What is Recovery Coaching?

Introduction

Recovery coaching is a form of strengths-based support for people with addictions or in recovery from alcohol, other drugs, co-dependency, or other addictive behaviours. They work with people who have active addictions, as well as those already in recovery. Recovery coaches are helpful for making decisions about what to do with one’s life and the part addiction or recovery plays in it. They help clients find ways to stop addiction (abstinence), or reduce harm associated with addictive behaviours. These coaches can help a client find resources for harm reduction, detox, treatment, family support and education, local or online support groups; or help a client create a change plan to recover on their own.

Recovery coaches do not offer primary treatment for addiction, do not diagnose, and are not associated with any particular method or means of recovery. They support any positive change, helping persons coming home from treatment to avoid relapse, build community support for recovery, or work on life goals not related to addiction such as relationships, work, or education. Recovery coaching is action-oriented with an emphasis on improving present life and reaching future goals.

Recovery coaching is unlike most therapy because coaches do not address the past, do not work to heal trauma, and put little emphasis on feelings. Recovery coaches are unlike licensed addiction counsellors in that they are non-clinical and do not diagnose or treat addiction or any mental health issues.

Refer to Recovery Model.

Relationship to Life Coaching

Similar to life and business coaching, recovery coaching uses a partnership model wherein the client is considered to be the expert on his or her life, the one who decides what is worth doing, and the coach provides expertise in supporting successful change. Recovery coaching focuses on achieving goals important to the client, not just recovery-related goals. The coach asks questions and offers reflections to help the client reach clarity and decide what steps to take. Recovery coaching emphasizes honouring values and making principle-based decisions, creating a clear plan of action, and using current strengths to reach future goals. The coach provides accountability to help the client stay on track.

Other Similar Terms

The moniker “recovery coach” is used for a variety of specific addiction support roles. The main distinction is between the professional or highly compensated recovery coach and the volunteer or agency-employed peer recovery support specialist. Recovery support roles include the following:

Sober Escort

A sober escort, or travel escort, is a paid sober travel companion or travel escort that accompanies a client to an event, to treatment, or to court, to ensure the client maintains sobriety. Transportation can be a significant challenge to a newly abstinent person. Whether the client is interested in maintaining an ongoing recovery or just needs to stay abstinent for a period of time, getting from point A to point B can be difficult. This version of a recovery coach may be required to transport a person in recovery across town, across the state, or across the county.

Sober Companion

A sober companion or sober coach works full-time with the client: full work days, nights, weekends or extended periods where the coach is by the client’s side 24 hours a day. This long-term option can begin with treatment discharge and may develop into a coaching relationship that continues for several weeks, months or longer.

When returning home from treatment, the client trades a secure, drug-free environment for a situation where they know there are problems. The sober companion may provide the symbolic and functional safety of the treatment centre. This coach will introduce the client to 12-step meetings, guide them past former triggers for their addiction, and support them in developing a recovery plan. The sober companion helps the client make lifestyle changes in order to experience a better quality of life in the first crucial days after discharge from a treatment centre. Sometimes a recovery coach is necessary to keep a client sober in order to regain custody of a child.

Recovery Support Specialist

A recovery support specialist (RSS) or a peer recovery support specialist (PRSS) is a non-clinical person who meets with clients in a recovery community organisation or goes off-site to visit a client. They may volunteer for these coaching services, or be employed by a recovery community organisation for a low wage. The recovery support specialist ensures there is a contract for engagement, called a personal recovery plan. This is a key component of the recovery management model, which all RSSs follow. These specialists are sometimes also called “recovery coaches”. William L. White, researcher and original author of the recovery management model, uses the term “recovery support specialist”. This is referenced in the paper titled “Recovery Oriented System of Care (ROSC) Substance Use Disorder (SUD) Glossary of Terms”, compiled by the Bureau of Substance Abuse and Addiction Services (BSAAS). Another term for a peer recovery support specialist is “peer mentor“.

Family Recovery Coach

The family plays an important role for a person in recovery but is often neglected by traditional models of recovery. Specially trained family recovery coaches strive to create a calm, objective, non-judgmental environment for the family of a recovering addict. They are knowledgeable in specific models that help the family cope with the changes that they have gone through living with an active addict or living with a recovering addict. Regardless of an addict’s choices, working with a family recovery coach may help a spouse, partner, or loved ones avoid the mental obsession that plagues many families affected by addiction and learn to lead sane and productive lives.

Phone or Virtual Recovery Coach

A phone or virtual recovery coaching relationship may be established to continue beyond the face-to-face meeting of a client and a recovery coach. Today, many treatment centres are embracing virtual recovery coaching, and linking phone or virtual recovery coaches with clients prior to leaving treatment, as a way to continue the connection to the treatment centre, as well as meeting the guidelines of an aftercare programme. Online virtual coaching programmes also exist, either fee-based or for free, that will help anyone apply the methods of recovery (e.g. developing a recovery plan and building recovery capital), whether the client has completed a stay at a treatment centre or has relapsed many months after treatment.

Legal Support Specialist

Lawyers dealing with criminal drug cases or drug courts sometimes request a type of recovery coaching to ensure a client (perhaps under house arrest, enrolled in a drug court outpatient programme or pending trial) stays sober as per the law’s mandate. Recovery coaches with the required certification and legal knowledge are contracted for this purpose. Certified Peer Recovery Support Specialists, Licensed clinical social workers or certified alcohol and drug counsellors with training in assessments can perform these tasks. The court will request them to perform a client assessment and work with the client on a continuing basis and re-assess after a period of time. The coach will then draft a letter to the court and offer suggested placement in a residential alcohol/drug treatment centre, an outpatient treatment programme, or a sober living facility. A legal support specialist can also appear in court with the client and provide transportation to or from the courthouse.

In the Emergency Departments of Hospitals

The AnchorED programme, developed in 2014 with a group of Rhode Island hospitals and the Anchor Community Recovery Centre in Providence RI, was launched in an attempt to reduce the instance of accidental opioid overdose by connecting overdose patients with Certified Recovery Coaches in the emergency departments of regional hospitals. The AnchorED programme is now a benchmark in this field and is used nationwide. This programme is meant to connect people experiencing an overdose, or revived from an overdose in the ED in the hospital emergency departments with peer-to-peer recovery support. Specially trained ED Peer Recovery Specialists are on call to all Emergency Departments 24/7 and called in when individuals are transported to a hospital emergency department having survived an opiate overdose. The hours immediately after an overdose are medically risky, but they also present a unique opportunity. The AnchorED trained recovery coaches will make sure that patients and their families know that substance use disorder is a medical condition and that recovery is possible. Recovery Coaches engage with those who have survived an opiate overdose, listen and be present to answer questions patients may have about recovery supports or treatment options. These coaches also provide recovery and treatment information to family members. These same coaches offer post-discharge recovery contact and support to the revived patients for a period of weeks.

