Chapter 21. Enhancing Support, Incentives, and Resources | Community Tool Box

This section has been written, with permission, from materials developed by the Time Dollar Institute (now TimeBanks USA)

Many of us who volunteer our time, or work for not for profit organizations, do so because we want to help people; we hope to somehow improve their lives. Feeling better about ourselves through helping other people is an idea that has a very long history. For example, the Catholic Church's "Prayer of St. Francis" tells us that it is better to give than to receive. What the prayer doesn't say, however, is that it's sometimes easier to give than to receive.

Because frankly, it's hard for many of us to ask for help, whether that help is in the form of money, or assistance with a task, such as taking care of our children or getting our mail while we are out of town. And if we do ask for help, we're quick to offer something in return -- we pay the loan (often with interest!), pay the baby-sitter in cash or in taking care of her children in return, or bring a pie to the neighbors who watched our house. The last thing we want is for people to think we are "freeloading" or "not pulling our weight."

And yet many times when we as organizations offer to help people, that's exactly how we set them up to feel. "Don't worry about it," we say, as if somehow we are better than them, or have more to offer than they do. And messages like that -- even though they aren't what we mean, even if they are the last thing we want to communicate -- are often what gets transmitted, and they can be very hard to take.

That's where the idea of Time Dollars comes in. The thought behind Time Dollars is that everyone, no matter what they do, or where they are in their lives, has something to offer. And Time Dollars asks individuals to use their talents and skills; and in doing so, allows them to retain their sense of pride when they need help.

What are Time Dollars?

Time Dollars are a currency that turns time into money. Volunteers in Time Dollars programs earn credits for the time they spend helping other members. One hour of service earns you one credit, or "time dollar." Then in turn, you can "buy" an hour of a service you need. If you don't need all the credits you earn, you can save them up, give them to someone you know, or give them back to the "bank." That way, the people who run the program can use the extra "money" to make sure the members with the severest needs get all the help they require.

Unlike traditional volunteer programs, Time Dollar programs recognize that people who need help can often help others, too - just in different ways.

A minister's experience gives us an example of how this works. For fifteen years, this gentleman was the pastor of a Baptist church in Washington, D.C. People relied on him as someone they could turn to 24 hours a day for guidance, comfort, or just a little conversation. However, when the Reverend, who suffers from diabetes, lost his right leg to an infection, he retired from the church. He felt overwhelmed by the sudden changes in his life, and for a long time lived almost as a recluse, refusing to leave his apartment.

The local Time Dollar program helped him adjust to the seemingly insurmountable problems he faced. He is once again an active member of the community. He earns Time Dollars by conducting prayer services for his fellow tenants, and he spends them to have his meals prepared by another volunteer.

This kind of exchange isn't new. It has always occurred among families and friends. All Time Dollar programs do is provide a new structure for neighborliness - one that turns good deeds into real purchasing power.

So, what exactly do Time Dollars members do? To give you an idea of the possibilities, here's a sampling of the kinds of services Time Dollar members exchange:

• Personal care, such as grooming, meal preparation, feeding, letter writing, reading, and respite care
• Care for family members, such as baby-sitting and elder care
• Help with household chores, such as light housekeeping, gardening, home repairs, and laundry
• Help outside the home, such as with shopping and transportation
• An escort to the doctor
• Language translation services
• Telephone support services, both check-in calls (to make sure a person is okay) and social calls
• Peer counseling
• Education, such as literacy services, English as a second language classes, tutoring grade-school and high school students, and preparation for the GED
• Administrative support of the program

Many of these things are being done in some places by home care professionals, but can be done by individuals in our communities without paying money. And in allowing people to do things themselves to "pay" for the help they receive, we help people regain control over their own lives.

Why should you develop a Time Dollars Program?

There are many advantages to developing a Time Dollars program in your community. A few of these reasons to begin such a program include:

• To empower people with a sense of self worth - Time Dollars help people understand that whatever circumstances they are in, they can still give, and not just receive
• To strengthen the communities in which we live
• To make sure that all of the members of our communities, including those who are very proud, receive the help that they need

Who should develop a Time Dollars program?

Quite simply, a Time Dollars program can be started by anyone who sees needs in his or her community which are not being met. These needs may be in any part of the population. The first generation of programs often focused on the abilities and needs of senior citizens, because many of them have free time, and many others have many unmet needs. However, programs now can and should build networks serving other groups, such as teenage mothers, people with AIDS, public housing residents, children in urban schools, and parents needing day care for their children. In short, the uses of Time Dollars programs are as varied as the different needs of our communities.

Although anyone can start such a program, they are often developed within existing support networks, such as churches or social service agencies. In the next section, we will look at the development of a Time Dollars program as if it is being developed by an organization that's already in existence. Individuals or new groups can then modify the "how-to" steps accordingly.

How do you develop a Time Dollars Program?

Once you've decided to start a Time Dollar program, there is some hard but rewarding work ahead. Let's look at what you'll need to do step by step.

Before you even begin, however, make sure you're not reinventing the wheel. Many communities already have Time Dollars programs; check in your area to see if there is one that you might work with. A partial list of programs is listed by state in the Resources at the end of this section.

Ensure that you have a committed group of people that is ready to work and serve one another

You need to have people willing to give and receive, or a Time Dollar program just won't work. The most important element of your program is the commitment of the people involved. Time Dollar programs thrive on the work of people who are committed to serving others. Have a group of people in mind with whom you plan to start the program, such as elderly people living in a community living situation, or high school students working on community service projects. Be sure to talk with some of the people you want to work with and make sure there is enough interest to get things started. (We'll talk more about recruitment later.)

Develop a core group of people who will be working on the program

At a minimum, you will need one or two coordinators who will match people and serve as liaisons for the program. You will also want to involve people you want to have as "customers" involved in setting up the program.

Gather the resources your program will need

Some of the things your program will need include:

• A coordinator or director (preferably full-time, either paid or unpaid)
• Office space
• Clerical help (to answer phones, keep track of hours worked, and so on)
• A phone, desk, and office supplies
• Copying equipment (for brochures, fliers, forms, notices)
• Volunteer insurance or workmen's compensation (usually necessary for existing organizations)
• A computer
• A place to meet, train, and socialize

Decide how much money to spend on the program

The cost of a Time Dollar program varies depending on a number of things, such as:

• If your staff is paid or volunteer
• If the paid staff is full- or part-time
• If you are required to pay volunteer insurance
• If you need to rent office or meeting space

While you can actually run a Time Dollars program for next to nothing, those operating in the context of an on-going social service organization can cost anywhere from $10,000 to $100,000. Since costs vary over time and country, actual figures mean little here.  The chances are good that if you have a program with paid staff (probably a full- or part-time director, perhaps a part-time assistant director, and a part-time clerical person), most of your budget -- perhaps 70-80% -- will go for salary and related expenses.  The rest will be spent on rent, equipment and supplies, insurance, phone, printing and copying, and the odd costs that most programs have (food for celebrations, certificates, etc.)  If your space is donated, your budget will be smaller, but a larger percentage of it will go to salaries.

