1.1 Introduction
In this unit, we will introduce the concept of peer support and will specify which form of peer support ATL training focuses on. We will introduce the purposes and values of peer support. We will take a closer look at the figure of the peer support agent, considering his core functions and responsibilities. We will discuss the importance of mutual confidentiality to a professionalized peer support building a peer relationship of trust. Additionally, we will consider the impact that helping others may have on the Peer Support Agent.
1.2 Learning objectives
In this unit the learners will
- Develop an understanding of peer support
- Learn the principles of peer support
- Recognize that there are several types of peer support
- Learn about the role of a peer supporter
- Learn to identify the responsibilities of a peer supporter
- Understand the importance of secrecy and confidentiality in the work of a peer support agent
1.3 Introduction to peer support
Peers can be defined as a group of people who belong to the same societal group based on a specific characteristic, i.e. age, background, abilities, or social status. Equally, we can talk about peers as of the participants in a determined activity, carried out in a group: a workshop, an association for a social cause…
Peer support is generally understood when two or more people with similar life experience form a relationship in order to offer each other support, especially if one (or more) individuals is facing a challenging situation (Peer2peer vocational training course, 2015). Providing a strict definition of peer support is a challenging task, primarily because one of the defining features of peer support is its flexibility and adaptability to suit the needs of the people it serves. This is why diverse forms of peer support have surged over time and co-exist nowadays.
Probably, its’ most common form is the one offered by mutual support and self-help groups, which is also the origin of an organized peer support practice. A more recent form of peer support delivery is the one offered by Peer Support Workers, employed at professional facilities and services – a more formal way of peer support organization and delivery.
In terms of the numbers of people involved, peer support can take place in a larger group, where several (or all) members seek support and offer support to the others, at the same time. In this case, the exchange of support is multilateral and it is easier to maintain a relative balance between support given and received. Another form of peer support is the one involving only two individuals at a time, in which usually one individual takes up the role of a mentor who supports his peer on his way to recovery from difficult circumstances.
The present training program focuses on the formalized type of peer support delivered by specialized Peer Support Workers, taking place between two individuals.
To date, peer support has been used primarily to assist individuals struggling with mental health challenges and those affected by substance abuse. The use of this methodology in the context of other social and individual problems has been limited. In particular, with regard to the people affected by homelessness, we did not find any training programs available. Likewise, we found little information about ongoing peer support programs for this collective. It does not necessarily mean that they do not exist at all; likely, the peer support has taken place in a rather informal context between people with shared experience of homelessness. This is a conclusion that we have reached based on a documentary research and focus groups and interviews with professionals and service users affected by lack of stable housing.
In view of the above, with this training program, we would like to set the foundations that will allow to kick-start a more formal and structured peer support practice available for persons struggling with homelessness.
The general objective of peer support is to help a person navigate her way through challenging situation/circumstances, which can be of very different nature. For that purpose, peer support looks forward to establishing a dialogue, sharing information, challenging, and encouraging each other.
In order to understand the purpose and the nature of peer support, it is fundamental to realize that it is not supposed to provide ready-made answers and solutions. Most of the times, the personal answers are to be found, and each person has to find their way to them. Therefore, rather than giving directions, a peer supporter will accompany his peer in the process of finding his own answers, and for that, he will use his experience. Likewise, peer support does not come down to giving or receiving advice on every possible topic. Sometimes, it can be about simple acts such as talking to someone as a way to be heard and taking things off your chest.
The shared experience is the cornerstone of the peer support in the sense that someone who has been through a similar experience and has overcome the difficulties might be a right person to turn to for help for someone who is struggling to overcome similar challenges. Apart from offering support, such a person can be the best example that not only there is a way out, but also it is tangible and reachable. However, even though the peers may share experiences broadly speaking, their experiences may still differ in nature and duration. It is important to acknowledge that both the Peer and the Peer Supporter will have their personal story, their specific needs and particular traits. Having that present, there is always the opportunity to establish a mutual connection and relationship that is based upon mutual understanding, respect and sharing.
