Introduction
Methods
Study setting, participants, and data collection
Focus group interview guide
Data management and analysis
IRB statement
Results
Theme 1: Building client–peer provider relationships
Subtheme | Exemplary Quotes |
---|---|
Building Trust & Connection | RELATABLE/LIVED EXPERIENCE If they haven’t been through the same thing as you have, then you don't know where they're coming from, they don’t know where you’re coming from. (Male 1, Group A) The fact that I feel like she [my peer] knows where I'm coming from. I’m not saying anything bad about my therapist, but they just have this feeling that they might not know completely know what I go through... But I feel like she basically knows where I'm coming from, she's in my scene now. Like, the therapist, I feel like they have… not power over me, but coming more from a spectator look. (Male 1, Group B) SUPPORTIVE Honestly, they’ve always really just been supportive through everything I wanted to do and at the end of the day I'll come back and tell them and they'll be like ‘oh yeah you should do this and that and that,’ and be supportive … one time when I had to remember this whole speech, it was… something I had to remember for a job… I was here and I was really stressed out because I couldn't remember it and they were being really supportive, it was like… ‘here’s a room to go to, and just calm down, we’ll get you some water,’ and I was like I can't do it, but they were really supportive the whole time I learned how to do it. (Female 2, Group A) TRUST I feel like for a peer support, like opening up and telling stories of what happened to them, like relating to people, I think that'd be a really good, an important step for peer support. I think I should be a mandatory thing, in a sense. Because it brings up a level of trust and it will make people feel more comfortable to talk to them. I feel like that should be something important. (Female 1, Group A) A lot of people don't like being asked questions but when it comes from more comfortable people like from [the peers], it comes in handy to actually get to understand somebody. Me personally, there's a certain boundary of trust I have to be able to put in somebody before I just answer questions left and right. (Male 2, Group A) |
Addressing Basic Needs & Goals | BASIC NEEDS- TRANSPORTATION, HOUSING, SHOPPING, HYGIENE, ETC. And they provide transportation. Man, [my peer provider], he’ll drive you wherever you want, swear to god, he would, took me all the way to [neighboring city], from here, it was raining. (Male 1, Group A) He's helped me a lot with shopping, hygiene, he's a pretty cool dude… And transportation… when I got out of jail, I didn't have shoes and he got me everything I needed, toothpaste, body wash, clothes. (Male 1, Group D) They helped me get out of [being] homeless. (Male 2, Group A) FLEXIBILITY/KNOWLEDGEABLE ABOUT RESOURCES They’re very flexible… whenever you ask for something, they’re always like ‘yeah, we can do that, we can do this.’ They’re always helping us with the showers… They're just very helpful. They have very good suggestions too. (Male 5, Group E) They definitely help point you to other resources, like say you need something or are struggling with something, they obviously point you in the direction of whatever else that [the program] offers. (Female 1, Group C) IMMEDIATE GOALS Like [my therapist is] a great person but with her, it was more of a serious thing, like we're here to work, we're here to fix whatever you have and whatever your goals are. And then with peer support, they do that, like they support our goals and everything but with them it's a different kind of goal, like, what kind of goals do we have realistically, like hey, what do we need, do we need a job, what steps do you do. (Male 3, Group C) |
Providing emotional support | LISTENING/HAVING SOMEONE TO TALK TO And I can talk to [my peer] about anything, everything that's very confidential. I met her through one of our groups, so I felt like ‘okay I'm not the only one dealing with what I'm going through.’ Because at first, you really don't know, you think you're out there by yourself, but once you get to the program that you’re in and deal with peer counselors or whatever, you find out that there's other people just like you and you might not be on the same level but everyone is different and everyone is loving so it's like a big family. (Female 1, Group F) Female 1: Someone who understands like everything you're coming from, who will listen. Especially listens because, man, it means a lot to a lot of people if somebody like really listens to you. Female 2: I agree. Male 1: Really understands where you're coming from. Male 2: Well, it’s like solving a math equation, if you don’t understand it you can't properly solve it. (Multiple Participants, Group A) SUPPORT WITHOUT PRESSURE I’ve seen how it is important that not only we connect on a human level but just being able to… come to places where you feel safe, you don’t feel judged, you don’t feel the pressure. That’s one thing I love about this place, you work at your own pace, nobody’s really pushing you, it is self-reliant, and it’s about you showing up. (Female 3, Group F) There was [another peer provider] used to be here… [she] helped me to recognize that I could recover and be healthy. I mean, it’s not, how can I put it, it's not what she said, it was the way she was saying it… Like she wouldn’t say, ‘you need to do this,’… she said ‘oh, you should come to the computer room,’ and I said okay. She didn't say you should do any of the work… so I would just go in there and dang, just sat around, and then one day I just said you know, I want to start doing some of the work, on my own… the next thing I know I was volunteering and being here, you know. So it’s like, the person who can encourage you, you know, the person who encourages you and remembers where they came from. (Male 3, Group F) |