Develop the tracking materials you will need to follow volunteers and their efforts

You will need a membership form and timesheets for members to track their Time Dollars. Members can sign up, chart what they can do, when they can do it, what they want to receive, and what they have done. The coordinator can then use these files when people call and request a service.

One way to help you do this is TimeKeeper Software, which was developed specifically for people running Time Dollars programs. It is available as freeware over the Internet.

The software incorporates the way in which people manage Time Dollar programs on a step-by-step basis. It can also be customized by you to meet your program's needs.

The Timekeeper system can free you up from tasks that can be computerized, such as sifting through individual files to find an appropriate available volunteer, and reduces the time spent on paper work. In addition, the software does the following:

• It can produce personalized bank statements for each member
• It can supply the information to ensure that no volunteer goes too long without a new assignment
• It can help you to monitor performance systematically and follow-up on assignments
• And it can also become a tool in planning new initiatives that can help strengthen your community and target resources to meet special needs

Check on the legalities of your work

In general, there are no legal requirements to starting a program. However, you should check with authorities in your state.

In addition, two legal issues also come up often for people running Time Dollars programs: liability and taxation. Let's look briefly at each of them.

Liability:

The question of liability includes things such as, "What if a service provider is injured on the job?" or, "What if the service provider injures the person being helped?"

You can deal with these questions in very much the same as you would for any volunteer program. One possibility your organization might consider is purchasing insurance for volunteers and staff. See Resources for a company that provides such a service at low cost.

Taxation:

Another question some new members have concerns about is taxes. The concern is that using Time Dollars is just like barter, and so members worry that they will be taxed on Time Dollars earned.

However, this possibility is very unlikely to occur. The IRS has ruled twice that credits earned by volunteers are not taxable. Now, there is no guarantee that the IRS won't decide otherwise in the future, but that possibility seems highly unlikely.

Develop a way to evaluate your work

As you are developing your program, a question that you should keep in mind is, "What, exactly, do we want to accomplish?" And additionally, "How will we know when we've reached our goals?"

Developing a plan for evaluation -- and incorporating it into your work from the start -- is an excellent way to set your program up for success from the very start. An evaluation can help keep your program on track and give you early warning signs when things aren't going well. The information gathered in the process of evaluating your work can also be a great way to convince grantmakers of your credibility, and ultimately, to convince them to support your work.

Recruit members

Recruiting members primarily includes connecting with the people and communities you would like to take part in your program. This recruitment can occur in many different forms -- from word of mouth, to advertisements in local papers or on the radio, to posters, flyers, or almost any other form of communication you can think of.

Along with recruitment of individuals, your program might want to encourage involvement of the local business community as well. There are several ways in which private businesses can get involved in your program.

The simplest way is by contributing financial support or by donating office space, supplies, and telephone service. Businesses can also encourage their employees to become involved as members. At one neighborhood bank in San Francisco, for example, all the employees joined the Time Dollar program run by the local senior center and donated their credits to elderly members unable to earn their own credits.

Another way businesses can get involved is by providing discounts to members of Time Dollar programs. For example, participants in Elderplan, a Health Maintenance Organization in Brooklyn which runs a Time Dollar program, can redeem their Time Dollars to join a silver or gold club. Each club has different offerings, including luncheons at local restaurants to meet social needs, free transportation, and gifts, most of them health-related, such as blood pressure monitors and exercise equipment.

Get started!

When you've got all of your ground work done, it's time to get going! Additionally, most programs find it necessary to "prime the pump" when they first get started by "issuing" Time Dollars. In essence, programs give away services without requiring people to "pay" for them. This works as a great way to get people interested in your program. It also offers needy recipients the chance to receive services, even if they don't have any Time Dollars in their "account."

Celebrate!

As with any work you do, be sure to take the time to enjoy the small and large successes you will have as your work evolves.

Evaluate your work

Be sure to use the methods you developed in step seven to look at what you are doing and know what's working, what's not working, and how you can make it better.

In Summary

The concept of Time Dollars is about community; about drawing on the strengths of all of our members and helping to ensure that we all benefit from the diverse gifts everyone has to offer. It is a program of service, not of financial gain. And so, it's important that Time Dollar programs are run in a spirit of helping those who need it, not on accounting principles.

This section offers you a first look at what you will need to do to develop a Time Dollars program. Much more information is available from TimeBanks USA (previously the Time Dollar Institute). These materials include a "how-to" manual, the Timekeeper Software Manual, video presentations and other useful materials.

Example: Germantown Settlement House, Philadelphia PA

This story was originally posted on the Time Dollar Institute website.

The initial focus of the Time Dollar program at Germantown Settlement House is building informal support systems with and for the elderly and the community at-large. On June 1, 1999, the first issue of the Neighbor to Neighbor Time Dollar News (newsletter ) was distributed. This first issue highlighted the start of the Time Dollar program at Hamill Mill Apartments with 15 new members joining the Tme Dollar Network.The primary goal for the Neighbor-to-Neighbor program is to rebuild trust back into the community. Time Dollars is an all-inclusive plan to seek out and enhance the skills of people in the surrounding community. Some of the services offered include: Administrative Work, Babysitting, Errands, Meal Delivery, Religious Escort, Home Repair, Meal Preparation and more. Public Housing Sites, Washington, DC

Successful Time Dollar programs are running at three public housing sites within Ward 7 - Benning Terrace, Kenilworth Parkside and East Capitol - involving over 100 people of all ages.

At Benning Terrace and Kenilworth Parkside, members that have earned at least 100 Time Dollars have purchased nearly 40 refurbished computers for their homes. The Time Dollar Institute is intent on bringing technology into homes that otherwise may not have had the opportunity.

At Benning Terrace, a Time Dollar Food Bank has been in operation for two years which offers food for purchase with Time Dollars by members. Time Dollar initiatives at East Capitol include helping to provide services and outreach through a Family Investment Center, a site for conducting Youth Court hearings, a teen literacy laboratory where young people earn Time Dollars that can be redeemed for computers.

Pleasant View Gardens - Baltimore, MD (Baltimore Housing Authority) The Lending A Hand Time Dollar Program at Pleasant View Gardens has 100 members including youth and senior citizens. In June, a full-time coordinator was hired and is currently enrolling new members, doing presentations to community groups, processing matches, developing goods and services that can be purchased with Time Dollars in the local community and serving as a liaison to the greater Baltimore community.

The U.S. Department of Housing and Urban Development (HUD) selected Time Dollars as one of the "Best Practices" being used in HOPE VI properties across the country. Time Dollars was part of a presentation made to national leaders of HOPE VI properties at a HUD conference in Kansas City, MO People Helping People, Tacoma Washington People Helping People (PHP), an emerging independent non-profit, orginally started as a program operated by Home, Safe designed to build on the strengths of neighborhoods and families. Home, Safe, was founded in 1994 to strengthen neighborhood-based support systems and to create strategies for blending child welfare and drug treatment.

