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Living Well with a Disability

University of Montana Rural Institute

Utah Arthritis Program: Fidelity Guide

This guide was developed for coordinators and peer leaders of the Living Well with a Disability program in Utah. The purpose of this guide is to hold organizations accountable to the fidelity of the program throughout the state. Organizations should use each item in this guide as indicated as a part of Utah Arthritis Program’s Fidelity Plan.

Much of the information has been taken from the University of Montana Rural Institute’s online Facilitator Training. Please refer to that website for more detailed implementation information. It is located here:

http://livingandworkingwell.ruralinstitute.umt.edu/living-well-program/

http://livingandworkingwell.ruralinstitute.umt.edu/living-well-program/

Fidelity Index: Document I: Annual Workshop Plan/Schedule

Living Well Coordinators are to use this template to record tentative locations, dates, and times of Living Well with a Disability workshops for the year. This schedule can be updated as needed. This schedule should also be shared with the UAP, who will share and help promote the workshops with community partners.

Document II: Living Well Coordinator Description

This document serves to maintain fidelity amongst Living Well Coordinators throughout the state. Living Well Coordinators are to read this to understand how to maintain fidelity through workshop implementation, as well as understand their role as a coordinator.

Document III: Peer Leader Position Description

This document serves to maintain fidelity amongst Living Well with a Disability Peer Leaders throughout the state. All potential peer leaders should read this to understand how to maintain fidelity, privacy and confidentiality, and professionalism through workshop implementation.

Document IV: Peer Leader Application

This document is NOT REQUIRED can be used by the Living Well Coordinator or Peer Leaders to recruit people who are interested in becoming certified peer leaders. The Peer Leader Application may help an organization better keep fidelity of the LWD program by ensuring its peer leaders are qualified individuals.

Document V: Peer Leader Script

This document ensures that all peer leaders are saying the same thing to workshop participants regarding data collection and privacy of personally identifiable information.

Document VI: Peer Leader Agreement

This document ensures fidelity across peer leaders who are teaching Living Well with a Disability throughout the state. When a leader initials the responsibility and duty items, and then signs this form, the UAP knows he/she understands his/her responsibilities of being a peer leader.

Document VII: Non-Disclosure Agreement

The fidelity of the Living Well with a Disability program requires that no personally identifiable information be released. By signing this form, the UAP knows the individual agrees to the privacy responsibilities that come with implementing Living Well with a Disability workshop.

Document VIII: Participant Information Form (PIF)

This document ensures fidelity through standardized collection of information from all workshop participants. Additionally, this form, maintaining privacy fidelity, collects no personally identifiable information. Lastly, peer leaders are to give these forms to their Living Well Coordinator, who in turn submits this information to the UAP within ten days of workshop completion, enabling the reporting of workshop data.

Document IX: Workshop Attendance Log

A peer leader is required to complete this document for each Living Well with a Disability workshop and give it to his/her Living Well Coordinator within ten days of workshop completion. By doing this, the UAP will be able to gather participant attendance information without receiving any personally identifiable information.

Document X: Workshop Fidelity Checklist

The Workshop Fidelity Checklist is to be used by a certified peer leader during their Living Well with a Disability workshop observation. The workshop observation will occur between session 1 and 5, allowing time for leaders to utilize any feedback given in the remaining sessions. Workshop observations ensure fidelity of the LWD Program by holding peer leaders accountable to program requirements and standardizing program implementation.

Document XI: Leader Workshop Checklist

The Leader Workshop Checklist is for peer leaders to ensure they are fully prepared to deliver the Living Well with a Disability workshop. By using this checklist, leaders will have all materials necessary to successfully lead a workshop and to maintain fidelity of the program by making sure all leaders use the same materials.

OMB Control No. 0986-0036; Exp. Date 10/31/2019 Updated: 2/8/2018

Research & Training Center on Disability in Rural Communities

Living Well with a Disability Workshop

Annual Workshop Plan/Schedule Proposed Annual Calendar for Scheduled Living Well workshops

Partner name: Living Well Coordinator’s Name:

Workshop Location Location Address Day of the Starting Ending Starting Ending Contact Person (Name of Site) (Street Address, City & Zip) Week Date Date Time Time to Register

1. M T W Th F Sa

2. M T W Th F Sa

3. M T W Th F Sa

4. M T W Th F Sa

5. M T W Th F Sa

6. M T W Th F Sa

7. M T W Th F Sa

8. M T W Th F Sa

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Living Well With a Disability Workshop

Coordinator Position DescriptionPlease read carefully

The Living Well Coordinator is key for the successful implementation of the University of Montana’s Rural Institute’s Living Well with a Disability Program (LWD). The Living Well Coordinator is the organization’s main contact for implementing and managing all aspects of Living Well with a Disability program as well as the main contact for communicating with the Utah Arthritis Program (UAP). Outlined below are the basic roles of a Living Well Coordinator:

• Recommended dedicated time: The Living Well Coordinator position should not be an add-on for an already busy person. It is recommended that this position be part of a job description with a specific time allocation (10%-50% FTE depending on number of workshops planned).

