Evaluation of the experience of hosting Peer-Support Worker students on placement in EVE New Horizon
Acknowledgements
EVE is indebted to the staff of New Horizon HUB for their willingness to take a leap of faith as the first location in EVE to offer placements to Peer Support Worker (PrSW) students. Their openness to change and the possibilities the role could offer service users is commendable. We are also grateful to our two PrSW students who trusted us to support them in their placement and to participate in the evaluation and the working group. It is never easy to be the first to break new ground but we are confident that the learning from this experience will reap dividends across all EVE services and for this, we are extremely grateful.
Support from the DSKWW Lead for Mental Health Engagement and Recovery, Emma Mcguire, throughout this process grounded this experience in the context of the broader ambitions of the CHO to introduce PrSW posts in mental health teams. By facilitating the service user focus groups as part of the evaluation process, she provided a safe space for service users to share their feedback in an open and honest way. Her support and perspective throughout was much appreciated.
Whilst the report was co-authored, great credit is due to Jenny Langley one of our PrSW students whose expertise in data analysis and report writing is evident throughout and I thank her on behalf of the group and EVE. Her willingness, and that of our other PrSW student, Breda Molloy, to take on tasks related to this evaluation, in addition to their studies, was a reflection of their passion for the project, their skills and their commitment to the advancement of the PrSW role in EVE and the wider HSE.
Finally, I wish to thank the service users in New Horizon HUB who chose to engage with the students. Integrating peer support in EVE services would not be possible without their willingness to engage and share with us their feedback. Their positive assessment confirms that there is a valued role for peer support working in EVE and gives us a mandate to undertake the work required to support future PrSW students and staff in our services.
EVE’s mission to offer values-based, quality recovery-oriented services would not be possible without this level of commitment and effort by staff, students and our service users who are willing to take committed actions in the pursuit of their values.
Míle Buíochas, Margaret Webb General Manager EVE Services
1 Introduction
Consistent with the HSE approach to employing Peer Support Workers (PrSWs) across mental health teams and services, EVE volunteered to host students completing the Certificate in Peer Support Working in Mental Health with DCU for the academic year 2022-2023. With the support of EVE services, DCU and the students, EVE set out to learn from this experience and explore how this role best suits the particular characteristics and nuances of our community-based service delivery models. EVE’s ambition to introduce the role of PrSWs as part of the skill mix is currently the subject of discussion with the office for Mental Health Engagement and Recovery.
After communications with DCU and centre locations, New Horizon HUB – a HUB service based in Tallaght – agreed to host placements for two students who were in situ between September 2022 and May 2023. New Horizon HUB offers a person-centred, recovery-oriented service, designed to support people in their recovery to set and achieve personal goals, reconnect and regain active citizenship within their local communities (Keenan & Molloy, 2016). The HUB programme was co-produced and is consistent with national policy including A Vision for Change (2006), New Directions (2012), Healthy Ireland (2013) and Sharing the Vision (2020)
2 Working Group & Evaluation
A working group was established in January 2023 to capture the learning from this pilot placement of PrSW students in an EVE centre. Members of the working group included the New Horizon HUB Service Manager, the two PrSW students on placement, the lead for Mental Health Engagement in DSKWW, the EVE General Manager, the Slánú team and the QA Manager. The group referred to national policy toolkits and frameworks to support them identify and implement best practice. In addition, there were tripartite student supervision sessions with each student, the service manager (placement supervisor) and the DCU academic supervisor, from which significant learnings were gleaned. The group also sought advice from the national lead for Peer Support Working in the National Office for Mental Health Engagement and Recovery. Issues arising during the year were discussed and solutions co-produced.
The aim of the working group was to explore the role of the Peer Support Worker in the context of the overall skill mix in EVE services and, drawing on learnings from this evaluation process, develop a Guide to Peer Support Working in EVE Services per the agreed terms of reference (Appendix 1).
2.1 Aim of the Evaluation
The evaluation was designed to capture learnings from the pilot placement of the PrSW students in the New Horizon HUB using feedback from the two PrSW students, the participants, staff and management in New Horizon, to inform the development of the Guide.
2.2 Evaluation Methodology
The five-module evaluation process overleaf set out to capture the feedback from the perspective of the PrSW students and the service users, staff and management in New Horizon HUB. Qualitative questions were asked of each stakeholder group, responses were collated and a thematic analysis process was undertaken. From this, key themes and learnings were established and service readiness for peer support working in EVE was assessed. Participation was voluntary and a commitment was given that the final report would be subject to review and local consultation prior to dissemination. In addition, all participants were advised that their responses would be anonymised in the final report.
Modules 1-3 of the evaluation took place in the last two weeks of March 2023, with further discussion taking place in April at the working group, to agree a consensus outcome for Modules 4 & 5.
Module 1: Service user Feedback
A series of questions were co-produced by the working group and formed the basis of two separate focus group discussions. The first group comprised those service users who were directly supported by the PrSW students (i.e. one-to-one engagement). The second comprised those who engaged with PrSW students more indirectly (i.e. group-based peer support sessions and/or casual engagement within the centre). Both focus groups were hosted onsite in New Horizon HUB by Emma McGuire, Lead for Mental Health Engagement in DSKWW, accompanied by a Doctorate of Clinical Psychology student who was shadowing as part of her course. The service user feedback from the focus groups was summarised by Emma in report format, with illustrative quotations, and – alongside other stakeholder responses – was then subject to thematic analysis.
Module 2: Staff Feedback
A series of questions were co-produced by the working group, from which a survey was created and issued via Survey Monkey, for completion by the staff, including the local Service Manager.
Module 3: PrSW Student Feedback
A series of questions were co-produced by the working group for completion in writing by the PrSW students. By agreement, these responses were not anonymised.
Module 4: Service Readiness
The PrSW students, the local service manager, the Slánú team and the management team of EVE were invited to complete the Service Readiness tool (Tool 4 in the PrSW HSE Toolkit) to establish their perspective on EVE’s service readiness to engage PrSWs. The tool was designed to be used in advance of employing a PrSW in the HSE. In this instance, we were keen to establish stakeholder views based on their experience of this pilot phase of PrSW student placements.
