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Defining the Step-Up Step-Down Model

By Fred Poisson, Executive Director of Connections Peer Support


Step Up Step Down is a unique, 90-day, transitional living model that is completely Peer Run, offering 24-hour Peer Support, 365 days a year. This model offers guests a stable living situation with both built in and on demand Peer Support. This is an at will, sober living program that is designed to support, and at times challenge, participants as they move towards their goals.


Transitional living is intentional living and a transitional program requires intentional participation. Our Step-Up Step-Down program has a daily check in time, Monday through Friday, at 9:30am. All guests are expected to join this meeting. In this meeting the Peers on staff engage the guests in a conversation in regard to where they are at for the day. This is an opportunity for Participants to let the Peers on staff know if they need a little more support or a bit of space. The Peers on staff also engage the guests in a conversation in regard to what their goals are for the day and what does support look like for them around those goals?

This meeting is important for a number of reasons, 

  • It allows the guests to have a set starting point to their day. Guests who are in transition are often looking to get back to work or into a routine and having a set starting point for the day with an intentional check-in fosters the development of a routine that can support these goals. 

  • It fosters an environment where participants are reminded that their days have purpose and hope while reminding them that they have entered into an agreement to be moving towards a place of greater strength in their wellness and with that comes accountability to themselves and those supporting them. 

  • It exists as a place of reflection and reminder, where the Peer staff can support guests to reflect on what is driving them and give gentle reminders to the guests around topics that are important to their movement towards sustainable recovery.


Peer Support in the Step-up Step-Down model is offered throughout the day and shows up in a number of ways.

  •  Sometimes it looks like the Peer on staff and a guest having a casual conversation while the guest makes their breakfast. 

  • These casual conversations can actually be very beneficial for both the Peer on staff and the guest. The Peer on staff has an opportunity to learn more about and come to a better understanding of the guest and how best they can support them. The guest has the opportunity to develop a deeper relationship with the Peer on staff that is there to support them. To develop a sense of trust and to walk through whatever it is that they may be thinking about, worrying about or stuck on. 

  • It can also be an opportunity for the guest to share a victory or something they are proud of or feel good about but may not have had someone to share it with.

  •  Sometimes it looks like the Peer on staff knocking on the guest’s bedroom door when they have decided to retreat there, being curious with them as to the reason and then challenging them on the need if the situation calls for it. 

  • This is where the development of a real and honest relationship is important. In a healthy relationship we are not afraid to challenge one another when we sense there is a need. In a healthy relationship we are able to both give and receive feedback and foster growth in one another. Peer support in a residential setting really allows for this to happen in a different, more sustainable way.


There is also a reflective check in at 4:30 where guests and the Peers on staff reflect on the day and what has unfolded, where they are each at and what the night holds for them. 

  • This group presents a great opportunity for guests to let staff know if they are having a night where they might need a little more support or where they might really need to be left alone. 

  • This meeting also fosters a sense of accountability for the day which plays a significant role in a sustainable recovery.  

Pictured: James (Our SUSD manager) and Liane, a SUSD Peer Support Specialist.


The language of Peer Support is intentional. It is a language that is designed to be reflective and to serve the purpose of moving those who practice and participate toward the life they want and deserve. Peer Support is a lot of things but it is not a modality that is designed to allow people to stay stuck, it is a tool of empowerment that can have a significant impact on those who seek it out and incorporate it into their overall approach to their health. An example of what the language of Peer Support sounds like would be:


“I’m glad to see you here this morning, I was worried about you yesterday when I didn’t see much of you outside of your room.”

“I wasn’t feeling well yesterday, I haven’t had my medication in 3 days, it's over at Hannaford but honestly I just can’t walk there right now, I feel terrible.”

“I can respect that, when I used to take medication, I know if I missed it for any length of time, I felt awful.”

“Yeah, it was just such a pain getting it called into a new pharmacy that I wanted nothing to do with it when I was done, honestly, I don’t even know if it is there because I didn’t even want to check my messages, I was so frustrated.”

“That whole process can be really frustrating but I’m wondering if you wouldn’t mind if I offered you some support here?”

“How so?”

“I’m wondering if I could sit with you while you check your messages. I know for me sometimes it helps if someone is just there, I don’t know what it is, but it allows me to push through the frustration.”

“Okay.”

“And then maybe if they are there, I could walk over with you while you pick them up if you’re ok with that? Might make it seem less daunting if you don’t have to go alone?

“If you wouldn’t mind, I would definitely appreciate that”.


Peer Support is not about persuading people, it is not about coercing people; it is about offering people the tools and support to make the best possible decisions for their own health and wellbeing. It is about fostering a healthy relationship that includes accountability and taking ownership of one’s own goals, challenges and victories. The residential setting of the Step-Up Step-Down model allows for so many moments like this and each of those moments is an opportunity for our guests to practice and to grow as they move towards a life of greater independence and long-term recovery.


Peer support at its heart is about people having honest conversations with each other and using these conversations to build healthy relationships that support the movement toward one’s goals. It is very intentional. Peer Support was designed as a method for people who have managed to overcome the challenges and obstacles of their own mental health to support others who are currently facing their own challenges to move toward their own goals and successes. That is the root of the design of the Step Up Step Down model, people with lived mental health experiences who have come through the other end supporting others to get there, asking participants to reflect on the challenges they have faced and continue to face and supporting them to find their own path through the obstacles by practicing the principles of Peer Support.