PHP has continuously enrolled new members and families into the Time Dollar bank. At this point, there are 500 Time Dollar members in the Tacoma program.

Many of those earning Time Dollars are using them to receive services as well. On average, 400 Time Dollars per month are being earned. Families, referred from Child Protective Services, have enrolled in the Time Dollar program, and have started earning and using Time Dollars.

You understand the purpose and benefits of a Time Dollars program:

___To empower people with a sense of self worth. Time Dollars help people understand that whatever circumstances they are in, they can still give, and not just receive

___To strengthen the communities in which we live

___To make sure that all of the members of our communities, including those who are very proud, receive the help that they need

You understand the requirements for implementing a Time Dollars program:

___You have a committed group of people that is ready to work and serve each other

___You have developed a core group of people who will be working on the program

___You have gathered the resources you program will need

• A coordinator or director (preferably full-time, either paid or unpaid)
• Office space
• Clerical help (to answer phones, keep track of hours worked, and so on)
• A phone, desk, and office supplies
• Copying equipment (for brochures, fliers, forms, notices)
• Volunteer insurance or workmen's compensation (usually necessary for existing organizations)
• A computer (optional, depending on the size of the program)
• A place to meet, train, and socialize

___You have decided how much money to spend on the program, considering the following:

• If your staff is paid or volunteer
• If the paid staff is full- or part-time
• If you are required to pay volunteer insurance
• If you need to rent office or meeting space

___You have developed the tracking materials you need to follow volunteers and their efforts, with these capabilities:

• It can produce personalized bank statements for each member
• It can supply the information to ensure that no volunteer goes too long without a new assignment
• It can help you to monitor performance systematically and follow-up on assignments
• It can also become a tool in planning new initiatives that can help strengthen your community and target resources to meet special needs

___You have checked the legal requirement of your work:

• Liability
• Taxation

___You have developed a way to evaluate your work

___You have recruited members and started your program

___You celebrate your successes

___You evaluate your work to keep improving it

A PowerPoint presentation summarizing the major points in the section.

Portions of this section adapted from The Self-Help Leader's Handbook: Leading Effective Meetings by Adrienne Paine-Andrews, Yolanda Suarez-Balcazar, Stephen B. Fawcett, and Leslie Borck Jameson, with the collaboration of Melody G. Embree, published by the Research and Training Center on Independent Living at the University of Kansas.

Did you know that there are over 500,000 support groups in the United States? Because they are both inexpensive and effective ways to offer assistance to people dealing with a variety of concerns, support groups have become a common method of serving the needs of people who are experiencing problems in their lives.

Support groups can be found in big cities, small towns, and even rural areas, dealing with anything from substance use and gambling addiction to surviving domestic violence to gender issues. 

If your group or initiative does service work with people who might benefit from talking to others who have similar experiences to their own, perhaps you should consider adding a peer support group to the services you offer.

What are peer support groups?

Support groups - also often referred to as self-help groups - are groups of people who gather to share common problems and experiences associated with a particular problem, condition, illness, or personal circumstance. In a support group, people are able to talk with other folks who are like themselves - people who truly understand what they're going through and can share the type of practical insights that can only come from firsthand experience.

Some of the common characteristics of support groups include:

• They are made up of peers - people who are all directly affected by a particular issue, illness, or circumstance
• They usually have a professional or volunteer discussion leader or facilitator
• They tend to be fairly small in size, to better allow everyone a chance to talk
• Attendance is voluntary (although sometimes people are required to attend support groups by employers or the court system, especially if criminal or destructive behavior has been involved)

Why create and facilitate a peer support group?

There are many benefits to peer support groups:

• When someone doesn't know many - or any - other people who are going through what he is coping with, he can feel isolated and stigmatized. Support groups help people with a problem or illness feel less alone and more understood.
• Support groups don't cost much to run - advertising for the group and maybe some refreshments are all you'll probably need to pay for. Another cost might be meeting space, but you can usually get someone to donate it.
• Support groups empower people to work to solve their own problems.
• Members can share information, keeping one another up to date on news of interest to them.
• Among people who are experiencing similar problems, there is a unique emotional identification that is different from the type of support that can be gotten from professionals.
• Members act as role models for each other. Seeing others who are contending with the same adversity and making progress in their lives is inspiring and encouraging.
• A support group is a safe place for someone who needs to talk about intensely personal issues, experiences, struggles, and thoughts.
• Talking to a counselor or doctor can be very intimidating for some people, because those relationships tend to place more power with the professional. In a support group, members are equals; this can make people feel much more comfortable opening up about their problems.
• Talking to others in support groups reduces anxiety, improves self-esteem, and helps members' sense of well-being overall.

Who can be served by peer support groups?

Almost anyone! At any given time, over 6.25 million Americans are using self-help groups, and about 15 million have participated in such a group at some time in their lives. Support groups are used to address a myriad of concerns, such as:

• Diseases, injuries, or chronic medical conditions
• Eating disorders
• Sexual identity questions
• Physical disabilities
• Bad or unhealthy habits
• Emotional problems
• Addictions
• Bereavement
• Parenting

Besides serving people directly affected by a problem, support groups often welcome family members or friends of those experiencing illnesses or difficulties. Also, many independent support groups exist just for family members or friends: for example, one such group is Al-Anon, a group for families and friends of alcoholics.

How do you create a peer support group?

Think about what you want to accomplish

Decide what your group's purpose will be and who you want to reach. You might find it helpful to write vision and mission statements for your support group.

Find out whether there are existing national, regional, or local groups your group can be involved with

There are several benefits to setting up your support group under the auspices of a larger organization, if you can. A larger organization can often offer resources and assistance in setting up a new support group. The name recognition that comes with affiliating with a big, well-known organization can give your group more credibility. It can also make it easier for people who need your support group services to find you. Finally, working with a larger organization keeps you from having to "reinvent the wheel" in deciding how the group will operate - you can take advantage of a tried and true model.

Using a fictional example, let's look at how someone might set up a support group with the help of a larger organization.

Yoshiko's support group

Yoshiko's sister was recently diagnosed with muscular dystrophy. Feeling frustrated and isolated, Yoshiko wanted to start a support group for the disease's sufferers and their families. After carefully studying this section of the Community Tool Box, Yoshiko decided to find out whether the Muscular Dystrophy Association, a national organization, sponsored a support group in her town.

She visited the MDA's website and found out that they offered a group in a nearby town, but there wasn't one in her city. After Yoshiko called the organization's national office and found out the many ways that they could help her new support group, Yoshiko decided to start a local MDA support group rather than an independent one.

Consider whether the group will meet for a specific period of time or for an indefinite period of time

Support groups can be long-running, or they can be restricted for certain periods of time. For example, the local crisis center may offer a six-week support group twice yearly for people who have lost a family member to suicide, rather than a single, year-round group. This type of time-limited format is best suited to crisis situations, such as bereavement or divorce. A drawback of this format is that the group may not be available at a time that someone needs it. Problems that are more long-term in nature - a chronic disease, for example - are better served by ongoing, long-term support groups.