Module 5: Role Clarity
Using the Role Clarity tool (Tool 8 in the PrSW HSE Toolkit), a discussion took place within the working group to review our shared concept of role clarity for the PrSW role in EVE, following completion of Modules 1-4.
Evaluation Mathodology
2.3 Participants
Participants in Modules 1-3 included service users (those who received both direct and indirect support from the PrSW students), staff, local management and the two PrSW students on placement. Of the eight service users who received direct support from the student PrSWs, six chose to engage in the focus group. Nineteen service users received indirect support of whom five were available and chose to attend the focus group. All four staff and both PrSW students chose to complete their respective surveys. Participants in Modules 4 and 5 included the local line manager, Slánú, members of senior management and the PrSW students, all of whom were members of the working group.
Module 1: Service Users
Table 1: Number of Respondents Modules 1-3
Supported by No. who attended Focus Group
Table 2: Number of Respondents Modules 4-5
2.4 Results
Once stakeholder responses were collated in April, a thematic analysis was undertaken for modules 1-3. The key themes and learnings identified from that process were borne in mind as further discussion took place regarding Service Readiness and Role Clarity.
Results of Modules 1-3
Using the qualitative data analysis tool Taguette, a thematic analysis completed on the collated feedback from respondents is presented under the following headings:
• The role of the PrSW student
• The value of the PrSW role
• The future of the PrSW role in EVE services
Result of Module 4
Results from the completion of the Service Readiness Tool are presented below, in Section 6, and include the initial views of the PrSW students, the local line manager, Slánú and the Senior Management, as well as the final co-produced assessment of EVE’s readiness to host both PrSW students and staff.
Result of Module 5
The need for role clarity emerged as a key finding from all stakeholders. Using the Role Clarity Tool, the working group explored the issues that had arisen. As the tool focuses on analysing situation specific issues, it was agreed that it should be included as a resource in the Guide to Peer Support Working in EVE Services, to be used on those occasions where role clarity is required within the team.
3 The Role of the Peer Support Worker
3.1 Expectations vs Reality
Overall, the pilot introduction of the Peer Support Worker role in New Horizon HUB was considered a positive experience by service users, staff and PrSW students. The challenges and learnings encountered included the need for role clarity between the students and keyworkers; the need for improved communication and collaboration between these roles; and the need for the availability of one-to-one time between PrSWs and peers.
SU Focus Group Facilitator’s Report
“Participants stated that the PrSW students were more accessible “
Staff Feedback
“Keyworker was unaware of what advice and support the PrSW was giving to the service user”
“I feel the role of the Peer Support student overlapped my role as a keyworker and facilitator”
3.2 Role Overlap
PrSW Student Feedback
“I originally thought I would have more time with dedicated peers, unfortunately that wasn’t the way things evolved”
Role overlap between the student PrSWs and keyworkers was identified as a key challenge during this period as both positions involve the provision of support to participants in pursuit of their individualised goals, working with them in both group and one-to-one capacities. It was acknowledged that any resulting confusion could potentially create friction between colleagues, and that this will need attention going forward, to ensure peer support working is incorporated fully into EVE, with minimal disruption and to maximum effect.
SU Focus Group Facilitator’s Report
“When asked about differences between PrSW and keyworker, 5 out of 6 stated that there were no differences in the role –both exist to help”
Staff Feedback
“As it stands I think the role overlaps too much with the [keyworker] and facilitator role within the centres”
PrSW Student Feedback
“It has proven more difficult than I anticipated to demonstrate to staff and peers what delineates the role from other staff members and the value that the role of PrSW can offer“
3.3 Role clarity going forward
All respondents agreed that addressing the identified need for greater role clarity would facilitate more effective coordination between PrSWs and keyworkers, ultimately leading to better outcomes for service users. It was acknowledged that both keyworkers and PrSWs play an important role inspiring hope and encouraging self-determination and self-belief in participants, which may occasionally lead to overlap or “grey areas” in terms of who does what. It was agreed that good communication, team working and use of the Role Clarity Tool should greatly assist in addressing any issues that may arise.
SU Focus Group
Facilitator’s Report
“One participant added that working with PrSW students was more personal and that learning about their recovery journey gave him hope about his own recovery.”
Staff Feedback
[Current lack of role clarity] “Can infringe on keyworker role offered”
PrSW Student Feedback
[Service users are] “more likely to go to their keyworkers if they need to discuss something to do with their wider support network – e.g. CMHT, MDT, housing body, etc – as the keyworkers are more likely to have the technical knowledge to support them”
3.4 Overcoming Challenges Experienced
The majority of identified challenges centred on: lack of role clarity; resulting role overlap; insufficient communication and collaboration; difficulty getting one-to-one time with peers; and, balancing competing priorities.
Suggestions to address these issues focussed on forums for “airing-and-sharing” between students and staff; establishing suitability of individual learning environments; and ensuring the PrSW role is not so narrowly defined that students cannot “explore” it. It was generally agreed by all parties that careful planning, comprehensive induction, clear governance protocols and robust guidance documentation would support successful future placements.
SU Focus Group Facilitator’s Report
“It is important to acknowledge the complexities involved in introducing a new role that were faced by staff and students alike. Overall, the findings are very positive and the development of a guidance document will serve to improve an already positive and valued support”
Staff Feedback
“Communication skills –Teamwork – Role clarity”
PrSW Student Feedback
“I’ve rarely been overtly challenged for anything said/done in the course of my role, but I have occasionally sensed that staff may not feel entirely comfortable with aspects of our work”
4 The Value of the Peer Support Worker Role
4.1 The Value of Peer Support Working
The key function of the PrSW’s role is to use their lived experience to build collaborative, reciprocal relationships with participants, investing time and encouragement to foster their self-determination towards recovery, also investing time with keyworkers to maximise the impact of both skillsets for the benefit of participants. Staff and current PrSW students in New Horizon HUB identified a number of key areas where PrSW roles have the potential to be most useful and effective as follows:
• Assisting participants through periods of transition, struggle or relapse
• Supporting participants in community integration
• Developing and delivering recovery-based programmes
• Ensuring the voice of lived experience is represented at organisational level
SU Focus Group Facilitator’s Report
“Participants who worked oneto-one stated that the experience of working with a PrSW afforded them extra support that they wouldn’t normally get.”
