Stephanie Barker on peer support and homelessness: understanding what makes it work

Peers are those who have been there and survived. They have intimate knowledge of social systems, barriers that they experienced, and know people or services that can help.

First published February 2019 by Dr Stephanie Barker, Research Fellow, University of Southampton.

People who are homeless usually represent individuals who have the most complex issues that often cause breakdown in relationships with family, friends, and support service alike. The experience of homelessness subjects a person to isolation and feelings of worthlessness, which can lead to depression and loneliness. This is important, as research has found that social support is vital to health—weak or non-existent social ties is a risk factor for death, comparable to smoking.

Peers are those who have been there and survived. They have intimate knowledge of social systems, barriers that they experienced, and know people or services that can help. Peers have a unique ability to access those who are socially excluded and recent work evaluating Groundswells Homeless Health Peer Advocacy (HHPA) programme showed how peer advocates have been able to have a positive impact on people’s lives and save social systems money.

“If they hadn’t taken an interest in me, I would be dead by now”—Daniel

Daniel, who had suffered many health problems as a result of being homeless, spoke about the peer advocates who had helped him on his journey out of homelessness. People like Daniel express how peer advocacy can have such a massive impact on their lives, but research has not been consistent in its findings. Narrative data recounts the positive impact of peer support, but this is not consistently reflected in statistical analyses—impacting on the availability of funding.

I research and work within peer support and homelessness, trying to provide a much-needed evidence base. This blog summarises one study that I did with peers and clients as part of my PhD. Not only is it important to publish these studies in journals, it is key to communicate outcomes to the peer support community, sharing new knowledge and stories from people who have survived and thrived so that we all can learn how important and valuable lived experience is.

Arguably, once we have a better theoretical understanding of how peer support works, we can test it appropriately to provide an accurate picture of the real impact of peer advocacy. A recent study, “Peer support critical elements and experiences in supporting the homeless: A qualitative study” began this process. The aim was to understand what peers and clients believe are the critical factors for effective peer advocacy. We interviewed 29 people from different organisations in England and asked about their experiences and what they thought was important about peer mentoring.

The analysis resulted in six themes describing participants’ experiences and opinions of key elements peer mentoring:

1) ‘Never Give Up’ –  describes how peers are persistent and committed in providing support.

2) ‘Experience-based Relationships’. Peer-mentors develop relationships with their clients based on their shared experiences of homelessness; they connect as equals and are distinct from professionals and informal peers because of their experiential knowledge of homelessness, as described by one peer:

“So if someone gives them that (gestures to a piece of paper) that is the client. The client can come through the door and they could stand on their hands again the wall, for two hours, but [professionals] will always…be talking to this (paper) than the person…And that’s where I am (gestures to wall) standing on my hands with this person. Having a chat. And this (gestures to a piece of paper) I can do later. If you train me how to do it, I’ll do it later, but I’m not going to do it first.” – Oliver

3) ‘Motivations’ to engage in peer advocacy. Participants described the importance of their peer advocates having honest or genuine motivations to. Barriers to providing support are described in ‘Overcoming Obstacles’, such as policies, client behaviour, maintaining own recovery, and coping with difficult service staff.

4) ‘How Peers Help’ outlines the methods peers use to support their clients—being role models, breaking barriers, providing individualised treatment and social support. For example some participants talked about receptionists being “battle axes”—a formidable barrier to getting their client help:

“If you don’t get past the receptionist, you don’t see the doctor” –Harry

5) ‘Breaking boundaries’. Some peer advocates reported ‘breaking boundaries including buying their clients alcohol, ‘moving’ them and all of their possessions and being available out of hours:

“If it’s very important, I do cross boundaries sometimes… we’ve crossed so many boundaries just to get this person, you know thinking that, otherwise something more serious would have happened you know what I mean. At least I know I’ve actually helped someone” –Timothy

Severe as they might seem, when understood in context, peer advocates described they were making judgment calls on a case-by-case basis.

6)  ‘Benefits for Peers’ explores the idea of the advocate being in a  helping role. This impacts the peer advocates self-esteem, confidence and identity:

“I felt valued and to have a purpose, to be able to work and felt capable of, you know how I felt, my self-esteem, made me feel better about myself, stronger.” – Diane

This work is a foundation to building the theoretical basis of peer support, developing a testable and clearly defined intervention that helps people escape homelessness for good.

If you would like a copy of the study, please click here to request a copy from Stephanie.

You can follow Stephanie on twitter @stephLBarker.