Offering advice, based on personal experience, is not the only purpose of peer support. Understanding this is essential to avoid a mistaken idea that peer support is, broadly speaking, about offering advice. Actually, many Peer Supporters report that they avoid giving advices. They do talk about their experiences and what works for them, but they leave it to the peer who receives support to decide if she wants to try out their approach.
A recent study conducted to identify critical elements of peer support within a homeless population with participation of 40 peers and professionals from organizations offering services highlights the following attributes of peer support as the most appreciated by the respondents (Barker et. al. 2019):
- Peer supporters’ ability to develop strong, trusting, experience-based relationships with clients
- Peer supporters’ respect for confidentiality
- Peer supporters providing emotional support
- Peer supporters being adaptable to clients’ personalities and behaviors
- Peer supporters’ uniqueness, their difference from professionals
- Peer supporters providing an empathic, listening ear
- Peer supporters being a bridge between clients and professional help
- Peer supporters being committed to their clients
Peer support is addressed at helping people experiencing a particular difficulty or disadvantage, which often has a systemic impact on the person’s life. It is frequent for a person to face not one but multiple disadvantages. For instance, a person in a situation of homelessness can, at the same time, be a victim of gender violence, experience mental ill health, substance misuse or other forms of disadvantage. In some cases, these disadvantages were the trigger for the situation of homelessness, in other cases they are a consequence of unstable or lack of housing. Whatever is the case, all these factors are intrinsic ingredients to the individual’s present situation and exert influence on its possible developments to the point that, it might not be possible to achieve sustained recovery and social inclusion of a person experiencing homelessness if those disadvantages are not taken into account and acted on. This is why knowing which additional disadvantages a person is facing is highly relevant to designing an adequate peer support intervention that will act on these challenges.
(Adapted from de Peer2Peer, 2015)
| HOPE |
| • The peer relationship offers a unique healing environment and powerful way of promoting hope and optimism. • Peer workers are powerful role models and evidence of the reality of recovery. • We are all unique individuals, with hopes, dreams and aspirations with the potential to be all that we can be. • It is possible to learn and grow from challenges and setbacks. |
| Experience |
| • We are all experts in our own experience. • There are many roads to recovery and different ways of understanding and interpreting experiences. • The sharing of experiences can be a powerful catalyst for personal change and growth. • Peer workers use their lived experience intentionally to encourage and support recovery. |
| Equity |
| • Peer support relationship is an equal to equal one and it embraces equally-shared power, which enables people to trust and to share their wisdom. • The peer supporters do not express or exercise power over those they support • Peer supporters do not diagnose or offer medical services to their peers • Peer supporters have a responsibility to challenge stigma and discrimination encountered in their role. |
| Mutuality |
| • We are interdependent and all have something to contribute. • Mutuality is developed through respectfully sharing ideas, learning and experiences. • Mutuality develops through discussion and negotiation of what is helpful in the relationship. • Everyone involved in the relationship has a responsibility for making it work. |
| Empowerment (self-determination) |
| • Recovery is the job of each individual and the peer relationship is based on learning together. • Empowerment happens as we draw on our strengths and abilities both individually and collectively. • Taking risks, trying new things and moving beyond our comfort zone are essential to personal growth and change. • Having power and control comes from identifying our own needs, making choices and taking responsibility for finding solutions. • Supporting people to make changes is achieved through ‘being with’ rather than ‘doing for.’ |
| Acceptance |
| • Peer relationship is about accepting the person as she is, without judgment, expectations or requirements. • Peer relationship seeks to help the peers accept themselves as they are, taking into account that there are things about themselves that cannot be changed, which is totally fine. |
| Empathy |
| • Empathy and compassion are at the heart of the peer relationship. • Having compassion for others is grounded in being compassionate towards yourself. • Empathy in peer support is the ability to understand and share the feelings of another • The peer supporter can often feel personally identified with the experience the peer has been or is going through. |
Peer Support Agent (Peer Supporter)is an individual who has been through a similar life experience to the one his Peer is living through. Now he is on an advanced stage of recovery path, sustained over time or, perhaps, has fully recovered. He refers to his personal experience and path towards recovery in a manner that contributes to inspire a sense of hope in his peers. His life experience contributed to him acquiring specific, experiential knowledge on the particular problems and situations his peer might be currently facing.
