Peer Support for Youth and Young Adults: An Outline of the State of the Science
Abstract: This article outlines some of the main research findings related to peer support for youth and young adults who experience serious mental health conditions, as well as remaining questions and challenges, and what is being done at Pathways RTC to address these challenges.
"Peer Support for Youth and Young Adults: An Outline of the State of the Science" (2018)
By Janet Walker, Caitlin Baird, & Mary Beth Welch
Peer support for youth and young adults who experience serious mental health conditions is rapidly growing in popularity as an addition to the mental health service array in communities around the United States.1,2 Research focusing on various aspects of the youth/young adult peer support role has been accruing in recent years; however, many questions remain regarding how the role is defined and supported, and what sort of outcomes can and should be expected once peer support is implemented as a service. This article outlines some of the main research findings related to peer support, as well as remaining questions and challenges, and describes work being done at Pathways RTC in response.
Impacts of Peer Support
Despite the growing popularity of peer support in mental health services, there is only limited evidence of its effectiveness, and research assessing effectiveness comes almost exclusively from studies examining peer support for adults. The most rigorous research available provides "little evidence" of effectiveness. However, less rigorous studies have found that peer support services can have positive impacts in a variety of areas: hope and belief in the possibility of recovery; empowerment and increased self-esteem; self-efficacy and self-management of difficulties; and social inclusion, engagement, and increased social networks.3
Virtually no research addresses the impact of peer support implemented specifically for youth or young adults with serious mental health conditions (SMHCs). Regarding the 30 programs included in their scoping review, Gopalan, et al.1 concluded that almost none employed rigorous research designs, and none evaluated the unique contribution of youth peer support services in the context of other program components.
Challenges in Research and Implementation
Discussions of the implications of existing research are remarkably consistent in their descriptions of the challenges that need to be overcome in order to ensure high quality research and implementation for peer support roles in mental health.
Understanding the Role
The most frequently-cited challenge is the lack of specification regarding the peer support role. Indeed, qualitative research confirms that peer support providers are themselves unclear about their roles and tasks.4 Regarding peer support for youth and young adults specifically, role clarity is also consistently mentioned as a challenge.1,4,5,6 Challenges stemming from a lack of role clarity are compounded by a lack of clear specification regarding the mechanisms of change and the unique contribution of "peerness" (i.e., the unique aspects of peer roles) to outcomes, both for adult peer support providers and for youth/young adult peer support providers specifically.1,6,7
Training and Supervision
A lack of clarity regarding the peer support role contributes in obvious ways to difficulty in training and supervising peers to undertake the work. Similarly, the lack of clarity regarding specific mechanisms of change gives rise to challenges around training and supervision for issues related to peerness, and specifically how to operationalize in practice what are generally seen as core functions of the role, such as inspiring hope, role modeling, building social networks, and employing strategic self-disclosure.1,6,8
Regarding youth and young adults specifically, there is recognition that training and supervision should be tailored to young adults' unique needs and stage of development.1,6 What is more, young adult peer support providers often have limited or no prior work experience, and thus need support in developing professional skills such as time management and effective communication.9 Thus, existing training and supervision strategies utilized in adult and family peer-to-peer models likely need significant adaptation in order to be optimal for young adults.
Relationships with Colleagues
Numerous commentaries in the literature point to significant friction between peer and non-peer staff as one of the central challenges to implementing the role successfully. A lack of role clarity is cited as a significant contributor to this problem. Often, organizations do not clearly understand and/or articulate the role and value of the peer support providers to other staff. This can result in a variety of misunderstandings that can lead to non-peer staff members stigmatizing, ostracizing, or disrespecting peer staff.4,10 These tensions are likely even more pronounced for young adult peer support providers, who report feeling ignored and belittled by colleagues, which in turn can lead to increased job stress.5
Response to Challenges and Next Steps
Anecdotal evidence and information from the internet indicates that there are a number of stakeholder groups engaged in responding to these challenges. In particular, work is underway to adapt existing adult peer support curricula to be more developmentally appropriate and to better meet the training needs of young adult peer support staff; however, evaluations of these efforts have yet to be published.