• Schedule workshops: Find and reserve community or organizational sites to host workshops. Create a workshop calendar (preferably year-long) that outlines scheduled workshops and share with UAP. Update schedule as needed. If classes are open to the public communicate the date, time, and location to UAP to post to the online schedule on UAP’s website.

• Recruit and manage Peer Leaders: Identify and recruit ideal Peer Leaders following the UAP’s guidelines, assist with the Peer Leader application and registration process for the online LWD Peer Leader training. Maintain contact information for all leaders and coordinate two leaders for every scheduled workshop. Obtain supervisor’s approval for Peer Leaders who use staff time to lead workshops. Coordinate stipends for volunteer Peer Leaders. Manage base of Peer Leaders with respectful communication and recognition whenever possible.

• Recruit participants: Coordinate marketing and promotion efforts to find and register 8-10 participants for each Living Well with a Disability workshop. Begin promotion at least a month in advance for a scheduled workshop. Consider suggestions and guidance found in the Implementation Guide, the Living Well Coordination Workgroup, and from UAP staff. Be the point contact for interested persons calling

and wishing to register into your organization’s scheduled workshops (your name and number will be listed on promotional materials) or communicate with the UAP who the contact person will be for registering participants.

• Maintain program fidelity: Be familiar with and maintain LWD program fidelity requirements.

• Provide materials: Order or print sufficient Workshop Manuals (see Implementation Guide, Pg. 6) and compile all program materials necessary to hold a workshop.

• Submit Data and Paperwork: Gather and submit workshop data (Participant Information Form and Attendance Form) to UAP within 10 days after the end of a workshop.

• Follow security and privacy protocols for personally identifiable information of participants, and ensure Peer Leaders do the same. Maintain data records collected from program participants in a secure, locked place. After entering data into Compass, or if data is electronically submitted to the UAP via email, the Living Well Coordinator will continue to securely store the data for 3 years or until informed that the records can be destoryed via shredding.

• Attend the Living Well Coordination workgroup calls when scheduled.

• Reach out to and communicate with UAP for any technical assistance needs or questions.

• Be familiar with the Living Well with a Disability program. It is strongly recommended that the Living Well Coordinator be trained as a LWD peer leader, although this is not required.



• Read the Living Well with a Disability Implementation Guide, and review/refer to it as often as necessary.

• Serve as the Emergency Contact to cover workshops when one of your Peer Leaders cannot lead a workshop, falls sick, or for cases of emergencies or questions.

• Receive periodic site visits from the UAP for support, assistance, or coordination.

• Submit bi-annual progress reports and if under contract with UAP, submit invoices.


Coordinator Position DescriptionPage 2




Peer Leader Position Description

Program DescriptionUtah implements the evidence-based, Living Well with a Disabiltity program developed by University of Montana’s Rural Institute. This program is a ten-week workshop that take place once a week for 2 hours, in groups of 8-10 individuals. They are facilitated by two trained peer leaders.

This workshop helps participants with disabilities or physical impairments develop the skills needed to manage their disabilities and helps increase life satisfaction for those living with one or more disability. The subjects covered include: behavior change, strategies to enable participants to solve problems, ways to increase physical activity levels, effective communication skills, nutrition, decision making, and techniques to deal with problems such as frustration, fatigue, pain, and isolation.

Desired Characteristics of a Peer Leader• Possess life experience resulting in empathy to the needs and abilities of those living with a disability or

physical impairment • Living with a disability or has experience living with others with a disability• Possess good listening skills and be non-judgmental• Reflect the make-up of the community participants (race, ethnicity, gender)• Be dependable and consistent • Must be literate• Motivation of Peer Leaders should come from a desire to serve others, and not to earn money • Possess ability to lead entire workshop (10 sessions, each 2 hours in length) • Has reliable transportation to and from workshop site• Can make necessary time committment

The Peer Leader needs to plan time for transportation, arriving early to set up, and class time of 2 hours once a week for ten weeks. An additional half hour preparation a week is necessary to set-up and clean up the workshop site.

