2.1 Introduction

Through this unit we will explore the ways peer supporters can be involved in an organization, sustainably, their place in the organogram, their profile and description and the content of the training they may need in order to better support their role as part of a multidisciplinary team. For this purpose, it is important to clarify the reason why peer support is chosen as a method of intervention, what are the values and the philosophy that inspire such interventions, formally or even informally.

“Peer support strives for recovery and, in doing so, it considers the wellness of the whole person. Empowering relationships, engagement in meaningful activities, and an ability to experience happiness are all part of recovery. The reduction or elimination of symptoms may be an important goal, but it is only one aspect of the person’s experience.

The philosophy of peer support is that each individual has an innate desire to find a path towards recovery, improved health and wellbeing, and has within themselves the knowledge of what will work for them. The peer support worker supports that person as they find that inner knowledge and reignite that hopeful desire.” (Guidelines for the Practice and Training of Peer Support, 2016, page 13)

2.2 Learning objectives

In this unit the learners will

Learn how to identify the key persons who can address the need of a peer supporter in the organization
Learn how to identify challenges and good practices
Understand the funding mechanisms to sustain the position of a peer supporter
Understand how to create an organogram where peer supporter position is clearly positioned
Learn how to create a job profile and description for the Peer Support Agents in the organization

2.3 Peer supporters’ meaningful involvement

The peer supporter’s involvement, training and working standards very much depend on

the type, the culture and the values of the organization that deploys them,
the community surrounding it,
the funding options and their sustainability
the philosophy and values of peer support as a concept
the profile of the peer supporters themselves that need to be identified and be included at the early stage of the recruitment process.

Thus, the involvement of the peer supporter can vary to a quite wide spectrum from the ad hoc friendly and informal involvement at the one edge of the spectrum to the structural formal one in a clinical setting at the other. Preparing the path internally at the organizational level is a first essential step to better accommodate a peer support intervention. The process of preparation will also vary depending on

the organizational culture and philosophy
who is suggesting it (for example: whether it comes from the case managers or the administration, the degree of influencing the decision-making process)
our goals and the resources that will be required.

The organizational culture and philosophy

According to the Mental Health Commission of Canada, “The philosophy of peer support and its values of hope, self-determination and recovery were, in part, a response to the historic prevalence of social injustice and stigma towards those with mental health challenges.” (Guidelines for the Practice and Training of Peer Support, 2016, page 34)

It is widely documented that meaningfully involving people with lived experience in the planning, delivery, and evaluation of services is crucial to creating more responsive and empowering service experiences. And this is the reason that there is a significant growing interest to involve peers in different settings and diverse organizational structures. However – within the mental health system- peers have been historically disempowered and defined by labels associated with their mental health status.

Despite the diversity in the internal process that may apply in different organizational settings and types, there are certain core elements that apply for all. These include the concept of recovery embodied in a holistic perspective of a person-centered approach, where the relationship between professionals, peer supporters and homeless people is the foundation. A relationship that is built on honesty, trust, empathy, authenticity, non-judgmental approach and guards distinctively the boundaries from a directed intervention to an enabling support, mutual learning and empowerment.

“Recovery is a process through which people find ways of living meaningful lives with or without the ongoing symptoms of their condition. Helping someone recover is not just about managing symptoms, it includes helping people find a job, getting them somewhere safe to live and developing supportive relationships with family.” (Guidelines for the Practice and Training of Peer Support, 2016, page 11)

The core values in the philosophy of peer support are

hope
self-determination or empowerment
equity
mutuality
empathy
acceptance
experience

For any organization planning to implement the peer support approach, in the first place, it shall be discussed internally how this philosophy and core values of peer support apply to the organization?

“When a person feels that they are truly accepted by another, as they are, then they are freed to move from there and to begin to think about how they want to change, how they want to grow, how they can become different, how they might become more of what they are capable of being.” (Gordon, 2000)

Involving peer supporters within the organization

Peer support happens in the context of human relationships where each person brings the impact of their life experience. It is increasingly used in the homeless sector formally and informally. The involvement of peer support in different moments of the recovery continuum can have a transformational impact on all the involved parties.

Essentially, preparing internally the path for a peer support involvement should clarify:

The type of peer support: formal or informal
Meaningful involvement: engaging non-peer employees and peer supporters
Funding mechanism and its sustainability

A formal or an informal involvement?

