UNIT 4: PEER SUPPORT AND HOMELESSNESS

4.1 Introduction

“Peer support is not scripted. It does not follow steps. It is about relationship. It comes from the heart through insight and knowledge gained from experience”.

Wendy Mishkin, Peer Support Consultant, BCSS Victoria

Through this unit we will explore the different roles that peer supporters can have when involved in the recovery process of the homeless. Through the existing literature, we can observe an increasing awareness of the positive impact that the peer support involvement can have in the recovery from homelessness. It also acknowledges the challenges that come along with it and explores recommendations that work so to better support peers in their effort to gain the control of their lives positively. The journey is continuous, and often may need adjustments in an ever-changing environment. The necessary adjustments should form part of the everyday practice. 

4.2 Learning objectives

In this unit the learners will

  • Understand the different roles a Peer Support Agent can have in the process of recovery from homelessness.
  • Understand the challenges related with the involvement of peer support during the process.
  • Identify ways that are enabling the peer support involvement to maintain an igniting and transformational role in the recovery process

4.3 Peer supporter’s role and challenges

“People who are homeless usually represent individuals who have the most complex issues that often cause breakdown in relationships with family, friends, and support service alike. The experience of homelessness subjects a person to isolation and feelings of worthlessness, which can lead to depression and loneliness. This is important, as research has found that social support is vital to health— a weak or non-existent social tie is a risk factor for death, comparable to smoking” (Barker et al., 2018).

The increasing involvement of peers in the homeless sector is evident through the increased primary research in the field that is taking place notably the last years. (Miler et al., 2020) Most of it comes from the United States, Canada and Australia, and the concern of transferability is well addressed given different context, access and legislation in housing, health system, criminal justice, welfare benefits. Additionally, the lack of a globally accepted definition of homelessness supposes a difficulty when comparing best practices. Taking all these into consideration, we select here the lessons learnt so far that have the potential to commonly apply to different settings and can inform practitioners, administrators, and decision and policy makers so to adjust accordingly where necessary.

The role of Peer Support Agents in the homeless sector can vary and may include one or a combination of the following:

  1. Role model/mentor in different moments of the recovery process
  2. Breaking the boundaries
  3. Individualized treatment
  4. Social Support
  5. Advocacy

In more advanced settings with a history of involvement of peer supporters the role of a peer supporter may expand to:

  1. Providing services and/or training
  2. Supervising other peer workers
  3. Developing tools
  4. Administering programs or agencies
  5. Educating the public and policymakers

In all these roles the philosophy and values of peer support are at the core of the intervention: the ways that the lived experience of a peer authentically, trustfully, respectfully can inspire hope and influence positively and mutually a transformational process during the journey of the recovery.

The role of the professionals or non-peer staff is not substituted or threatened by the peer supporters. They complement each other to reach a common goal as a team. Concrete arrangements (as for example the meeting place of the peers on or off site), systematic meetings of the multidisciplinary team to discuss the case plan, the specific objectives as they have been agreed with the homeless and the progress on their achievement, all done in a simple, understandable language, can help clarifying the grey zones that can easily appear in the daily practice.

Role model/Mentor

The peer supporter focuses on the emotional aspects of the lived experience rather than the facts. They have been there, and they have survived, so they are a proof that there is a way. “I know what you mean. I have been there!” There is an authentic empathy in the process that inspires hope and mobilizes the peer into taking action. Ability to share their own story in their own words and to describe its milestones is essential. The value of self-determination is a core one at this role: people are free to choose their way to recovery even if, in certain cases, there may be pitfalls, the process is slow or does not seem to progress. This role can apply at different moments of the recovery process:

  • During the initial approach (first contacts), to create a feeling of trust towards the available support resources and help the peer into the essential stage of realizing the potential of recovery and requesting support towards this direction.
  • During the recovery process, encouraging the peer to persist in their effort to recover. During the process there may be a relapse or other difficulties that seem to burden the path of recovery. At this point, the Peer Support Agent may share their own experiences and methods that were helpful for them. This sharing shall have for objective to enable the peer to understand their own strengths.

Breaking the boundaries

“If it’s very important, I do cross boundaries sometimes… we’ve crossed so many boundaries just to get this person, you know… thinking that, otherwise something more serious would have happened… you know what I mean. At least I know I’ve actually helped someone.” –Timothy

There is plenty of challenges when the Peer Support Agent needs to combine in a successful and effective way trust, a fundamental element of a peer relationship, together with their own well-being and safety as an absolute priority. Since the peer supporters are confronted with this dilemma, they may need to cross boundaries in certain occasions. Generally, the peer supporter will make decisions regarding boundaries based on a case-by-case judgment. This is a matter of appropriate training, experience, skills and personal mentality; however, this may cause significant stress that is often overlooked, not always recognized by professionals or the organizations and should be taken into consideration when arranging support for the peers.

Individualized treatment

Homeless people usually have health problems- caused or aggravated due to precarious living conditions- that may need a daily management, adherence to medication and follow up. Peer supporter can support the implementation of a treatment plan, the set-up of reminders that work for the peer or assist with DOT (Directly Observed Treatment) if necessary. In a clinical setting, a peer supporter may also be part of the treatment as part of the multidisciplinary team.