Steps to becoming a Peer Leader1. Fill out the Peer Leader Agreement.2. Become certified as a peer leader by completing the entire online Living Well with a Disability facilitator

training.3. Lead a workshop within six months of peer leader training.4. Lead at least one ten-week workshop annually to maintain certification



Duties and ResponsibilitiesFidelity

• Deliver the program as set forth in the Workshop Manual and in the Leader Training; no additions no deletions. Follow the program’s detailed script.

• Refrain from using any professional/other titles that may be held unrelated to being a Peer Leader (i.e. manager, RN, etc.) during workshops.

Privacy and Confidentiality• Keep all participant identity and contact information

confidential. Use their telephone numbers/emails only to remind them of the classes or for communications related to the class. Abide by all data security protocols.

• No selling, advertising, solicitation or promotion of any kind during class. Do not recruit class participants for any type of campaign.

Respect for DiversityNo participant should be discriminated against or become the target of ridicule, disrespect, or gossip due to their ethnicity, religion, gender, national origin, age, physical disability, political affiliation, sexual orientation, color, marital status, veteran status or medical condition. Peer Leaders who exhibit discriminatory behavior will lose their affiliation with the project.

Workshops• Prepare all materials at least two days before you

begin to teach the workshop series. This will give you an opportunity to organize the material and split responsibilities with your co-leader.

• Discuss any problems promptly with the Living Well Coordinator.

• Keep track of required paperwork for the class including attendance sheets, participant data, and evaluation forms. Submit paperwork within two weeks after completion of the workshop.

• Must have reliable transportation to and from workshop.

• It is NOT expected that Peer Leaders will find community sites, order materials, or recruit participants; this is the job of the organization’s Living Well Coordinator.

• Some organizations offer stipends for Peer Leaders’ efforts. If you have questions about possible stipends contact your Living Well Coordinator.

Professionalism and Team Work• Arrive 15-30 minutes before each workshop to

organize materials, arrange the classroom, etc. Make every attempt to start promptly and end on time. Clean up classroom after sessions.

• Introduce yourself as a peer leader with the organization you are volunteering with or for whom you are working.

• When preparing charts, make sure to use BIG letters and write clearly and legibly.

• Be a positive role model for participants.• Respect each other; never contradict, interrupt, or

embarrass your co-leader in front of participants. Try to resolve differences directly with your co-leader in private, always maintaining a positive and open attitude. Notify the Living Well Coordinator if differences cannot be resolved.

• Provide adequate notice (at least 24 hours) to Living Well Coordinator if it is necessary to miss a session due to illness, and make every effort to find a replacement leader.

• Obtain supervisor approval at work in order to participate, if using staff time to lead workshops.

• Facilitate communication between your direct work supervisor and the Living Well Coordinator.


Peer Leader Position Description




Peer Leader Application

Applicant’s Name: E-Mail: Phone:

Address: City: State: Zip:

Organization/Company Name:

Living Well Program Coordinator’s Name: Title/Position:

E-Mail: Phone:

Address: City: State: Zip

Yes No

1. Have you attended a Living Well with a Disability workshop as a participant?

2. Are you living with a disability?

3. Have you lived with someone else who has a disability?

4. Have you read the Peer Leader Position description and do you understand the duties and responsibilities outlined there?

5. Do you have reliable transportation?

6. Do you have time to dedicate three hours a week for ten consecutive weeks?




Peer Leader ApplicationPeer Leader Screening Questions (suggested)

Briefly describe your interest in participating in this program:

1. Why are you interested in becoming a peer leader?

2. What experience do you have with disabilities?

3. Are you able to model self-management principles to participants? Please give examples.

4. What experience do you have facilitating health education or problem solving groups?

5. How would you describe the difference between teaching and facilitating?

6. What skills or characteristics will make you an effective peer leader?

7. What is your availability for co-facilitating workshops (days of the week/time of day)?




Peer Leader Script

Read the following statement to participants prior to their completing of the Participant Information Form.

• This workshop is made possible by grants, such as one from the U.S. Administration on Community Living (ACL), and other funding agencies/sources.

• As you begin the workshop, we will give you a Participant Information Form to complete.

• Before we can share your information with the Utah Arthritis Program, its federal funders, and secure database contractors, we want to explain how your information will be used and protected.

» We use it to learn who is being reached by this program, and to improve our services.

» It helps show our funding agencies that they are spending their money wisely.