The range of peer support options of involvement begins with “informal peer support” when the peers notice the similarity of their lived experience with homeless challenges and therefore listen to and support each other. Neither is more experienced or better prepared to offer support than the other. “Hence, the authentic nature and mutual benefit that comes from empathetic support is more identifiable”. (Guidelines for the Practice and Training of Peer Support, 2016, page 14) Two or more people share similar challenges (either personally or in relation to loved ones) as each strives to find a path towards wellbeing. It happens naturally most of the times. Case managers of any organization can identify this type of interaction and use it without involving further resources from the organization. However, since there is no other involvement of the organization, this type of involvement may be limited in time and impact since it is based on an individual level and disrupted easily as none of the involved parties (case manager-peer supporter) has any further binding expectations.

At the continuum of the recovery spectrum is the intentional involvement of the peer support within a structured setting where peer supporters are involved either as volunteers or employees, in order to make a connection with homeless based on shared lived experience that focuses more on the emotional variances experienced than to facts and events, and offer the opportunity for a supportive, empowering, non-judgmental relationship. For this purpose, it is essential that the peer supporter learns to promote the critical aspects of hopefulness, recovery-orientation, empowerment, non-judgmental acceptance, and trust within the peer support relationship. Deciding the involvement will need the consensus of the decision makers and case managers within the organization.

A set up of a committee to decide where and how peer supporters may be initially involved has worked successfully in many organizations. This committee can consist of management members, usually constituted of an Expert by Experience (ideally a person who has recovered or is currently recovering), a financial manager and non-peer professionals involved in the case management.

Since the capacity, the operational structure and the culture of each organization are different and tailored to its priorities, not all the organizations have such a possibility structurally. It is important that the internal structure at this point is respected and followed, for instance, if the proposal of peer support involvement derives from the case managers, then the communication process within the organization should be followed appropriately to assess and implement the request. Along with the formal communication processes that should be followed, it is important to understand the informal dynamics that exist to move forward the request which can involve e.g. identifying and approaching key persons that may influence the decision-making process in practice, due to their seniority or respect they arouse within the organization.

If the proposal comes from the top of the hierarchy of the organization, then the non-peer employees should be involved in the process at an early stage. Indicatively:

• Explaining the philosophy-core values of peer support to the employees, as well as the benefits and effectiveness of peer support
• Sharing and identifying the possibility of defining and planning for the implementation of a peer support program in the organization
• Creating a channel (e.g. focus groups) through which the organization’s employees can freely express their potential concerns regarding the peer support program (professional threat, responsibility, misconceptions, time consuming engagement, stereotypes, professional or personal experiences) and address them to the extent possible
• Involve them in the creation of the peer supporter job description and necessary competencies; consult the decision of whether to engage peer supporter on a volunteer or an employment relationship basis
• Facilitate their exposure to other similar practices e.g. networking and links to other professionals that are collaborating with peer supporters and encourage the interaction
• Involvement in the recruitment of peer support agents
• Joint creation of necessary positive supportive mechanisms for the peer supporters (mentoring, supervision sessions, capacity building through training, participation in workshops or other forms of adult learning, possible performance reviews, etc.)

The involvement of the human resources department is important in the decision concerning the type of relationship (volunteer or employee), in order to provide necessary guidance

If volunteer
The recruitment processes
Code of conduct
Identify the frequency of service (once or more times a week) in collaboration with the case managers
The location (meeting on or off site)
The focal person from within the organization that the peer will report to, how they will communicate and how often: written via e-mail, report, scheduled appointments on a regular basis or on an ad hoc basis if something happens?
Support package/insurance (health or other type of coverage that needs to be considered to better support the work of the volunteer)
Evaluation process: Is there one for the volunteers? Do they participate in the process?
Covering expenses: Travel expenses to and from the organization, pocket money for the expenses incurred during outreach (possibility to offer e.g. a coffee or a tea when meeting with a peer) or small emergency cash (e.g. urgent escort to a hospital).

If employee
The recruitment processes
The code of conduct that applies for all the employees
The position in the organogram: Who the peer supporter will be accountable to?
The communication lines within the organization: how the Peer Support Agent and the supervisor will communicate? Written, via e-mail, orally? Will they fall in the routine communication process that exists in the organization? Is it necessary to establish a support mechanism for that? Do they need to write regular reports? How are these reports structured? Are they familiar or will they need to familiarize with the process?
The salary scale: where in the scale the position of a Peer Support Agent is? Will any previous education or working experience be taken into consideration? Ensure equal treatment in terms of any additional benefits the organization is offering to its employees. Considering additional accommodations may be needed and the possibility to apply to all employees in similar situation
Evaluation process: Does the organization have an evaluation mechanism for its employees? Do they participate in the evaluation process? What are they evaluated for? Who is evaluating their performance? How?

