Please read the Agreement and then complete the application that follows.

As a volunteer in Spinal Networks Peer-Mentor Program, I understand the importance of my position, and will make every effort to perform my duties as expected, and follow all policies and procedures relevant to my assigned role.

Requirements:

• I am at least 18 years of age
• I have demonstrated a successful reintegration into the community (e.g. Demonstrated independence in activities of daily living, participation in recreation, involvement in community activities and/or employment).
• I possess a high school diploma or a General Equivalency Diploma (GED).
• I have completed an appropriate treatment/rehabilitation program, and one year of experience living in the community, following treatment/rehabilitation.
• I have demonstrated positive behaviors related to reliability, dependability, trustworthiness, and resourcefulness.
• I have reliable public or private transportation.
• I understand that my personal treatment/rehabilitation experience may have been effective for me, but may not be the correct approach for others.
• I realize that people can adapt successfully in many different ways; individual differences must be respected.
• I have or will successfully complete the United Spinal Peer Mentor Training Program.
• I will participate in continuing education, training, and supervision as required.

All volunteers are obligated to adhere to codes of ethical conduct and behavior. When meeting with Peers within an acute care hospital, rehabilitation center, outpatient clinic, or community-based setting, they are required to conduct themselves in a manner consistent with the Host Agency policies related to treatment of patients, and patient confidentiality.

1. If uncertain about an issue, the Mentor should say so, and refer the Peer to an appropriate staff member or care professional.
2. A volunteer should use respectful language when speaking with their Peers.
3. A volunteer should not use language that may be considered as offensive or derogatory.
4. A volunteer should not accept money, goods, or services from a Peer as payment for their services.
5. A volunteer should not use the Peer relationship for personal, religious, political, or business gains.
6. A volunteer should not sexually harass or become sexually involved with a Peer, a Peer’s relatives, or other individuals with whom the Peer has a close relationship.

The responsibilities of a program volunteer Mentor, Coordinator, or Group Administrator may include, but may not be limited to:

• Providing Mentoring to assigned peers who could be in different settings (e.g., acute care hospitals, rehabilitation facilities, and outpatient clinics), or in the community.
• When in a hospital or rehabilitation facility, the volunteer is expected to follow all institutional policies and procedures.
• Establish a friendly relationship with their assigned Peers and with co-volunteers.
• Respect their Peer’s right to make their own decisions.
• Help the Peer by listening, offering empathy and support.
• Maintain the confidentiality of the Peer Mentor relationship, except in the following circumstances:
  1. The Peer reports that he/she has been abused emotionally or physically, or believes they are at risk of being abused.
  2. The Peer reports that he/she has or has had suicidal thoughts or is threatening suicide.
  3. The Peer reports that he/she has/had intentions, thoughts or explicit plans to harm someone or damage property.
• Maintain and submit all necessary information in a timely manner.

I understand that in the course of performing my role with the group, I may have access to confidential information related to a peer. I am expected to exercise the greatest caution and concern in the protection of any information that might be considered confidential by Spinal Network or a Peer participant in the Peer-Mentor Program. Knowledge of confidential information is subject to the mandates of all relevant confidentiality laws, and is a trust to be honored. I understand that divulging confidential information without a peer’s consent is grounds for termination, and possible legal action.

Data Security

As part of my responsibilities in keeping data secure, I will adhere to the following:

• Transmit data only over secure wireless networks.
• Not leave printed data in open view.
• Store printed data in a secure container within a secured room when unattended.
• Store digital data (downloaded files) on a secured storage device.
• Share data with only those parties within your group who have a clear need or purpose for the information.
• Share data with parties outside of your group only with permission of the person who is the subject of the data.

Personal Information