Staff
Feedback
“Peer support workers allow the participants to see that even when they go through tough times because they talk openly about their experiences they can study and return and offer the support to people who are in a similar position. This is hopeful and inspiring.”
4.2 Impact of Peer Support Working on Staff
PrSW Student Feedback
“Peer support is like someone holding your hand until your (sic) brave enough to move forward on your own.”
Staff considered PrSWs a valuable addition to teams going forward, acknowledging their capacity to afford service users one-to-one time and to share their lived experience. However, this was conditional on role clarity, clear guidelines and improved communication and collaboration. There was concern that ongoing continuity of support by the student PrSW could not be offered as the placement was time limited.
SU Focus Group Facilitator’s Report
“One participant stated that ideally she would first discuss an issue with her keyworker as the keyworker relationship is more formalised by working off the PCP with clearly identified goals whereas the PrSW relationship can be very informal with some interactions being conversational.”
Staff
Feedback
“Whilst this has been challenging at times in New Horizon HUB it has helped shape our views and educated us to the role peer support workers have in our organisation.”
PrSW Student Feedback
“I would hope that by encouraging/inspiring participants to stay the course and engage in the steps towards recovery, that the guidance given to them by their keyworkers becomes more meaningful”
4.3 Impact on Peers / Participants
Peers were unanimous in their positive experience of peer support working in EVE New Horizon HUB. Whilst they were unable to describe differences between the PrSW and keyworker role function, service users recognised that “the keyworker relationship is more formalised by working off the PCP with clearly identified goals”, while working with PrSWs was considered more “personal”, because the lived experience piece brought a sense of being understood without having to explain. It was acknowledged by staff that the student PrSWs also helped to advocate for peers, supported them in undertaking challenging tasks and were able to offer time in a one-to-one setting.
SU Focus Group
Facilitator’s Report
“they were unsure what the role of PrSW really entailed but that they saw it as an opportunity to get extra support”
Staff Feedback
“The lived experience piece of their story offers hope to others as a living example of someone who can make changes and work towards life goals.”
PrSW Student Feedback
“some stuff can be taken for granted as understood without having to be spelt out when you know the other person has been through something similar“
4.4 Impact of Peer Support Working on EVE Services
Respondents highlighted a variety of benefits PrSWs could bring to EVE services which included: offering one-to-one support of participants during difficult or transitionary periods as they reintegrate in community, promoting peer-to-peer engagement, supporting student placements and participant feedback forums, designing and delivering recovery-based programmes and representing the voice of lived experience is represented at an organisational level.
SU Focus Group
Facilitator’s Report
“PrSW afforded them extra support that they wouldn’t normally get.”
Staff Feedback
“Organisationally or part of the Slánú team I think there are endless opportunities for a peer support worker to make a real impact on EVE service users and our services.”
PrSW Student Feedback
“A peer on staff provides a new additional layer of support”
5 The Future of the Peer Support Worker Role in EVE services
5.1 The Future of Peer Support Working in EVE
Overall, respondents concluded that peer support working had the potential to be a valuable addition to EVE services. Respondents identified many areas within the organisation that could be enhanced with the introduction of the role including:
• The generation of peer-to-peer support within and between centres
• The development of co-produced recovery education material
• Support of service users through difficult or transitionary periods
• The opportunity for PrSWs to facilitate service reviews
• Support for the PrSW student placement programme
• Representing lived experience at organisational level
• Co-ordinating with the assigned PrSW Liaison.
There was general agreement that a PrSW post would not be required in each centre, with most alternative suggestions coalescing around the idea that EVE would (over time) develop a team of PrSWs working with the Slánú team who would be available to support EVE services. The Slánú Team Leader would provide line-management, with supervision provided by a suitably qualified person.
To ensure the most effective impact, a clear set of guidelines, a compendium of resources, a training and development programme for staff and participants, alignment to Slánú for line management and nomination of a PrSW Liaison within the organisation would all be required.
SU Focus Group Facilitator’s Report
“The six participants who worked one-to-one all stated they would like to see the PrSW role continue in New Horizon HUB”
Staff Feedback
“ …with role clarity, a clear induction process, clear set of guidelines and an EVE policy on this I think the role has a lot to offer.”
5.2 Future Student Placements in EVE
PrSW Student Feedback
By encouraging participants “to stay the course and engage in the steps towards recovery, the guidance given to them by their keyworkers becomes more meaningful.”
Feedback from respondents recommend that future placements should be supported by the development of a guidance document, a comprehensive induction programme for students, a briefing session for staff, plus a collective agreement on local mechanisms to support communication and collaboration between staff and student PrSWs. There was agreement that learnings from this pilot placement would enable all parties be better prepared for future placements.
With just one PrSW student likely in each future placement, it was suggested that a regular forum for “airing and sharing” learnings and challenges should be facilitated. A similar forum for staff/supervisors and a wider meeting for all parties (moderated by Slánú or the assigned PrSW Liaison) would also be helpful.
Concerns were expressed that Clubhouses, with their work-ordered day and open door policy might not be conducive to peer support working in the same way it was offered in the HUB model. EVE’s Autism Spectrum Condition & Intellectual Disability (ASC/ID) services would add significant additional learning challenges for PrSW students unless those individuals are already well experienced in this area. Additional work will be required to explore opportunities to engage PrSW students in these services.
SU Focus Group
Facilitator’s Report
Service users “were unable to make any suggestions for improvements with all saying that they found the two PrSW students very supportive, approachable and accessible.”
Staff Feedback
“Education piece for centre managers / staff/ Service Users… an employed Peer support worker could offer these to locations prior to a student’s start date.
Expectations from both sides on the table.”
PrSW Student Feedback
“…staff should be given some training on the core principles of peer support not only for their own benefit but also to aid future students keep the delineation between roles”
5.3 Success of PrSW Placement
Whilst recognising the challenges identified in the feedback, the general consensus was that the pilot placement of PrSWs students in EVE New Horizon HUB was a very positive and worthwhile experience. It was agreed that there is scope for future PrSW students and employees to fulfil valued roles, conditional on the development of Peer Support Working guidance documents, information for staff and participants, robust governance, supervision and role clarity.