Building trust and connection
Addressing basic needs and goals
Providing emotional support
Theme 2: Bridging and engaging with mental health services
Subthemes | Exemplary Quotes |
---|---|
Reducing Barriers to Mental Health Services | REDUCING BARRIERS [Peers] provided a lot of things for me, which I never knew there's stuff like this that’s provided. Because if it wasn’t for them, my life would be much worse, and they make sure that where I stay is comfortable for me and provide enough food and services that I needed… My therapist, I didn’t have a therapist for a while, but now I do. But it's okay, because there’s a service pretty often, and they make sure you get there on time. Sometimes they pick you up and everything so. (Male 2, Group D) AMENITIES DRAW CLIENTS IN Male 2: They even have a little snack store or whatever for people that want to use their stamp cards and the stamp card just helps you get whatever you want from there. Facilitator: What you have to do to earn the stamps ? Male 1: Go to Class Male 2: yeah you go to class, or, they call it groups… Facilitator: Is that the ones on the board that I saw, like the meditation, anger management? …[group agreement] Ok, cool. so, you guys enjoy that? [group agreement] (Multiple participants, Group E) All you have to do is call [the peer outreach team] and tell them where you are, give them your name and destination… your name, destination, and where you are, and they’ll pick you up and drop you off. But you do the classes in order to get a ride, to get back where you were. (Male 1, Group E) Facilitator: Was it the outreach team that made you familiar with the program? Male 4: No, it was knowing that I could come here during the day and shower and, you know, have a meal, it's a cool thing. I was actually going to try to go talk to a therapist [soon], because like, emotionally I wasn't there. So, I need to talk to somebody. (Male 4, Group E) |
Collaborating with Mental Health Team | But [the peer provider will] get notes from the therapist. Our therapist will be like ‘oh, I’m going to tell [your peer] to help you with this service, this service or this or this’ or give a note and [your peer] would later check up on you, like ‘oh I heard you need this’ and they’ll just update if you need to know more or not, so they’ll just help you out with services that your therapist mentioned that [the therapist] can’t help you out with but that your peer support could. (Male 3, Group C) They [peer providers] have good cooperation skills…. With us… and with each other. They help each other to help us too. (Male 3, Group E) Facilitator: And is there something different about the support that you get from the peer partner versus the therapists or the case manager? Male 1: It’s like the same thing, honestly. Male 2: Yeah. They give each other connections basically. And our connection with them. So basically, if something is wrong with say, the client, they would tell it… Male 1: address it. Not to you, but… Male 2: To each other and then they would go to you and tell you whatever. Facilitator: So, they work in a team, your peer partner works with the therapist or your case manager… Male 2: Yeah so, it's like, that team, whatever their name is, it’s that team. Facilitator: Has that been your guys' experience too? That there’s communication between your peer partner and other people here? Male 4: Yeah. That's been my experience. (Multiple Participants, Group E) |
Building Mental Health Literacy to Navigate Mental Health Services | Facilitator: Do [peer providers] make it easier to use the mental health services? Male 3: To be honest, yes. When I was here I was trying meds for a bit, so you basically add another person to your team which is a doctor so now you have three people which is more work Facilitator: Ok so it would be the therapist, the peer, and now the doctor. Male 3: Yes, and so we're just going off, you know, diagnosis and everything and you know sometimes when it comes to the medical field or like anything you choose, you have to click with the person. If you don't, you just- we ain't vibing, sorry. Deuces. So like with [my peer] it was helpful like ‘Hey how do I tell this person that we're not vibing or we’re not, like you know.’ You can just tell them like, oh, they said something to me, which was always helpful, trying to have someone work it out for you or help you like oh, well you could do this and this or you can take these steps, so that was helpful for peer support, they will just be by your side, like help you out, even with the news and everything you hear. (Male 3, Group C) I'll update [my peer] or she’ll ask, like ‘how was your appointment, how do you feel,’ that was more the thing about the peer support is more like, just checking up on you, you know, ‘how you're feeling, are you cool, I heard you had a pretty intensive session last week, are you okay?’ So that was that's how they help, they’re more like little ice packs, and you go out on the field and then bam, you got an ice pack. (Male 3, Group C) |
Reducing barriers to mental health services
Collaborating with mental health team
Building mental health literacy to navigate mental health services
Theme 3: Modelling recovery and supporting skill acquisition to instill hope and empowerment
Subtheme | Exemplary Quotes |
---|---|