• Completing the Participant Information Form is entirely voluntary. If you decide not to complete the form, or to skip certain questions, you can still participate in this program.

• We follow very strict rules to protect all of your information and to keep it private. We will maintain these paper forms securely following careful practices for protecting private data.

• At the top of the Participant Information Form, there is a space for your participant identifier that we will assign to you. These identifiers will be matched to the Attendance Log to track how many times you attend class. We will enter your participant identifier on the top of your forms. Please do not turn in the forms without the participant identifier filled out.

• If you agree, please take time now to complete the Participant Information Form. The Form asks you to provide information such as your age, zip code, and gender. You may skip any question(s) you do not want to answer. While completing the Form, you may ask us to explain any questions you find confusing.




Peer Leader Agreement

As a qualified Peer Leader, I _________________________________ (print name) agree to abide by all of the procedures for this program as set forth in the Organization Terms & Agreements and the Living Well with a Disability online leader training. I agree to be held accountable for the following responsibilities:

Please initial each responsibility.

I have read and understand the Implementation Guide and Peer Leader Description. I have a copy as a reference to remind me of my responsibilities.

I agree to read and work through all of the Living Well with a Disability online leader training and understand I am not certified to lead a workshop until the training is completed. I also understand that the UAP is the established licensed organization and I may lead only through an organization partnering with them.

I understand that if a volunteer stipend is offered by my sponsoring organization it will be agreed upon with my Living Well Coordinator.

I understand that if becoming a Peer Leader is part of my job or staff responsibilities, I have obtained supervisor approval and support, and both my supervisor and Living Well Coordinator are in communication to coordinate time availability to lead workshops.

I understand I will be authorized to lead my first workshop only after I have satisfactorily passed all competencies during the online leader training, as approved by my Living Well Coordinator.

I agree to co-facilitate my first ten-week workshop within six months of completing the online leader training.

I understand that I may not share my personal login information to the online Living Well with a Disability training website with anyone.

I understand that I must lead one workshop a year to maintain my certification. Otherwise, I understand I need to go through the online leader training in full to become re-certified.

I agree to ensure fidelity by delivering the program as set forth in the Living Well with a Disability Workshop Manual, with no additions or deletions, and following the script as outlined. I understand that guest speakers may not lead any part of the course.

I understand that I am a role model for the participants of self-management. I am committed to leading the workshop to the best of my abilities and be open to feedback.

I will refrain from using any professional or other titles unrelated to being a Peer Leader (RN, RD, etc.) during workshops. I agree not to offer personal advice, health advice, or medical advice during workshops. I agree to no selling, advertizing, or solicitation during class. I will not recruit class participants for any type of campaign.

I agree to introduce myself as a Peer Leader with the organization for which I am working or volunteering.

I will always co-facilitate with a trained Peer Leader. I agree to prepare in advance for each workshop including preparing materials and splitting responsibilities with my co-leader. I agree to respect my co-leader and resolve any differences in private, always maintaining a positive and open attitude. I will notify the Living Well Coordinator if differences cannot be resolved.




Peer Leader AgreementPage 2

I will distribute a copy of the Workshop Manual to each participant, either downloaded, printed, and distributed each week, or purchased through University of Montana. I agree to leave all copyright information on any printed and distributed materials.

I agree to maintain workshop attendance forms and complete other workshop-related paperwork (Participant Information Form, Attendance sheet, data security documents, evaluations, etc) to submit to my organization’s Living Well Coordinator within five work days of workshop completion.

I agree to respect participant confidentiality and abide by all data security protocol requirements. I agree to keep participant contact information confidential and only use their telephone numbers and emails to remind them of the classes or assignments related to the class.

I agree to respect participant diversity. No participant should be discriminated against or become the target of ridicule, disrespect, or gossip due to their ethnicity, religion, gender, national origin, age, physical disability, political affiliation, sexual orientation, color, marital status, veteran status or medical condition. Peer Leaders who exhibit discriminatory behavior will lose their affiliation with the project.

I commit to co-facilitate each workshop to the full duration. If I am not able to attend a session due to illness or other circumstances beyond my control, I agree to notify my co-leader and Living Well Coordinator with at least 24 hours notice. I will make every effort to find a substitute peer leader to take my place.

I understand that _____________ is my organization’s Living Well Coordinator; I agree to communicate with him/her regarding all program implementation details, including program fidelity and submitting workshop data. I will report any problems (with the host site, participants, co-leader etc.) to my Living Well Coordinator immediately.