SU Focus Group Facilitator’s Report
“The findings are very positive and the development of a guidance document will serve to improve an already positive and valued support.“
Staff Feedback
“The experience of having peers (sic) support students has been positive, as a pilot centre for students we have had challenges along the way however I believe this has created the opportunity to shape the role of peer support in a positive way and to that end was worth the journey.”
PrSW Student Feedback
“We were the guinea pigs”
6 Service Readiness for Peer Support Working in EVE
6.1 Service Readiness
The HSE’s Toolkit To Support Peer Support Workers working in the Health Service Executive (2019) has been designed as a resource for all relevant stakeholders involved in the implementation and expansion of peer support working throughout the HSE. According to the HSE Toolkit (pg. 21), there are key organisational readiness factors deemed necessities by Jorgenson & Schmook (2014) to support the introduction of Peer Support Worker roles in services. They include senior leadership buy-in, using a readiness checklist, identifying staff champions, defining and planning the role with multiple stakeholders, creating job descriptions and determining how the impact of the peer role will be evaluated.
As the student placements drew to a close, all stakeholders involved, including the PrSW students, the local line manager, Senior Management and Slánú were invited to complete the Service Readiness Checklist (Appendix 2). A meeting took place at which each item on the checklist was discussed and a consensus compliance rating agreed. It emerged from this process that Senior Management were able to share information that allowed others review and update their original rating. Table 3 (below) is a summary of the consensus compliance rating agreed by the group. Three of the four domains achieved a 100% compliance rating.
Two statements were deemed non-compliant in the fourth domain, Multidisciplinary Team ReadinessResponsibility of Head of Service Mental Health. Whilst acknowledging the intention towards co-production was evident and the significant collaboration with service users in the design and delivery of programmes, it was agreed that there is a lot more work required in this area to achieve true co-production. In the absence of a PrSW supervisory structure in the HSE, the requirement for a line manager to identify an appropriate supervisor was deemed non-compliant.
Service Readiness Checklist
Is your service ready to support a Peer Support Worker?
Table 3: Service Readiness Domain Compliance
Statement
# 2. Co-production is central to the multidisciplinary team’s practice when working with service users and family members.
Comment
Work in progress - intention evident in current practice.
Word “co-production” does not fit very well“collaboration” a more appropriate description
No - PrSW supervisory structure not in place in HSE MDT Team Readiness-Areas Deemed Non-Compliant
# 8. The line manager has identified a supervisor who has supervisory experience with a recovery ethos and capacity for the supervisor role.
6.2 Role Clarity
As stated in the HSE Peer Support Toolkit, “PrSWs often struggle with a lack of role clarity or role ambiguity” (pg34). Tool 8, ‘Getting Role Clarity’ was designed to facilitate a discussion to help the PrSW and their team answer the question “Should a Peer Support Worker do this in their role”? (Appendix 3). Respondents’ feedback pointed to role overlap being a key challenge and the need for improved communication and collaboration between the keyworker and the PrSW to maximise the value of both roles within the service.
The original intention was to complete the tool at the end of the evaluation. However, the group concluded it would be of greatest value as a resource to facilitate future team discussions analysing situation specific issues and should be included in the Guide to Peer Support Working in EVE Services.
In hindsight, the group conceded that the tool could have supported the team members address some of the concerns around role clarity that arose over the course of the year.
Table 4: Service Readiness – Areas of Non-Compliance
7 Key Learning Points
For EVE, a HSE service committed to supporting people in their recovery journey, this opportunity to host two PrSW students has provided invaluable learning and furthered our understanding of both the role and the responsibilities it entails. Critically, the evaluation has highlighted key learning points for us to consider in our preparations to support future students on placement and develop a full time post in our service. Four key themes have emerged:
• Teamwork
• Value of lived experience
• Preparing for Success
• We will know it is working when…
7.1 Teamwork
As a core competency in staff job descriptions, the ability of staff and allied supports to work as a team is key to offering seamless support to service users on their recovery journey. For New Horizon HUB, this means that all staff commit to working together to offer a person-centred, recovery-oriented service, designed to support people in their recovery to set and achieve personal goals, reconnect and regain active citizenship within their local communities.
Overall, staff and participants reported that the placement of two PrSW students in EVE New Horizon HUB was very positive with the general consensus that peer support has a valuable role to play in the service. As identified across the feedback, the introduction of peer support working in New Horizon HUB offered participants an additional layer of support, as student PrSWs were in a position to spend time one-to-one supporting them pursue the goals they had identified in their Person Centred Plans with their keyworkers. Additionally, their lived experience offered hope and “living proof” to participants that recovery is possible. This served to reinforce the guidance and advice offered by keyworkers, which highlighted the complementarity of the keyworker and PrSW roles and the value add they bring to the service offering.
Amongst staff and student PrSWs, there was recognition that most of the discomfort experienced and challenges identified resulted from lack of PrSW role clarity, unintended role overlap with keyworkers and missed opportunities for collaboration between keyworkers and PrSW students. Whilst New Horizon HUB had prepared for the introduction of the PrSW students, there was recognition that clearer guidelines and mechanisms were required for all parties to support better integration of students into the team, minimise role overlap and achieve better complementarity within the team.
Specific measures identified as useful to support effective teamwork include:
• Completing the Tool 4 of the HSE Peer Support Worker Toolkit to assess the service’s readiness factors, designing an action plan to address any issues arising and implementing same in advance of taking students on placement and/or employing PrSWs. This is essential to ensure that staff team have the opportunity to develop an understanding of the PrSW role and address any concerns arising.
• Co-producing a comprehensive Induction programme for future student PrSWs and employees that gives them the opportunity to gain a clear understanding of the range of skills and experience within the team and their colleagues’ explicit roles and responsibilities. A period of onsite shadowing of team members in advance of engaging in peer support work was highly recommended.
• Developing forums and mechanisms for team members to share information is key for teams to work effectively. Regular check-ins / handovers between PrSWs and keyworkers (while remaining mindful of confidentiality) along with clear guidelines for students on when, what and how to contribute to participant files, would ensure that all staff are aware of pertinent information in a timely manner. Group forums for “airing and sharing” learnings and challenges would also be helpful in identifying areas that need attention and opportunities for service improvement.
• Using the Role Clarity Tool, should issues regarding role ambiguity arise, would provide a useful format to analyse the task and determine its appropriateness for the PrSW.
