"I Felt from That Place": A Qualitative Case Study of Emerging Practices to Build Youth Peer Supports in Residential Care

Background and Purpose: Effectively responding to children and youth who experienced trauma and enter the foster care system is an ongoing challenge in child welfare. In response to poor outcomes across the system, and the growing understanding of the effects of complex trauma, the Family First Prevention Services Act (FFPSA) was enacted in 2018 by Congress to overhaul the child welfare system. Among the many required changes, states were required to establish processes for residential agencies that receive youth in foster care to become qualified residential treatment programs (QRTPs) adhering to trauma-informed care requirements.

Trauma-informed frameworks often include a component for peer supports although research on implementing youth peer supports is limited, presenting implementation challenges. Available research on youth peer relationships among this population suggests a range of potential positive and negative outcomes. However, prioritizing youth peer relationships is consistent with adolescent developmental imperatives.

This study examined perceptions of youth relationships and peer supports held by administrators, clinicians, and direct care staff members in QRTPs in a state located within the Northeast United States. Additionally, participants reported on the peer support interventions at their agency, specifically how the agencies were translating the peer support component of trauma-informed frameworks into practice.

Methods: Using a case study design, QRTPs were recruited from the selected case state, and administrators, clinicians, and direct care staff members from selected QRTPs participated in interviews up to one hour long. A total of 26 participants in five QRTPs participated in the study. The analysis strategy involved first and second cycle coding and multiple coding strategies such as axial coding to develop study themes.

Findings: The study found that participants had a balanced view of peer relationships. Relationships were perceived as being emotionally supportive and generative, but held potential for being emotionally unsupportive and unproductive for youth. Youth peer supports were perceived as naturally occurring between youth without adult intervention, though participants also perceived that youth peer relationships can require adult initiation and facilitation through targeted interventions in order to maximize the supportive elements. Multiple interventions were identified: (1) peer-to-peer mentorship; (2) youth peer advocates; (3) youth advisory boards; (4) youth review boards; (5) social advocacy groups; (6) peer support groups; (7) therapeutic or skills-based groups; and (8) campus recreation programs. Participants also reported multiple considerations informing their perceptions and selection of practices.

Conclusions and Implications: Research on youth peer supports is minimal, especially youth in residential care agencies. Youth peer relationships and supports offer emotional support, connection and a social network that can extend beyond residential care and can be harnessed by agencies to solve agency problems and build positive social climates. A robust developmentally responsive approach to peer supports offers interventions that allow youth to initiate and facilitate relationships without adult interference while also providing youth with opportunities to develop skills and knowledge necessary for successful relationships with adult support. This is consistent with available research on youth peer relationships and aligns with positive youth development framework.