Decide whether the group will be open or closed

Open support groups are those in which new members are welcome to join at any time during the life of the group. This may also mean that anyone can join the group - friends, family members, etc.

In closed groups, people are only allowed to join the group at certain times (e.g., for the first three weeks only) or under certain circumstances (e.g., groups that are only for women). Some organizations offer both types of meetings - open meetings, which anyone can attend, and closed meetings, which are only for people going through the program.

If you plan on working on a very specific issue and want the entire group to go through the process at the same time, you may want to consider having a closed group. However, open groups are best for most kinds of support groups.

Set a time and place for your support group to meet

Decide on a time that will make it possible for the most people to be there; for example, if your group members are likely to be church-goers, it wouldn't be a good idea to schedule meetings for Sunday mornings. Mid-afternoon on weekdays won't be good for most people who work during the day. Usually, early evenings on weekdays are the best times for the most people.

Picking a good location is far more crucial than you might think. If you work with an organization or coalition that has meeting space of its own, you might want to have your support group meet there, but don't automatically assume that this is the best space for it. You might find that a school, church, restaurant, library, or some other public building is better suited to your needs. Depending on the type of group, members may want to be discreet about their attendance, and may therefore be less likely to come if the group meets in some heavily-traveled place where they might be seen. A support group for former child molesters might want to be as nearly invisible as possible, for instance. While that's a particularly outrageous example, the same might be true for Al-Anon or a group for pregnant teens.

First and foremost, the location should be easily accessible for the people who will be coming to the support group. Is the building in an easy place to find? Is it accessible to people who use wheelchairs, canes, or service dogs? Is there adequate parking nearby?

The location should also be somewhere where people can feel comfortable enough to talk about their problems and able to offer each other support. If you're working with survivors of violent crimes, meeting in a high crime section of town or next door to the county jail might make people in your group uneasy or reluctant to even show up.

While the location you decide on should be accessible and comfortable, it also needs to fit the type of group you want yours to be. For example, meeting in a member's home can add an element of comfort, but groups are much more accessible to newcomers if held in public places; therefore, meeting in somebody's home should probably only be done if it's a closed group.

When you finally have a location picked out, make any needed room reservations or other arrangements, and you're ready to move on!

Select a group leader or facilitator

Picking the right person to lead your support group is of utmost importance. The group leader or facilitator opens and closes the meetings, sets the tone for the discussion, helps members learn how to listen and offer support to each other, and deals with any problems that come up during the meeting. The ideal facilitator will possess the following qualities:

• Flexible schedule: He should have enough time to perform the required tasks and commit to be there for every meeting.
• Lots of energy: He should have a positive attitude, be in generally good health, and be able to work after hours if necessary.
• Ability: Ideally, he should have experience in facilitating such groups. He should also be responsible, articulate, fair, organized, and able to work well with others.
• Support: Your facilitator needs to have access to needed resources to run the group (a phone, a car, etc.), and people he can rely on for assistance, if necessary.
• The desire to do the job: He should have an interest in the topic or at least a commitment to helping others. It helps if the facilitator has some sort of affinity for the group and its topic. For example, if your support group is for survivors of breast cancer, then a good facilitator might be someone who has survived breast cancer herself, has been close to someone who experienced it, or at least has had similar experience with other types of disease. This isn't to say that people who haven't been personally touched by the topic can't be great facilitators. You might try folks who have done a lot of volunteer work or have an interest in counseling, such as a graduate student in social work or counseling psychology.

The details of the facilitator's job - running the meetings - are explained later on in this section; you may wish to refer to that when selecting somebody for the position.

Decide on any remaining details

Going back to step one, think about what you want this group to be like. This can help you make up your mind about whatever other ins and outs of the group are left, such as:

• How often should we meet? Most support groups meet every week or two.
• How long should meetings last? Most support groups meet for between one and two hours; you may want to have shorter meetings if you end up having a small group or if members' physical problems make sitting through a long meeting uncomfortable.
• Should we serve refreshments? Refreshments help make everyone feel at home and encourage socializing among members; unless they aren't allowed by your location or you run a group that focuses on food issues (such as an overeaters or eating disorder groups), it's a good idea to have refreshments. If you're on a strict budget, you may have to be creative to get it set up. People can take turns providing cheap refreshments, with some discreet help if someone simply doesn't have the resources to do so. Or perhaps someone knows a merchant or restaurant who has some connection to the purpose of the group, and would be willing to donate refreshments.

Recruit members for your support group

Consider how large you want the support group to be before you start recruiting. Generally, it's best to have a group that's large enough to function well even when some of the members are absent, but small enough for all the members to feel comfortable. As a rule, 5 to 15 people is a pretty good number; anything larger too easily becomes unmanageable and impersonal.

There are many ways to get the word out about your group, and the most successful support groups usually use some combination of all of them.

Use referrals

• Network with other groups and professionals in your area. Let local clergy, doctors, administrators, agency directors, social workers, media personnel, nurses, and other such people know about your group, and encourage them to tell people about it. Send out letters and, if you have them, brochures or flyers to the offices of local organizations that address your group's area of concern -- e.g., the local mental health agency or chapter of the American Cancer Society. You might also do presentations to some agencies and organizations
• If your city or county has any community information and referral hotlines, be sure that they have information on your support group
• If the support group is related to a health matter, be sure to send information to your local hospital's social services and community health education departments
• Find out which agencies or organizations publish community or social service directories and request that your group be included in the next one

Use the media

• Posters and flyers: These can be posted at clubs, shops, hospitals, churches, libraries, schools, post offices - just about anywhere that you think interested people might see them
• Press releases: Sending information about your support group to the local press might interest them in doing stories on your group, which can generate interest
• Paid advertising: Ads in the local newspaper, as well as those in publications or newsletters put out by agencies or businesses that reach the same folks you want to are a good idea, if you can afford them.
• Letters to the editor: These can be used to tell the public about your group. They're more likely to be printed if they're in response to a story the paper has published about a related topic
• Public service announcements: Getting these aired on local radio or television stations can get the word out to large numbers of people

Use personal invitations and word-of-mouth

• This is the most informal method of recruiting people for support groups, but it's the most effective. The "people chain" happens when one person tells another person about a group, and then that person tells another, and so on. Tell everyone you can about the group, and ask them to tell others. When your group starts meeting, encourage members to tell others about the support group.

Once you have enough members, contact them to let them know the date and time of the first meeting. Give them a couple of weeks' advance notice so they can make any necessary adjustments in their schedule, and follow up with a postcard or telephone reminder a few days before the meeting.

How do you facilitate a peer support group?

You've put in a lot of hard work in preparing for your support group to begin, and now the day has arrived. If you are the group's facilitator, here are some helpful guidelines for running these meetings.

Prepare yourself for the meeting

Take a few minutes to think about possible topics for discussion. If this isn't your first meeting, review the topics that were talked about last time. Go over any notes you took. This can help you remember to bring up things that members might want to revisit or give updates on. If you plan to make any announcements of community events or activities that may be of interest to the group, make sure you have them ready.