• Provision of a PrSW Liaison in the organisation, whom staff, students, supervisors and participants can consult as required with any difficulties or concerns.
7.2 Value of Lived Experience
Staff feedback from the pilot placement of PrSW students in New Horizon HUB recognised that participants responded well to the student’s presence. In particular, their availability to spend time one-to-one with participants and use of their lived experience were identified as key benefits. Service users were unanimous in vocalising a positive experience of peer support working in New Horizon HUB and identified the interactions with PrSWs students as an additional layer of support and a source of hope for their own recovery.
While peers did not verbalise any significant differences between the roles of PrSW and keyworker, there was some recognition that “the keyworker relationship is more formalised by working off the PCP with clearly identified goals”, while working with the students was considered “more personal”, because the shared lived experience brought a sense of being understood without having to explain.
The introduction of someone who “understands the path you’re walking and who demonstrates that recovery is feasible” was welcomed, offering hope to peers that they too could achieve change and recovery. The student PrSWs helped to advocate for peers when required in centre and community settings, supported them in undertaking challenging tasks and were able to offer time in individual support sessions, where other staff members were unable to do so, due to timetabling constraints.
Feedback from the students suggested that the use of intentional recovery language in day-to-day interactions with participants was a way for staff and students to strengthen an individual’s understanding of their own potential and further their recovery. Discussing concepts such as “self-determination”, “agency” and “self-compassion”, etc. along with intentionally using these words, could help participants begin to understand the relevance of these terms to their own recovery journey and carve out a role for these ideas in their own lived experience.
The evaluation of student PrSW placements in New Horizon HUB concluded that the following key functions of the PrSW role contributed the most added value to the service:
• Connecting with participants to build mutually supportive relationships;
• Strategic sharing of lived experience, to normalise mental health struggles and foster a sense of hope and empowerment in participants;
• Collaborating with participants on agreed projects in line with service plans and objectives, in pursuit of their personal goals;
• Offering participants a degree of companionship on their recovery journey, that keyworkers (due to timetabling constraints) are not in a position to provide;
• Investing time one-to-one with participants, to establish how best the individual can be supported;
• Collaborating with their keyworker to ensure that shareable insights are incorporated into PCPs and keyworker skills are being fully leveraged.
In addition, staff and current PrSW students identified several ways in which EVE could most effectively deploy peer support working across the organisation, including: assisting participants through periods of transition, struggle or relapse; supporting participants in community reintegration; developing and delivering recovery-based programmes; and, advocating and representing the voice of lived experience at organisation level.
7.3 Preparing For Success
With the support of New Horizon HUB, DCU and the PrSW students, EVE set out to learn from this pilot project how the role of PrSW best suits the the particular characteristics and nuances of our communitybased service delivery models. There was consensus that with the first PrSW student placements, all parties were “starting with a blank page.” This circumstance, while affording a huge opportunity for exploration, made it perhaps inevitable that there would be challenges. The learnings from these challenges subsequently informed decisions about how peer support working should be rolled out in EVE. To prepare for success, we have learnt that we need to focus on three key areas: supporting student placements, supporting staff and ensuring robust governance to underpin both.
Student Placements
With the benefit of experience from the pilot placement of student PrSWs, it is recognised that reliable supports for both student and staff teams will maximise the opportunities peer support can bring to the service and assist students in their learning. These include:
• Developing a Peer Support Working guidance document, a comprehensive student induction programme, staff training and collective agreement on local mechanisms to support teamwork between staff and PrSWs. Feedback from staff and the PrSW students indicated that this would be beneficial to minimise incidence of role overlap and maximise team effectiveness and cohesion.
• Establishing local communication forums to allow staff and students collaborate, share and learn. This should be agreed at the start of the placement to ensure all team members and students in a given centre can discuss the experience of peer support working in their service and address any issues arising.
• Establishing tripartite supervision arrangements between the student, DCU and EVE placement supervisor(s), where the placement experience can be discussed and any issues arising explored.
• Establishing a communication forum for students across placement locations could provide opportunities for shared learning and peer support between the participating EVE PrSW students. This might manifest as regular online meeting, with the additional possibility of wider meetings (to include supervisors, staff and Slánú), where any opportunities or challenges can be “aired and shared”. This could be managed by a PrSW Liaison in the organisation, as could a separate forum for placement supervisors, if required.
There may be times and individual services where it will not be possible to host PrSW placements. For example, some centres may not be in a position to facilitate private individual support meetings because of open door policies. Meanwhile, in other centres, participants’ busy or inflexible schedules may inhibit a PrSW student’s ability to develop the relationships required for effective peer support to flourish. EVE management recognises that this is a matter for local discussion and agreement.
PrSWs Employed in EVE
There was general agreement that a PrSW would not be required in each centre, with most alternative suggestions coalescing around the idea that EVE would (over time) develop a team of PrSWs working with Slánú, and who would focus on supporting those participants facing periods of transition or difficulty throughout the services
As with student placements, preparation is key to supporting new PrSWs as they integrate into staff teams, establish their role and ensure that their colleagues have had the opportunity to understand what this new role may mean for the day-to-day functioning of the service. Measures required include:
• Establishing the line management and supervisory function for the PrSW employee, so it is clear from their first day in post to whom they direct their queries. A regular schedule of meetings should be agreed to support induction and the provision of ongoing staff support.
• Developing a Peer Support Working guidance document, a comprehensive induction programme, staff training and collective agreement on local mechanisms to support teamwork between staff and PrSWs.
• Establishing communication forums for the team (be that centre based or with Slánú) where team members can share their experience of the role, highlight successes and concerns (if they exist) and arrive at team-based solutions to situations if necessary.
• Establishing a peer network within EVE & beyond to support both PrSW staff and students
There was overwhelming consensus in the feedback that peer support working has a valuable role to play in helping EVE to deliver effective recovery-oriented care to HUB participants and Clubhouse members across the service, with most respondents identifying specific areas for possible PrSW involvement, to the benefit of all stakeholders in the organisation.
Areas for potential role development of employed PrSWs proposed include:
• Generating peer-to-peer support within and between centres
• Continued development of co-production initiatives and recovery education programmes
• Contribution to development and delivery of new recovery programmes
• Investment of one-to-one time for intensive support of peers through difficult or transitionary periods
• Assistance with service reviews (participant focus groups, EASI Tool, etc.)