Brief History

Alida Schuyler, a coach credentialed by the International Coach Federation (ICF), who was in recovery from addiction, wrote the first recovery coach certification training programme specifically aimed at training students to coach people with addictions. She also created the first special interest group for recovery coaches, and she co-founded the non-profit Recovery Coaches International with Andrew Susskind.

William L. White used the term “recovery coach” in his 2006 paper “Sponsor, Recovery Coach, Addiction Counselor”, but later adopted the term “peer recovery support specialist” to emphasize a community-based peer model of addiction support.

White’s Recovery Management model, adapted from the Minnesota Model, includes recovery coaching (peer recovery support specialist) and was developed in 2006. Many recovery coaches use different recovery approaches adapted from the Minnesota Model. Schuyler developed a professional model of life coaching for addiction recovery by blending the Minnesota Model and Harm Reduction model with the core competencies of the ICF.

Through the research of White, David Loveland, Ernest Kurtz, and Mark Saunders, and the efforts funded through Faces and Voices of Recovery, the Fayette Companies, Great Lakes Addiction Technology Transfer Centre, the Chestnut Health Systems and many other universities, research on recovery coaching is progressing rapidly. The theory has been developed that recovery coaching reduces relapse by providing ongoing support developing healthy problem-solving skills and self efficacy (reaching worthwhile goals), as well as connecting with the local recovery community for additional support. In other words, recovery coaching helps the client develop the cognitive skills necessary for considering options and consequences, making clear choices, planning, and taking actions toward a healthier life and recovery goals.

Recovery coaching is currently offered by some notable 12-step treatment centres as well as several private “academies” and “institutes” with certifications that are usually country and/or state specific. Be sure to check local laws for compliance.

Addiction Recovery Support Groups

Recovery coaches encourage (but most do not require) participation in groups such as Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, or non 12-step groups such as LifeRing Secular Recovery, SMART Recovery, Moderation Management, and Women for Sobriety. They also work with individuals who dislike groups to help them find their own path to recovery.

Niches within Recovery Coaching

Recovery coaches may work with any type of addict. There are also niches within recovery coaching such as those who work exclusively with families of recovering individuals, or a financial coach who works on rebuilding an overspender’s credit rating. Many peer recovery support specialists work with individuals who have left the prison system and are attempting to rebuild their lives. Some recovery coaches specialise in emotional and financial recovery after divorce.

A few recovery coaches specialise in merging the characteristics of recovery coaching within a life coaching framework. This concept takes into account the often overlooked reality that those in early recovery tend to have unique difficulties in applying the realities of day-to-day living within their new sober lifestyle. Such unique coaching styles are able to span far beyond the recovery component and properly introduce outside influencers, such as family relationships, employment, schooling, and relationships.

For those requiring a higher level of care, such as medical detoxification for heroin or opiate withdrawal, or 24/7 sober companion and oversight services, there exist recovery coaching firms which specialise in providing what could often be described as an alternative to inpatient or outpatient treatment. Companies like The Addictions Coach and others which have nationwide credentials are able to essentially bring the addiction treatment component to the client, no matter where he or she may be located.

What Recovery Coaches Do

Recovery coaches support the client in achieving and maintaining a solid foundation in recovery, and building upon recovery to achieve other life goals that make recovery worthwhile. David Loveland and Michael Boyle wrote a lengthy manual on recovery coaching and how to guide an individual through creating their recovery plan. William White, preeminent scholar on addictions, worked closely with the Philadelphia community-based recovery centre PRO-ACT to prepare a document outlining the “Ethical Guidelines for the Delivery of Peer-Based Recovery Support Services”. These documents provide a discussion of what a recovery coach does. Also included in these guidelines are the definition of coaching roles as they relate to others in the realm of personal conduct and conduct in service relationships with the community service provider or treatment team. White’s document presents a simple statement of core competencies.

What is PARfessionals?

Introduction

PARfessionals is an US, Arkansas-based, private research development firm for Peer Support and Recovery Providers in Addictions.

Background

The company was founded in 2011 by Jorea M. Kelley-Hardison She self-published the book “Getting Ahead: An Ex-Offenders Guide to Getting Ahead in Today’s Society”, where she encourages ex-offenders to participate in clinical research trials. She is mentioned in Dr. Jon Marc Taylor’s book “Prisoners’ Guerrilla Handbook to Correspondence Programs in the United States and Canada,” published by Prison Legal News in 2008.

Jorea Kelley-Hardison was taking classes to become a Clinical Research Coordinator (CRC) before she decided to transition into the addiction industry to become an Addictions Counsellor in 2009. Around that time, she received her CCJP – a status from the Texas Certification Board of Addiction Professionals and has been granted numerous credentials from the board, including the Peer Recovery Specialist (PRS), Peer Mentor/Peer Recovery Coach (PM-PRC) and the Associate Prevention Specialist (APS) credentials, but has since retired those credentials.

Jorea Kelley-Hardison earned a B.S. degree in Management in 2009 and has completed degree requirements in order to graduate with a M.A. in Criminal Justice from the American (Military) Public University System. She has also earned a graduate certificate in Applied Forensic Psychology Services from The Chicago School of Professional Psychology. In addition, she has obtained certificates in mental health, non-profit management, applied forensic psychology services, basic clinic research, family and business mediation, substance abuse, as well as emergency management. In addition, she has received training throughout the years in various important topics such as rape/domestic violence crisis intervention, hospice, and health unit coordination from various organizations and colleges including Parkland Health & Hospital System, Brookhaven College, Lakewood College, Centre for Degree Studies, Northwestern University Feinberg School of Medicine, Thomas Edison State College, University of Texas at Arlington-Continuing Education Division, and Richland College.

She is currently a member of the American Association on Intellectual and Developmental Disabilities, NAADAC – The Association of Addiction Professionals, National Alliance for Direct Support Professionals, National Association of Health Unit Coordinators, Psychiatric Rehabilitation Association and the International Association for Correctional and Forensic Psychology.

Brief History

In 2011, the word ” PARfessionals” was created by the company’s founder. In 2012, PARfessionals decided to develop the first peer-based online recovery coach training programme designed for those interested in mentoring individuals into and through long-term recovery from co-occurring disorders and other addictions and addictive behaviours.

In 2013, PARfessionals developed the first Peer Recovery/Addiction Recovery Coach Study Guide, a free Peer Recovery/Addiction Recovery Coach Curriculum Guide, a free Peer Recovery/Addiction Recovery Coach Practicum Guide and an online Peer Recovery/Addiction Recovery Coach Train the Trainers course. Additionally, PARfessionals’ founder and several family members applied for an ACE college credit review with The American Council On Education and then to Distance Education Accreditation Council (DEAC) in August 2015. After being rejected by DEAC, the founder contacted Charter State Oak College who in November 2015 about their program being recognised for college credit under their college assessment programme.

