Peer support critical elements and experiences in supporting the homeless: A qualitative study

Abstract

Peer supporters are individuals with lived experience and are an integral part of health care systems, providing support to those affected by various phenomena such as homelessness and addictions. However, little is known about the critical elements that underpin peer support interventions. This qualitative study sought to understand the critical elements of intentional peer support with a homeless population, voiced by those who provide and/or receive this support. Twenty‐nine participants from 4 different homeless charities in England were interviewed about their experiences of providing/receiving peer support and what they felt were critical factors to its success. Participants defined peer support as an experience‐based relationship, built upon mutual understanding, empathy, and support. Thematic analysis was utilised to in developing 6 themes. Results identified peers' persistence in developing unique experience‐based relationships, providing social support, role modelling recovery, and peers' motivations were perceived as important factors involved in peer support. It was also found that peers described benefitting from helping, such as, undergoing transformative identity developments that helped them to escape homelessness. Through the retelling of their stories, they create meaning and restructure their autobiography, attributing experiences of homelessness as a catalyst for positive changes in their lives. Limitations and future research are discussed.

Provision of peer support at the intersection of homelessness and problem substance use services: a systematic ‘state of the art’ review

“…The systematic review examined the effectiveness of intentional peer support (IPS) as an intervention with people who were homeless (including people who were street-dwelling and those within services [26]), termed 'intentional' because it is fostered and developed by professional organisations and can include either mentorship support or mutual support. There were two other papers looking specifically at IPS -a qualitative study looking into the experiences of peer providers and recipients and their opinion of what makes IPS effective in homelessness recovery [34]; and a mixed methods Qsort study investigating the opinions of experts on what makes peer support effective with people who are homeless [35]. The remaining studies included: a quantitative pilot intervention of peer-led support for homeless youth [79]; a feasibility study of involving vendors of The Big Issue (a magazine sold by individuals who are homeless or at risk of homelessness that provides them with opportunities to earn an income) to become peer educators for people who are homeless to reduce drug related harms [55]; a study protocol for peer-led intervention for people who are experiencing homelessness and problem substance use [81]; a report from an independent evaluation of the Homeless Health Peer Advocacy Service programme on the impact on client's health, cost, and impact on the peers themselves [27]; a commentary on the need for more safe/supervised consumption sites and other overdose prevention interventions across a range of housing sites to minimise overdose risk [83]; a longitudinal evaluation of a Housing First peer support model [36]; an evaluation of the effects of peer delivered permanent supportive housing on health and mental health of an ethnically diverse population [51]; an evaluation of a group intensive peer support model of case management in a supported housing programme for homeless veterans [67], and four studies relating to smoking cessation peer interventions in poly-substance using individuals experiencing homelessness ( [47,48,54,80]).…”

“…Eleven of the included papers looked at the challenges that those in peer support roles can face ( [34,43,47,55,57,59,65,70,[88][89][90]). Five key themes emerged: vulnerability; authenticity; boundaries; stigma; and a lack of recognition of value of peers and these are now discussed.…”

“…Often vulnerability related to a peer worker's own recovery and there was an implication that working with people who have experienced problem substance use could lead to relapse ( [34,90]). In Barker's et al study [34] peer supporters discussed the need to know themselves, control their emotions and identify triggers to maintain their recovery. They expressed the need to be secure in their own recovery to be able to cope with any situation that occurs: 'Knowing your limitations for yourself … it's just knowing what you can do and what you can't do.…”

“…They expressed the need to be secure in their own recovery to be able to cope with any situation that occurs: 'Knowing your limitations for yourself … it's just knowing what you can do and what you can't do. Yeah, it's just them being aware of their own triggers … it's a hard one because you … you never … you don't know who you're going to meet' ( [34] p. 222). Moreover Barker et al [34] identified the recovery of peers as a potential obstacle, for example, relating to the minimal length of time in recovery from drugs and/or alcohol which may be imposed by a prospective employer and which may be a barrier to those assuming a peer role.…”

Understanding how engagement in a self‐managed shelter contributes to empowerment

“…Participants who are less engaged with activities and program management, experience fewer benefits (Brown, 2012; Segal & Hayes, 2016). Peer support, in general, is associated with empowerment (Barker, Maguire, Bishop, & Stopa, 2018).…”