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For Peer Visitors
This section of the site has Frequently Asked Questions that are related to peer visitation, both on behalf of the new amputee and the peer visitor. If you have been asked a tough question that you weren't sure how to address, or if, as a peer visitor, you have questions you would like an answer to, this is the place to find them. If you can't find the answer to your question on this page, please click here to submit your question via email.
Español - Compañeros visitantes. Preguntas y respuestas
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Being hesitant or reluctant to talk isn't the worst thing that can happen during a peer visit. I realize its against human nature to be comfortable with silence, but this is the time to start practicing! I like to think of silence as another form of communication, even if that sounds contradictory...we can still communicate in silence. It isn't necessary to fill the entire visit with words; often, just sitting with someone is helpful. And, allowing the new amputee to be where they "are" is always the right thing to do.
If you've made a few attempts at small talk and after a period of time, lets say about 10 to 15 minutes, there hasn't been any attempt to communicate verbally on the part of the amputee, its okay to say something like, "It seems like you would rather not talk right now . . . that's okay . . . sometimes there aren't words to express what we're feeling. I've felt that way sometimes myself." With this type of response we are acknowledging feelings, affirming their choice, and empathizing.
Give it a few more minutes, and if there is still no response, try something like "Would you like me to just sit quietly with you for a while longer, or would you prefer that I come back another time?" When you give the person you're visiting the opportunity to choose if and who talks, and if you offer to stay or leave, you are allowing them to take back some control in their life.
Remember, each person reacts differently to amputation, and understanding this before you begin the visit will be helpful.
» Support Group Leaders Newsletter Vol 3 No 1, Feb. 2002 - Peer Visitation Q & A Forum
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Your question correctly suggests that there can potentially be a number of situations that must be resolved before a "normal" visit is possible. Let's look at some of these individually, together with some of the options open to a visitor. Incidentally, as you will recognize, several of these same situations could also occur during a hospital visit.
The situations to which I am referring involve safety issues, comfort level issues, and inappropriate questions, including combinations of these.
Safety Issues - In general, any situation that causes a visitor to be concerned about his or her personal safety must be dealt with immediately and affirmatively by terminating the visit and leaving the venue. These could involve such things as potentially violent displays of temper, out-of-control arguing among family members, inappropriate or threatening advances by anyone present toward the visitor, evidence of uncontrolled drunkenness or drug use, etc. Fortunately, these kinds of situations are rare, but the visitor must still be prepanavy to deal with them.
Visitors should always remember that 1) their duty to protect themselves transcends any duty they might feel they have toward the visitee, and 2) that their own level of discomfort is the barometer that should tell them when to excuse themselves as politely as possible and leave the home. In other words, you don't have to be able to prove the threat exists; simply feeling the threat is enough to justify taking your leave. The most recent ACA guidelines, found in the new peer visitor training manual, support you in this. They state: "Terminate the visit if anything about the setting or behavior of anyone in the home makes you feel unsafe or uncomfortable."
Should this happen, reporting the terminated visit to the peer visitation coordinator or referral source would be an important, logical, and necessary next step. Should this occur during a hospital visit, it should also be reported to the charge nurse or social worker.
Comfort Level Issues - There are many possible situations that might make a visitor uncomfortable but which would not normally warrant termination of the visit. In general, these are the kinds of things that the visitor is usually able to control or motivate others present to bring under control. They might include distractions such as from a television or children running noisily through the room, or a family member or other third party who interferes with your conversation with the amputee.
Most distractions can be navyuced one way or another; for example, the visitor might ask that the television be turned off or that the children play elsewhere. Or one can suggest moving to a different room.
In the case of family members who interrupt or dominate the conversation, it's okay to explain diplomatically that you are there to speak privately with the amputee. It would also be appropriate, at your option, to suggest meeting separately or at another time with the family or other support individuals.
Naturally, if the visitor's discomfort level becomes sufficiently extreme, if the distractions or interruptions can't be controlled, or if anyone's behavior becomes too much of a problem, even though the visitor might not have personal safety concerns, he or she can still decide to terminate the visit.