Prepare the room for the meeting

Arrive 20 to 30 minutes early to arrange the room. Put the chairs in a circle large enough for latecomers to fit in, with enough room for folks who use wheelchairs to easily join. If you're going to have refreshments, set them up on a table to the side or back of the room. If you're going to use name tags, have them ready. Have a pen and paper to take notes.

Start the meeting

As people begin arriving, be sure to make eye contact and say hello, greeting them by name if you've met them before. Call the meeting to order on time, or at least within five minutes of the designated time. This encourages other members to be prompt. It also rewards those who are punctual; if you always start the meeting late because you're waiting for that one person who shows up 15 minutes late every time, you risk alienating those who made the effort to be there on time. A simple "Let's get started," or "Well, it's five minutes after seven o'clock, why don't we begin the meeting," is adequate.

Give preliminary introductions and information

Introduce yourself briefly; if you have some experience with the group topic, be sure to mention it. Make any announcements and ask the group if they have anything to add.

Opening a support group meeting

At the first meeting for Yoshiko's MD support group, she was pleasantly surprised to see that 15 people showed up. Opening the meeting, Yoshiko introduced herself: "Hello everyone. My name is Yoshiko Hatori and my sister Miho has been living with muscular dystrophy for over a year now. I'm happy to see so many of you came tonight."

She had only one announcement: "By the way, there'll be a car wash fundraiser for the local chapter of the MDA next Saturday from noon to four p.m. at First Baptist Church, so tell as many people as you can about it."

If this is a new group or there are new members present for the first time, explain the ground rules. The most common ground rule for support groups is that everything discussed in the group must be kept confidential. Reminding the group of this from time to time is very important. Explain whether the group is open or closed and what that means. Be sure that everyone understands the rules.

Have everyone introduce themselves, stating their names and a little bit about why they were interested in the group. Then begin the discussion, either by touching on something that was mentioned by one of the members or by bringing up a prepared topic.

Starting a discussion

When members of Yoshiko's group were introducing themselves, one young man named Brian mentioned that his family was planning a trip to the Rockies and that he was concerned about his ability to withstand the higher altitudes. She had planned to talk about family issues in general, but Brian's comment gave Yoshiko an idea. When introductions were finished, she began the discussion this way:

"Brian, you mentioned your apprehension about this upcoming family trip. Could you tell us more about your concerns?" After the group discussed Brian's trip for a while, Yoshiko said, "I found that Christmas with my family was overshadowed by Miho's MD diagnosis. We were all worried about her, and it really made it hard to just enjoy being together as a family. Would anyone like to talk about what effect MD has had on their own family gatherings?" This prompted several members to jump into the discussion.

Encourage members to listen to each other

Being a good listener - and acting as an example to group members in this regard - means being an active listener, one who is obviously listening and understanding what is being said. How do you let people know that you're listening?

• Body language (leaning slightly towards the speaker, not fidgeting)
• Eye contact (looking in the speaker's eyes, not looking around the room)
• Brief encouraging statements, also sometimes called nonverbal encouragers ("Uh-huh" or "Mmm-hmm")
• Nodding
• Repeating or rephrasing the speaker's last phrase to let him know you understood. ("I can't believe my mother was so cold about it," could be responded to with, "So you were really hurt by what your mother did," for example)

Encourage members to offer support to one another

While being supportive yourself, you must also help others in the group learn how to be so as well. Demonstrate the active listening skills listed above while the member is speaking. Wait 10 seconds or so and then, if no other members have done so, offer support. Group members will usually pick up on this and start offering support themselves. If they don't you may have to ask them questions about how they are affected by the discloser's experience.

For example, Yoshiko might say the following things in her group:

• "Shawna, what can you say to Brian that might help?"
• "How can we give Brian some support now?"
• "What do you think about what Brian is going through, Annie?"

Encourage members to talk about themselves

One advantage of support groups is that they can create an atmosphere in which members feel comfortable talking about and working through very personal issues and experiences. Disclosure - the act of revealing personal information - gives other members a chance to offer support, ideas, and assistance. It also encourages other members to share their own experiences and fosters an atmosphere of trust in the group. To maintain that trust, facilitators may find that they also need to disclose information from time to time.

When a member discloses information, the facilitator may have to guide the discussion to make the member comfortable or encourage others to join the discussion. Asking open-ended questions - those which cannot be answered with a simple "yes" or "no" - is very useful at this point.

Asking open ended questions

Camilla, a single mother in Yoshiko's support group, talked about how hard it's been for her to take care of her three children over the past few months. She was having a hard time expressing herself, so Yoshiko coaxed her with these open ended questions:

• "What's it like for you when you're trying to get your kids ready for school in the morning?"
• "What have you told your children about what's going on with your health right now?"

Yoshiko wanted to get other members to offer support, and she wanted to use Camilla's disclosure to encourage further disclosure from other members.

She asked the following open-ended questions:

• "What sorts of things in your own lives make you feel the way Camilla feels about this?"
• "How do you all manage it when you have to be a caretaker for others while dealing with your own illness?"

You can also plan topics ahead of time. Some support groups do things like have their members do reading or keep journals of their experiences to help spark discussion.

Offer support

This is the main reason your group exists! Fortunately, offering support is one of the simplest things to do in the course of running a support group. Giving members support can help them realize that reaching their goals is possible, give them hope, or just let them know that you empathize with what they're going through.

Support consists of making statements that show your understanding, sympathy, and concern. Listen for the feelings expressed by the member, and address those feelings. Support can also be expressed through body language (such as making eye contact or smiling) or touch (hugging, patting the member's arm). Care should be taken in using touch as a form of support - in some circumstances, such as a support group for survivors of child sexual abuse, touch may be threatening and uncomfortable instead of comforting.

Usually, members will offer support to each other on their own, or they will quickly pick up on how to do so by following your example. However, you may have to ask questions to coax them into offering support by asking questions.

Providing support

When Brian said, "I feel bad because I think I'm becoming a burden to my family," Yoshiko could have offered support by saying:

• "I know things are really tough for you, but I hope you can take some comfort from how much your family obviously loves you," or
• "I'm sorry to hear that. But I know that I don't mind the extra time I put into taking care of my sister since she's gotten sick - as a matter of fact, I really cherish that we've been able to spend more time together. You might find that the same is true for your family.

Yoshiko could also encourage other members to offer support by saying:

• "How can we support Brian now?"
• "Has anyone been through similar experiences with their families?"

Help members solve problems

While solving problems shouldn't be the only goal of a support group, it is something that many members hope for and expect. All members should take part in the problem -solving process so that no single person is seen as the solution to their difficulties. It's the facilitator's job to help members learn how to help each other with problem solving.