Prior to becoming a Peer Supporter in a formalized and professionalized context, the person shall go through a specific training, in order to acquire baseline knowledge about peer support methodology and to develop further the skills needed to carry out peer support interventions.
Peer support is a practice that seeks to support individuals in producing the desired changes in their lives. This is why recovery and wellness are critical components of lived experience and, in particular, the belief in the capacity of a person to build, change and rebuild herself and her relationship with the surroundings is intrinsic to this practice.
Thus, it is highly important that the peer supporter-to-be has been working towards establishing a healthy self-relationship before resolving to help others. This embraces the following concepts:
Self-respect is showing respect to oneself as one does with other people and being kind to oneself.
Self-concept isthe way in which the person sees herself, the image she has of herself, and the ability to self-identify.
Self-acceptance is a person’s ability to accept herself the way she is. The good and the not so good traits, as well as what she can and what she cannot change.
Self-determination is aperson’s ability to make choices and manage her life. It allows her to feel that she has control over her life.
In any case, the organization preparing and/or recruiting the peer supporter shall ensure that he has reached a positive state of recovery and resiliency to support others.
Social learning theory states that individuals learn by observing other people’s behaviors, attitudes and the outcomes of those behaviors. Through observation the individuals decide which part of those behaviors to reproduce. When an individual looks forward to another person in order to gain inspiration or motivation to achieve a certain objective or to emulate certain attributes of that person, it takes place repeatedly over a determined period of time, we can say that the second has become a role model to the first.
Role models can be historical, cultural, celebrity, fictional, personal (family, peers) or professional. Most of us have had a role model at some point. You can have one or more role models at the same time. One individual can serve as a role model for a determined area or aspect of life or can be seen as a global role model.
One of the key functions of a peer supporter is to role model a way out and recovery from difficult life circumstances and sharing own lived experience is an important element in the process of role modelling. Experiences of peer support in the mental health services suggest that peer supporters are often seen as role models not only for the peers but also for the staff with no lived experience, since they encourage both groups to be optimistic and recovery oriented (Lawn et al., 2008).
Benefiting from helping others
Research shows that helping others is not only beneficial to those who receive help but also to the helpers themselves. Having an impact on another person’s life and receiving social approval leads to an improved perception of self-worth and self-efficacy. Results of surveys among individuals that provide support to others (peer support agents, volunteers) point to multiple benefits for the helpers, such as feeling appreciated, feeling important, and enhanced confidence, positive changes in self-perception, sense of identity, and personal development.
Still, we should not forget that the role of a carer may also lead to wear the individual out and to produce negative emotions such as feeling frustrated or overburdened. However, in peer support programs, the negative outcomes can be prevented and the risk reduced to a minimum if the program is correctly planned and executed, and the peer supporters undergo a specific training beforehand and are offered ongoing support during the participation in the program. In fact, research suggests that precisely the balance between offering and receiving support is what leads to an effective implementation of peer support where all the parties can benefit from this practice. This is due to the fact that receiving support himself will not only help the Peer Supporter deal with his difficult feelings but will also prevent the helper from feeling that they only give away but do not receive.
It is worth mentioning that we shouldn’t confuse different concepts related to the helper receiving support— the support he may receive as a result of a reciprocal relationship with his peer or the support offered by a third person, not involved in the peer relationship, e.g. a supervisor, counselor. These forms of support do not exclude but rather complement each other, and the type of support received will be of different nature. In the Unit 3, you will find more information on the potential challenges the peer supporters may encounter and ideas on how to support them to deal with those challenges.
