County Behavioral Health, the Oregon Health Authority, National Alliance on Mental Illness – I just have to plug that because this would not have happened without this team effort. So I just look at … I’m so grateful to have people like Terry. I mean I just have goose bumps. I’m smiling ear to ear listening to him. Locally, being able to see peers being hired, is going to be so wonderful for me and so rewarding. And also to continue to learn from other peers that are going to continue to take these courses and allow me to hone my skills even more and be able to give back to the community that feeling of self reliance and hope. It’s really, it’s fantastic.

Miller: Jenny Cruickshank and Terry Rogers, thanks very much.

Cruickshank: Thank you.

Miller: Jenny Cruickshank is an assistant professor of health and human performance at Central Oregon Community College, one of the instructors in this new program. Terry Rogers was one of the members of the first cohort. He is also the founder of Bible Street Ministry.

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