PARfessionals designed a Peer Recovery Facilitator Development e-Course in an effort to support the ongoing efforts of social service agencies, foundations, government agencies, and employers worldwide. This course would also work towards the development of community re-entry programs for inmates and workforce development skills for disadvantaged individuals such as ex-offenders, disabled individuals, low-income communities and minorities.

It was developed in collaboration with post-secondary educators and coaching experts for a diverse population with an array of learning skills who may be teaching, employing or supporting those who may be inmates, ex-offenders, mental health consumers, recovering addicts and individuals with intellectual and developmental disabilities. It provides adult-oriented learning strategies for a diverse group of individuals with different learning abilities.

The online Peer Recovery Facilitator Development e-Course was officially approved in 2014, by the Association for Addiction Professionals, also known as NAADAC.

In 2014, PARfessionals developed the first free Peer Recovery Support Specialist/Addiction Recovery Coach classroom curriculum kits in addition to a home study course, a correctional correspondence course for inmates, research journal, universal Code of Ethics and an international certification board. Additionally, PARfessionals’ founder created an in-house private virtual research institute, the Powell Leary Jacobs (PLJ) Multicultural Institute for Transformation Research in Addictions, to self-fund resources on Peer Recovery and Prevention. It was internally closed in 2014.

From 2013-2014, PARfessionals and its parent organisation, the SJM Family Foundation (which closed in January 2015 through the Texas Secretary of State) provided seven scholarships for eligible candidates from the general public who were devoted to seeking training for addiction treatment and peer recovery services.

Kelley-Hardison also established the International Certification Board of Recovery Professionals (ICBRP), the first ever, peer-run certification board created for peer recovery professionals in the world. The ICBRP’s mission was to be an independent, informal ad-hoc advisory board that provides guidance and accountability for the National Certified Peer Recovery Professionals (NCPRP) credentialing programme. However, it was later dissolved (through the Georgia Secretary of State in March 2015), and merged into PARfessionals’ private corporate structure.

In Spring 2017, The PARfessionals’ Cultural Intelligence in Addictions course supplemental student workbook was included in the German National Library.

As of August 2018, PARfessionals is a private product design and consulting firm doing business as PARfessionals Behavioural Health Research Development Corporation. The founder, Jorea Kelley-Hardison is a nationally certified psychiatric technician and social impact artist that has successfully worked with dozens of licensed professional clinicians and medical staff worldwide, including professionals from Harvard Medical School and the National Institute of Health. to create 45+ PARfessionals’ branded resources, including Peer Recovery Practicum Guide, a Peer Recovery Pre-Certification Review e-Course. a Peer Recovery Supervision Training Course, and Peer Recovery classroom curriculum kits.

In order to accomplish the company’s goals, Kelley-Hardison, along with members of the AR SJM Family, hired and privately paid independent contractors and freelancers, also Ms. Hardison and several of her family members working as volunteers using their own money, and collaborating with a group of qualified contracted experts from across the world that had acquired degrees, held additional credentials and had significant work experience in their own respective fields.

The Definition of “Peer Recovery”

The term peer recovery can be first defined through PARfessionals as “the process of giving and receiving encouragement and assistance to achieve long-term recovery. Peers offer emotional support, share knowledge, teaches skills, provide practical assistance, and connect people with resources, opportunities, communities of support, and other people”.

The Association for Addiction Professionals provides a different definition of recovery. According to William White, MA, “recovery is the experience… through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life”.

The International Certification & Reciprocity Consortium states that “peer recovery is experiencing rapid growth, whether it is provided by a peer recovery coach, peer recovery support specialist, peer navigator, patient navigators, public health learning navigators, behavioural health navigator or peer recovery mentor. Peer support services – advocating, mentoring, educating, and navigating systems – are becoming an important component in recovery oriented systems of care”.

IC&RC credentials and examinations, including Peer Recovery are administered exclusively by various certification and licensing boards in the United States and the world.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the US Department of Health and Human Services that leads public health efforts to advance the behavioural health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

SAMHSA states that:

Peer support services are delivered by individuals who have common life experiences with the people they are serving. People with mental and/or substance use disorders have a unique capacity to help each other based on a shared affiliation and a deep understanding of this experience. In self-help and mutual support, people offer this support, strength, and hope to their peers, which allows for personal growth, wellness promotion, and recovery.

Research has shown that peer support facilitates recovery and reduces health care costs. Peers also provide assistance that promotes a sense of belonging within the community. The ability to contribute to and enjoy one’s community is key to recovery and well-being. Another critical component that peers provide is the development of self-efficacy through role modeling and assisting peers with ongoing recovery through mastery of experiences and finding meaning, purpose, and social connections in their lives.”

Peer Recovery Navigator Academics Programme and (Micro-Certification) Registry

In 2012, PARfessionals developed the first globally recognised online training programme for peer recovery professionals. As of September 2015, PARfessionals offers an online distance learning pre-certification training course, a home study correspondence course and an inmate correspondence course for student-candidates to study at their own pace for global certification in peer recovery. The curriculum is based on proven research in order to make it the most specialised and comprehensive training programme for a new generation of Peer Recovery Professionals for a variety of settings.

Students worldwide have completed the training and shared their satisfaction with PARfessionals training programme.

PARfessionals developed its own exam and credential, NCPRP, which stands for “National Certified Peer Recovery Professional”.

The NCPRP credential and exam primarily emphasize the concept of peer recovery, with the main purpose of providing guidance, knowledge or assistance, especially among those with similar experiences who can meet as equals. The certification was integrated into the academic programme and renamed the PARfessionals’ Peer Recovery Workforce Development Certification Programme.

In Fall 2016, PARfessionals’ founder worked with qualified and licensed clinicians to create and sponsor the world’s first college level peer recovery training course and lifetime credential for the behavioural healthcare workforce, which was submitted and reviewed through the Connecticut Credit Assessment Programme and The Consortium for the Assessment of College Equivalence of Charter State College in Fall 2016.

Global Health Impact

Deloitte provides an annual look at the topics, trends, and issues impacting the global health care sector. According to its 2017 Global Healthcare Sector Outlook Infographic, “Peer support, self-management education, health coaching, and group activities, along with workforce training, and investments in the right technology” are “potential enablers of patient activation and engagement” and “key ingredients for productive health care operations”.

Behavioural Health Educational Mobile Apps

In February 2016, PARfessionals’ founder, Ms. Kelley Hardison started to partner with several independent app developers to develop Behavioural Health educational apps and games for the Addiction Peer Workforce.

Mobile Library Garden and Pocket Park Commemoration

In the fall of 2016, the AR SJM Family distributed two college preparatory guides, PARfessionals’ Peer Recovery/Cultural Intelligence in Addictions and PARfessionals’ Peer Recovery Navigator Practicum Guide to 240,000+ digital libraries and 2,000 digital publishers across the world. In 2017, the successful worldwide distribution was commemorated with a plaque in a mobile library garden and pocket park in Centennial, Texas.