• Representing lived experience in EVE working groups (Strategic planning, Healthy Ireland, etc.)
• Contribution to PrSW student placement programme
• Liaising with other staff to explore opportunities for communication and collaboration
Governance
Ensuring safe practice for staff and service users is a key consideration for EVE. Governance protocols set out the way in which activities and functions of the service are carried out and risk is mitigated. Effective line management is key to ensuring compliance.
Insights shared to support governance include:
• Integrating PrSWs into the Slánú team, reporting to the Team Leader. In contrast, PrSW students would be most appropriately line managed by their placement supervisors (and thereafter by centre managers, if it is not the centre manager acting as placement supervisor) with support from Slánú on a needs basis.
• Nurturing collaborative relationships with other team members was deemed a protective factor within the team to support safe practice and a healthy work environment for colleagues.
• Ensuring both students and employed staff adhere to the same policies, protocols and induction as their colleagues.
• Developing the Guide to Peer Support Working in EVE, drawing on the evaluation findings and the HSE Peer Support Worker Toolkit. Whilst the toolkit is a valuable resource we recognise that it was developed to support teams working in clinical settings and acknowledge the need to customise governance protocols appropriate to EVE’s non-clinical, community-based settings.
• Ensuring appropriate professional supervision and support of PrSWs is a key requirement for those employed in this role. The establishment of supervision structures for PrSWs is the subject of discussions within the HSE, the outcome of which will apply to EVE services.
7.4 We will know it is working when….
There was definite consensus among respondents that the role of PrSW in EVE offers a catalyst for participants’ personal growth, empowerment and recovery. Grounded in the principles of lived experience, empathy and shared understanding, peer support working creates a huge opportunity for participants to experience solace, encouragement, and hope in the presence of someone who has walked a similar path. By fostering genuine connections, offering support, and embodying a spirit of resilience, successful peer support within EVE services paves the way for meaningful journeys toward recovery and well-being.
Through the evaluation process, we have identified the importance of role clarity and specificity, cohesive teamwork, effective communication structures, comprehensive guidance to support team members and clearly delineated line management and professional supervision for the PrSW. Given the acknowledged potential for role overlap, it is essential that services develop mechanisms and/or utilise the Role Clarity Tool to resolve issues where role ambiguity arises, promptly.
We will know the PrSW role is working when participants…
• Report higher levels of satisfaction and well-being after receiving support from PrSWs, providing positive feedback about the effectiveness of peer support and its impact on their lives.
• Seek increased levels of support from PrSWs.
• Feedback that peer support working has led them to increase their support networks within the community and reach out to other services and individuals to further their recovery.
• Adopt and utilise the coping strategies and tools learned through peer support.
• Report feeling less isolated, more resilient, more connected to their communities and better able to manage their mental health recovery journey due to their involvement with PrSWs.
• As modelled by PrSWs, incorporate recovery language into their personal narratives, demonstrate an understanding of the applicability of these concepts to their own journey and show an enhanced appreciation for the value of their own lived experience.
• Grow their peer-to-peer connections within our centres, actively sharing their experiences and offering support to others.
• Can schedule one-to-one interactions with their PrSW easily, without significant disruption to their other scheduled activities.
• Introduce or seek to contribute to new initiatives, such as an annual inter-centre Peer Day, EVE-wide participant forums, etc.
• Express that they feel their needs and voice are adequately represented and advocated for at organisational level by their PrSW, who will engage with EVE in working groups such as Strategic Planning, Healthy Ireland, EVE Social Connects, etc.
We will know the PrSW role is working in EVE Services when …
• PrSWs and other staff all report having sufficient support, input and feedback from each other in fulfilment of their roles, to deliver the best possible service for participants.
• Staff and participants are able to verbalise the difference between PrSW and other support roles and can identify the value that peer support working brings to EVE services.
• The Guide to Peer Support Working in EVE Services and induction programme for PrSW (staff and students) enables quick and straightforward integration of the role into staff teams.
• Teams use the Guide, Role Clarity Tool, PrSW Liaison and “air and share” forums as resources to facilitate discussions around the remit of the role in their service.
• Regular, appropriate professional supervision is available for PrSWs.
• There is increased and improved delivery of co-produced content and recovery courses (e.g. WRAP, RCI, personal development) as a result of peer support worker involvement
• There is a perceptible reduction in self-stigma around mental health throughout the service and an increase in open discussions about lived experience of mental illness and recovery in our services.
• Peer support working contributes to a cultural shift that facilitates other staff feeling able to share their own lived experiences, amongst each other or with participants, safely and with confidence.
8 Conclusions & Recommendations
8.1
Conclusions
Peer support working has the potential to play a valuable role in the delivery of quality, recovery-oriented community services by EVE. With considered investment by teams in planning for the introduction of the role, the development of a comprehensive induction programme and an agreed governance structure, the introduction of a PrSW creates opportunities to both complement and expand our current service offering. Success requires a willingness on all team members to be open to the potential value of the role, to embrace a new way of working within their team and to commit to the inevitable process of adaptation that this initiative will bring.
8.2
Recommendations
In light of the findings and learnings from this project, EVE should:
• Continue hosting PrSW students and commit to a process of ongoing learning and refinement of the role, in particular within our Clubhouses and ASC services.
• Ensure opportunities exist in our programmes to facilitate service users engage with PrSWs both for one-to-one peer support and in-group environments.
• Meet with DCU to share the learning from the evaluation to support future students coming on placement.
• Develop a Guide to Peer Support Working in EVE Services which will be available to all PrSW students, employed PrSWs and the wider staff body, addressing the key areas of: Induction, Role Clarity, Team working, Communication and Governance.
• Design a briefing session for staff teams to support an understanding of the Guide, that would be hosted in advance of the introduction of a PrSW (be it student or staff) in a centre, address any concerns and ensure adequate preparation is undertaken.
• Develop a suite of resources, including but not limited to: a guide, posters and briefing session for participants to support the introduction of the role, highlighting its value, the support it offers and the instances where it might prove helpful to them in their recovery journey.