Recovery Role Models | FEELING LESS ALONE The main thing was [my peer] just relating to me, the whole thing was like, you know, having a new diagnosis… and feeling like you're alone. And her listening and telling me like ‘I know exactly what you mean and I know exactly how you feel and I've gone through that too during these certain phases of my life. I totally get that.’ So that's the biggest thing that I got from [my peer] was the feeling of not being alone. (Female 1, Group C) It’s kind of essential for you to interact with at least one other person who knows exactly what you're going through or has gone through what you're going through, so you don't feel like you're abnormal or weird or anything like that. So, I think it's essential for someone who really wants to recover. (Female 1, Group C) SEEING AN EXAMPLE OF SUCCESSFUL RECOVERY It's really helpful when you have a new diagnosis and especially when you're young, it’s peaking. Because your brain is still developing and it feels kind of like the end, but it's really refreshing to see someone who's actually a functioning adult with the same thing. So, sharing similar experiences. (Female 1, Group C) The education is great that they have it, but sometimes you need someone to say ‘this is how it is, I've been through this and this is how you can change, this is how I changed.’ So sometimes we need people to say ‘no, I've been through this too, and this is how you can make it better.’ (Female 4, Group F) Everyone is struggling and everybody's on a different level and you can see people evolving and that's really wonderful because you know [recovery is] possible for you… You can see that it’s possible and you can set goals and I just… it's life skills, you know, it should be taught in grammar school. (Female 2, Group F) HOPE FOR THE FUTURE I've been inspired to go to the peer training program, so I did that, peer, what is it, the peer specialist program… it helped me because as I continue to get better and get well and walk in my wellness and complete the goals that I have, I can look at certain people that come up here as newb- I was gonna say newbies. But, they made me think of that's how I was when I first came, so that makes me gravitate to that person and try to be of assistance and to help them in any way. (Male 3, Group F) They helped me a lot, the peer partners. They helped me see a better view of life… they were just very positive. … I’m not going to name names, but some have been through the struggle. You know, and they just gave me an open eye that I could do it and life is worth it. (Male 1, Group E) To put it frankly, I just felt like she understood me. And basically that helped me to motivate myself to be better. She also said that I could… that I should give it a try to become a peer specialist also and that’s not for me, but it does give me some kind of hope that I can make it. (Male 1, Group B) |
Building/ Practicing Skills for Recovery | INCREASING INDEPENDENCE IN EVERYDAY TASKS AND INTERACTIONS With [my peer], he gets me out of the house at first, and then… as the months progress, we focused more on being productive and what's stopping me from being productive… I have a problem staying motivated with doing tasks. [He] helped me focus on what would be the issue, if there was something else that was bothering me or just, I don't know, if it's just lacking energy or just if it was me… [he taught me strategies like] taking a break when you need to, not trying to take it all in one big bite, but trying to break it down. (Male 2, Group C) [My peer and I] started going to places because I have a big fear of getting outside my house. It's a bit embarrassing, but… I have this tremendous fear that people are looking at me… I have paranoia, psychosis. She takes me places, I'm learning a lot about it. Like last time we went to the mall… I actually don't want to be here [at this program] anymore, not that I don’t enjoy the services, but I want to seem normal and more stable… And that's why I'm pushing myself to go to different places with people now. (Male 1, Group B) REINFORCING MENTAL WELLNESS SKILLS DURING CHALLENGING TIMES/SETBACKS One of the coping skills was when I first came here [my peer] said I had a lot of stuff to let go, he said ‘let it go,’ that just encouraged me so much, I do t-shirts and things like that, so I’m going to make a t-shirt that says that. And then learning that we have no power over the outward environment, we have to be concerned about this environment right here, taking care of ourselves, and a lot of times, I know for myself I was more into taking care of everybody else and letting myself go, so that has helped me a great deal. (Male 3, Group F) When I broke my leg, I had to have surgery and I literally just backed up, like everything just sort of backed up, everything I learned stalled because I was just broken... And after that she told me ‘don't forget your teachings,’ like you know she just reminded me, ‘don’t forget what you learned, it's just a little bump’ and that's the thing, we, as young adults that we forget, that sometimes when something happens either we have simple ways of sitting down and shutting down or in my case I just cry about it and then get over it. But they remind us that there are other options… there’s always other ways to figure out a problem. (Male 3, Group C) When I started using drugs again, I started making excuses, not go to school, I have some anxiety. She said, ‘well sometimes you gotta, you know, go through the consequences of your actions’ and that’s true, because that’s my own action that I put upon myself. And she just said, ‘sometimes you just have to, it’s scary, but you have to do it,’ just, you know. Since I don't take pills, like I was asked, but she told me ‘if you want to get better, the pills, taking pills on time and regularly on schedule can help me.’ So, I appreciate that. (Male 2, Group D) |
Recovery role models
Building/practicing skills for recovery
Theme 4: Peer provider roles and experiences specific to young adults, gender, and racial/ethnic minority groups
