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Training Description DBSA Peer Specialist training prepares people who
live with mental illnesses to use their experiences to work with
others as peer specialists. Facilitated by nationally-recognized trainers,
this comprehensive course delivers a foundation in recovery principles,
intervention techniques, and ethical practice. Curriculum focuses
on the use of peer-delivered services to support the recovery of
others. DBSA Peer Specialist training is delivered in affiliation with
Appalachian Consulting Group, Inc., innovators of the Georgia Certified
Peer Specialist Project that pioneered Medicaidbillable peer support services. Training topics include: • Role of peer support in recovery • Problem solving with individuals • Effective listening and the art of asking questions • Combating negative self-talk • Dissatisfaction as an avenue for change • Facilitating Recovery Dialogues© • Peer specialist
ethics … and more Who Can Participate • Individuals age 18 or older with personal experience as consumers of mental health services who wish to use this experience to assist others • Those
willing to publicly identify as a person living with a mental illness [Please do NOT apply if you do not meet these
first two standards.] •
DBSA especially encourages people who currently hold a peer specialist position or who are
actively seeking such a position (paid or volunteer) to apply, although this is not a requirement
to participate. • DBSA actively seeks a diverse group of training applicants with
respect to race, gender, age, sexual orientation, diagnosis, and disability. Requirements Training participants must commit to •
attend and actively participate in five full days of training. • participate in
discussion and role-plays utilizing solely their personal experiences as mental health
consumers rather than any clinical roles or training. • take a written certification
examination within four weeks of training completion. Location The Westin, 70 Yorktown Center, Lombard, IL 60148 Dates Training begins on Monday, August 16, 2010, at
9:30 a.m. and ends on Friday, August 20, 2010, at approximately 12:00 p.m. Registration Fee $950 per person includes training fee and all training materials, beverage breaks, light breakfast (Monday–Friday),
and post-training certification testing. Registration fees will be due at a later date. Do not submit paymentwith this application. Fee does NOT include hotel accommodations, travel, or meals other than breakfast.
Participants are responsible for paying these costs or obtaining outside funding support. DBSA
has reserved a block of rooms at The
Westin. For reservations, call toll-free (888)627-9031 , and be sure to request the “Depression and Bipolar Support Alliance room block.” The rooms are reserved at $110.00 per night plus tax (single or double). Reservation cut-off date is July 25, 2010. After that date, reservations will be accepted based on availability at the regular
room rate. Room cancellations must be made no later than 72 hours before your scheduled arrival date. ALL
APPLICATIONS MUST BE RECEIVED BY DBSA NO LATER THAN JULY 8, 2010. Please mail or fax your completed application to: Peer Services Department DBSA 730
North Franklin Street, Suite 501 Chicago, Illinois 60654 Phone: (800) 826-3632 Fax: (312) 642-7243 E-mailed applications are NOT accepted. Do not submit payment with this application. This is an application
only and does not guarantee you will be selected. All applicants will be notified of
their status no later than July 15, 2010. Registration payment will be due at that time. Selection: Enrollment is limited, and participants will be selected through a competitive application process. DBSA Peer Specialist Training August 16–20, 2010 Lombard,
Illinois Application for Participation 2010 DBSA Peer Specialist Training August 16–20, 2010 Please answer the following questions to the best of your ability. This
is not a “test” about right and wrong answers. Your responses will
help us get to know you and will assist the Selection Committee in identifying and selecting qualified applicants. Make sure to answer all questions and
sign your application. Write your answers on a separate sheetof paper, and submit them along
with this application. If you handwrite your answers, please make sure they are readable.
THANK
YOU! 1. Understanding
and Interest A.
Why do you want to become a peer specialist? B. What makes you a good candidate to work with other consumers
in the mental health field? 2. Recovery Experience A. What does recovery mean to you? B. What were/are important factors in your
own recovery? C.What types of experiences have you had in assisting, or advocating for, consumers of mental health services (for example, support group leadership, selfadvocacy, public testimony,
programs you started, etc.)? Please be specific. 3. Environment and Access A. Do you currently hold a position where you will use the skills gained through Peer Specialist
training and certification? �� Yes ��
��
NoIf yes, do you receive pay for this position? �� �� Yes �� �� No Position
title/location B. Are you a current candidate for a position where you will use the skills gained through
Peer Specialist training and certification? �� �� Yes �� �� No If yes, will you receive pay for this position?
�� ��
Yes �� �� NoPosition title/location NAME STREET ADDRESS CITY
STATE ZIP PHONE NUMBER(S) FAX NUMBER E-MAIL NOTE ANY SPECIAL ACCOMMODATION
REQUESTS Please
initial all items below to indicate your understanding of each: I certify that I have personal experience as a consumer of mental health services. If I am chosen as a training participant, I understand that I am responsible for funding my own
registration fee, travel, hotel accommodations, and meals other than breakfast. I understand that participating
in the DBSA Peer Specialist training does not guarantee me employment or a volunteer position. I
understand that payment is due by August 2, 2010. YOUR SIGNATURE PLEASE ALSO PRINT YOUR NAME Important: Each individual state or service delivery system sets its own peer specialist training and certification standards. Please check local
requirements with your state certification body, office of consumer affairs, or service delivery system
before making the decision to participate in this training course. DBSA can provide you with information
on training curriculum content. Demographic Information Please provide the following optional information to help ensure diversity
of the training group. Aside from using aggregate numbers, DBSA will not maintain
or use this information in any way. GENDER �� Male �� Female AGE �� 18–25 �� 26–39 �� 40–55 �� 56+ PHYSICAL
DISABILITY ��
Yes �� No ETHNICITY �� Asian/Pacific Islander �� American Indian �� Black (not of Hispanic origin) �� Hispanic �� White (not of Hispanic origin) �� Other
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