Leveraging Virtual Co-Facilitated Focus Groups for Developing a Theory of Change for Adolescent and Young Adult Peer Support in Community Mental Health Settings

Background and Purpose: Youth peer support (YPS) has become increasingly available as a formal mental health service in community-based settings. However, high quality research and implementation of peer support has been hampered over the years by the lack of theory that clarifies YPS roles and explains exactly how these roles foster positive outcomes for peer support users. Theory is particularly sparse in peer support for older adolescents and young adults. To improve implementation and outcomes, there is a need for theory that not only clarifies roles and mechanisms of impact, but also identifies how YPS for young people might differ from peer support for older adults.

Methods: Informed by participatory action research methods, this qualitative study brought 52 young people with experience providing and using peer support together in small group discussions focused on understanding the activities and outcomes of peer support. Participants were recruited by circulating an electronic flyer to formal and informal email listservs that reached YPS Specialists across the US directly, and/or reached other staff in programs employing YPS Specialists, who then forwarded the flyer to YPS Specialists and young people who were working with YPS Specialists. The flyers provided urls and QR codes linking to further study information as well as an online form that potential participants used to indicate interest in the study. Twenty-four small group discussions were facilitated virtually with one to five participants in each group. Discussion groups were held in three “rounds,” allowing the project team to work on analyzing the data and formulating new questions between rounds. Participants could engage in up to three groups. Most groups were co-facilitated by a young person with lived mental health experience. Focus group transcripts were transcribed by Zoom and cleaned by a young adult with lived experience. To analyze the data, four members of the study team—including two young adults with lived experience—coded discussion group transcript using reflexive thematic analysis. Each team member separately reviewed transcripts from a completed round of discussion groups, identifying codes and exemplar excerpts, creating and editing code and theme descriptions, and attaching “memos” to particular excerpts for later discussion. As analysis proceeded, the team worked collaboratively and iteratively to identify additional exemplar excerpts for existing codes and themes and/or recategorize exemplars into new codes, to group/re-group codes within themes and themes within larger themes, and to review and revise theme definitions in light of revised sets of exemplars.

Findings: Coding processes resulted in the development of a theory of change that outlines key activities that constitute a one-on-one peer support role for young people, and describe how and why carrying out these activities should lead to positive outcomes. The theory highlights the characteristics of a successful “peerness-based relationship,” and proposes that the development of this kind of relationship mediates other positive outcomes from YPS.

Conclusion and Implications: Study findings can inform YPS role specification, training and supervision, and other organizational supports. Study processes can inform future research efforts that privilege lived/living experience expertise.