• Establish a PrSW Liaison function to support staff and students on placement in the organisation.
• Establish forums to support PrSW students and staff to air and share learnings and challenges as they arise and collectively agree next steps.
• Describe how peer support working will be integrated into local services and EVE overall, specifically in relation to one-to-one peer working, group environments and peer representation at organisational level.
• Harness the lived experience expertise of PrSWs in developing and delivering co-produced programmes, services and strategic planning.
• Pursue funding to establish the post of PrSW through the National Office for Mental Health Engagement and Recovery.
Evaluation of the experience of hosting Peer Support Worker students on placement in EVE
• Identify appropriate professional supervision for PrSWs in advance of commencement of staff member in the post, in line with HSE guidelines.
• Formalise the line management function and associated governance with the Slánú Team Leader in advance of commencement of staff member in the post.
• Conduct a follow up review to evaluate the introduction of PrSW students on placement in Clubhouses and our ASC services, to capture the learning and update our guidance/resources if required.
• Disseminate the evaluation report and share the learning within EVE and the DSKWW Service Improvement Group.
8.3 Strengths & Limitations of The Evaluation
While compiling this evaluation, the working group has been as thorough as possible in ensuring that all findings and analysis as are accurate and reflective of individual perspectives as possible. However, we recognise that there are limits associated with this type of self-rating exercise, and the attendant risk of bias, given that our assessments have not been externally validated. The following table outlines the strengths and limitations of our evaluation process.
Strengths
This evaluation has been co-produced by people with lived experience of mental distress (EVE participants and student PrSWs) as well as by EVE staff and management.
The value of lived experience has been represented at every step of the process.
Evaluation has been a priority since early in the students’ placement, in order that learnings can be maximised for the process.
All stakeholders have been given an opportunity to have their views represented in this evaluation process.
Limitations
This evaluation was not independently produced or validated by any third party individual or organisation.
The valued outcomes of this evaluation are qualitative in nature and difficult to measure
Small sample sizes, as evaluation relates to experience in one EVE HUB only.
Peer support working was represented in this process only by PrSW students, and not by any PrSW employees, limiting the scope of PrSW experience that might have been beneficial to the evaluation.
There has been general consensus all throughout the process in summarising common themes, with no strongly dissenting voices.
The service readiness tool was completed by PrSW students, as well as by EVE staff and management, lending a degree of independence to the service readiness conclusions.
The students have themselves highlighted that without representation by PrSW employees in this process, the scope of findings may be narrowed, given that students would not be entirely au fait with all HSE governance requirements that might apply if they were employed by EVE.
9 References
Government of Ireland (2006) A Vision for Change. Dublin: Department of Health & Children.
Government of Ireland (2020) Sharing the Vision: A Mental Health Policy for Everyone. Dublin, Department of Health.
Government of Ireland (no date) Healthy Ireland: A Framework for Improved Health & Wellbeing 2013 –2025. Dublin, 2: Department of Health.
Health Service Executive (2012). New Directions: Review of HSE Day Services and Implementation Plan 2012-2016. Personal Support Services for Adults with Disabilities. Working Group Report. Dublin: HSE.
HSE Mental Health Services (2019) ‘Toolkit To Support Peer Support Workers working in the Health Service Executive’. Health Service Executive (HSE).
Keenan, C. and Molloy, K. (2016) ‘EVE HUB Model Programme Framework Document - An evaluation of the implementation of a community- focussed programme in adult day services’. EVE Slánú.
10 Appendices
Appendix 1: Working Group Terms of Reference
TERMS OF REFERENCE (agreed 10.02.2023)
Working Group on Peer Support Working in EVE
Introduction:
Consistent with the HSE approach to employ Peer Support Workers (PsWR) across mental health teams and services, EVE volunteered to host students completing the Certificate in Peer Support Working with DCU for the academic year 2022-2023. With the support of EVE services, DCU and the students, we hoped to learn from this experience and explore how this role best suits the nuances of our community-based service delivery model(s).
Our interest in exploring the introduction of PsWRs as part of the staff skill mix within EVE was expressed by the GM when invited to attend a series of forums convened by John Mc Crusker of the National Office for Mental Health Engagement commencing 27.01.2022.
After communications with the college and centre locations, New Horizon HUB agreed to host placements for 2 students who have been in situ since Sept 2022. The learning/experience for all involved has been very positive and identifying the role students have within the centre alongside staff has and continues to grow. To capture this learning and future development needs it is suggested a “Best practice” guidance document be co- produced for future peer support students in EVE services and also explore how the role of a “Peer Support Worker” would look like in EVE services. In addition, there is an opportunity to explore the value of introducing the role of “Peer Support Worker” into the EVE skill mix and what that might look like.
New Horizon HUB staff, current peer support students, participants of New Horizon HUB, management team and Emma Mc Guire, Mental Health Engagement Lead CHO7 will work together to establish the above. The group will be guided by national policy, toolkits and frameworks to support them identify and implement best practice.
Terms of Reference:
The purpose of this group is to explore how the placements of students from the DCU Certificate in Peer Support Working can be supported across EVE’s services. The group will offer support to both students and supervisors and capture the learning from the experience of hosting the DCU PsWR students during the academic year 2022-2023 and develop a guidance document for future student placements in EVE. In addition, the group will also explore the value of introducing the role of Peer Support Worker into the EVE skill mix and what that might look like in operational terms.
Aim:
The aim of the working group is to develop best practice guidelines for Peer Support Students in EVE services and to explore the role of Peer Support Worker in the context of the overall skill mix in EVE services.
Objectives:
1. Identify current best practice guidelines, policies, toolkits for Peer Support Workers
2. Design methodology for capturing the input of participants and staff in New Horizon HUB around their experience of peer support students in New Horizon HUB
3. Design methodology for capturing the experience of the PsWR students in New Horizon HUB
4. Identify common tasks that students can engage in over the course of the year
5. Identify any challenges the role of the student has come across over the course of the academic year 2022/23
6. Identify any supplementary/optional training requirements for students
7. Identify current job descriptions of Peer Support workers in HSE and community settings/organisations.
8. Compare and contrast the role of peer support worker and Instructor/supervisor in EVE and identify differences, uniqueness or other within the 2 roles in EVE services.