Subtheme | Exemplary Quotes |
---|---|
TAY-specific age & gender concordance | AGE It does matter to have someone who is a little older than you and has more experience in life because you’re going to relate to someone who’s been through your experiences and you can see that like, right now I’m not functioning but I can be them where they’re full-on adult and they’re functioning and they’re doing normal adult things even with all the symptoms that they experience that are like mine. (Female 1, Group C) Sometimes there’s things going on in your life that you want to get advice from older people, so it would be better to speak for someone who’s older than you vs. you’re going through something for the first time in your life and you want to get the experience of someone younger who just went through that. (Female 1, Group A) I would prefer somebody about my age for advice, maybe a little older but not too old. Because when they’re way older than me, they look down on my intelligence. (Male 2, Group A) GENDER I don’t think it matters about the gender, like we were talking about before. I have a male peer support and a female therapist and we both get along the same way so I don’t think it matters. (Male 1, Group C) Well, mental illness is not exactly easier being a woman so to actually be paired up with another woman who would experience the same, who pretty much understands that mood swings can be twice as bad, and certain symptoms can act up twice as bad during certain times of the month, that's really helpful. (Female 1, Group C) HOW TO DO THINGS AS AN ADULT We all know being an adult is fucking boring. Sometimes you have to do things you don’t like, like signing up for Medi-Cal, doing those things, getting insurance, all those things. That’s how [peers] help you. Just the essentials you feel like you need to learn, they teach you that, they let you know that this is what adults do. (Male 3, Group C) I don't really see myself relating with someone that’s like, close to my age like ‘okay you’re 2 years or 5 years ahead of me, buddy, like, oh well.’ But older people, I used to have a peer support where she was older and, she was, I don’t know, it was just fun to hang out with her, and the way she'll think differently, and I’m like ‘okay!’, like she’ll teach me like whenever you fill out forms, when you turn in forms, you always have to put out the date you filled out on top in the corner so that way you keep it filed, so you know, things that old people will do [laughter]. No offense, but you learn different things and you start seeing things in a different view as well, because you know every age has a different perspective in life. (Male 3, Group C) |
Racial/ Ethnic or Culture-Specific Peer Provider Roles | DIVERSE ENVIRONMENT Facilitator: What about race or ethnicity? Is it important to have the same race as your peer or it doesn’t matter? Male 1: No, it doesn’t matter. [group agreement] Female 2: But I think it should be also important that it should be a mixed environment of ethnicity because you can kind of come and feel out of place when it's not diverse. (Multiple Participants, Group A) SHARED LATINO IDENTITY Male 3: And also the good thing about it is too is like how you're focusing on colored communities which is a great think because in the colored communities, mental health is not a thing, everyone knows it at this table, you know, our parents have always told us, if they can't see it, it doesn't exist. We all heard that at one point. So even our own, so with relating to someone, [my peer provider] is Latina and you know I'm Mexican so it's with her I could just talk to her too in Spanish and finally someone… because before when I was younger I used to, like I’ve been in therapy since I was six, when I was younger I would talk to the therapist and they would just be English speakers and I'm like okay, great I can't really reach you. Facilitator: You felt like that side of your life wasn't addressed? Male 3: Yeah because mostly our impact comes from our family’s descent, the way they perceive the mental health, the way they received it all to them it doesn't exist, like I said. It doesn't exist to some of them but it's just a whole new thing to them. And it's good to have someone like peer support who, on the other side went through the experience too and they had the same experience like they have the family as well. [My peer provider] said, ‘my family is the same way, we don’t, they didn't believe in it until things started happening.’ (Male 3, Group C) Not even that, sometimes when you're just in the moment you just start speaking Spanglish and then you just start mixing up words and everything, it’s just a whole hot mess but at least they get it. Because with my therapist, sometimes I’ll start speaking Spanish because when I get pissed I just start speaking in Spanish because that's the first language I learned. So after that, my therapist is like ‘woah, woah, what does that mean’ and I’m like ‘forget it, you’re not [my peer provider], like you’re not her,’ you know but I’ll translate it, but with [my peer provider] I don't have to, we can just talk and then it’s just whatever. But it's helpful, it is helpful because if you know, sometimes when I talk about my family, and then she’s like ‘oohhh well this and this,’ you know when it’s always about family, we’ll talk about it all in Spanish for some reason. And then I’m like [to my therapist?] ‘we’re talking about our family here, and it’s all in Spanish right now, because I don’t want to translate what my mom will say or what my parents will say and I'm like you know what, I’m just going to tell you what she said in Spanish to me and that's how it will go off. So it was helpful. (Male 3, Group C) |