Employing Participatory Action Research Methods to Examine the Relational Complexity of the Near-Age Peer Support Provider Role in Community Mental Health Settings

Background and Purpose: Increasingly, US community mental health settings are integrating professional near-age youth peer support providers to improve youth service engagement and outcomes. Youth peer specialists (YPS) use their lived and living experiences with a mental health diagnosis to validate, empathize, and provide individualized support, while also improving their program’s overall responsiveness to young people’s needs. Although promising, these roles tend to lack clarity—responsibilities vary immensely, and turnover is high. Examining near-age youth peer on-the-job experiences is needed to design effective on-the-job supports. Massachusetts began YPS implementation between 2013-2017 through a SAMHSA System of Care grant, and supports on-going quality improvement efforts to support YPS implementation.

Methods: In 2022, a community-based participatory action research team was formed to better understand YPS experiences and needs to develop actionable ways to support YPSs in their roles. This team was composed of a PhD qualitative mental health services researcher, a former YPS, a current YPS trainer, two former YPS service participants, and a young person with lived mental health experience. Together, the team designed a study, developed an IRB protocol together, and after approved, then recruited, conducted, and analyzed surveys and in-depth-interviews with current and former YPSs. Recruitment was largely achieved through state training and professional development listserves, and YPS sharing the study opportunity with one another. Twenty-two YPSs completed brief online surveys, and 10 completed interviews. Interviews were co-conducted virtually on Zoom with a researcher and a lived experience research team member. The research team first cleaned and organized survey data for analysis, and then met several times to discuss how to analyze and visualize results for a report. Then, the research team used reflexive thematic analysis, a qualitative data analysis technique in which existing theory and constructs are held in mind during code development. The team consulted with another PhD qualitative social work researcher to organize the themes into the five most common relationships discussed within and across participant interviews. From there, the team discussed the most common theme within and across participant interviews that helped and/or hindered YPS on-the-job success: relationships.

Findings: Identified relationships uniquely require YPS relational practice skills and self-awareness, and included relationships with (1) self, (2) clients, (3) supervisors, (4) non-peer colleagues, and (5) other near-age peer providers.

Conclusion and Implications: Findings directly expand on current near-age peer practice and associated on-the-job challenges, and the team published both a policy white paper for the State of Massachusetts Department of Mental Health and an academic journal article based on study findings. Study findings have also been presented at two state YPS policy academy meetings in Massachusetts, led to a monthly YPS statewide virtual learning collaborative co-led by a former YPS and a YPS trainer, and informed both supervisor and YPS trainings in Massachusetts. And, several lived experience team members have secured university research assistant positions since their experiences as co-researchers in this study.