Peer support within mental health services has a growing evidence base and aligns with current policies of recovery-oriented care. Despite these advantages, widespread implementation of peer support remains limited, likely due to various methodological and implementation issues. Researchers have noted the importance of utilizing an implementation framework to understand best practices for implementation. Therefore, the purpose of the current study was to synthesize the existing literature on the implementation of peer support interventions and identify barriers and facilitators using an implementation framework. The Consolidated Framework for Implementation Research (CFIR) was used to organize the literature obtained in the systematic search and synthesize best practices for implementation. The systematic search identified 19 published articles that were coded for relevant information including implementation barriers and facilitators. The review highlighted a number of important elements for implementation within the CFIR domains, including clear role definition, a flexible organizational culture, and education for peer and nonpeer staff. Implementation barriers included an organizational culture without a recovery focus, allied practitioners' beliefs about peer support, and an unclear peer role. The results of this review provide a summary of best practices for the implementation of peer support in mental health services that can be used by researchers and service providers in future implementation. These practices should continue to be tested and reworked as the climate of recovery-oriented services within mental health organizations evolves. Impact StatementPeer support interventions have a growing evidence base within mental health services; however, a number of barriers have prevented widespread implementation. The current study systematically searched and synthesized the literature on the implementation of peer support interventions within mental health services. The results provide important information on the best practices of implementation that can be used by service providers in order to increase the uptake of peer support interventions.

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Indigenous youth are disproportionately represented among youth experiencing homelessness in Canada and are at an increased risk for mental health and substance use problems compared to non-Indigenous youth experiencing homelessness. Research is needed that considers how best to support Indigenous youth in acquiring and maintaining stable housing. Indigenous youth peer mentorship is one possible mechanism that warrants consideration, as Indigenous youth who have previously been homeless can share experience with the barriers that other youth encounter as well as skills that may be well-suited to facilitate hope and understanding to other homeless youth. In the present study, we examined the process by which Indigenous peer mentors engage in a peer-driven project designed to support other Indigenous youth experiencing homelessness in Northwestern Ontario. This process was documented through qualitative interviews with three peer mentors and three staff, as well as ethnographic fieldnotes. Thematic analyses revealed that peer mentorship positions appear to be useful for the Indigenous youth who engage in them, as these positions provide them with a paid avenue to engage in advocacy and support others with similar experiences as them, while simultaneously increasing their cultural connectedness, confidence, self-esteem, self-awareness, and ability to advocate for their own needs. The present study also yielded important considerations for organizations implementing Indigenous youth peer mentorship positions, including offering training and providing opportunities for cultural engagement, avoiding tokenism, being cognizant of possible dual-relationships, and supporting peer mentors who may be grappling with personal difficulties outside of their roles.

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