The need for community health services is growing – according to the NHS Five Year Forward View – as it is recognised as being beneficial to peoples’ health and wellbeing. Moreover, most people prefer support at home – or within their community – where they control the agenda and care schedule and enjoy familiar surroundings.
The following guidance will support you to support others who use community services.
If you are working in a community team, visiting people in their homes will become a big part of your role. It can be daunting visiting someone in their own home, especially if you’re meeting for the first time. It can also be daunting for the person you’re visiting to have people in their home. This is a short guide which might help with your initial visits. The most important thing to remember is to listen to your instincts. When you are in someone’s home, you will be able to pick up on a lot of information about them and how they feel. They might be very relaxed and welcoming, or your instinct might tell you that something doesn’t feel quite right, or that the person doesn’t feel like talking. The more you can pick up on and respond to the feelings you get, the better you will be able to offer peer support (or not, if that’s what the person prefers!)
Here are some tips to help break the ice the first time you meet somebody in their home:
Follow the lead of the person you are visiting - This is about acknowledging that it is their home and you are a guest. Ask if they would like you to take your shoes off and allow them to lead the way to whichever room they feel comfortable talking in. You can ask where they would like you to sit, or you could wait for them to choose where to sit first and then check “is it okay to sit here?”
Introduce yourself and peer support - It might be that you have already met the person whose house you’re in or spoken over the phone about peer support. Your first visit is an opportunity to expand on what they already know about peer support. Peer support workers have different ways of introducing themselves and peer support. How you do this might depend on how much you feel comfortable sharing about your own lived experience, and how helpful you feel this would be. Some peer workers speak broadly about peer support, by saying that all peer workers have their own lived experience or have used mental health services and our role is to work as equals as we don’t have any clinical expertise and will not direct people on how their recovery should look.
Take things slowly – although you might have explained that you have your own lived experience, this doesn’t have to be the focus of your first meetings together. You can play it by here and allow the conversation to flow in a way that helps you to get to know each other. Meeting somebody in their home has its advantages as you can talk to them about who they live with, or you might pick up on their hobbies by noticing their surroundings. There is no need to rush to get to talking about the “problem”. While they might want to do this, some people are more nervous, and it can take a while to built up a rapport and trust. There is also no need to establish clear ‘goals’ on the first visit. It might be enough for them to meet you and make another appointment, you can take your time getting to know each other depending on the pace that you sense would work for the person.
Setting some gentle boundaries – while it might not be helpful to be too heavy handed with a conversation about what you can’t do within your role, it is a good idea to share some of the boundaries you work within. For example, you can share your working hours, and let people know that you won’t be able to answer your phone outside of these times. You can also say that sometimes you will miss calls if they try and ring you but that you will always try and ring them back when you can. If there are limits within your service about the length of time you’re able to offer support to someone for, you should share this with the person, so that they can plan how to use the time you have together, and so the ending doesn’t come as a shock to them.
When to wrap things up – you might pick up on cues that the person you’re with has had enough of talking. If you feel that the person is particularly nervous, you could ask them how long they would like you to stay for and make an agreement that you will leave at a certain time. This might help them to feel more in control. If you have to leave by a certain time, it’s helpful to say that at the beginning of your meeting too, in case you get talking and lose track of time. Before you go, don’t forget to ask them if they would like to make another appointment. You can remind them that there is no pressure for them to continue seeing you so that they know it’s their choice. You could also ask them how they would prefer you to contact them if you need to between visits, as some people prefer texts and others phone calls.
As the time you spend together continues, you might begin to think about the kinds of activities that you could do together. Of course, you will be led by what the person you’re supporting says that they would like to do, or by any goals they have set for themselves. This is the beauty of peer support and what makes our roles so varied in what we can do with people.
If the person you’re supporting doesn’t have any ideas of things they would like to do, you could ask if they would be interested in some of these activities, which are popular within peer support relationships:
Visiting a coffee shop or art gallery
Going for a walk around a nature reserve or park
Visiting the library
Supporting them in a hobby they’d like to pursue, e.g. horse-riding lessons or help them find volunteering opportunities
Doing some gardening
Going shopping – perhaps they need help with meal planning and budgeting
Cooking together – once you’ve supported them with shopping, use the ingredients to cook or bake
Supporting them in accessing short courses – Inspire have some great ones www.inspireculture.org.uk
Going to a group together, or supporting them to attend a group that is run within your community team
Don’t forget that you can be clear about any activities that you don’t feel comfortable doing, as peer support is reciprocal. For example, some peer workers would feel very uncomfortable supporting somebody to go swimming, and this is OK. You know for yourself the times when you could push yourself to try something new, and when this would not be helpful.
Sometimes peer workers are asked whether they can focus on a specific activity by the person’s care co-ordinator. This could be something like helping them clean their home or taking them shopping. In these situations, it can be helpful to check with the person whether this is something that they want, rather than something their care co-ordinator feels would be good for them. When it comes to these activities make sure that the person is still taking the lead, and that they feel mutual, so that you don’t feel stuck cleaning someone’s home or getting their shopping in a situation that doesn’t feel like it’s helping enhance the peer support you can offer.
Sometimes there are occasions where we realise we don’t feel safe in somebody’s home. These tend to be quite rare, but it helps to be prepared. Before you go on the visit, you can ask the care co-ordinator of the person you are seeing if there is anything they think you need to be aware of so that you can make a decision for yourself about whether this feels safe for you. If you are aware of specific things that would make you feel uncomfortable (for example large dogs) you can ask about these, and even ask that the person you are visiting makes some changes to support you to feel comfortable.
Your team should have a ‘whereabouts’ policy which is designed to make sure everybody who is working on their own in the community is safe and that the team are aware of where people will be. Typical whereabouts policies include:
If you have any concerns, always share these with a member of your team, and if you are very worried about making a home visit, you can decide to meet in a public place or to do a joint visit instead. If there are situations where you feel unable to make a visit because of your safety, this is OK. Your safety comes before anything else, and your emotional and physical needs should be your priority.
There are lots of reasons why a visit might be particularly difficult for us. For example, you may find yourself talking about topics that are particularly meaningful to you, or experiences you haven’t fully processed from your own life. There may also be times that the person you are working with becomes distressed or is admitted to an inpatient unit and these can leave us wondering if there was something we could have done differently, or something we should have picked up on.
The most important thing to remember is to be kind to yourself. There is no way that every peer relationship we build can go to plan 100% of the time. Every peer worker encounters difficult situations as part of their role so you are not alone. It can be helpful to reflect on any difficult situations within supervision. Reflection rather than rumination can help us to take some learning from the experience, rather than place shame or blame on our shoulders. If you’re ever in doubt about what to say to someone in crisis or worry about their safety then you can also contact the Duty Worker in your team or speak to your Supervisor. It’s important that you don’t carry the worry on your own.
There might also be times where you feel that you are not ‘clicking’ with the person you are supporting and this is OK too. Despite our best efforts, there is no way we will always feel a close connection with everybody we support. You might feel that persevering in trying to build rapport will send an important message to the person that you will not give up on them, or you might feel it is better to show them that you respect their space and have a conversation about ending peer support if it is not helping them. Only you will be able to know what is best based on your understanding of each situation, but again, supervision can help, as can being honest with the person you’re supporting about what you’re sensing in the relationship.