“What We Have in Common”: The Role of Shared Experience in Peer-Delivered Services

Background and Purpose: Current theories regarding how peer-delivered services operate emphasize key elements such as trust, rapport, credibility, and role modeling. The concept of “shared experience”, typically defined as personal experiences of mental health conditions and treatment that distinguish peer from non-peer staff, has been described as a key element in the literature on peer-delivered services. However, it is not well-understood how shared experience is used in practice. Further, there is a need to counter the current research bias of qualitatively examining the impact of peer-delivered services on the provider’s own recovery or features of their employment vs. their perceptions of the actual peer provider-consumer dynamic. This study sought to capture peer specialists' perceptions of the peer-consumer dynamic and to understand how shared experience is used in practice.

Methods: In-depth qualitative interviews were conducted with nine peer specialists who worked in a Peer Wellness Program that was embedded within a Housing First agency. The Peer Wellness Program sought to enhance existing Housing First services by offering peer-delivered wellness services that combined peer specialists with evidence-based and emerging practices, such as Illness Management & Recovery / Wellness Self-Management. Interviews explored aspects of peer specialists’ perceptions of their role as service providers. A modified grounded theory approach was used to analyze interview transcripts and included strategies for enhancing rigor such as utilizing codes that stayed close to the text and multiple coders.

Results: Three overarching themes were identified in the interviews relating to how peer specialists’ characterized 1) their roles, 2) definitions of consumers’ progress, and 3) shared experience. Peer specialists’ described their roles as being consumer-centric, flexible, and often serving to bridge gaps or buffer tensions between consumers and other providers. Consumer progress was defined as highly relative, incremental, and subtle. Much emphasis was placed on intangible client outcomes (e.g., importance of changes in attitude, fostering hope) vs. more tangible and commonly reportable evaluation outcomes. While “shared experience” emerged as a key component of the relationship and was described as infusing all aspects of practice, peer specialists’ rarely reported explicit sharing regarding experiences with mental health conditions and treatment. Instead, peer specialists described these experiences as creating a “shared perspective” that framed their practice, promoted empathy, and helped them identify questions to ask of consumers and to anticipate consumers’ needs. In contrast, explicit sharing to engage consumers occurred around issues such as significant life events (e.g., death of parent), cultural background, and physical health.

Conclusions and Implications: Shared experience regarding mental health and treatment informed peer specialists’ perspective and was implicitly present throughout the peer-consumer dynamic. Shared experience regarding other commonalities was more explicitly present and used for engagement. Peer specialists’ perspectives on service delivery can inform the training and practice of both peer and non-peer staff. Further research is needed to understand how unique aspects of peer specialists’ perspective and experience is enacted in practice, whether the current findings might be unique to Housing First services, and how to measure consumer progress that is more intangible and highly relative.