I understand that I conduct workshops at my own risk. RTC: Rural Institute of Montana will not be liable for any damages with respect to any claim by me or my third party on account of conducting a workshop or using any program materials.

I understand that failure on my part to adhere to the program policies and procedures can result in the loss of my status as a certified peer leader.

Name of Sponsoring Partner Organization

Peer Leader Signature Date

Peer Leader Email Peer Leader Phone

Living Well Coordinator Signature Date

Living Well Coordinator Email Living Well Coordinator Phone




Non Disclosure Agreement

Living Well with a Disability Data Collection and Data Entry Personnel

I will not disclose any personally identifiable information provided by Living Well with a Disability (LWD) workshop participants. I will follow the data security protocols as outlined in the Implementation Guide. If involved in data entry, I will only share the data via the designated, encrypted, password protected database authorized by the Administration for Community Living, including Compass. After the data are entered, I will store all forms in a secure, locked cabinent, if forms are not destroyed.

I understand that unauthorized disclosure of any sensitive LWD participant data may subject me to disciplinary and adverse administrative action.

Name Signature

Position/Title Date

Organization Living Well Coordinator’s Name




Particpant Information FormPlease print clearly

How old are you today? Do you live alone? What is your sex? ___________ _________ _______ years old Yes No Male Female

What type(s) of health insurance do you currently have (mark all that apply) Medicaid Veteran’s Health

Medicare No insurance

Tricare Private insurance, please specify: _______________________________________

Are you of Hispanic, Latino, or Spanish origin? Yes No

What is your race? (check all that apply) American Indian or Alaska Native Black/African American White Asian/Asian American Native Hawaiian/Pacific Islander

What is the highest grade or year of education you completed? Some elementary, middle, or high school Some college or technical school

High school graduate or GED College 4 years or more

Did your doctor or other health care provider suggest that you take this program? Yes No

During the past year did you provide regular care or assistance to a friend or family member who has a long-term health problem or disability? Yes No

Do you now use tobacco (cigarettes, cigars, or smokeless)? Everyday Some days Not at all

In general, would you say that your health is: Excellent Very Good Good Fair Poor

Are you deaf or do you have serious difficulty hearing? Yes No

Are you blind or do you have serious difficulty seeing even with glasses? Yes No

Because of a physical, mental, or emotional condition, do you have serious difficulty walking or climbing stairs, dressing or bathing, or doing errands alone such as visiting a doctor’s office or shopping? Yes No

Because of a physical, mental, or emotional problem, do you have serious difficulty concentrating, remembering, or making decisions? Yes No

PLEASE CHECK ALL THAT APPLYHas a health care provider ever told you that you have any of the following chronic conditions?

Arthritis/Rheumatic Disease Asthma/Emphysema/Other Chronic Breathing or Lung Problem

Cancer or Cancer Survivor Chronic Pain Depression or Anxiety Disorders

Diabetes (High Blood Sugar) Heart Disease Hypertension (High Blood Pressure)

High Cholesterol Kidney Disease Osteoporsosis/Low Bone Density

Obesity Stroke Schizophrenia/Other Psychotic Disorder

None (No chronic conditions) Other Chronic Condition(s): _________________________________

(continued on the back...)

Participant Identifer____________________________




Particpant Information FormPlease print clearly

How did you hear about this workshop?

Friend or family Newspaper advertisement Website

Flyer Radio advertisement Other: _______________________________

Doctor or healthcare provider (Please specify): _________________________________________________________

The following is completed at the END of the last program session.

After taking this workshop, I am more confident that I can manage my chronic condition(s).Not at all 1 2 3 4 5 6 7 8 9 10 Totally Confident Confident

How satisfied were you with this program? Very dissatisfied Dissatisfied Okay Satisfied Very satisfied

Please provide comments or feedback for us!

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________




Attendance LogEnsure the participant class number on the participant information form

matches the row number next to their initials below.

Funding Source: (Check all that apply) Workshop Type: Workshop Language:

CDC AoA Other CDSMP CPSMP DSMP LWD English Spanish Other

Hosting Agency Workshop Start Date (mm/dd/yyyy) Workshop End Date (mm/dd/yyyy)

Site Name Site Address (Street, City and Zip)

Leader 1 First Name Last Name Phone Number Email

Leader 2 First Name Last Name Phone Number Email

Did you offer a “Session 0” with this workshop? (“Session 0” is an optional pre-workshop session) Yes No Don’t knowIf you charged the participants a fee to attend this workshop, please indicate the amount:

Mark attendance for the week(s) each participant attended. Place their initials along with their row number on their PIF.Class Participant WEEK Number # Identifier Session 0 1 2 3 4 5 6 7 8 9 10

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.