Approvals

PARfessionals is an approved behavioural health training provider recognised by many states, national and international professional associations and state boards.

What is Peer Mentoring?

Introduction

Peer mentoring is a form of mentorship that usually takes place between a person who has lived through a specific experience (peer mentor) and a person who is new to that experience (the peer mentee). An example would be an experienced student being a peer mentor to a new student, the peer mentee, in a particular subject, or in a new school. Peer mentors are also used for health and lifestyle changes. For example, clients, or patients, with support from peers, may have one-on-one sessions that meet regularly to help them recover or rehabilitate.

Peer mentoring provides individuals who have suffered from a specific life experience the chance to learn from those who have recovered, or rehabilitated, following such an experience. Peer mentors provide education, recreation and support opportunities to individuals. The peer mentor may challenge the mentee with new ideas, and encourage the mentee to move beyond the things that are most comfortable. Most peer mentors are picked for their sensibility, confidence, social skills and reliability.

Critics of peer mentoring insist that little is known of the nature of peer mentoring relationships and that there are few consistent studies indicating the outcomes of peer mentoring beyond good feelings among peers and the development of friendships. Peer mentoring led by senior students may discourage diversity and prevent critical analysis of the higher education system.

Refer to Peer Support, Peer Support Specialist, and Support Group.

Programme Design Characteristics

The frequency with which peer mentors and mentees meet varies according to the particular mentoring programme. Some pairs may make contact once a month, while others may meet 3-4 times per month or more. It is usually advised that mentors and mentees meet more often in the beginning of the relationship in order to establish a good foundation. Mentors and mentees may maintain contact through email, telephone or in-person meetings. Peer mentoring organisations may also set up social events for those participating in the programme. These events provide good opportunities for increased social interaction between mentors and mentees.

The compatibility of mentor and mentee is a factor that should be taken into consideration when choosing pairs. Mentors and mentees may benefit from having similar backgrounds, interests and life experiences. Age, gender, ethnicity, language preferences, and education may be taken into consideration when pairing mentors with mentees.

The quality of the peer mentoring relationship is important for mentees to experience positive results. A mentor relationship is more successful when the mentor cares for the whole person and not just the academic or career side of a person. Successful mentors tend to be available, knowledgeable, educated in diversity issues, empathic, personable, encouraging, supportive, and passionate. Although this is not an exhaustive list of qualities, they have been shown to be important for successful mentoring relationships. It is important to keep qualities like this in mind when recruiting and training mentors.

The objectives of a peer mentoring programme should be well-defined and measurable. The effectiveness of the program should be monitored to ensure that the objectives are being met. One way to monitor the effectiveness of a programme is to administer evaluations to the mentors and mentees.

In Education

Peer mentoring in education was promoted during the 1960s by educator and theorist Paulo Freire:

“The fundamental task of the mentor is a liberatory task. It is not to encourage the mentor’s goals and aspirations and dreams to be reproduced in the mentees, the students, but to give rise to the possibility that the students become the owners of their own history. This is how I understand the need that teachers have to transcend their merely instructive task and to assume the ethical posture of a mentor who truly believes in the total autonomy, freedom, and development of those he or she mentors.”

Peer mentors appear mainly in secondary schools where students moving up from primary schools may need assistance in settling into the new schedule and lifestyle of secondary school life. However peer mentoring can occur at the grade school level, the undergraduate level, and the graduate school level. The goals of the programme may vary according to the level, the educational institution or the discipline.

Peer mentors in secondary schools aid in the transition of younger students from primary school to secondary school. They may assist mentees with their school work and study skills, peer pressure (such as pressure to use drugs or have sex), issues with attendance and behaviour, and typical family problems. Youth mentors are persons for children or adolescents to spend time with, often to compensate for absent family members or an inadequate home environment. Mentoring programmes for youth can be especially useful for students who are suffering from a lack of social support, and who therefore may be susceptible to delinquency.

Peer mentors for undergraduates may assist newly admitted students with time management, study skills, organisational skills, curriculum planning, administrative issues, test preparation, term paper preparation, goal setting, and grade monitoring. Additionally, such mentors may provide other forms of social support for the student, such as friendship, networking, and aiding the student’s adjustment to college life.

A peer mentor at the graduate school level may assist new students in selecting an advisor, negotiating the advisor/advisee relationship, preparation for major examinations, publishing articles, searching for jobs, and adjusting to the rigors of graduate school life.

In Higher Education

Peer mentoring in higher education has enjoyed a good name and is seen favourably by both educational administrators and students. During the last decade, peer mentoring has expanded and is found in most colleges and universities, frequently as a means to outreach, retain, and recruit minority students. Peer mentoring is used extensively in higher education for several reasons:

  • Benefits attributed to classical mentoring (when an older adult mentors a younger person) can translate to peer mentoring relationships, mainly when the peer mentor and the mentee have similar backgrounds.
    • Some colleges and university campuses have encouraged peer mentorship programs to aid retention of under-represented populations, such as women in economics.
  • The lack of role models or volunteers forces administrators and student leaders to use students as peer mentors of other students – usually first year students, ethnic minorities, and women – in order to guide, support, and instruct junior students;
  • Because peer mentoring programmes require a low budget for administration and/or development, they become a cheap alternative to support students perceived as likely to fail.

Advantages in Education

Peer mentoring may help new students adapt to a new academic environment faster. The relationship between the mentor and mentee gives the mentee a sense of being connected to the larger community where they may otherwise feel lost. Mentors are chosen because they are academically successful and because they possess good communication, social and leadership skills. As a consequence, mentors serve as positive role models for the students, guiding them towards academic and social success. Mentors provide support, advice, encouragement, and even friendship to students. Peer mentoring may improve student retention rates.

Mentors also stand to benefit from the mentor/mentee relationship. Mentors develop friendships through their participation in mentoring programmes and usually derive satisfaction from helping a younger student, and possibly shaping his or her life in a positive way. Mentors may also be paid, and they may receive other benefits such as prioritised registration, course credit, and references.

In higher education tutorial settings, the benefits of peer mentoring programmes also extend to class tutors. Using grounded theory techniques, Outhred and Chester found that five themes underlie their experiences:

  1. Role exploration;
  2. Sharing responsibility;
  3. Regulation of the peer-tutored groups;
  4. Harnessing the peer tutors’ role; and
  5. Community.

Criticisms

Peer mentoring programmes usually target ethnic minorities, people with disabilities and women. This approach tends to be conceived out of the “deficiency model” where multi-ethnic students, women and students with disabilities are perceived as being in need of help and unlikely to succeed unless senior students or successful adults help them. One of the main criticisms of peer mentoring is the lack of research to show how peer mentoring relationships work, how they develop, and what their outcomes are. Also, the nature of being either a mentor or mentee and at the same time a peer can make the relationship a dual one where other identities also converge. Some peer mentoring programmes promote assimilation among ethnic minority students because of the use of student role models who are perceived as successful in social and educational environments characterised by majority students. These role models then become the people that peer mentees strive to imitate or emulate. A more subtle criticism of peer mentoring refers to their lack of supervision and structure: most peer mentoring programmes led by undergraduate students rarely have direct supervision of full-time university staff.

