By Robert J. Fetsch, Extension Specialist & Director, Colorado AgrAbility Project,

1. AANTWPeerSupport10.3107 (Rev. 10.1807b)AgrAbility NTW Peer Support UpdateSacramento, CA3:45-5:30 October 31, 2007 By Robert J. Fetsch, Extension Specialist & Director, Colorado AgrAbility Project, Human Development & Family Studies Colorado State University

2. In Last Year’s EvaluationsYou Asked for… Have an update on State’s programs. More information on the “assessment” of possible peer supporters. New data acquired. Dr. Fetsch’s raw or analyzed data.

3. More Information on Our “Assessments.” One of our successes was the Detailed Screening Process we used to find people who are ready. Cf. Denial-Acceptance Continuum. Cf. Telephone Interview protocol.

4. Available Resources Fact Sheet: Peer Support Checklist Denial-Acceptance Continuum Dear John Doe Letter Telephone Script to Screen Farmers/Ranchers Who Are Ready. Telephone Script to Screen Caregivers Who Are Ready

5. Three Trainings AANNPST—7 CO farmers, ranchers, & caregivers 7/15/04 Denver, CO AANNPST TtT—19 AgrAbility staff 5/10-11/05 Kansas City, KS AgrAbility Peer Advocate Training—7-9 OK farmers & ranchers 4/18-19/06 Stillwater, OK

6. Program Changes From 8 hours on 1 day to 4 hours (PM) plus overnight plus 4 hours (AM).

7. Successes We delivered 3 trainings. We have empirical results and an article on peer support training with farmers and ranchers with disabilities and with comparisons to population norms and with pretest-posttest changes.

8. Brief Review of the Literature Four peer support studies were found with experimental-control designs. Training ranged from 2.5 hours to day-long training. No studies reported successes with farmers/ranchers with disabilities.

9. Brief Review of the Literature Peer support literature is long on theory and short on empirical impacts. Four peer support studies were found with experimental-control designs. 206 first-time mothers in peer support decided to breastfeed earlier and continue longer. 42 new mothers identified as high risk for post-partum depression reduced depressive symptoms.

10. Brief Review of the Literature Four peer support studies were found with experimental-control designs. 115 primary caregivers of individuals with Alzheimer’s decreased depression symptoms. 136 individuals with Multiple Sclerosis became more realistic, made negative appraisal of one’s abilities, reduced self-efficacy, increased use of blaming coping strategies, and increased external locus of control.

11. Brief Review of the Literature Peer support theory hypothesizes improvements in social skills, optimism, goal achievement, problem solving, acceptance of disability,and reductions in denial, withdrawal, stress, depression, anger and blame, reassessment and reaffirmation, coping, self-esteem, hope, and optimism.

12. Measures Used in the Colorado Study Acceptance of Disability Scale McGill Quality of Life Questionnaire Problem Solving Inventory CES-D (Depression) Scale Hostility Scale State-Trait Anger Expression Inventory Overview of chronic pain, stress, anger, depression, self-esteem, and perception of financial situation, and demographics.

13. Results Immediate anecdotal feedback was quite positive. Participants were: Excited, enthusiastic Appreciated “normalizing” their experience Gave rave reviews about learning the 7 skills to provide effective peer support What were post-test (8 weeks later) to follow-up (6 months later) changes?

14. Posttest-Followup Skill Levels of Colorado AgrAbility Peer Support Participants (n = 7; n = 3)

15. Posttest-Followup Skill Levels of Colorado AgrAbility Peer Support Participants (n = 7; n = 3)

16. Results How similar/different was our sample from population means?

17. Comparison of Colorado Group Mean Scores (N = 7) with Those of Non-Agricultural Populations (N = 1,266; 654) (p < .05)

18. Comparison of Colorado Group Mean Scores (N = 6-7) with Those of Non-Agricultural Populations (N = 143) (p < .05)

19. Comparison of Colorado Group Mean Scores (N = 6-7) with Those of Non-Agricultural Populations (N = 143) (p < .05)

20. Comparison of Colorado Group Mean Scores (N = 3) with Those of Non-Agricultural Populations (N = 498) (p < .05)

21. Comparison of Colorado Group Mean Scores (N = 3) with Those of Non-Agricultural Populations (N = 1,182; 1,182; 498) (p < .05)

22. Results CAP’s small group mean scores were significantly better than the population mean scores on: Self-esteem levels State Hope levels McGill Quality of Life levels

23. Results CAP’s females scored significantly higher than the population on: Problem solving confidence levels State Anger Trait Anger Anger In

24. Results What were pre-test to post-test changes? None of the pretest-posttest group differences were statistically significantly different. Hostility levels fell at a level that approached statistical significance (Pretest M = 10.29; Posttest M = 9.29, p = .086).

25. Conclusions It is striking that the present sample scored significantly higher on so many indicators of health well being. The findings speak well of the good work that our farmers, ranchers, and caregivers did on their own over the years to deal well with denial, anger, blame, depression and unfinished business related to their acquired disabilities & conditions.

26. Conclusions The findings attest to the strength, stamina, hard work, and resilience of our peer support advocates. The findings verify the effectiveness of the screening technique CAP used to identify ranchers, farmers, and caregivers who were ready.

27. Recommendations For all of us: Continue screening well to select those who have accepted their disabilities and who experience joy of life. Be vigilant and tune in to signs of high denial, anger, depression, and suicidal thinking and refer to appropriate professionals.

28. Recommendations For those of us who continue to offer 8 hours of training: We invite you to use our pre-post surveys to replicate the CAP study so we can compare apples with apples. E-mail me (fetsch@cahs.colostate.edu) or call me (970-491-5648) for copies.

29. Recommendations For those of us who want to achieve better pre-post survey results: Consider using CAP’s pre-post-follow-up surveys to assess your results. Offer two full days of training over a 2-4 week period.

30. Recommendations For those of us who want to achieve better pre-post survey results: Incorporate multi-component training that includes AANNPST Curriculum, experiential learning and practice of problem solving, management of stress, depression, anger, hostility, and enhancement of self-esteem and practice ways of enhancing hope levels.

31. Conclusions This empirical study with ranchers and farmers with disabilities: Identifies ranchers/farmers’ strengths and resilience. Provides affirmation to ranch/farm families who are second only to non-construction laborers in disability rates and work-related death rates.

32. Conclusions This empirical study with ranchers and farmers with disabilities: Provides empirical evidence that CAP’s sample was able to bounce back. Provides hope that others with acquired disabilities can grow stronger in hope, self-esteem and quality of life.

33. Conclusions This empirical study with ranchers and farmers with disabilities: Encouragement to farm/ranch caregivers that they too can improve their anger management and problem solving confidence skills.

34. Challenges Getting farmers/ranchers with disabilities to call our peer support advocates.

35. Next Steps We hired a skilled MFT graduate student to promote Peer support. She is beginning to make 1:1 calls to all 6 of our peer support advocates to check in and assess their training needs. She and I are considering offering a 1.5-2.0 day training. We’re working with KS, OK, NE, WY, and others of you who are interested?

36. From previous research,what do we not know? Whether 2 day peer support trainings are effective with groups of farmers/ranchers with disabilities and caregivers. CO is poised to find out! Won’t you join us?

37. Thank you very much!