Background
Peer support in youth mental health
Theoretical underpinnings of youth peer support
Purpose
Methods
Realist-participatory approach
Context
Qualitative procedures
CMOC 1 | C (Peer supporters share similar experiences and recovery journeys with clients) + M (Peers demonstrate positive identity and wellness while moving forward in recovery & clients develop a more positive evaluation of shared social reference group) ➔ O (Clients experience enhanced positive identity, decreased self-stigma and enhanced wellbeing) |
CMOC 2 | C (Peer supporters organize social events) + M (Opportunities to participate in social activities & clients build their sense of social connections) ➔ O (Reduced social isolation) |
CMOC 3 | C (Peers bring lived experience and practical knowledge with respect to successful coping / overcoming challenges) + M (Peers offer guidance based on their lived experience in addition to other mental health supports clients are receiving & clients recognize the value of peer advice and apply strategies) ➔ O (Clients’ experience success in applying strategies and increased self-efficacy / self-determination) |
Program theory n (%) | ||||
---|---|---|---|---|
CMOC1 | CMOC2 | CMOC3 | CMOC4 | |
Level of agreement | ||||
Agreed/strongly agreed | 16 (89) | 13 (76) | 11 (65) | 10 (62) |
Neutral | 1 (5) | 1 (6) | 5 (29) | 6 (38) |
Disagreed | 0 (0) | 1 (6) | 0 (0) | 0 (0) |
Strongly disagreed | 1 (5) | 2 (12) | 1 (6) | 0 (0) |
Quantitative procedures
Results
Over-arching context: peer features that contribute to client engagement
Part of creating the safer space for clients involves connecting through shared experiences, such as trauma, stigma, discrimination, homelessness and challenges related to mental health. Having these shared experiences increases the value of the peer relationship and the relevance and practicality of the advice they can offer. The TAY program serves a wide variety of clients coping with issues that range from human trafficking to eating disorders and clients may feel isolated as a result of these challenges.A lot of our clients actually have a lot of lived experience accessing service… so this might be their first time experiencing someone who doesn’t really come with a lot of that jargon or that really arms-length approach. And that could extend the feeling of being a little bit more accepted and safe, which makes them more likely to connect to our services and more likely to connect to others. (P6)
Having a peer to facilitate communication and help them process these experiences can increase the likelihood for meaningful client engagement.If I'm working with someone who's been trafficked like, it's not something you want to talk about, per se, right? But being like, ‘Hey, you know what, I'm a survivor. Like, I get it’. And not that I get what you went through, but you don't have to explain it to me. I know why you wouldn't want to get out of bed in the morning. (P2)
I remember times where I was speaking with somebody, and they had mentioned, like, disordered eating things and not like, it was something that they felt so uncomfortable talking about. But like, they said, knowing that, I had some experience with this as well, they felt less judgment for being able to talk about it. (P7)
CMOC 1
I think it's just like having someone that you work with and you have respect for and seeing, and understanding that they have gone through some similar hardship as you um and they are doing okay. That's like really, I think affirming, for a lot of people. (P9)
Non-peer staff also recognized that they could perceive this process unfolding within peer practice.The ability for the stigma within to kind of, like unfold itself and to feel like you're kind of out of this box that society puts us in. Or even oneself can, with shame, can just reveal this really like empowered feeling towards oneself. (P8)
I do also see a lot of [peers] just fully embrace some of their challenges, and so showing up so honestly about themselves, I think that sends some really accepting messages out… and clients feel that and they feel more accepted. (P6)
CMOC 2
Part of the peer role at TAY is to create opportunities for social interaction, such as during drop-ins, within group settings and out in the community.Being able to like talk about certain things because you feel like someone can relate to you, gives you some sense of how to navigate certain friendships and relationships and what not. (P9)
Peers noted the value of social connections as a bridge to navigating the healthcare system.I think that as a peer I was able to... show people some ways of how to interact … I really made it a point to talk to people who weren’t talking and maybe felt alone in a drop-in setting. (P10)
I think social connections also extend to like healthcare connections you know? And getting different services you know? Because that does require you to leave your house and go out there. So, I think just the act of being a peer supporting someone to go to an appointment is enhancing a social connection. (P1)
Not only were social interactions helpful for clients to develop more ease in socializing, they represented very positive and rewarding experiences for clients. “Once they start having the experience of joy and finding people that they can talk to, it becomes so much easier to fix everything else.” (P10).