Core functions of a Peer Supporter
The Peer Housing Support program, promoted by the Greater Victoria coalition to end homelessness, developed a framework defining four core functions of peer support for persons experiencing homelessness.
| Social and emotional support | Links to professional support and community resources |
| · Inspire hope and a belief that there is a way out of the situation · Provide emotional and social support to the Peer, including listening, sharing of experiences, problem solving and coaching. Procure to understand the social or emotional barriers the peer may be experiencing, that could be preventing him from progressing in their recovery journeys | · Help the Peer acknowledge the barriers and bridge the client-professional gap which might be preventing the Peer from starting (or progressing upon) his recovery journey Create awareness and encouragement for Peers to reach out to/ engage in community services and resources |
| Daily management | Ongoing support, extended over time |
| Provide assistance to manage daily life situations (suggest activities, explain new tools, help work on healthy habits, based on own experience) | · Offer a long-term personal relationship and support to help keep up the engagement in the recovery process · Inspire the Peers to set their own goals related to housing and recovery, and support them over time with achieving these goals |
The Peer Housing Support Program has identified the following responsibilities of the peer supporter (Program Toolkit: Best Practices for Peer Housing Support, 2019):
- Establish positive and meaningful relationships
- Provide active listening and supports that encourage hope, responsibility, increased self-efficacy, personal empowerment and growth, and mutual understanding
- Support Peers to access social and recreational programs
- Accompany Peers to appointments when requested as a silent witness
- Support Peers in accessing and developing appropriate person-centered social networks
- Assist Peers in accessing and navigating community resources
- Encourage the Peers with achieving self-identified goals
Confidentiality
Peer support specialists typically have access to sensitive information about clients’ lives, which may include details about a mental condition, substance abuse, criminal activity, infectious diseases, and sexual orientation, among others. In the face of the Law, Peer Support Workers may not have the same legal duties as other professionals- social workers, case managers, psychologists- regarding the management of clients’ private and confidential information. However, the organizations that promote peer support programs should ensure that Peer Support Agents are familiar with and understand the prevailing standards with regard to clients’ right to privacy and confidentiality. Equally, they shall be familiar with any exceptions to these rights (for example, when sharing certain confidential information is required to prevent imminent, serious, and foreseeable harm to the clients themselves or third parties).
Another issue has to do with self-disclosure of information by both the Peer Supporter and the peer. The relationship between them has a quasi-professional nature, but it involves certain level of openness and intimacy and can give place to social activities and interactions that resemble those that take place between friends. Therefore, both parties can potentially become in possession of some very personal information about one another, on a more emotional level, which can lead to an important level of perceived vulnerability for both.
In order for both parties to feel comfortable and safe- which is a pre-requirement to building a relationship based on trust-, clear guidelines on mutual confidentiality shall be established. The two peers shall discuss this issue in detail during the first meetings to reach a common understanding. On the other hand, maintaining professional boundaries is important in the Peer Supporter role and an awareness of confidentiality aspects is an important part of this.
The general rules to follow concerning confidentiality are (Peer2Peer, 2015):
- Organizations that employ peer supporters have a responsibility to clarify how to manage confidentiality and support the Peer Workers in this regard
- People providing a service should not share information about individuals they work with unless specifically authorized to do so by the peer.
- Information within confidentiality is passed on a need-to-know basis.
- Peer supporters can be vulnerable because they share their experiences within the context of their role in helping others. They need to be in control of this and should not be forced to share anything they are uncomfortable with.
- A peer supporter could be a member of a team working with the same person. In these circumstances, information is likely to be shared and this could affect their ability to develop connections and relationships.
In order to ensure effective implementation of a peer support program it is recommended that peers receive adequate training before starting the intervention. It must be taken into consideration that despite the importance of shared experience in peer support, the latter alone does not ensure a successful peer intervention for either of the parties- the peer that offers support or the peer that receives support.
Training can prepare peers to manage effectively various situations. Regarding the content of such training, the conclusions of a research among individuals involved in peer support initiatives conducted by Barker et al. (2019), suggest that participants didn’t feel that peers getting training in strictly psychological skills was integral to peer support. The authors of the study suggest that such training should concentrate on the peer role within the given context. For instance, receiving training in how to use one’s own experience to help others, how to use positive language or how to manage challenging client behavior, may help peers to play their role effectively and prevent them from responding inappropriately and/or relapsing into old behaviors. You will find more information about training peer supporters in Unit 2.
