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Armstrong Institute for Patient Safety and Quality

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Peer Supporters

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Role and Experiences of Peer Supporters

The main role of the peer supporter is to help a person cope or deal better with problems, and equip or encourage them to do things that could improve their health and outlook on life. Peer supporters may have a certain health problem or difficult personal situation that is similar to the program participant. The fact that they have lived through similar challenges (a “practical living example,” someone who has been there) may help them share their experience, provide non-judgmental support, and bring encouragement and hope for positive outcomes.

Another key part of the peer supporter role is to provide practical information that health care professionals may not offer as part of formal treatment services or clinical practice. This information may be especially important to help participants adapt to and cope with the changes and new challenges in their life.

“If I can be a sounding board or someone to listen or to share, I think it's useful. And so in whatever capacity, I'm willing to do that for people. People have done it for me…it's better to give than to receive.”

— Quote from a peer supporter

“…when you listen to others going through the difficult situations…it’s a win-win situation. You feel that you are doing something for somebody else and at the same time, you are doing something for yourself.”

— Quote from a peer supporter

“… people don’t usually wanna talk about tough subjects…sometimes it can be difficult to talk to a complete stranger…especially if you’re unsure, you know, if you’re not confident …”

— Quote from a program participant

“I think sometimes for some of these conversations I have to sort of gear myself up, because it takes me back to a very traumatic period in our family's life.”

— Quote from a peer supporter

Peer supporters may benefit in a number of ways from their relationship with program participants, as described below:

  • Giving back: Peer supporters may feel a sense of satisfaction by giving back to people in a similar situation and making a difference to their lives.
  • Reciprocal benefit: The act of giving practical and emotional support to a person can also benefit the peer supporter.
  • Means of coping: Supporters may build upon their strengths and insights to sustain their own recovery and help themselves cope with their own health challenges.

Peer supporters could also face a number of challenges, some of which may not be visible or known at first. Programs can guide supporters by helping them understand what could be potentially challenging to them. These challenges may include:

  • Communication issues: There may be difficulties in discussing sensitive or difficult subjects (this could occur on the part of the participant or the supporter).
  • Change in availability: Supporters may need breaks from their role because of time constraints or other demands, or because they personally need support.
  • Challenges with role: Supporters may experience a fear of revisiting difficult or traumatic periods (the potential return of painful memories that may resurface by supporting someone else going through a similar experience).

Additional issues that peer supporters may face include:

  • Feeling guilty because they cannot follow up regularly with their participants
  • Concern that the participant is feeling obligated to talk, and the supporter is not sure how to get them to open up
  • Frustration in continued efforts to reach a patient/participant but not being able to connect
  • Making a connection and getting concerned about how a participant is coping, but then not being able to reach them to check on them.
  • Grief and emotional distress when a peer backslides, becomes more ill, or dies

Providing Support for Peer Supporters

Programs need to have a way to provide ongoing support for the peer supporters. For example, supporters may have questions, or need help addressing challenging situations. They may need personal support if experiencing distress or any negative impacts from providing peer support.

Examples of Ways for Peer Supporters to Get Support:

  • Positive reinforcement from program leaders and other program staff
  • Recognition of peer supporters through organizational and other opportunities
  • Events for peer supporters to talk about their disappointments, worries, and challenges
  • “Ebbing and flowing” type of reciprocal support between the peer supporter and the program participant
  • Family networks/friends
  • Specific religious and spiritual beliefs
  • Mutual support through social gatherings (to promote connection) and social media (private peer supporter page on Facebook)
  • Buddy system: pairing two peer supporters to look out for each other
  • Psychological support from clinical professionals when needed

Provide Support in Times of Emotional Stress

Peer support programs should have a clear plan for supporting peer supporters during times of emotional stress. Of particular note are health care-based programs that serve people with sensitive or severe illnesses or conditions. One-on-one counseling sessions may sometimes be needed to help supporters work through instances of emotional distress. Peer support groups for the peer supporters can also be formed and led by experienced program leaders.

Programs should routinely check the well-being of their supporters to find out how they are feeling and make it clear that they can take breaks from their role as a peer supporter. In some cases, program leaders might encourage them to attend another support group as a program participant, see their physician, or receive support outside of the program.

Core Skills/Competencies

A peer supporter often needs to acquire certain core skills to prepare them to successfully provide peer support. There are general skills that apply to all programs and specific ones that depend on the health condition and/or people that the program is intended to serve. Programs should anticipate what their peer supporters will need or may potentially encounter when working with participants and include these matters in peer supporter training.

The general core competencies for a peer supporter are listed below:

  • Describes Peer Supporter role and responsibilities including limits, defining role boundaries, maintaining privacy and confidentiality
  • Demonstrates how to initiate and end the support relationship
  • Describes the role of the program participant
  • Demonstrates well developed communication skills including active listening, and ability to provide respectful empathetic responses
  • Applies strategies to stimulate open conversation with a focus on the other person
  • Uses personal experiences to strengthen relationships and stimulate dialogue
  • Demonstrates ability to provide constructive feedback
  • Displays non-judgmental attitudes, stays positive, and provides affirming responses
  • Identifies how to manage potential or real emergency/crisis situations
  • Follows a partnership approach

Recruitment and Retention

Peer support and recruitment

It is important to devote both time and attention to recruiting the right [appropriate] peer supporters. This will be key to ensuring strong and successful peer supporter-program participant relationships and the overall success of the program.