Given the fact that students are led by other students who serve as peer mentors, critics say that university staff may free themselves from their responsibility to listen and help first year students classified as peer mentees, the group with the largest attrition rate in higher education. Without extensive training and supervision, senior students who serve as mentors may offer unreliable guidance to peer mentees. There is little research on what happens within peer mentoring relationships. Maryann Jacobi, in an extensive meta-analysis of mentoring research, concludes by asking, “Does mentoring help students succeed in college? If so, how? Both theoretical and empirical answers to these questions are lacking.” Stephanie Budge states:

“The concept of mentoring has become increasingly popular over the past few decades. Mentoring has been advertised as necessary in order for students and employees to flourish in their environment. However, the lack of research concerning peer mentoring programmes in particular is surprising. While there is an abundance of articles on the topic of mentoring in the educational setting, authors must be held to more stringent research standards and more definitional consistency. In addition to higher quality research, the fundamental flaws within peer mentoring programs need to be corrected before these programs can reach their full potential on college campuses.”

Peer mentoring in higher education usually focuses on social, academic, and cultural skills that can help students graduate from colleges and universities, and how the educational system works (e.g. how to apply for financial aid, how to register for classes, how to write papers, how to choose a major, etc.). The knowledge students receive usually comes from senior students who serve as peer mentors.

Although peer mentoring programmes are appealing to most people and seem easy to implement and develop, there is little research to suggest that peer mentoring gives the same results as classical mentoring.

Versus Classical Mentoring

Morton-Cooper and Palmer distinguish between classical mentoring (also known as primary mentoring) and contract or facilitated mentoring. Classical mentoring is characterized as an informal, often spontaneous enabling relationship between an older mentor and a younger mentee, based on a shared wish to work together, usually for a long period, without financial compensation for the mentor.

Peer mentoring differs from classical mentoring in two aspects. First, in peer mentoring mentors and mentees are close in age, experience, educational level, and they may also overlap in their personal identities, which are usually the criteria for matching, but this may leave junior students vulnerable to peer pressure and unsupervised rivalry. Second, peer mentoring programmes are semi-structured planned programmes with specific guidelines and frequently with a set number of meetings and activities within a predetermined amount of time. Students who enrol in peer mentoring programmes tend to be matched mostly according to major course of study, gender, language of preference, and ethnic background, and those students who share the largest number of similarities tend to become peers in the peer mentoring relationship. Little research is available to know what happens between peer mentors and peer mentees who have different characteristics.

Cross-Age

The Handbook of Youth Mentoring provides the following definition of cross-age peer mentoring:

“Peer mentoring involves an interpersonal relationship between two youths of different ages that reflects a greater degree of hierarchical power imbalance than is typical of a friendship and in which the goal is for the older youth to promote one or more aspects of the younger youth’s development. Peer mentoring refers to a sustained (long-term), usually formalized (i.e. program-based), developmental relationship. The relationship is “developmental” in that the older peer’s goal is to help guide the younger mentee’s development in domains such as interpersonal skills, self-esteem and conventional connectedness and attitudes (e.g. future motivation, hopefulness).”

Cross-age mentoring can be distinguished from peer mentoring by the fact that the mentor is in a higher grade level and/or is older than the mentee. Whereas in peer mentoring students of the same age are paired together based on varying levels of achievement. Karcher (2007) also notes:

“Cross-age peer mentoring programs utilize structure, meet for more than ten meetings, do not focus primarily on deficit or problem reduction, and require an age span of at least two years.”

Advantages of Cross Age Mentoring

In general, cross-age mentoring programmes can involve a tutoring or teaching component, personal mentorship and guidance, or both, and they incorporate many of the advantages of other forms of peer mentorship. Because student mentors are closer in age, knowledge, authority and cognitive development than adult mentors, mentees often feel freer to express ideas, ask questions, and take risks. These similarities also make it easier for mentors to understand personal and academic problems that the mentee may be experiencing, and present solutions in a more understandable and relevant way. Furthermore, unlike same-age peer mentoring, cross-age programmes can prevent feelings of inferiority on the part of the mentee when they are mentored or tutored by a student of the same age or status. Thus, mentors who are slightly older than their mentees can take advantage of the higher status provided by their age difference while enjoying increased compatibility with their students. The specific benefits of cross-age mentoring/tutoring are numerous, and are briefly described here in three main categories:

  • Increased academic achievement;
  • Improved interpersonal skills; and
  • Personal development.

Cross-age mentorship, and tutoring programmes in particular, support the academic achievement and learning process of both the mentor and the mentee. Mentees benefit from increased personalised attention in a one-on-one setting and can work at their own pace. Sessions are customised for the mentee’s individual questions, needs, and learning styles, and mentees gain a greater mastery of the material and concepts, while developing creativity and critical thinking skills. The mentor may also gain a deeper understanding of the material or subject that they are teaching, as this relationship often encourages a deeper dedication to their own studies so that they may more effectively communicate what they have learned. The mentor gains a deeper sense of responsibility, dedication, and pride in being able to help a peer, while both students take pride in mutual accomplishments and successes. Ultimately, cross-age mentorship programmes may increase retention and graduation rates, especially among minority students.

In addition to improved learning and transmission of information, the mentorship process allows both students to develop more effective interpersonal communication skills. Mentees learn how to effectively form and pose questions, seek advice, and practice active listening and concentration. Similarly, the mentors gain valuable practice in effective teaching strategies. This format fosters increased self-esteem, empathy and patience in both participants, potentially creating new friendships and breaking down social barriers for students struggling to adjust to a new academic setting. Often the mentor will serve as an important role-model, and can model academic skills and work habits as well as personal values (e.g. dedication to service, empathy, and internal motivation). This relationship can be pivotal for the success of new or underserved students in academia by providing an opportunity for peers to discuss academic issues, career choices, research ideas, and personal matters.

Monitoring and Evaluation

Cross-age mentoring programmes require careful consideration of the goals, objectives and the available human, physical and financial resources in order to ultimately assess the progress made by the participants and the overall usefulness of the programme. Frequent assessment is important as it gives valuable insight into how well the cross-age mentoring curriculum is organised and implemented, and provides positive reinforcement for both the mentor and mentee. Mentors should be pre-screened according to their academic proficiency and attitudes to ensure that they will be able to meet the needs of a mentee. Moreover, mentors will also benefit from ongoing training, supervision and psychological support by teachers, administrators, parents and other members of the community.

In the Workplace

Peer mentoring can offer employees a valuable source of support and information in the workplace. Peer mentoring offers a low cost way to train new employees or to upgrade the skills of less experienced workers. Mentees may feel more comfortable learning from a peer than in a hierarchical setting. Mentors as well as mentees may also benefit from the bonds they form with colleagues. In 1978 Edgar Schein described multiple roles for successful mentors in the work setting. New employees who are paired with a mentor are twice as likely to remain in their job than those who do not receive mentorship.