Peers served as a stepping stone for clients to access larger spheres of social connections, with benefits beyond those of a clinical environment. Often, these interactions helped clients to overcome isolation or negative social environments and re-engage with society. “I think it’s really important that we get people out of the house and I think peers would be the perfect avenue for that specific task.” (P3)I think humour. Because I think for clients, they’re always stuck in this, place where it’s like, its usually like bleak and things suck, you know? I think humour brings, or at least allows people to take a second away from all that mess and it causes people to open up more. And you know, you can joke around with people. And I think altogether, for me at least, I think it’s really important to get people out of their shell and have some fun… (P10)
The value of peer-led programming is that young people are more connected to what is important and interesting to other young people.I really believe that [the peer] role in that relationship is the bridging role, right. So it's like, if I'm up here, and I'm working with a youth who maybe isn't quite ready for therapy or case management, but they just kind of want to talk to someone that gets it. I think that's where the peer is the connecting link… (P2)
We’ve started the DND group, dungeons and dragons. People who met at the drop in, who, a lot of them are on the spectrum, so they have a lot of issues socializing, but when DND comes into it, then it makes it easy for them to talk to people. (P10)
CMOC 3
Peers also discuss the critical insight that clients gain through the recognition of the utility and potential of successful solutions that peers have applied in their recovery journey. Clients see that the same path is a possible opportunity for them and this can change their perspective on whether there is value in attempting these strategies. “If I were to say like ‘don’t do this, because this will happen.’ You know, [clients] are never going to learn like that. They just don’t.” (P10).I was able to tell him that I’ve experienced addiction, I’ve experienced issues at home, abuse and all these sorts of things and I really experienced a lot of situations, so giving him a little piece of that, I think it just is a reiteration of, ‘it is possible, and we can recover’ and there’s people who have taken steps to do that and there’s different avenues… I think it’s just giving them those options and telling them that “I’ve experienced it too” and I think that really gives them the hope and even just the seed of the idea. (P10)
Sharing these experiences can be a pivotal starting point for clients who are experiencing really intense challenges and who are having a hard time finding a way forward.Being able to share these lived experiences and kind of mentioning that there is a path behind me as well I find people tend to open up more because there is more understanding and validity to the interactions. And when you're able to validate the person using your own experiences and what they're doing seems effective I find really reinforces those skills that people are practicing. (P11)
I think, just listening and knowing that the worker’s coming from a vulnerable place, and they're willing to meet you halfway. Just diving into the depths of the struggles. And it's, like, a critical starting point for the intervention. Especially when the distress is so high that the person just, they can't even fathom, how to move forward. And that can really, just help them navigate themselves through that. And, feel like their support is really joint. And they can just use the inspiration from what they've heard to find that confidence start to develop. (P8)
CMOC 4
You get trapped in it if you don’t have the next step. Like, there’s so many people that I’ve known who have quit and kind of get their life together, but then they won’t find employment, and then what do you do now, well my life goes to drugs. You need that in place or you’re just going to fall back in. (P10)
The TAY program is connected to other organizations and services to address client needs more holistically and directly. This ecological approach is translated through integrating peers as complementary to other services and to support increased access and engagement for clients that benefit from support that is easier to relate to: “Not only is it integrated so much within the program, but there’s so many connections within different agencies.” (P8)There’s of course the newcomer mental health effect where there’s like, it’s doesn’t exist. There’s no words for it so it doesn’t exist socially. It doesn’t exist on the ground. And all of a sudden you’re here and you’re having these experiences of trauma and you can’t name them. (P1)
Peers help to tailor services so that clients are offered what they need in the moment and processes are set up so that services are matched to client needs.So a peer can't save the world. A case manager can't save the world. A police officer can't save the entire country. But if we come together, and we put our heads together, and we figure out a way that you're going to do this, I'll do this, because that's what I'm good at. (P2)