You can advertise about need for peer supporters with flyers and pamphlets that includes information about your program. Another approach to recruit peer supporters is to reach out to people who have received services from your program. For example, NAMI tries to recruit new peer supporters who have benefited from its peer programs rather than from the general public. In hospital settings, clinicians can also serve as referral sources.

Screening applicants

Part of the recruitment process should include screening to ensure the applicant is (or can become) a good peer supporter. Below are possible factors to look for and questions to ask:

  • Do they want to become a peer supporter for the right reason? (Example question: Why do you want to become a peer supporter?
  • Do they have the required personality or skills to support others? (Example question: If I asked your best friend to describe you, what might s/he say?)
  • Do they have experience as a peer supporter?
  • Are they at a place in their journey with the underlying issue/health problem that they can devote the time and energy to provide support to others? (Example questions: How does being a peer supporter fit into your life now? Do you have time to do this with everything else that you are already doing in your life? What do you think some of the challenges of being a peer supporter might be for you?)
  • Do they understand and agree with the values and philosophy of the program?

Survivors Helping Survivors has criteria for selection in their volunteer orientation manual. NAMI has “red flags” in interview materials to help screeners decide if the person is a suitable candidate at that time.

Pathway to becoming a supporter

A transition period may be used to prepare someone to become a peer supporter. For example, supporters may start by leading an informational session and eventually become a peer supporter; think of this as building blocks to becoming a peer supporter. If a supporter is not believed to be physically or emotionally ready for the role, they may require more coaching or may be directed to other volunteering opportunities. Program leaders should be ready to re-direct volunteers to another task or assignment where they can volunteer successfully.

Retention methods

Retaining peer supporters may help ensure a well-trained and experienced group of supporters. However, at times it can be difficult for programs to meet the needs of peer supporters and to keep an adequate number trained and available. Programs use a variety of methods to boost their numbers:

  • Programs can retain supporters by respecting their needs. For example, Parent Connection knows that peer supporters have other commitments (children, work, etc.).
  • Keep peer supporters engaged and interested in the program. NAMI coordinators try to keep mentors updated even when they are not involved with the program by sending newsletters and training updates.
  • Foster a positive environment that makes supporters feel valued and lets them know that “their work matters.”

Some ways to recognize supporters:

  • personal feedback from program leaders
  • gift certificates, e-gift cards
  • certificates and awards at events (for example, NAMI gives awards for program supporters each year at its state conferences and recognizes program supporters for length of service at its national conference)
  • retreats or quarterly dinner meetings to celebrate contributions
  • meal vouchers

Training

Peer supporters need to acquire the core skills needed for providing peer support and need to be prepared for the challenges that they may face. For example, knowing how to recognize crises or ‘red flags’ for participants and themselves. Training and guidance can help them learn and be effective sources of support. Many programs will use existing staff (nurses, social workers, program leaders, or experienced peer supporters) to conduct their training.

Initial Training

“The training opened me up to looking at my son’s illness’s from a more sympathetic perspective…my perspective is not necessarily the only perspective…it generally wasn’t even the right perspective.”

— Quote from a peer supporter

Initial formal training may differ among programs. The resources section has training materials to help meet the general competencies for providing peer support. Each program will have to adapt these materials to include information that is specific to their program to ensure their peer supporters are prepared to handle specific issues for program participants.

Key areas to cover in peer supporter training include:

  • The concept and methods of peer support, including benefits and limitations of peer support
  • The role of the peer supporter
  • Setting and maintaining boundaries
  • Identifying when self-care is needed and how to seek support
  • Navigating challenging conversations and keeping an open mind
  • Core communication skills for peer support: active listening, showing empathy, asking open-ended questions and showing willingness to provide ongoing support
  • When and how to share your lived experience

Role play may be a good way to enhance peer support skills. Experienced supporters can role play real events to help train new peer supporters. For example a program may have experienced supporters perform a role play at a training session. Ideas that peer supporters think of while viewing the role play are discussed as they arise, allowing the new supporters to draw on prior knowledge and develop new skills

Refresher Training

Refresher training can be done through follow-up and supervision meetings; both are critical parts of ongoing learning.

Example: At Survivors Helping Survivors where breast cancer treatments change rapidly, peer supporters attend continuing education activities. Guest speakers are invited to present updates on changing technology and methods for treating breast cancer.

Monthly national teleconferences are held for peer supporters in each of the NAMI peer programs. Topics are chosen partly based on debriefing forms completed by peer supporters after a peer support group.

On-the-job Learning

You can help peer supporters become prepared on-the-job using the following approaches:

  • Shadowing an experienced supporter (Survivors Helping Survivors)
  • One-on-one guidance from someone who can explain and show how the program works

Challenges to Training

  • If a program grows too quickly, new recruits may not be properly trained and ready to support others
  • Training (for example, extensive HIPAA online modules) may be a burden and deter people from becoming supporters
  • Covering all the training needed to provide certain types of support
  • Infrequent or varied types of refresher training

Feedback and Assessment of Training

It is helpful to ask those going through the training to provide feedback on the training, whether they have found it helpful, and what they would like to learn more about.

Examples: Parent Connection asks for feedback during the training process.

At NAMI, State trainers (experienced peer supporters who have gone through additional training to be trainers) provide evaluation of the trainees and determine if someone is certified, provisionally certified or not graduated.

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Updated: March 2018