Here are the steps to problem solving:

• Clarifying the problem: Make sure everyone fully understands the problem. If you aren't sure what the problem is, ask questions to get more information.
• Talking about the alternatives: Bring up possible solutions to the problem, but be very careful to word them in a way that doesn't give advice. For example, instead of "You should do this," a better wording could be "I wonder what it would be like for you to try this" or "Maybe you could do this." Telling people what to do is not the purpose or responsibility of a support group. It takes away a person's feeling that he can handle his own problems and can make people feel attacked and uncomfortable. Try asking members to tell what's worked well for them in similar situations. You can also ask the person with the problem what he thinks might work.
• Choosing which option(s) to take: Have the group discuss the pros and cons of each suggestion. You can then let the person with the problem come to a decision, or he may want to take some time on his own to consider the possibilities. Let him know that the group cares and wants to know how things turn out.
• Offering help: Sometimes members may offer to assist each other. For example, if the problem being discussed is a member's problems with transportation to the meetings, other members might offer to give that person a ride.

Problem-solving

Clarifying the problem:

Yoshiko asked some questions to find out more about Camilla's problem:

• "What parenting duties do you find to be the hardest to keep up with?"
• "Do you find that these things are consistently hard to get done, or is it more difficult at particular times?"

Talking about the alternatives:

Yoshiko used open ended questions to gently make suggestions and get members to offer them as well:

• "What would it be like to ask your kids to help out with chores around the house?"
• "What has helped you get through hectic times with your kids in the past? "
• "Would any of you like to suggest things Camilla could do to make things run more smoothly around her house?"

Choosing which option(s) to take:

Camilla's problem centered around transportation (getting her kids to and from school and soccer practice) and household chores. Camilla decided on the following solutions:

• Another member's children were part of the same soccer team, so she offered to let Camilla's children ride with them to and from practice
• One member's sister had children at the same school as Camilla's children. She offered to call her sister and arrange for Camilla's children to carpool with them to school in exchange for help with gas money.
• Another single mother in the group shared some ideas on using incentives to get her children to help out more with household chores that Camilla decided to try

Offering help:

As you can see above, two of the three solutions that Camilla decided on involved help from other members.

Close the meeting

Most support group meetings last between an hour and two hours. If the group is caught up in a particularly intense discussion or in helping a member solve a problem, you might go a few extra minutes, but generally it's best to stop before everyone is tired and eager to leave. When the discussion is winding down or when a previously agreed-upon ending time has arrived, wrap things up. Here are some ways you can close the meeting:

• Make a summary statement: Summarize the topics that were discussed and alternatives that were chosen. Highlight any positive observations or solutions that came up.
• Ask for additional comments or questions: Check to see if anyone in the group has anything to add.
• Remind members about the next meeting: Let everyone know the time and place for next time.
• Request volunteers, if necessary: If you need help with donations, refreshments, transportation, or other group needs, this is the best time to ask for it. Asking for help from members encourages them to take leadership responsibilities and fosters a sense of personal investment in the group's success.
• Give a final greeting: Thank everyone for coming, say goodbye, and encourage them to come again.
• Make final notes: Shortly after the meeting, make some brief notes about what was discussed while it's fresh in your mind. This information can be used to jump-start the next meeting. Keep any notes on the group in a safe place to insure confidentiality.

 Closing the meeting

After the discussion had wound down, Yoshiko followed the above steps in this way:

Making a summary statement:

"I see it's getting to be about the time we'd agreed that we'd stop, and I know many of you would like to get home, so I think we'd better wrap up for the evening."

Asking for additional comments or questions:

"We talked a lot about our families tonight. Are there any last thoughts anyone would like to add?"

Reminding members about the next meeting:

"Our next meeting will be on Wednesday the 23rd at 7:00 p.m. I hope you can all be there."

Requesting volunteers:

"Can someone volunteer to call everyone on the phone list a couple of days before the meeting to remind them about it?"

Giving a final greeting:

"I'm so glad you all came, and I think we got into some really interesting subjects tonight. I hope to see you on the 23rd!"

Making final notes:

After she got home, Yoshiko sat down with a cup of coffee and wrote some notes on the meeting: "Brian talked about his concerns about how MD will affect his upcoming family trip; Camilla talked about how tough it is to be a single mom with MD. Next time maybe we should focus more on issues that affect the people who are single or not close to their families."

Tips on Keeping a Support Group Going

• Keep track of your group's progress. From time to time, ask members for their feedback on how the group is going. Find out how useful they find it, how comfortable they feel, and their likes and dislikes about the group. Use this information to make adjustments.
• Share responsibility for the group. Letting others take leadership roles helps them feel more committed to and invested in the group. Make sure members know their help is appreciated. Since you may find it's often easier to do things yourself, asking others in the group to take over some responsibilities can be trying. However, no one person should have to do everything, and sharing responsibilities will help you avoid burnout.
• Be sure everyone has a chance to talk. Some people are naturally more talkative than others. Asking questions to get quiet members to speak up is important. It's also crucial to keep the more vocal members on-topic and gently remind them to let others have a turn at times.
• Emphasize the importance of confidentiality. In order for your members to feel safe enough in your support group to self-disclose and work through problems, they need to feel sure that nobody is going to be telling people outside of the group about the group's discussions. Make sure this is well understood by everyone.
• Encourage outside contact among members. Members can offer support to each other outside of meetings. The "buddy" system, used by groups like AA, encourages members to take interest in one another's well-being and form relationships outside the group.
• Keep recruiting. If you have an open group, make sure you continue to get the word out. Groups can stagnate when the membership remains the same all the time, and if members who leave are never replaced your group will not survive.
• Share rewards and failures. Let members know that you appreciate their contributions. When people make mistakes, don't place blame. Don't heap all of the praise when something goes well on any one person - or all of the guilt when things go badly.
• Keep a realistic perspective. Don't idealize the support group. There may sometimes be people that your group won't be able to help; this doesn't mean your efforts are futile. Also, when members leave, it doesn't mean you've failed them. Usually it means that they have used the group as much as they think is useful and moved on with their lives.
• Remember that this is a support group. The dynamics of a group may change over time - for example, it could become more social in function, or it could change focus in terms of topic. No matter how the group changes, your group's primary purpose is to provide support and understanding to its individual members.

Tips on Handling Difficult Group Members

In dealing with difficult group members, support group facilitators must learn a delicate combination of control mixed with kindness. This sort of assertive caring directly addresses problems with the group without insulting or offending members. You may use assertive caring during a meeting to get the discussion back on track, or you may wish to speak to the member in private after the meeting.