In Health Care

Peer mentoring has been shown to increase resistance to stress-related anxiety and depression in patients, or clients, affected by chronic illness or mental health issues. Mental health peer mentors and peer support groups help clients change their lifestyle and adhere to a more productive healthy lifestyle by adjusting habits and helping them realise helpful ways of coping and taking on personal responsibility. Peer mentors can also help patients prepare for medical and surgical procedures and adhere to treatment regimes. Peer mentoring has been implemented in programmes to support survivors of traumatic brain injury, cancer patients, dialysis patients, diabetics persons with spinal cord injuries, and to reduce HIV transmission and increase adherence to treatment in HIV-positive IV drug users. Peer mentoring is also used in training health care workers.

Other Applications

Peer mentoring has also been used to prevent gang violence in schoolchildren and teens, to support young people who have been sexually exploited, to improve the quality of child care among economically disadvantaged first-time mothers, and to improve performance in military recruits.

What is a Peer Support Specialist?

Introduction

A peer support specialist is a person with “lived experience” who has been trained to support those who struggle with mental health, psychological trauma, or substance use. Their personal experience of these challenges provide peer support specialists with expertise that professional training cannot replicate.

Some roles filled by peer support specialists include assisting their peers in articulating their goals for recovery, learning and practicing new skills, helping them monitor their progress, supporting them in their treatment, modelling effective coping techniques and self-help strategies based on the specialist’s own recovery experience, supporting them in advocating for themselves to obtain effective services, and developing and implementing recovery plans.

In 2007, the US Department of Health and Human Services recognised peer support services as an evidence-based practice. It also informed all 50 state Medicaid directors that The Centres for Medicare and Medicaid Services would pay for peer support services, provided that peer support specialists – like other types of healthcare providers – were governed by a statewide training and credentialing programme. As of 2016, 42 US states, the District of Columbia, and the Veterans’ Administration have adopted such programmes to train and certify individuals to work as peer support specialists.

Refer to Peer Support and Support Groups.

Recovery Planning

Recovery plans can take many forms. A key component of the recovery management model is a personal recovery plan which is drawn up by the individual looking for support, and reviewed with an RSS. This plan is instrumental for individuals in the process of their recovery.

Central to such plans are the overall health and well-being of each individual, not just their mental health. Components often include support groups and individual therapy, basic health care maintenance, stable housing, improvements in family life and personal relationships, and community connections. The plan may also include education goals, vocational development and employment. Some plans outline a timetable for monitoring, and/or a plan for re-engagement when needed to balance the health and overall quality of life of each individual.

Peer recovery support specialists can be found in an increasing variety of settings, including community-based recovery centres. Funding for peer recovery programmes comes from a combination of federal and state agencies as well as local and national charities and grant programmes, such as Catholic Charities and the United Way.

Training and Certification

When peer support specialists work in publicly funded services, they are required to meet government and state certification requirements. Since the adaptation of the Recovery Management Model by state and federal agencies, peer support specialist courses have been offered by numerous state, non-profit and for-profit entities such as Connecticut Community for Addiction Recovery, PRO-ACT (Pennsylvania Recovery Organisation-Achieving Community Together), The McShin Foundation, Tennessee Certified Peer Recovery Specialist Training and Programme, Appalachian Consulting Group, and the State of New York’s Office of Addiction Services. PARfessionals has developed the first internationally approved online training programme for peer support specialists in the fields of mental health and addiction recovery. In addition, numerous for-profit firms offer peer support specialist training. Training includes courses on the ethics of a recovery coach, recovery coaching core competencies, clinical theories as stages of change, motivational interviewing, and co-occurring disorders.

Core Competencies

Adapted for the recovery support specialist by William L. White:

  • Outreach worker:
    • Identifies and engages hard-to-reach individuals.
    • Offers living proof of the transformative power of recovery and makes recovery attractive.
  • Motivator:
    • Exhibits faith in client’s capacity for change, encourages and celebrates their recovery achievements, and mobilises internal and external recovery.
  • Resources:
    • Encourages the client’s self-advocacy and economic self-sufficiency.
  • Ally and confidant:
    • Genuinely cares and listens to the client, can be trusted with confidences, and can identify areas of potential growth.
  • Truth-teller:
    • Provides feedback on the recovery progress.
    • Identifies areas which have presented or may present roadblocks to continued abstinence.
  • Role model and mentor:
    • Offers their life as living proof of the transformative power of recovery and provides stage-appropriate recovery education.
  • Planner:
    • Facilitates the transition from a professionally directed treatment plan to a client-developed and directed personal recovery plan.
    • Assists in structuring daily activities around this plan.
  • Problem solver:
    • Helps resolve personal and environmental obstacles to recovery.
  • Resource broker:
    • Is knowledgeable of information, for individuals or for their families, about sources of sober housing, recovery conducive employment, health and social services, and recovery support.
    • Matches the individuals with particular support groups or twelve-step meetings.
  • Monitor or companion:
    • When the client will be best served with regular, around the clock attendance, or attendance for a set number of hours per day, the client may need a sober companion.
    • This companion can be available for travel in and out of the country.
    • The sober companion processes each client’s response to professional services and mutual aid exposures to enhance engagement, reduce attrition, and resolve problems in the relationship.
    • The companion provides early re-intervention and recovery re-initiation services.
  • Tour guide:
    • Introduces newcomers into the culture of recovery; provides an orientation to recovery roles, rules, rituals, language, etiquette; and opens doors for opportunities for community participation.
  • Advocate:
    • Provides an invaluable service for those resistant to remaining abstinent from drugs and/or alcohol, but who must do so due to legal, medical, family or contractual obligations.
    • Helps the individual’s families navigate complex social, service and legal systems.
  • Educator:
    • Provides a client with normative information about the stages of recovery.
    • They can facilitate the process necessary to remain free from the addiction, inform client of the professional helpers within the community and about the prevalence, pathways, and lifestyles of long-term recovery.
  • Community organiser:
    • Every member of the community support centre helps develop and expand recovery support resources, enhances cooperative relationships between professional service organisations and local recovery support groups, cultivates opportunities for people in recovery to participate in volunteerism, and performs other acts of service to the community.
  • Lifestyle consultant/coach:
    • Supports the client through challenges arising from everyday activities.
    • For some, this is done through several one-on-one sessions each week, while some clients prefer daily telephone contact.
    • Assists individuals and their families to develop sobriety-based rituals of daily living; and encourages activities across religious, spiritual, and secular frameworks that enhance life’s meaning and purpose.
  • Friend:
    • Provides sober companionship; a social bridge from the culture of addiction and mental illness to the culture of recovery.

What is Peer Support?

