Utilization Peers in Services for Youth with Emotional and Behavioral Challenges

Background and Purpose: Youth peer support services (YPSS) involve young adults with current or prior emotional/behavioral challenges and service receipt history, who provide direct support to other youth currently struggling with emotional/behavioral difficulties.  Youth peers are an emerging workforce across many states and localities in the U.S., and are frequently integrated within child-serving service systems (e.g., mental health, substance abuse, child welfare, juvenile justice, special education). This scoping review synthesizes and consolidates published and unpublished information on YPSS to uncover gaps in knowledge, identify variations in service delivery characteristics (e.g., roles, core competencies, training/supervision needs) and associated outcomes, as well as make recommendations for future practice and research.

Methods: Published literature were searched with pre-specified search terms in PsycInfo (EBSCO), Medline (Ovid), SocIndex (Ebsco), Social Work Abstracts, (Ebsco), ERIC (Ebsco), CINAHL (Ebsco), the Cochrane Library, and Social Sciences Citation Index. To collect unpublished or “grey” literature, 30 organizations or individuals engaged in YPSS and presenters from relevant recent research conference were contacted by email and telephone. As results of thorough screening process including two-stage title/abstract and full-text review, 23 documents (out of 2071) were included for data extraction and qualitative syntheses. Analysis of study findings utilized a descriptive analytic framework.

Results: Generally speaking, YPSS were integrated as a component of a larger service delivery model.  Three categories of YPSS emerged from this review: (1) peer-mediated treatments which integrated youth peers as a part of an larger individual-level intervention, (2) peer-delivered services which focused on direct provision of support services by youth peers, and (3) peer delivered services with an emphasis on youth self-determination.  YPSS roles included providing supports for youth emotional needs, action planning/priority setting, advocacy, information/education, skill development and mentorship, as well as promoting youth engagement, bridging youth and adult cultures, and facilitating youth groups.  Predominant core competencies included shared or lived experience of emotional/behavioral difficulties, being further along in recovery than youth served, collaborative and youth-focused orientation, as well as specific skills relevant to formal employment requirements (e.g., written and oral communication skills, advocacy).  Identified training and supervision needs focused not only on youth peers (e.g., active listening, job readiness) but also on existing organization staff regarding how to integrate YPSS into their programs.   Finally, outcomes identified benefits to youth served regarding overall program satisfaction, quality of interpersonal relationships, social and emotional functioning, and perceived empowerment. Youth peers, themselves, also felt more empowered, included, and respected by providing YPSS.

Conclusions and Implications: Findings support that YPSS show promise in benefitting both youth and youth peers. However, documents varied greatly in terms of methodological rigor, with few studies employing rigorous experimental designs. Consequently, recommendations include more studies with greater methodological controls and which are able to tease apart the unique contribution of YPSS within larger service delivery models.  Given the limited training materials available, recommendations further include developing standardized training manuals and certification procedures to promote the spread of YPSS.