Providing high-quality, developmentally appropriate training is not likely to be sufficient for producing skilled peer support, however. It is generally known that training alone, while it may increase knowledge, is extremely unlikely to produce skilled practice.10 In contrast, effective training approaches often involve multifaceted strategies including a treatment manual, multiple days of intensive workshop training, ongoing coaching, live or taped review of client sessions, supervisor trainings, booster sessions, and the completion of one or more training cases. The follow-up coaching – provided either by designated coaches or by supervisors – is particularly essential for learning new practice, and should include observation of practice (either live or via audio- or video recording) and provision of feedback in a manner that is connected to the intervention theory and based on objective criteria.11
This kind of comprehensive support is likely even more important for young adults training to be peer support providers, since they do not have prior experience delivering interpersonal interventions. However, providing comprehensive support for skill acquisition is likely to be particularly difficult for young adult peer support providers, since, as noted previously, organizations find it difficult to access coaches, trainers, and supervisors who have provided peer support in the past, and who understand the role and how to build skills that are particular to the unique aspects of the role. More generally, the cost of providing comprehensive support has proven to be a major barrier to implementation of training and coaching best practices.10
Pathways RTC is exploring a response to these challenges by developing and testing an enhancement for the youth/young adult peer support role called AMP+. AMP+ is an adaptation and extension of the empirically-supported Achieve My Plan enhancement12 (i.e., "original" AMP) that is designed to be implemented by providers who work with youth and young adults to build self-determination and create person-centered plans (e.g., transition, treatment, Wraparound, or other types of service/support plans). AMP+ responds to challenges noted here by providing: "a clear model for practice and reliable fidelity assessment; comprehensive training and coaching via the internet and a proprietary web-based platform so as to comply with best practices while keeping costs down; training and coaching provided by peers experienced in these roles; and clear definition of skills related to 'peerness.'"13 In a recently completed study, peer support providers participating in the AMP+ enhancement demonstrated significant increase in relevant skills, decreased job stress, and increased confidence in their capacity to promote self-determination and to support young people to create and carry out plans and activities in service of personally meaningful goals.
In sum, while there are many challenges associated with implementing peer support for youth and young adults, there are also well-informed and creative responses to these challenges being developed. This work contributes to optimism that peer support programs can and will be successful when peers are provided with appropriate practice models, training, and supervision; when mental health professionals are educated about the roles and benefits of peer support; and when measures are taken to reduce peer support providers' isolation by ensuring that they are seen as a critical part of efforts to promote mental health and wellness, as well as successful transitions to adult roles and responsibilities.
- Gopalan, G., Lee, S.J., Harris, R., Acri, M.C., & Munson, M.R. (2017). Utilization of peers in services for youth with emotional and behavioral challenges: A scoping review. Journal of Adolescence, 55, 88–115.
- Walker, J., Gowen, K., Jivanjee, P., Moser, C., Sellmaier, C., Koroloff, N., & Brennan, E.M. (2013). Pathways to Positive Futures: State-of-the-science conference proceedings. Portland, OR: Portland State University, Research and Training Center for Pathways to Positive Futures.
- Repper, J., & Carter, T. (2011). A review of the literature on peer support in mental health services. Journal of Mental Health, 20(4), 392–411.
- Cronise, R., Teixeira, C., Rogers, E.S., & Harrington, S. (2016). The peer support workforce: Results of a national survey. Psychiatric Rehabilitation Journal, 39(3), 211–221.
- Delman, J., & Klodnick, V.V. (2017). Effectively employing young adult peer providers: A toolkit. Worchester, MA: The Learning and Working Center, Transitions RTC. Retrieved from https://www.umassmed.edu/globalassets/transitionsrtc/publications/effectivleyemployingyoungadultpeerproviders_a_toolkit.pdf
- Delman, J., & Klodnick, V.V. (2016). Factors supporting the employment of young adult peer providers: Perspectives of peers and supervisors. Community Mental Health Journal, 53(7), 811–822.
- Silver, J., Nemec, P.B., & Hampshire, N. (2016). The role of the peer specialists: Unanswered questions. Psychiatric Rehabilitation Journal, 39(3), 289–291.
- Myrick, K., & del Vecchio, P. (2016). Peer support services in the behavioral healthcare workforce: State of the field. Psychiatric Rehabilitation Journal, 39(3), 197–203.
- Research and Training Center for Pathways to Positive Futures. (2013). Implementing the peer support specialist role: Providing direct, individualized support in a local program. Portland, OR: Research and Training Center for Pathways to Positive Futures, Portland State University.
- Lyon, A.R., Stirman, S.W., Kerns, S.E.U., & Bruns, E.J. (2011). Developing the mental health workforce: Review and application of training approaches from multiple disciplines. Administration and Policy in Mental Health, 38(4), 238–53.
- Beidas, R.S., & Kendall, P.C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology Science Practice, 17, 1–30.
- Walker, J.S., Seibel, C.L., & Jackson, S. (2017). Increasing youths' participation in team-based treatment planning: The Achieve My Plan enhancement for Wraparound. Journal of Child and Family Studies, 26(8), 1–11.
- Walker, J.S., Baird, C., & Welch, M.B. (2018). The AMP+ skills enhancement training for peer support providers. Focal Point, 32, 8.
Walker, J., Baird, C., & Welch, M.B. (2018). Peer Support for Youth and Young Adults: An Outline of the State of the Science. Focal Point: Youth, Young Adults, and Mental Health, 32, 5-7. Portland, OR: Research and Training Center for Pathways to Positive Futures, Portland State University.