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It’s difficult for people who’ve had a spinal cord injury (SCI) to find new roles in their family, workplace, and community. If they also are young, without a high school degree, and have no legitimate work experience, the transition is even more daunting.
Schwab Rehabilitation Hospital and Care Network of Chicago teamed up with the University of Illinois in Chicago to provide a peer mentor program for people with SCIs who were injured by a gunshot wound. The program, called the Disabling Bullet Project, provides three weeks of training to peer mentors, who are then hired as part-time employees by the hospital.
"The purpose is to assign new patients on the unit a peer who is similar to them in their disability and who will provide support by listening and identifying community resources that are available for them," explains Brigida Hernandez, PhD, project director of the Disabling Bullet Project. Hernandez is a post-doctorate research associate with the University of Illinois at Chicago through the Department of Disability and Human Development and Psychology.
Investigators spent the first year developing the training curriculum and additional time piloting the project. It was finally launched in September 2000.
Unlike Schwab’s In My Shoes program, this project does not address violence prevention, says Kris Vertiz, LSW, spinal cord team leader at Schwab. "The main focus is on the patient’s need to integrate into the community," she says. Here’s how the program works:
1. Mentors are selected and trained. The mentors are patients who have spinal cord injuries caused by gunshot wounds and who have been through the entire rehabilitation process. They typically are two to four years post-injury. Mentors are interested in sharing their experiences in seeking community support and coping with the changes in their lives with newly disabled patients. The mentors receive three weeks of training and then they are supervised by Vertiz on a weekly basis. They work 10 hours a week. If they have any questions, whether it’s about how a patient will receive medication, supplies, etc., the mentors can ask Vertiz for answers.
2. Mentors meet with new patients. Vertiz identifies which of the new patients is likely to benefit from this program and then she connects them with mentors. Each mentor is responsible for no more than five SCI patients at a time.
"They meet with the patients several times a week during their inpatient stay," Hernandez says. For paraplegic patients this might be for four to six weeks, and for quadriplegic patients for three months.
"Peer mentors stop by patients’ rooms, stop by their therapy sessions, and just talk with the patient about how their adjustment has been going," Hernandez says. "The big issue is talking about how they are adjusting to the disability, and then they discuss how they’ll go back to the community, and how to have accessibility in their homes and safety in their neighborhoods."
Safety is an important goal because so many of the gunshot victims are young men of minority backgrounds who were involved in gangs and illegal activities, Hernandez notes. "Many have not completed high school, so their needs are great," she notes. "And many do not have stable employment history because they basically have been hustling on the streets, so life can be very overwhelming."
The mentor program aims to help these patients realize that their life isn’t over because of the disability, she adds. "When in the hospital, the mentors and patients have conversations about how the individual was shot and what the experience was like," Hernandez says. "The mentor and mentee share stories, and oftentimes the patient goes through the phases of shock, disbelief, and sadness so the peer mentor is a sounding board for the patient to share these experiences."
Peer mentors have a more emotional relationship with the patients than the therapists who have been working with them. "In occupational therapy and physical therapy, patients learn how to develop with the disability, but the mentor adds the component of how do you emotionally deal with the disability, especially if you go back into the community where being on your own and being independent is so important," Hernandez says.
3. Mentors help SCI patients set new goals. The mentors themselves demonstrate how SCI patients can develop new lives, with new goals. For example, one of the peer mentors recently decided to attend a technical school to study computer science, and another went back to high school to complete a math course and then obtain a high school diploma, Hernandez says. "As the peer mentor relationship develops, more concrete things are talked about," Hernandez says. "First, it’s the patient’s adjustment to the disability and what life’s going to be like."
Then the patient and mentor begin to talk about what the patient will need to do to get his or her life back on track. "That’s where the peer mentor comes in with goal-setting in mind," Hernandez says.
"We don’t have prescribed goals, and we don’t make the patient talk about employment or education," she adds. "It’s up to the patient what goals to set."
Peer mentors also might help to expose patients to the various recreational activities available to people with SCIs. For example, Schwab has wheelchair basketball that a patient might be interested in trying after being discharged. "Before the peer mentor program we’d hear that patients go back to their homes and try to be involved in the lifestyle of gangs, but slowly their gang friends drift away," Hernandez says. "So they sit around in their apartment or home and watch the years go by without doing much."
4. Mentors provide follow-up support. Within one week after an SCI patient is discharged the peer mentor will visit the patient at home or meet with the patient when the patient returns for an outpatient visit. Peer mentors also may call patients to see how they are doing. The mentors continue to stay in touch with the patients on a weekly basis, at least by telephone. This way they can continue to provide support and serve as role models as patients adjust to their home environment and attempt to fit into the community.
Since the program is a demonstration project that is being researched, investigators will interview peer mentors, patients, and hospital staff to evaluate its effectiveness, Hernandez says. The project probably will be expanded and implemented at several other rehabilitation hospitals during the next couple of years, she adds.
"Once we have outcomes, and hopefully they’ll be positive, the idea is to disseminate them to other hospitals and independent living centers," she explains. "The idea is to educate independent living centers about this new emerging disability group and show them a way to reach out and better serve them."
• Brigida Hernandez, PhD, Project Director, Disabling Bullet Project, University of Chicago, Department of Disability and Human Development and Psychology, Chicago, IL. Telephone: (312) 996-6824. Fax: (312) 413-1804. E-mail: firstname.lastname@example.org.
• Kris Vertiz, LSW, Spinal Cord Team Leader, Schwab Rehabilitation Hospital and Care Network, 1401 South California Blvd., Chicago, IL 60608. Telephone: (773) 522-2010. E-mail: email@example.com.