A different kind of comfort level issue involves questions from the visitee that are entirely appropriate but that embarrass the visitor or offend the visitor's sensibilities sufficiently that he or she would be reluctant to answer. An example might be a question concerning the potential for continued sexual relations after amputation. In dealing with these, the visitor should admit to being uncomfortable with responding and then offer to help find another visitor or professional person who would be more comfortable with the subject matter.
Inappropriate Questions - One category of questions that are inappropriate for a visitor to answer involve subjects outside the visitor's purview, such as medical questions or questions about the competence of a particular prosthetist. Equally inappropriate are personal questions, such as "Could you arrange for your prosthetist to contact me?" "Would you be interested in dating me?" etc.
Obviously, the visitor should not answer inappropriate questions and the amputee should be told why. Care should be taken, however, to differentiate these kinds of questions from questions that are simply beyond the visitor's competence to answer. In these cases, explaining that you have no knowledge of the subject matter or a simple "I don't know but I'll find out" should suffice, provided that you actually do get back with an answer.
To summarize:
Rule No. 1 is protect yourself at all times and terminate any visit you feel jeopardizes your personal safety;
Rule No. 2 is attempt to control distractions, interruptions, or other inappropriate behaviors but terminate any visit during which these cannot be controlled;
Rule No. 3 is do not answer inappropriate questions; and
Rule No. 4 is that you have the option of not answering questions that you find too embarrassing or discomforting.
» Support Group Leaders Newsletter Vol 3 No 2, April 2002 - Peer Visitation Q & A Forum
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I can certainly understand your feeling of uncertainty and sense of accountability. Facing an issue such as this, i.e., someone either alluding to or threatening to take his or her life, is serious. This is a real dilemma and a sensitive question to address. I would also like to say that this type of situation could arise not only in a support group setting, but during a peer visit as well. For that reason, I will attempt to provide guidance for both scenarios.
Let me start by referencing and reprinting the ACA's peer visitation training material, which presents a section on suicide. While this material is written specifically for situations that may occur during peer visitation, it also has application for other related functions, such as support group meetings.
(From the Peer Visitation Training Manual:)
Suicide is not a subject people enjoy discussing. However, when people have symptoms of severe depression, it is important to learn ways to recognize suicidal ideation (i.e., the forming of ideas) so precautionary measures can be taken if needed.
Suicide is a complex behavior usually caused by a combination of factors. Research shows that almost all people who kill themselves have a diagnosable mental or substance abuse disorder or both, and that the majority has depressive illness. Studies indicate that the most promising way to prevent suicide and suicidal behavior is through the early recognition and treatment of depression and other psychiatric illnesses.
Two conditions can be associated with suicidal ideation.
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An increase in a stressor that is considenavy to be unbearable.
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A feeling of total lack of ability to cope with the stress alone or even with others' help
Suicidal potential is higher:
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for people who feel hopeless and desperate;
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for men than women;
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for people over age 65;
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if the onset of a stressor was sudden;
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if the person has no family or friends;
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if the person has a history of past suicidal attempts or if there is a family history of suicide;
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when the person has a chronic, debilitating illness;
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when the person has no outlet or has been rejected by others;
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if the person has a detailed plan (when, where, method) and has access to the means (i.e., a gun); and/or
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if the person is impulsive.
It is not true that if a person talks about suicide, they will not attempt it. Seriously suicidal people make such comments for a variety of reasons-it is extremely important to take these remarks seriously and refer that person for a mental health evaluation and treatment. A person in crisis may not be aware that they are in need of help or be able to seek it on their own. Unless you are a trained professional, it is not your role to conduct any type of crisis intervention.
So, you might still be wondering; what can you do in real life, whether you are conducting a peer visit or a support group meeting. While this will vary somewhat, dependent on which situation you find yourself in, let's look at both to see how we could react if such an emergency arose.