Introduction

Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters (although it can be provided by peers without training), and can take a number of forms such as peer mentoring, reflective listening (reflecting content and/or feelings), or counselling. Peer support is also used to refer to initiatives where colleagues, members of self-help organisations and others meet, in person or online, as equals to give each other connection and support on a reciprocal basis.

Peer support is distinct from other forms of social support in that the source of support is a peer, a person who is similar in fundamental ways to the recipient of the support; their relationship is one of equality. A peer is in a position to offer support by virtue of relevant experience: they have “been there, done that” and can relate to others who are now in a similar situation. Trained peer support workers such as peer support specialists and peer counsellors receive special training and are required to obtain Continuing Education Units, like clinical staff. Some other trained peer support workers may also be law-enforcement personnel and firefighters as well as emergency medical responders.

Refer to Support Group and Peer Support Specialist.

Underlying Theory

The effectiveness of peer support is believed to derive from a variety of psychosocial processes described best by Dr. Karen Fortuna in 2019 as “social support, experiential knowledge, social learning theory, social comparison theory, the helper-therapy principle, and self-determination theory.”

  • Social support is the existence of positive psychosocial interactions with others with whom there is mutual trust and concern. Positive relationships contribute to positive adjustment and buffer against stressors and adversities by offering:
    1. Emotional support (esteem, attachment, and reassurance);
    2. Instrumental support (material goods and services);
    3. Companionship; and
    4. Information support (advice, guidance, and feedback).
  • Experiential knowledge is specialised information and perspectives that people obtain from living through a particular experience such as substance abuse, a physical disability, chronic physical or mental illness, or a traumatic event such as combat, a natural disaster, domestic violence or a violent crime, sexual abuse, or imprisonment.
    • Experiential knowledge tends to be unique and pragmatic and when shared contributes to solving problems and improving quality of life.
  • Social learning theory postulates that peers, because they have undergone and survived relevant experiences, are more credible role models for others.
    • Interactions with peers who are successfully coping with their experiences or illness are more likely to result in positive behaviour change.
  • Social comparison means that individuals are more comfortable interacting with others who share common characteristics with themselves, such as a psychiatric illness, in order to establish a sense of normalcy.
    • By interacting with others who are perceived to be better than them, peers are given a sense of optimism and something to strive toward.
  • The helper-therapy principle proposes that there are four significant benefits to those who provide peer support:
    1. Increased sense of interpersonal competence as a result of making an impact on another person’s life;
    2. Development of a sense of equality in giving and taking between himself or herself and others;
    3. Helper gains new personally-relevant knowledge while helping; and
    4. The helper receives social approval from the person they help, and others.
  • Self-determination means that individuals have the right to determine their own future – people are more likely to act on their own decisions rather than decisions made by others for them.

In Schools and Education

Peer Mentoring

Refer to Peer Mentoring.

Peer mentoring takes place in learning environments such as schools, usually between an older more experienced student and a new student. Peer mentors appear mainly in secondary schools where students moving up from primary schools may need assistance in settling into the whole new schedule and lifestyle of secondary school life. Peer mentoring is also used in the workplace as a means of orienting new employees. New employees who are paired with a peer mentor are twice as likely to remain in their job than those who do not receive mentorship.

Peer Listening

This form of peer support is widely used within schools. Peer supporters are trained, normally from within schools or universities, or sometimes by outside organisations, such as Childline’s CHIPS (Childline In Partnership With Schools) programme, to be “active listeners”. Within schools, peer supporters are normally available at break or lunch times.

Peer Mediation

Peer mediation is a means of handling incidents of bullying by bringing the victim and the bully together under mediation by one of their peers.

Peer Helper in Sports

A peer helper in sports works with young adults in sports such as football, soccer, track, volleyball, baseball, cheerleading, swimming, and basketball. They may provide help with game tactics (e.g. keeping your eye on the ball), emotional support, training support, and social support.

In Health

In Mental Health

Refer to Peer Support Specialist.

Peer support can occur within, outside or around traditional mental health services and programmes, between two people or in groups. Peer support is increasingly being offered through digital health like text messaging and smartphone apps. Peer support is a key concept in the recovery approach and in consumer-operated services programmes. Consumers/clients of mental health programmes have also formed non-profit self-help organisations, and serve to support each other and to challenge associated stigma and discrimination. The role of peer workers in mental health services was the subject of a conference in London in April 2012, jointly organised by the Centre for Mental Health and the NHS Confederation. Research has shown that peer-run self-help groups yield improvement in psychiatric symptoms resulting in decreased hospitalisation, larger social support networks and enhanced self-esteem and social functioning. There is considerable variety in the ways that peer support is defined and conceptualised as it relates to mental health services. In some cases, clinicians, psychiatrists, and other staff who do not necessarily have their own experiences of receiving psychiatric treatment are being trained, often by psychiatric survivors, in peer support as an approach to building relationships that are genuine, mutual, and non-coercive.

For Anxiety and Depression

In Canada, the LEAF (Living Effectively with Anxiety and Fear) Programme is a peer-led support group for cognitive-behavioural therapy of persons with mild to moderate panic disorders.

In a 2011 meta-analysis of seven randomised trials that compared a peer support intervention to group cognitive-behavioural therapy in patients suffering from depression, peer support interventions were found to improve depression symptoms more than usual care alone and results may be comparable to those of group cognitive behavioural therapy. These findings suggest that peer support interventions have the potential to be effective components of depression care, and they support the inclusion of peer support in recovery-oriented mental health treatment.

Several studies have shown that peer support reduces fear during stressful situations such as combat and domestic violence and may mitigate posttraumatic stress disorder. The 1982 Vietnam-Era Veterans Adjustment Survey showed that PTSD was highest in those men and women who lacked positive social support from family, friends, and society in general.

For First Responders

Peer support programmes have also been implemented to address stress and psychological trauma among law-enforcement personnel and firefighters as well as emergency medical responders. Peer support is an important component of the critical incident stress management programme used to alleviate stress and trauma among disaster first responders.

For Survivors of Trauma

Peer support has been used to help survivors of trauma, such as refugees, cope with stress and deal with difficult living conditions. Peer support is integral to the services provided by the National Centre for Trauma-Informed Care. Other programmes have been designed for female victims of domestic violence and for women in prison.

Survivor Corps defines peer support for trauma survivors as “Encouragement and assistance provided by a colleague who has overcome similar difficulties to engender self-confidence and autonomy and to enable the survivor to make his or her own decisions and implement them.” Peer support is a fundamental strategy in the rehabilitation of landmine survivors in Afghanistan, Bosnia, El Salvador and Vietnam. A study of 470 amputee survivors of war-related violence in six countries showed that nearly one hundred percent said they had benefited from peer support.

A peer support program operated by the Centre d’Encadrement et de Développement des Anciens Combattants in Burundi with support from the Centre for International Stabilization and Recovery and Action on Armed Violence has assisted survivors of war-related violence, including women with disabilities, and female ex-combatants since 2010. A similar programme in Rwanda works with survivors of the Rwandan genocide. Peer support has been recommended as a fundamental part of victim assistance programmes for survivors of war-related violence.