Any form of involvement can apply depending on the organizations’ available resources, needs, type and culture. However, if the organization operates based on paid staff and not on a voluntary basis, it is rather unusual not to have also paid peer support workers. Best practices, so far, indicate that for the services/organization to benefit from incorporating the peer support methodology, it is important to consider a longer-term perspective of an employee position.

Meaningful participation

Meaningful involvement of the peer supporter includes active participation in the decision- making processes regarding the design, delivery and review of services. Organizations will need to establish supportive structures- if not already established- to promote an environment capable of addressing issues of power and equity, given that meaningful participation is a requirement in the organization’s policy. Creating meaningful opportunities for peers to contribute to a range of decision-making processes helps services to better respond to service users’ needs. Peers’ experience is expertise; peers have a unique first-hand perspective about what works well and what needs improvement.

Point of involvement

It is important to clarify whether the peer supporter will be engaged:

• At the initial stage when e.g. approaching a rough sleeper to help build the trust towards the services or at the reception for the first admission.
• During the recovery process, in collaboration with the professionals, to clarify which part of the lived experience is important to share and how.

See more analysis on the potential role of the peer supporter within the organization in the Unit 4. Peer support and homelessness.

Location
Meeting outside, in the community or inside, at the organization’s premises (it might be necessary to prepare the space for this) or both, depending on the occasion.

Engaging peer and non-peer employees
It is essential to accept a peer supporter as an equal member in a multidisciplinary team where their contribution is the lived experience per se. The way in which non-peer employees perceive the contribution of the lived experience in the case management can impact the effectiveness of the peer support. Issues of power and equity amongst peer and non-peer employees are the ones that are reported most frequently and can harm the potential of the positive impact that the peer support involvement may have at the services. Peer supporters may be stigmatized- even unintentionally- due to their lower educational level or previous experiences. The adherence to the values of the peer support is an essential reminder for all parties involved, and dedicating time to explore further the concepts of power and equity in the professional relationship is important.

Additional ways that can support meaningful engagement are:

• Clear job description and understanding by all members involved that it can be updated if such need is identified on the way of practice. It is advised to include the peer supporters in this process of adaptation.
• Safe environment to identify prejudices and stereotypes and discuss constructive ways to overcome those that may burden the working environment
• Mutual agreement on the code of conduct (ANNEX 3)
• Clarity on the day-to-day duties and responsibilities: minor issues that may happen on a day-to-day basis need to be resolved on-time, respecting the communication lines within the organization. Repeatedly remaining unresolved, minor issues may grow into greater issues that may hammer the relationship between peer supporters and other employees.
• Clarity regarding the conflict resolution mechanism within the organization (publicly or anonymously.

Funding Mechanisms-Sustainability

When planning the involvement of peer supporters, it is important to consider the financial means the organization will provide for this purpose in a longer-term perspective, taking into account the time and the effort that will be needed to reach the results. Involvement in the payroll, capacity building and personal growth or other additional benefits should be taken into consideration. Existing funding mechanisms via co-funded programmes, as for e.g. EU Structural Funds, can include in their budget actions conducted by peer supporters. Public organizations usually have a state budget, and the process and timeframe may differ. Depending on the organization’s nature, private funding can be used for internal training and capacity building, or medical and legal support as they are usually for short term and clearly focused objectives.

The ANNEX 4 contains an organizational readiness assessment tool which can help you to quickly address the necessary questions when considering incorporating a peer support approach.

Recruiting the peer supporter

Having clarified the type of involvement and the role will help profiling the peer supporter that the organization needs. Certain personal characteristics are commonly identified across the existing literature, and these are:

• Lived experience: having experienced homelessness personally is the core element, regardless of its duration. Depending on the profile of the organization and its’ clients, the lived experience may cover other issues (e.g. drug addiction, mental health, chronic health problems).
• Recovery: being on an advanced stage of recovery or having recovered completely from homelessness is also essential for a formal involvement.
• Communication skills: interacting with and supporting others is a normal social function. The ability to connect positively with others is an essential basis to build on in peer support.

The development of a detailed job description that includes responsibilities and duties, and communication lines within the organization is also necessary and should be adjusted accordingly. A sample of a job description is provided in ANNEX 2.

Questions to discuss in the recruitment process of a peer supporter for a formal involvement indicatively include

• Motivation for the position: how he/she understands the position; how this position may affect his/her own life; what does he/she expect
• Self-awareness/resilience: what are the incidents that they felt stressed / frustrated / angry about; how did they handle them
• Previous working experience (if any): what did they learn from it; possibly useful for their work to the organization; How do they feel they can use the skills and experience they have gained.
• Educational level and training needs.
• Adaptations that may need to be taken into consideration for employment.