Social circle reconstruction

Reestablishing connection with family, friends or significant others, or simply establishing connections with the community where they live is an essential part of the recovery process. Having gone this part of the journey or being on its way, the peer supporter can shade light on how this can be done. Discrimination and stigma are the challenges to overcome in a relationship of mutuality, in a non-judgmental manner.

Social support

Having experienced the existing barriers, especially when dealing with the bureaucracy at the social benefit system, the peer supporter can provide adequate information and tips to facilitate access to it. Knowing when to ask for help and whom to address is an essential step.

Advocacy

During the 2014 Canadian Alliance to End Homelessness conference in Vancouver, a group of individuals, including both peer supporters and professionals, came together with a common goal: to ensure that individuals with lived experience received equitable representation from service providers, researchers, policy makers, and others, so that they can better understand and tackle the problem of homelessness. Perhaps the best example that exists of advocacy is the principle paper produced by the Lived Experience Advisory Council of Peers in Canada during this 2014 conference. The title “Nothing about us without us” includes seven core guiding principles when planning to end homelessness involving peers and explains why it is important to do so (see the full reference in the section Further Reading). These are:

  1. Bring the perspective of the lived experience to the forefront
  2. Include those with lived experience at all levels of the organization
  3. Value the lived experience time and provide appropriate supports
  4. Challenge stigma, confront oppression and promote dignity
  5. Recognize the expertise of the lived experience and engage them in the decision making
  6. Work together towards the lived experience equitable representation
  7. Build authentic relationships between people with and without lived experience

Peer supporters bring in the advocacy process the strongest evidence: speaking through the lived experience, they can provide a living example of the existing gaps in the system, the existing attitude, what helps and what doesn’t, as well as enforce the recommendations for policy change. It can include all the different levels of the recovery journey, starting from the initial approach until the necessary policy changes to bridge potential existing gaps. Creating formal groups (e.g., peer associations) that have a legitimate space in the different platforms of policy making can also improve access to recovery for many people. 

Other roles, as described above, e.g., leading a peer group, or developing resources, may be encouraged in an organizational environment that promotes personal growth, capacity building and provides career opportunities to its human resources, both employees and volunteers.

Challenges

In the “State-of-the-Art Review” (2019) the challenges that are registered more frequently through quite a significant number of research studies (62 in total) from the involvement of a peer supporter in the homeless or other sectors are grouped in five key themes:

  1. Authenticity: Formalizing the role of a peer supporter or moving further in the recovery journey appears to create issues of questioning the authentic input by the peer supporters themselves. Addressing peer supporters’ needs to wellbeing and development is essential.
  2. Vulnerability: Peer supporters are at risk of being exposed to traumatic experiences or grief, stigmatized within the working force of the organization, labeled by their lived experience, or relapsing due to other issues. This is why it is essential that a set of accommodating strategies, flexibility and support mechanisms are established within the organization prior to involving the peer supporters.
  3. Boundaries: Overwhelming responsibilities, more than a peer could or should handle- which in practical terms may mean the change of role from a user to service provider- can create stress or discomfort to the peer supporter. The dilemma of where, when and how to draw the line is an added challenge throughout the intervention. For instance, setting boundaries while the role requires self-disclosure or making judgement calls while maintaining mutuality in the relationship with the peer or previous community’ members, might be challenging and require advanced interpersonal skills. The peer worker might, on occasions, need support and supervision from other professionals to manage some of these aspects soundly.
  4. Stigma: Lacking support within the organization or feeling discriminated leads to weakening of the peer supporters’ position and what they can bring in the services. Some researches discuss the stereotypes amongst non-peer employees and different ways to cope with them. The preparation of the ground in the organization to accept peer supporters in the working force beforehand can alter this type of challenges.
  5. Lack of Recognition of the peer supporter: Challenges in this sense are related with:
  • The way peers are matched (e.g., if matched based on typical criteria as gender or language and not on their lived experiences).
  • Their position within the organization (being a volunteer or an employee) and lack of equal access to benefits as non-peer employees (as for example insurance, salary according to the salary scale, other employee benefits available for the non-peer employees at the organization).
  • Lack of possibilities for personal and career growth within the organization
  • Being perceived as a threat by the non-peer professionals

Best practices around the globe, where peer supporters’ impact had positive results, addressed these challenges using different strategies or their combination

  • Preparation of the organization before deploying the peer support service: practitioners and decision makers discuss and agree- so there is a consensus- on the peer involvement and their expectations. Setting support mechanisms such as training for the employees, setting up systematic clinical supervision, multidisciplinary team meetings where peers are involved as team members, regardless of if their position is formal or informal, are essential. Defining accommodating strategies to support potential relapse or other needs that burden the peer support whether covering transport or providing a lawyer when necessary are essential. Considering flexible schemes so to allow peer supporters to include other obligations e.g. attending therapy has proven effective in successful peer supporter’s interventions.
  • When involved in the organization: create an environment where peer supporters can freely express themselves (publicly or anonymously), revise the job description if necessary, organize regular team meetings or supervision and provide possibilities for personal growth and development as for the rest of employees. 

4.4 Further reading

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