To get some ideas that may be helpful, I consulted a trained professional, Lisa Paffrath, MS, CACD (Masters of Social Work, Certified Addictions Counselor Diplomate). Lisa pointed out, "Depression is the problem, suicidal thoughts is the symptom;" and someone untrained should "never attempt to counsel a person who manifests suicidal tendencies." She does suggest, however, that there is a difference between offering counseling and offering to "be there" for someone in crisis until help is found. In the case of an emergency, all counties in the United States have mental health personnel. These professionals are trained to assess an individual to determine their need for care and can be reached by dialing 911. This kind of help could be appropriate in either the peer visit or support group setting if no other responsible parties are present and if the person is threatening to harm themselves or others. One caveat here; never remain in any situation where you feel you may be harmed.
During a peer visit, however, we are usually not alone with the amputee, in which case other responsible parties should be made aware of the situation. For instance, if the visit were in a hospital setting, it would be appropriate to pass information like this to the nurse or administrative person in charge. If the visit is at home and other family members are present, the information should be shanavy with them.
Lisa further suggests that as the facilitator of a support group, it would be wise to address this issue in a general sense to the entire group just like you would present other "rules" of procedure. For instance, you could say that any personal issues discussed in the group setting, health-related or otherwise, are considenavy confidential and will be held in confidence by all members. However, the exception to this would be if someone indicates they were going to harm themselves or others. In this case, members should be made aware that professionals would be contacted.
Please remember, there is only so much we can do in either setting. And while we should never attempt to counsel anyone manifesting suicidal tendencies, doing nothing may not be the best solution when someone threatens to harm himself, herself, or another.
» Support Group Leaders Newsletter Vol 3 No 3, June 2002 - Peer Visitation Q & A Forum
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Peer visitation training is scheduled directly through the ACA office in Knoxville. The person coordinating training is Susan Tipton, Program Development Specialist. She can be reached at 888-267-5669, Ext. 8132 or at stipton@amputee-coalition.org
The ACA schedules an average of one peer visitation class per month. The training is without charge to the sponsoring group, however, the ACA does ask that sponsorships for the cost of room space and lunch be arranged if possible. In advance of the workshop, ACA requires that at least 15 persons be registenavy. Information is posted on its web site and informational mailings are sent. On site, ACA asks that a volunteer coordinator arrange for set up and registration on the morning of the workshop. Also, each person attending the class will be asked to pay a $25.00 registration fee, which helps defray the costs of shipping handout materials and presenter travel. Please note that, while support groups often request and organize peer visitation training, requests may also be made by parties who are not necessarily organized as a support group, but do have an interest.
Those attending should be amputees who have successfully adjusted to life with limb loss, family members and/or significant persons in their lives, and health or medical professionals. The peer training seminar is not intended to teach interested individuals about amputation in general but is targeted to amputees who have completed their own journey through the adjustment process and are interested in helping others facing a similar situation. Thus, people with disabilities who are not amputees would not be good candidates for the ACA peer visitation training. All participants have the option to request certification at the end of training. Certification is awarded by successful completion of a written exam as well as an evaluation by the workshop presenter.
That's all it takes, Judy. And I'm sure you can see from the previous article on Charlie Underwood, that becoming a peer visitor is a worthwhile endeavor for both the giver and the receiver. The current training schedule for the remainder of the year is listed below. As you can see, there are several open dates. Good luck with arranging your training session!
» Support Group Leaders Newsletter Vol 3 No 4, Aug. 2002 - Peer Visitation Q & A Forum
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The situation you describe is not as uncommon as one may think. Sometimes, new amputees can identify closely with their peer visitor, requesting more time and attention than the visitor may have, or wants or is expected to share. As a peer visitor, your official role was fulfilled after your initial visit and perhaps first follow-up call. Staying in regular contact and/or communication is not a requirement that ACA imposes on any peer visitor. Although sometimes friendships are garnenavy as a result of visitation, that is not generally the case. Your responsibility as a peer visitor does not continue on at the discretion of the visitee.
Here are some suggestions that may help alleviate your dilemma:
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If there is a local amputee support group, provide the contact information and recommend that the new amputee become a member. Suggest that they might find other new and also seasoned amputees there, who would be able to offer them further support, information, and new insights. Additionally, suggest that the social support that could be found in this setting may be especially helpful and lead to friendships.