Times to use assertive caring:

• When a member is often late to meetings
• When a member talks too much, monopolizing the discussion
• When a member rejects every suggestion that others make - the "yes, but" phenomenon
• When a member appears to have problems that are more than the group can handle - such as someone who's had a change in health and should seek medical attention, or someone who may have psychological problems needing professional attention
• When a member interrupts others or brings up inappropriate or irrelevant subjects
• When a member's problem doesn't match up with what the group is meant to address

The steps to assertive caring:

• Show that you understand the member's position or dilemma: State that you understand the reason(s) behind the member's negative behavior. Use "I" or "we" statements, which show how his behavior affects you and the group. For example, "I know things are difficult for you, but right now we're trying to figure out what Camilla can do about child care."
• Set limits: Gently but firmly correct the behavior. Explain your reasons; letting the member know why you need to change the situation will make him more likely to cooperate. For example, "I know things are difficult for you, but right now we're trying to figure out what Camilla can do about child care, and it's hard to do when you keep interrupting."
• Suggest an alternative: Explain what you'd like to see the member do instead of the negative behavior. For example, "I know things are difficult for you, but right now we're trying to figure out what Camilla can do about child care, and it's hard to do when you keep interrupting. I wonder if we could wait to talk about your problem until after we've come to some conclusions about what Camilla can do."
• Get the member's agreement on the alternative: Make sure the member understands what is being asked of him and agrees to do it. For example, "I know things are difficult for you right now, but we're trying to figure out what Camilla can do about child care right now, and it's hard to do when you keep interrupting. I wonder if we could wait to talk about your problem until after we've come to some conclusions about what Camilla can do. Is that okay with you?"

In Summary

Support groups are a great way to provide a service to the people your organization or initiative works with, without a huge investment of time or money. Moreover, running a support group is a good way to reach out and get people interested in the other things your organization or initiative does. It's also a way to give back to the community - improving or supporting a good public image for your group. Finally, it's just a good thing to do. With relatively little effort and cost, a support group can make a significant impact in the lives of people dealing with a problem. What better reason can there be?

Example 1: Interview with the facilitator of a grief recovery support group

David Hallenbeck, along with assistant Bill Hazelitt, facilitates a grief recovery support group sponsored by Rumsey-Yost Funeral Home in Lawrence, Kansas. The support group is offered as a free public service to the community.

CTB: Can you tell me a little bit about your support group?

Hallenbeck: We started it back in 1989, and we have two sessions a year. The fall session starts in September and goes through January, and the spring session starts in February and goes through May.

CTB: So is it a closed group with people who go through for the entire period, or can people join at any point during it?

Hallenbeck: Well, there's a certain point - probably about six or seven weeks into it - where I close the group to any newcomers, because we've traveled far enough along by then as far as confidentiality and trust and things like that.

CTB: Aside from the newspaper ad, what ways do you use to recruit people?

Hallenbeck: Well, it has grown quite a bit just by word of mouth and different doctors and people referring people to us. We do some radio advertising, and there 's just a lot of communication between families we work with at the funeral home and other funeral homes in the surrounding counties.

CTB: Right... most of the research I've been doing has all said that word of mouth seems to be the best way to let people know about this kind of thing.

Hallenbeck: Well, we have a kind of first hand referral process. Someone has been through it, then that person will go home or he'll go back to work and tell people what it did for him. It just gets strong referral.

CTB: How many years have you guys been doing the support group?

Hallenbeck: Well, this fall, this coming fall it will be ten years. We've had, I think, somewhere around 120 people go through the program.

CTB: Wow. How many people are in the group each time?

Hallenbeck: Group size has ranged anywhere from six or seven up to eighteen.

CTB: How does a typical meeting go? How do you start off and how do you wrap it up?

Hallenbeck: We just basically start by just reviewing the week and seeing how everyone's week has been. Our support group is not one that just comes back and rehashes the same horror stories week after week. There is a different reading assignment or writing assignment that all the participants are expected to do. So each week it's a different aspect or different phase of working through the grief.

CTB: Have you ever had to deal with re-directing people in the group who might be a lot more talkative than the others, or off topic? What are some ways you do that?

Hallenbeck: Well, if somebody just habitually comes in just trying to monopolize the whole conversation, then usually I will meet one-on-one with them and just talk about that. And if they're not comfortable with letting other people share in the conversation, then I might suggest that we just go through the same steps one-on -one together, or I might refer them to some other community resource. Support groups aren't for everybody. It just takes a lot of dedication and perseverance to get you motivated to even get to the meeting to begin with.

CTB: Sure. What kind of folks generally end up taking part in the group? Is it usually made up of people who've had a really recent loss?

Hallenbeck: Sometimes. Some people come because of something recent and then once we get into the homework and going through the process they may realize that they were still having issues with some grief episode 20 or 30 years ago. We just want to help them go back and clean up some of that stuff.

CTB: Is there anything that you see as unique about the way this group functions?

Hallenbeck: Well, it's task oriented. We go through the Grief Recovery Handbook (The Grief Recovery Handbook: The Action Program for Moving Beyond Death Divorce, and Other Losses, by John W. James and Russell Friedman, Harper Collins). They call it an action program for moving beyond death, divorce and other losses. And so each week I always say, "Well, next week will be the toughest one yet." And they'll do it, then two weeks after that I'll say, "Next week's assignment will be the toughest one," because each week just builds on the last one. And there are a lot of other programs I've seen or been a part of or used that haven't been quite that action -filled. I like it because it has you go back and really take a look at your whole life's story, all the ups and downs, and see how that all fits together in the fabric of your life today.

CTB: What do you do at the end of the period, when you're having your last couple of meetings, to bring closure to the group?

Hallenbeck: Well, there are four main written assignments during our three or four months together. We usually just go down to Three Sisters Inn down at Baldwin and have dinner together for a celebration of the journeys we've been on. A lot of the groups from the ten years we've been doing this are still getting together on a monthly basis. They may get together for supper or just get together and visit and catch up. A number of lifelong friendships that have been established.

CTB: I think it's probably really helpful to encourage people to develop social relationships with each other outside the group, so they feel able to give each other support not only just during the meeting. Is there anything else that you would like to add?

Hallenbeck: Well, we're open to practically any age. The youngest so far have been college age, and it's ranged up to 82 years old.

Some groups seem to gel together and others - even though it's been a good experience together - you can tell it hasn't pulled together like some of the others may have. Yet no matter whether the group gelled or not, we find when they evaluate their experience in the group that it sort of becomes a mutual admiration society. The strength and perseverance people have shared with each other have really touched them all.

Example 2: Interview with the facilitator of a support group for men who have sex with men
 

Harley Logan is an Information Outreach Specialist with the Douglas County AIDS Project in Lawrence, Kansas. To educate the public about safer sex, he facilitates two support groups for men who have sex with men.

CTB: Can you tell me a little about the structure of the support group?

Logan: Well, this is an informal discussion group that is for men who have sex with men. We really try to use that language -"men who have sex with men" instead of "gay and bisexual men"- because we don't want to turn off anyone who doesn't identify as gay or bisexual.

At first we tried to follow a structure called the Lifeguard program which was developed in California.

[Editor's note: Lifeguard 2000 was a project founded by the L.A. Gay & Lesbian Center.]

This is a series of workshops that has been approved by the Kansas Department of Health and Environment. This is a program that Topeka was using already, so it was already approved and we just decided to go with this. Like I said, it's a series of four workshops and comes with a notebook on how to do the facilitation.

CTB: So it's got a real structure to it?

Logan: It's very structured and, on the advice of the guy who did it in Topeka, I've pretty much taken it apart and adapted it and tried to let the group determine the direction or what topic were going to talk about. There were quite a few "touchy-feely" exercises which I didn't think would work very well with people here in Kansas, so we changed those, for example. I think this group works a lot better with younger people - say, college age - than it does for people in their forties, fifties and sixties.