In the TAY program, processes have been developed to support a warm transfer or enhance the circle of care surrounding clients. Previous to having these processes, there were many challenges around role clarity with respect to what the peer can offer the client. Often peers were placed with clients and there was little to no information offered to clients with respect to the purpose of the connection.So it is getting to appointments or accessing services and peers can be involved to help them. Like we’ve had peers do exposure therapy around going out in public or being in public places. So it’s like a very skillful thing to do, but it’s outside of the time that a case manager has in order to do that. (P6)
We developed a peer referral form so that the staff, when they’re considering engaging a peer would kind of give a thoughtful consideration to that. Like what’s the goal here? Like what’s the purpose of engaging a peer? And it would be around what skills does this peer have or what’s the specific thing they want to work on? And then they would bring that to me…but also they could express like I’d really like it if it could be [participant 4], or for it to be [participant 9]. Like I just think they would be a good match. Then we would talk to the peer to see if that really works for them. (P6)
Adaptations that are achieved to address client services more holistically are informed by client preferences and offer clients opportunities to take control over goal development and their direction in recovery. This helps to empower clients and to develop their agency to move forward independently:We’ve worked with people before where we both attend the meeting and [participant 4] is able to interject with DBT skills that might be helpful for that person in the moment or applying them to a specific situation. So like some of it, if I’m meeting with a person individually and I see that they could benefit then it’s something I suggest. It’s also up to the client whether or not like they want to work with another person. (P12)
You get to choose and you get to take power and own what you want in your life and what you don't. And it's just about empowering those people. When they make those decisions, like wow, you know, like ‘You did that. Like, you just made that choice!’ (P2)
Over-arching outcome: recovery
I noticed over time working with people that there is a sort of like level of hope and … they are capable of developing their wellness and, like developing their stability. (P7)
I've also been in situations where I felt like a kind of hopelessness, and they can sort of see somebody who is doing these things, you know, like finding stability and finding wellness. And I think that they can see people start to go into a more like a wellness and recovery-based mind where they feel like that future is possible. (P1)
It can also help create, like, the goal, and like the things that they're really working on in their own recovery become a little bit more tangible…I think that's probably the major impact on that, where they can actually see concrete proof of different paths, or interventions or strategies that can be used and taking care of oneself or finding recovery in their wellness. (P5)
Survey results
Participant characteristicsa | n | % | M | SD |
---|---|---|---|---|
Age | 22.43 | 3.15 | ||
Gender | ||||
Girl/woman | 44 | 57 | ||
Boy/man | 14 | 18 | ||
Alternative gender | 18 | 23 | ||
Racial background | ||||
Asian | 16 | 21 | ||
Black | 7 | 9 | ||
Middle Eastern | 4 | 5 | ||
Other | 5 | 6 | ||
White | 39 | 50 | ||
Service usage | ||||
Length of time as client at LOFT | ||||
0–6 months | 32 | 42.6 | ||
6–12 months | 9 | 12.0 | ||
1–2 years | 18 | 24.0 | ||
over 2 years | 16 | 21.3 | ||
Length of time receiving peer services | ||||
0–3 months | 32 | 43.2 | ||
3–6 months | 8 | 10.8 | ||
6–12 months | 12 | 16.2 | ||
Over 1 year | 22 | 29.7 |
Variable | M (SD) | 1 | 2 | 3 | 4 | 5 | 6 |
---|---|---|---|---|---|---|---|
1. Relating to peers | 3.07 (0.81) | ||||||
2. Comfort with peers | 3.37 (0.67) | .51** | |||||
3. Peers as role models | 4.20 (0.75) | .47** | .59** | ||||
4. Therapeutic alliance | 3.22 (0.57) | .40** | .59** | .54** | |||
5. Self-efficacy | 2.49 (0.63) | .14 | .29* | .06 | .13 | ||
6. Self-rated mental health | 2.14 (0.93) | .08 | .03 | −.08 | −.10 | .40** | |
7. Self-rated life satisfaction | 2.82 (1.00) | −.00 | −.02 | −.02 | −.06 | .40** | .67** |
“I have had the opportunity to meet new people, because of the peer support program.” “This has helped me learn new skills and experiences. This has been beneficial to me.”
“I have created genuine friendships where my peers do not judge me for my struggles that I go through and not to have the worry of somebody judging me for having anxiety or depression is very supportive.”
“Being a part of this group has given me a sense of support and community.”
“It helps to know other people feel the way I do and that you can have a mental illness and still get somewhere in your life.”
“I am pretty reclusive so even just talking to the peer support worker is progress, and its also nice to be able to reflect with someone on how I experience social interaction in the world.”