How the Principles of Peer Support Are Practiced in the Step-Up Step-Down Model


Building connection is one of the core principles of Peer Support. It can take some time at a Peer Center for this to happen as a member’s time there is broken up based on the schedule of the day and the hours they are open. Step Up Step Down allows for a different means of connection as guests live together, they share space with one another and have to navigate the challenges this presents. Peers on staff are there to support the negotiation process that goes along with this type of living situation. Open and respectful communication are defined and encouraged through shared household agreements and then fostered through groups, conversation, house meetings and conflict resolution supported by the Peers on staff. 


Our worldview is a very personal reflection of our own experience, and it is often something we hide away from others, either out of shame, fear, exhaustion etc. But it also plays a significant role in our recovery. Step Up Step Down fosters an environment where worldview is very important to the process. When you are sharing space with someone it is essential that they have an understanding of what drives you and what informs your decision-making process, and vice versa, so that they are able to navigate and communicate with you in a manner that is healthy. Letting others in on our worldview is important to our recovery for a number of reasons,

  •  It can open our eyes to the idea that others may not have had the same experience, but they have had similar experiences, and it offers us the opportunity to feel less alone.

  • It allows us to convey to others who we actually are and to be understood in the way that feels healthiest to us.

  • It allows us to understand that while our worldview informs the way we live and the choices we make, it does not necessarily inform the lives of others and the decisions they make but giving them an understanding of where we are coming from allows them to make more informed choices for how they will receive and support us. 


Worldview can also sometimes present itself as an obstacle to recovery, sometimes what we have faced in our challenges and experiences have shut us off to the possibility of hope, change and healing. This can show up in a number of ways and it is hard to hide it in a residential setting. Peer Support in this setting allows for moments where that worldview can be challenged in a way that feels healthy, respects the individual and their right to have that worldview but also acknowledges that there might be another way; that there might be some gray in a situation that feels very black and white. The residential setting also fosters a space where the guests really have to work on practicing skills of healthy self-advocacy as well as acceptance that sometimes there is going to be discomfort, and while we can’t negotiate that we can at least negotiate how we sit with it. 


The principle of mutuality in Peer Support allows us to look at the idea of help through a different lens where it is a co-learning and growing process. Guests and the Peer on staff grow and learn together, they support each other through their challenges and their triumphs. Peers on staff check in at the groups as well and they are encouraged to share their own experiences when they are relevant to the situations at hand and when they can support another to move toward their goals. A residential setting is a perfect environment for mutuality to grow, be tested and negotiated, fostered and better understood as guests have to navigate the space with other guests and learn how to fully respect one another’s space. 


These opportunities also arise between the guests and the staff as they have to negotiate the terms of what is their living space with what is a work environment. This can be challenging at times, but it is of great benefit as it allows our guests to learn skills they might not have had the opportunity to learn before; skills that are transferable as well. Knowing how to shift one’s communication style between casual and more formal communication can go a long way towards supporting how one will navigate in other settings, in particular the professional world which for many of our guests is a place they are trying to get back to.


Guests and the Peers on staff also have to navigate and practice mutuality in the upkeep of the house. It is important that a healthy, clean-living space is maintained. The responsibility for this does not fall on the shoulders of the Peers on staff, it is shared between them and the guests residing in the house. Guests enter into an agreement to participate in this upkeep when they join the program and the Peers on staff do remind them when necessary. This is a great opportunity for both our Peers on staff and our guests to practice giving and receiving feedback through healthy, mutual discourse.


The idea of moving towards, being intentional about this, rather than moving away from what we don’t want, is one of the most essential elements of Peer Support and one of our biggest points of focus in the Step-Up Step-Down program. One of the most important questions we ask, in our groups, in our conversations etc., is “How is this moving you towards your goals and the life you want and deserve?”. Again, it is important to remember that Peer Support is about honest conversations, and sometimes those conversations are going to present themselves as a point of challenge. Asking this simple question gives people a moment to pause, to look beyond the frustration of whatever moment they might be in and to ask themselves how the situation is serving them. 


 A residential setting also allows for a space for guests to learn and practice healthy coping skills in a setting that is as close to a real life setting while still having necessary support as possible. This is where Peer Support really shines, when peers come together to discuss what has worked for them to get through difficult moments. These coping mechanisms are not taught, they are shared. They are shared as an experience “Hey, I see that you are really struggling, do you mind if I share something with you that in the past has worked for me?”. Sometimes guests will be receptive to this and other times they will not, but the residential setting also allows for casual demonstration from which our guests can learn. When the Peers on our staff are overwhelmed or experiencing a heightened moment, they are presented with the opportunity to practice and demonstrate the very skills that our guests can benefit from.


The outside of our SUSD home.


The Step-Up Step-Down model is also a living, evolving model that responds to the feedback of our guests and our community. The model adapts to meet the needs of our individual guests as best as it can without compromising the principles of Peer Support or of our organization and while also respecting the limitations of our staffing model. This model challenges and rewards the guests who participate in it and offers them a real opportunity to feel supported while they move towards the goals they set for themselves. 


The Step-Up Step-Down model fosters an environment and experiences that allow guests to experience significant personal growth and to strengthen their abilities to navigate difficult situations and manage and overcome the challenges that come up in their lives. The Step-Up Step-Down model fosters an environment where our guests develop and strengthen a sustainable sense of recovery and have an opportunity to hone their communication and self-advocacy skills through everyday lived experiences with the peers they share the space with as well as the Peers on staff. It is a truly extraordinary model that presents a significant number of opportunities for growth, healing and sustainable recovery to all who participate in it. 


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