CTB: What sort of age range have you had in the folks that showed up?

Logan: When I started the first group here at the United Way Center, it attracted mainly guys who were in their forties and older. I'm 32 and I was probably the youngest one present. This is the same thing that happened in Topeka when they ran an advertisement for their discussion group - the people who showed were much older. And it worked out okay because it's a discussion group about topics that the older men were comfortable discussing; it's about issues around just being gay, being happy, a little bit of soul searching, self-esteem, that kind of work. Sometimes younger people aren't really in tune to that just yet.

We eventually started a second group with Q&A up on campus [KU Queers and Allies, the LesBiGayTrans student organization at the University of Kansas], inviting the guys to the discussion group. With these younger kids we end up incorporating a lot more information about safer sex, and they have a lot more basic questions about sex, unlike these guys who are older and have been having sex a lot longer. I also try to stay in the facilitator role with both groups, rather than interject my own opinion. I find the group very interesting, so I really step out of that facilitator role a lot with the older group.

CTB: Do you find that doing a certain amount of self-disclosure helps bring the conversation along?

Logan: Yes, very much so.

CTB: So how does a typical group meeting go? How do you set up? And how do you get the discussions started?

Logan: The volunteers of the organization supply us with brownies or cookies or what have you. We sit around a table, we have coffee. The discussion varies. At the last meeting I passed around some index cards and we talked about dating in the nineties and I asked a few questions - things like, "What is a date? What are some reasons you may or may not date? Does a date have to lead to a second date or to even a longer relationship? Where do you meet people?" And we wrote our answers to those out anonymously and then read the responses off the cards. After everybody answered the questions it generated tons of discussion surrounding dating issues and how is it to be a man having sex with other men, dating at this day and age.

One of the workshops for one of the groups focuses on eroticizing safer sex, so we talk a lot about condom use and the endless variety of condoms that are out there... We do talk about everything. People who are very much into any particular scene really can enlighten the rest of us about exactly what goes on - we have people in all different venues and certainly at different places in their life with safer sex. Other times we've talked about the coming out process. People are certainly at different stages in that and how it is in their workplaces and how it is with their families, that kind of thing.

CTB: So you're finding a really big range of topics that people are interested in discussing?

Logan: Yes. We try to focus on being gay, being happy, and saying yes to safer sex, because I try to tie it back into the safer sex issue. A man who feels good about himself and is okay with being gay is going to take care of himself more than someone who is feeling bad about it and, for example, drinking a lot of booze before he can do anything with another man.

CTB: What is it like to handle people who really tend to dominate the discussion or who bring up irrelevant topics?

Logan: I really haven't had very many instances where that's happened. Really the biggest problem I have in the group is keeping that discussion going, trying to throw out ideas and get them talking more. We have a few moments of silence every once in a while. But as far as having to get someone back on track, I always try to validate what they have said and say, "You know, that's a very good point, " or "I hear what you're saying, but can you explain that more or relate that to the topic back at hand?" What really helped me with facilitation was when I went through the Kansas Department of Health and Environment training and Red Cross fundamentals training about how to present a topic on HIV and AIDS and how to present education to a group. That training really helped. I've learned a lot about how to ask open questions, how to repeat what they say, or to even use moments of silence to get them to speak more. So that's really helped; I've felt really fortunate that I've studied some of that.

Tool 1: Role Play Scenarios

This tool was adapted from The Self-Help Leader's Handbook: Leading Effective Meetings by Adrienne L. Paine, Yolanda Suarez-Balcazar, Stephen B. Fawcett, and Leslie Borck Jameson, with the collaboration of Melody G. Embree.

Working with one or more partners, role play these scenarios, with one of you acting out the part of the support group facilitator and any others acting out the roles of support members.

• During a support group meeting for people who are experiencing stress in the workplace, one member is talking about having difficulties communicating with her supervisor. The facilitator should try to elicit supportive responses from other members.

• You are involved in a support group for people who have suffered severe spinal cord injuries. One member, who uses a wheelchair, is talking about how hard it is to find an apartment in town that is accessible. The facilitator should try to elicit supportive responses from other members.

• In a support group for family members of alcoholics, a member is talking about how she is upset that her husband won't get help for his drinking problem, and she is concerned that he will hurt their children. The other members are not providing support. The facilitator should try to elicit supportive responses from other members.

• In a support group for people who have lost a child in drunk driving accidents, one member is talking about the difficulties her other children have had after her daughter's death. The other members have been supportive, but none have talked about their own relevant personal experiences. The facilitator should try to get other members to start talking about these experiences.

• You are involved in a support group for women who have experienced breast cancer. One member has recently found a lump in her breast but has not seen a doctor about it. The facilitator should try to get other members to offer supportive comments and encouragement for her to seek medical attention without being coercive or condescending.

• In a support group for survivors of rape, one member has been talking about having flashbacks and other problems that make you suspect she may be suffering from post traumatic stress disorder. She may need more help than the group is able to provide. The facilitator should try to find a way to talk to her about getting some professional counseling help.

• In a support group for older people dealing with debilitating illnesses, one member has repeatedly brought up irrelevant topics, attempted to keep all the group discussions focused on himself, and interrupted other members when they try to talk. The facilitator should try to redirect the discussion and directly deal with this member's disruptive behavior.

• In a support group for parents of adolescents, one father is talking about how he suspects his son is drinking. Other members have been suggesting ways he can deal with it, but he has rejected every suggestion for one reason or another. The facilitator should try to find some way of dealing with the member's inflexibility and of moving the discussion along.

___You know what a peer support group is

___You know why to create a peer support group

___You know who your peer support group can serve

You've followed the steps to creating a peer support group:

___Decided on your purpose

___Researched other groups your group could be involved with

___Decided on a length of time for your group to meet

___Decided whether the group will be open or closed

___Set a time and place for your group to meet

___Selected a group leader or facilitator

___Decided on the remaining details

___Recruited members using

• Referrals
• The media
• Personal invitations/word-of-mouth

In facilitating a peer support group, you have:

___Prepared yourself

___Prepared the room

___Started the meeting on time and in a friendly manner

___Given preliminary introductions/information

___Encouraged members to listen to each other

___Encouraged members to give support to one another

___Encouraged members to talk about themselves

___Offered support

___Helped members solve problems by:

• Clarifying the problem
• Talking about alternatives
• Choosing which option to take
• Offering help

___Closed the meeting by:

• Making a summary statement
• Asking for comments/questions
• Reminding members of next meeting
• Requesting volunteers, if necessary
• Giving a final greeting
• Making final notes

___You have looked over the tips on keeping your support group going

___You know when to use assertive caring

___You know the four steps to assertive caring:

• Showing that you understand the member's dilemma
• Setting limits
• Suggesting alternatives
• Getting the member's agreement on the alternative

A PowerPoint presentation summarizing the major points in the section.