A 1984 study on the impact of peer support and support groups for victims of domestic violence showed that 146 battered women found women’s peer support groups the most helpful source of a range of available treatments. The women in these groups appeared to give direct advice and to act as role models. A 1986 study on 70 adolescent mothers considered to be at risk for domestic violence showed that peer support improved cognitive problem-solving skills, self-reinforcement, and parenting competence.

Pandora’s Aquarium, an online support group operating as part of Pandora’s Project, offers peer support to survivors of rape and sexual abuse and their friends and family.

In Addiction

Twelve-step programmes for overcoming substance misuse and other addiction recovery groups are often based on peer support. Since the 1930s Alcoholics Anonymous has promoted peer support between new members and their sponsors: “The process of sponsorship is this: an alcoholic who has made some progress in the recovery programme shares that experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety through AA.” Other addiction recovery programmes rely on peer support without following the twelve-step model.

In Chronic Illness

Peer support has been beneficial for many people living with diabetes. Diabetes encompasses all aspects of people’s lives, often for decades. Support from peers can offer emotional, social, and practical assistance that helps people do the things they need to do to stay healthy. Peer support groups for diabetics complement and enhance other health care services. J.F. Caro is the co-founder and Chief Scientific Officer of one of such groups named Peer for Progress.

Peer support has also been provided for people with cancer and HIV. The Breast Cancer Network of Strength trains peer counsellors to work with breast cancer survivors.

For People with Disabilities

Peer support is considered to be a key component of the independent living movement and has been widely used by organisations that work with people with disabilities, including the Amputee Coalition of America (ACA) and Survivor Corps. Since 1998 the ACA has operated a National Peer Network for survivors of limb loss. The Blinded Veterans Association has recently launched Operation Peer Support (OPS), a programme designed to support men and women returning to the US blinded or experiencing significant visual impairment in connection with their military service. Peer support has also benefited survivors of traumatic brain injury and their families. There is also FacingDisability for Families Facing Spinal Cord Injuries, which has a peer counselling programme in addition to 1,000 videos drawn from interviews of people with spinal cord injuries, their families, caregivers and experts.

For Veterans and Their Families

Several programmes exist that provide peer support for military veterans in the US and Canada. In 2010 the Military Women to Women Peer Support Group was established in Helena, Montana.

The Tragedy Assistance Programme for Survivors (TAPS) provides peer support, crisis care, casualty casework assistance, and grief and trauma resources for families of members of the US military. Operation Peer Support (OPS) is a programme for US military veterans who were blinded or have significant visual impairment.

In January 2013 Senator Patty Murray, Chairman of the United States Senate Committee on Veterans’ Affairs, sponsored an amendment of the National Defence Authorisation Act (S.3254) that would require peer counselling as part of a comprehensive suicide prevention programme for US veterans.

For Veterans with PTSD

Peer support outreach for those exposed to traumatic events refers to programmes that seek to identify and reach out to those suffering from or at risk for mental health problems following a traumatic event as a means of connecting those people to mental health services. Paraprofessional peers are defined as having a shared background as the target population and work closely with and supplement the services of the mental healthcare team. These peers are trained in certain interventions (such as Psychological/Mental Health First Aid) and are closely supervised by professional mental healthcare personnel. Peer support for recovery from PTSD refers to programmes in which someone with lived experience of PTSD, who experienced a significant reduction in symptoms, provides formal services to those who have not yet made significant steps in recovery from his or her condition. The peer support for recovery model focuses on improvement in overall health and wellness, and has long been successful in the treatment of SMI (serious mental illness) but is relatively new for PTSD.

A further review of existing literature found that carefully recruited, trained, supervised, and supported paraprofessionals can deliver mental health interventions effectively, and may be valuable in communities with fewer resources for mental healthcare.

Researchers at the Palo Alto VA National Center for PTSD also conducted focus groups at the VA Palo Alto Health Care System Trauma Recovery Programmes, a PTSD Residential Rehabilitation Programme, and a Women’s Trauma Recovery Programme to determine veteran and staff perceptions of informal peer support interventions already in place. Four themes were identified, including:

  • Peer support contributing to a feeling of social connectedness;
  • Positive role modelling by the peer support provider;
  • Peer support augmenting care offered by professional providers; and
  • Peer supporter acting as a ‘culture broker’ and orienting recipients to mental health treatment.

These findings have been put into practice through a peer support programme for veterans in the Sonora, Stockton, and Modesto VA outpatient clinics. The clinics are part of the Palo Alto Veterans Affairs Healthcare System that extend to more rural parts of northern California. The program is funded through grants in support of new treatment approaches to serve veterans in rural, traditionally underserved areas. Leadership for the program comes from the Menlo Park division of the Palo Alto VA system.

The peer support programme has been operational since 2012 with over 268 unique veterans seen between 2012 and 2015. The two peer support providers involved in the programme are veterans of the Vietnam and Iraq wars, respectively, and after having recovered from their own mental health disorders utilize their experiences to help their fellow veterans. The two providers have been responsible for leading between 5 and 7 groups each week as well as conducting telephone outreach and one-on-one engagement visits. These services have successfully helped to augment the often overburdened mental health treatment teams at the central valley outpatient VA clinics.

The peer support programme has been described in several publications. A personal story of success was featured in Stanford Medicine magazine and the collaborative nature of the programme was described in the recently published book, Partnerships for Mental Health.

For People at Work

Trauma risk management (TRiM) is a work-place based peer support for use in helping to protect the mental health of employees who have been exposed to traumatic stress. The TRiM process enables non-healthcare staff to monitor and manage colleagues. TRiM peer support training provides TRiM Practitioners with a background understanding of psychological trauma and its effects. TRiM was developed in the UK by military mental health professionals including Professor Neil Greenberg. There have been numerous scientific publications into the use of TRiM which have demonstrated it to be an acceptable and effective method of peer support. Similar to TRiM, the sustaining resilience at work (StRaW) peer support system is delivered by trained peers who are able to assist colleagues exposed to significant non-traumatic stressors, originating either at work or at home, and either support and mentor them or help them access professional support. StRaW was developed by March on Stress Ltd and early research again shows it to be a credible and effective way of supporting staff at work.

Sex Workers

Several peer based organisations exist for sex workers. The aim of these organisations is to support the health, rights and well being of sex workers and advocate on their behalf for law reform in order to make working safer. Sex work is work and there are many people who willingly choose it as a job/career. While sex trafficking does exist, not everyone who does sex work is doing so under duress. Social stigma is a major hurdle sex workers encounter, with many people trying to ‘save’ them. Peer support workers and peer educators are seen as best practice by the Sex Industry Network (SIN) when engaging with community members because peers can understand that someone could willingly choose to do sex work.