9. Identify scope of the role in EVE services based on experience of the role of the students in academic year 2022/23.
10. Summarise learning in report and presentation format for dissemination
Participants:
A working group will be established, chaired initially by the General Manager and will include Slánú/QA/Management Team and representatives from New Horizon HUB, Jenny Langley (Student PrSW), Breda Molloy (Student PrSW), Emma McGuire (Area Lead, MHER, CHO7) with input from Martha Griffith & Liam Magowan (DCU representatives).
Time Frame:
Feb 2023
Circulate Draft Terms of Reference
Confirm representatives
Feb 2023 First meeting of Working Group Agree Terms of Reference Develop a work plan for next 8 weeks
Feb/March Regular contact to monitor progress
April 2023 Draft Guidelines for Peer Support Student Workers in EVE Services be developed
April 2023 Final meeting of group to summarise learning & draft report/presentation for dissemination
Appendix 2: Completed Service Readiness Tool
As the student placements drew to a close, all stakeholders involved, including the PrSW students, the local line manager, Senior Management and Slánú were invited to complete the Service Readiness Checklist. A meeting took place at which each item on the checklist was discussed and a consensus compliance rating agreed. It emerged from this process that Senior Management were able to share information that allowed others review and update their original rating. The table below is a summary of the consensus compliance rating agreed by the group. Three of the four domains achieved a 100% compliance.
Service Readiness Checklist Tool - Is your service ready to support a Peer Support Worker?
Tick if you agree with the statements below ✔
Community Healthcare Organisation Senior Team–Responsibility of Head of Service Mental Health
1 The community healthcare organisation can demonstrate they are implementing their National Framework for Recovery 2018-2020 Implementation Plan.
2 The value and mission statement of the organisation is inclusive of co-production and enhancing recovery practice and have a strong degree in interest in the development of recovery focused practice.
3 The organisation can demonstrate their commitment to recovery by investing in recovery initiatives.
4 The organisation can demonstrate that lived experience is considered in the design, delivery and evaluation of services.
5 The organisation prioritises multidisciplinary teams that have expressed an interest in having a PrSW on their multidisciplinary team.
6 The organisation can articulate why it is hiring a PrSW and what outcomes are anticipated with the addition of a PrSW role.
7 Senior management support peer support working.
8 The community healthcare organisation has ensured privacy for the PrSW’s previous experience as a service user of the organisation.
Responses
Human Resources-Responsibility of Head of Service Mental Health and National Recruitment Service
1 Recruitment for the PrSW role will be in line with the agreed national job specification and eligibility criteria for the role.
2 The number of hours and the schedule of the position (i.e. what days are scheduled, is it morning or evening work etc.)is agreed from the onset of the role and communicated to everyone.
3 The PrSW has a clear and standardised contract which is explained in detail to them.
4 There is an understanding that as part of the recruitment process the candidate for the role of PrSW will be asked to demonstrate: a) Their understanding of, and training in, peer support b) How they have used and /or how they will use their peer support approach (using intentional use of lived experience and sharing wellness strategies) in sample scenarios they are likely to encounter in their role.
5 There is an understanding that as part recruitment process the candidate for the role of PrSW will be not be asked questions on their health and wellbeing that would not be asked of all other staff.
6 When checking references the employer is careful not to disclose that the PrSW role requires someone with lived experience.
7 HR informs Occupational Health that it is sufficient to accept a letter from the potential candidate’s doctor/GP to state that their mental health is in maintenance.
8 The line manager has identified a supervisor who has supervisory experience with a recovery ethos and capacity for the supervisor role.
9 The multidisciplinary team can provide evidence of their involvement in recovery activities they participate in, e.g. Recovery Education Facilitators and WRAP facilitators, working on co-production groups involvement in service improvement, etc.
Multidisciplinary Team Readiness-Responsibility of Head of Service Mental Health
1 The multidisciplinary team can demonstrate an openness to change and have an understanding of recovery practice and co-production.
2 Co-production is central to the multidisciplinary team’s practice when working with service users and family members.
3 The service agrees that the PrSW will not have to take up any duties of other team members especially when there is not a full complement of staff.
4 The majority of members of the multidisciplinary team have completed Recovery Principles and Practice Module 1 workshop and are willing to complete Recovery Principles and Practices Module 2.
5 The multidisciplinary team have incorporated recovery into their service plan to enhance recovery practice within their team.
6 The multidisciplinary team have a clear understanding of the specific tasks of the PrSW role and place a value on same.
7 The multidisciplinary team have agreed a line manager who has capacity for the line management role and is positive about the role of peer support working and works with a recovery ethos.
8 The line manager has identified a supervisor who has supervisory experience with a recovery ethos and capacity for the supervisor role.
9 The multidisciplinary team can provide evidence of their involvement in recovery activities they participate in, e.g. Recovery Education Facilitators and WRAP facilitators, working on co-production groups involvement in service improvement, etc.
Line Management and Supervision- Responsibility of Peer Support Worker Line Manger
1 A clear governance structure that identifies who line manages the PrSW, who is responsible for expenses, who approves annual leave and who is responsible for supervision is created for the PrSW.
2 The PrSW supervisor is a champion of peer support working.
3 The PrSW supervisor has received guidance in peer support working and practices.
4 The PrSW supervisors have access to other PrSW supervisors within the HSE and are aware of the link person for National Mental Health Engagement and Recovery.
5 PrSWs are not line managed or supervised by personnel who provided them with clinical services.
6 The PrSW has access to HSE induction training.
7 If further in-service training is required, such as writing in service user notes, a plan is created to achieve this.
8 The PrSW is encouraged to attend regular forums with other PrSWs nationally.
9 PrSWs are aware of the link person for the National Mental Health Engagement and Recovery team and their contact details.
10 If the PrSW was a service recipient, or is a service recipient, extra precautions have been taken to ensure privacy. The PrSW and the service provider are made aware of these precautions. Boundaries are established and extra supervision is allotted to ensure both workers can navigate these boundaries.
Evaluation of the experience of hosting Peer Support Worker students on placement in
Appendix 3: Role Clarity Tools
Evaluation of the experience of hosting Peer Support Worker students on placement in EVE New Horizon
Evaluation of the experience of hosting Peer Support Worker students on placement in EVE New Horizon HUB