Workshop Fidelity Checklist

Fidelity Criteria: Comments:Setting up the workshop:

_ Meeting room and building are accessible to all people, including people with disabilities

__ Tables and chairs arranged in a circle or square shape

__ Each participant has appropriate workshop manual and associated worksheets

Conducting the workshop:

__ Peer leader breaks any silences at beginning of meeting with an “ice breaker”

__ Peer leader discusses ground rules of confidentiality, respect, and attendance

__ Peer leader reminds group to maintain confidentiality

__ Peer leaders sit at eye level with group members, sitting among them, not above them

__ Peer leader is sensitive to accommodating participants’ needs

__ Peer leaders make themselves available before and after each workshop session if requested by participants

__ Peer leaders keep the group “on task”, focusing them on the materials and session topic

Observer ________________________________________ Date of Observation ___________________________

Peer Leader(s) Observed _____________________________ & _________________________________________




Workshop Fidelity Checklist(continued)

Fidelity Criteria: Comments:Workshop Agenda:

__ 10 minutes spent on welcoming participants and having them seated comfortably

__ 15 minutes spent reviewing last week’s session

__ 5 minutes spent introducing this week’s topic

__ 80 minutes spent on working through the appropriate week’s topic, scenarios, and exercises

__ 10 minutes spent concluding the session and challenging participants to apply lessons to their weeks

Facilitating a Healthy Group Process:

_ Peer leaders shows respect for each participant’s abilities and personal choices

__ Peer leaders celebrate each participant’s successes or advances towards his/her goals

__ Leaders make workshop materials upbeat and engaging

__ Peer leaders encourage writing during the sessions, emphasize that completing worksheets helps fully engage in material

__ Peer leaders make appropriate resource referrals when participants request help




Leader Workshop Checklist

Use this checklist when preparing for a workshop. Provide this list to workshop leaders when they pick up workshop materials to give them guidance about when to have paperwork filled out and handed in.

FormsAttendance FormComplete each week with a check mark after participant’s name/initials/code number in the table

Participant Information Form (PIF)Participants complete on first day of attendance and provide assessment (last part of form) on final day of workshop. If people start during week 2, give them a PIF. Count to ensure you have one for each person! Within one week of the end of the workshop, give PIFs to the Living Well Coordinator.

Week: 1, week 2 for any new participants, 6 for assessment

Participant Workshop Evaluation FormParticipants complete on the last day of attendance. Count to ensure you have one for each person!

Week: 6 or last day of attendance

Inventory for workshop

Healthy Living books # provided at week one_______

CD’s # provided at week one_______

CD Player

Participant scratch paper

Markers/ dry erase markers

Pens/pencils/sharpies

Kleenex

Name tags/cases

Masking tape, sticky gum, or other to hang charts with

Easels/ easel cases

Flip chart (extra), if needed

Tupperware carrying bucket

Hand cart/bungee cord

Snacks, water pitcher, paper cups




Leader Workshop Checklist

Other PaperworkIncluding this paperwork may be helpful

Leader applications Leader stipend sheetsIf your organization offers a stipend, supply this form to your leaders

Living Well workshop referral, invitation, or information cardsAvailable from UAP and other agencies for participants who would like to “refer” others into the program.

Living Well Coordinator’s business card for those with questions, concerns, etc.

Helpful Hints• Peer Leaders ensure that attendance sheet, name tags, Kleenex, scratch paper, pens, and snacks are available to

participants each week. • Peer Leaders are models for every activity.• Peer Leaders coordinate the lesson plans (even/odd) and action plan ideas (i.e. One Peer Leader does an “active” action

plan, the other might do a “relaxation” type action plan – this shows the diversity of “ideas” with action plans.) • Peer Leaders are active listeners: by being attentive, Peer Leaders are able to recognize statements/questions/comments

given by participants that may be helpful cues to re-enforce clarify or be aware of any issues or problems. • If participants do not have - or want to - make an action plan, it is okay; do not try to “force” a person to make one. If

the participant has an action plan but seems uncertain about achieving it, ask what the barriers might be to succeeding; ask if participant wants suggestions from the group.

• Be alert to words such as “try to” in an action plan; encourage the person to modify the action plan to be able to achieve it.

• Be aware of what is not in the scope of the workshop (i.e., recommending particular doctors, medications, etc. Encourage participants to research the internet, organizations, etc.)

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