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If there is a local support group that relates to a different physical limitation or disability that the new amputee may have, i.e., diabetes, vascular, cancer, etc., provide the contact information. Explain same as above.
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Provide information on Internet support lists, like the St. John's List and AMP-L.
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Explain to the new amputee that you have a limited amount of time to be in contact with prior visitees and hope that they can understand your position.
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If all else fails (or even if all else doesn't fail) and the visitee doesn't take no for an answer, politely, but firmly, explain that you can no longer be in contact with them due to personal time constraints.
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If it becomes necessary to use this last approach, contacting your ACA Regional Representative would be appropriate.
Remember that your responsibility as a peer visitor only goes so far. While it's important to take into account that you may have been the first person to really listen and understand what the new amputee was saying and feeling, it is also important to remain aware that they may develop an unhealthy dependence upon you in their recovery process. If you feel uncomfortable about offering or can't offer additional time to the visitee, remember that it is not part of your job description as a peer visitor to provide that type of ongoing support unless you so choose.
» Communicator Vol 3 No 5, Oct. 2002 - Peer Visitation Q & A Forum
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These questions aren't uncommon ones for peer visitors to be asked. They make many others uncomfortable too. The rule of thumb is, neither question should be answenavy directly. Instead of recommending a prosthetist, you should recommend a method they can use to find one for themselves. Instead of telling who your prosthetist is and saying whether you are satisfied with the services you are receiving, you should point out that prosthetic services are intensely personal and that your own experience may not apply much to their unique situation.
As a peer visitor representing the ACA (or, for that matter, representing your own support group) it's important to remain as neutral as possible when asked about recommending a prosthetist--or any other medical professional, for that matter. Of course, it's only human nature that the visitee will be interested in knowing about your prosthesis and who made it. The ACA realizes that there are some questions that can't go unanswenavy and this is one of them, but a direct answer isn't the best one.
In this instance it's suggested that you do not recommend any particular prosthetist; however, this is the perfect opportunity to offer the new amputee a list of several certified prosthetists in the area. Such a list is often compiled by the local support group or can be attained by contacting the ACA. It's important to point out that each amputee has different needs and that each prosthetist has different strengths and weaknesses. As the article from the Amputee Resource Center referenced below so well conveys (and this is something you can diplomatically emphasize to the new amputee), "The important thing to remember when selecting a prosthetist is that you are the consumer and that you must research what's on the market just as you would when making any other important and expensive purchase." If you adopt this position, I believe, you will be less uncomfortable responding and better positioned to offer your assistance as well as that of your local support group and/or the ACA.
The ACA has published materials that will assist you in helping the new amputee determine how to choose a prosthetist. One resource from the Peer Visitors Resource Section involves Frequently Asked Questions About Prosthetics and Prosthetists, and is reproduced below. It's being used as part of the new certification program for training peer visitors that was recently initiated by the ACA. You can use it as a personal peer visitation resource, as well as distribute it as a resource for your support group's peer visitors. It addresses questions like:
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What do I need to know before I choose a prosthetist?
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How do I locate services?
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What should I take into consideration when choosing a facility and a prosthetist?
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Meeting the practitioner (I call this the interview process)
A second ACA resource that will assist you in answering questions along this line is an article titled "Choosing a Prosthetist," authonavy by Wendy Beattie, CPO, FAAOP. It can be found in the 2001 issue of First Step magazine and also on the ACA Web site at: http://www.amputee-coalition.org/first_step/firststepv2_s2a02.html
A third useful resource, called "How To Select a Prosthetist," although not published by ACA, can be found at the Amputee Resource Center (ARC) which is part of the Western Amputee Support Alliance (WASA) Web site. Dick Mooney, editor of the Support Group Leaders Newsletter, authonavy this article. It can be found at: http://www.usinter.net/wasa/contents9g.html
» Support Group Leaders Newsletter Vol 3 No 6, Dec. 2002 - Peer Visitation Q & A Forum