Service providers’ perspectives on youth peer support: the importance of integration and oversight – an interpretive description study in British Columbia, Canada

Abstract

Objectives

Peer support in youth mental health settings holds promise as a developmentally appropriate and impactful initiative; however, research exploring implementation remains limited. To advance the field and strengthen future implementation efforts, the aim of the present study was to generate new understandings about how non-peer service providers working alongside youth peer support workers experience the peer support role in youth mental health settings.

Design

Guided by interpretive description and tenets of a research community partnership model, semi-structured interviews were conducted with non-peer service providers (n=11) across three integrated youth services centres in British Columbia, Canada, from August to December 2020. Data were analysed inductively using a constant comparative approach to identify and construct themes.

Results

Participants emphasised integration and supervision of youth peer support workers as essential for successful peer programming within integrated youth services, highlighting three interconnected themes: defining supervisory roles, envisioning role clarity and capacity and governance of youth peer support services.

Conclusions

Integrated youth services initiatives and peer-led agencies can play key roles—both directly and indirectly—to strengthen the governance and infrastructure of youth peer support.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• Providing rich insights from a heterogeneous sample of service providers at integrated youth services centres across urban, rural and northern settings in British Columbia, Canada.

• Using interpretive description methodology and tenets of a research community partnership model to effectively leverage experiential knowledge within practice disciplines and community care settings, ensuring relevant and practical next steps.

• Contributing evidence to inform best practices and support services for providers and organisations integrating the role of youth peer support worker.

• Offering opportunities for future research and policy, noting a nuanced understanding of youth peer support in a specific context.

• Conducting this study during the COVID-19 pandemic and during the early stages of programme implementation in British Columbia, without collecting longitudinal data, highlights the need for future research focused on understanding and evaluating the evolving experiences across supporting disciplines and regions over time.

Background

Peer support is widely recognised as an essential service in recovery-oriented mental healthcare around the world.¹,⁴ Peer support reflects programming or health services provided by people with lived and living experience of recovery from a similar health or social challenge.⁵ Given widespread discriminatory and stigmatising attitudes towards people with mental health and/or substance use challenges, including in the healthcare context,^{6 7} the potential benefit of peer support holds unique value. However, such stigma also extends to those employed in peer support roles—that is, peer support workers—serving as a barrier to developing positive workplace cultures and negatively impacting the success of peer support initiatives.⁷

Although there is a wide spectrum of peer support delivery models, they share an emphasis on connection and are valued for their potential to support the provision of non-judgemental, meaningful and mutually agreed-on engagement to promote wellness.⁵ The evidence base for peer support services has grown considerably over the last 15 years, with increasing attention to training, certification, competencies, standards, reimbursement mechanisms, delivery models and populations served across diverse settings.⁸,¹¹ Research suggests that effective integration of peer support roles requires organisational readiness, supportive management and transparent policies and procedures.¹²,¹⁴ Thus, effectively integrating and implementing peer support in clinical services is a complex undertaking.

Within the literature on peer support in mental health settings, there is evidence of tensions relating to scope of practice, including questions about whether peer services interrupt, or, conversely, complement other healthcare service provider roles and responsibilities. For example, past research has suggested that peer support workers are as effective as their non-peer service provider colleagues when comparing a range of psychiatric outcomes.¹⁵,¹⁹ Some scholars argue that these comparisons are problematic because they minimise the clinical expertise of regulated healthcare professionals,²⁰ while others suggest that such comparisons risk overshadowing peer support workers’ unique contributions to recovery.²¹ In either case, role confusion and conflict between peer and non-peer service providers have emerged as a concern.^{22 23} In the youth mental health context, this tension has been identified as contributing to ‘uncertainty among clinical staff about the boundaries of the peer role and the potential for ‘tokenism’.²⁴ Moreover, a lack of role clarity, training and integration into the clinical team has been noted to contribute the greatest challenges to establishing the peer support worker role.²⁵,²⁸ Hopkins et al found that non-peer mental health service providers felt they would have increased confidence in working alongside youth peer support workers (YPSWs) if clinical benefits were better articulated. They note that “clinicians and peer workers entered the multi-disciplinary space with conflicting views about issues such as record-keeping, confidentiality, risk assessments and boundaries”.²³ A lack of consistency and clarity in role, scope and setting contributes to confusion and frustration among YPSWs and their non-peer service provider colleagues. Efforts to bring clarity to the YPSW role and scope, while simultaneously addressing evolving tensions in youth healthcare settings, are an emerging priority. However, research interrogating this tension and exploring the YPSW role from the perspectives of diverse healthcare providers is notably lacking. Thus, the aim of this study is to understand how non-peer service providers working alongside YPSWs experience the peer support role in youth mental health settings.

Methods

Study design

Interpretive description methodology and principles of research-community partnerships were used to address the study aim. Interpretive description supports a constructivist approach to qualitative inquiry that privileges disciplinary knowledge and leads to the generation of findings positioned for clinical impact.²⁹ Research community partnerships provide an approach to research premised on the idea that collaborating with community-based partners results in findings that are more useful to individuals and organisations making decisions about health policies, programmes and practices.^{30 31} In conducting this research, the tenets of interpretive description and research community partnerships were operationalised through a collaboration with Foundry, an integrated youth services (IYS) initiative operating in British Columbia (BC), Canada. IYS aims to provide a youth-friendly, holistic and streamlined approach to assessment and care that addresses the multifaceted and often interrelated health and social needs of youth, including those related to mental health.³²

Study setting and recruitment

In recent years, IYS have emerged globally as a best practice in responding to youth mental health.³³ Within this model, peer support serves as a central service. In BC, Foundry operates a network of IYS across the province.^{34 35} At the time this study commenced in 2020, there were 10 operational centres in BC and a new provincial virtual service that launched in May 2020, along with virtual appointment options at centres in response to in-person appointment restrictions due to the COVID-19 pandemic. Across the IYS network, volumes ranged from 1440 to 2666 unique youth client visits per month, totalling 46 699 visits per year (personal communication, Foundry data team). At this time, peer support services were accessed during approximately 5% of these visits,³⁶ which may reflect funding constraints that limited peer availability at that time. When data collection began in August 2020, the IYS network employed 26 YPSWs and over 450 service providers from various disciplinary backgrounds, including medicine, nursing, counselling and social work. YPSWs employed through the IYS had at least a Grade 12 education, a willingness to self-identify as a person with lived or living experience of mental health or substance use challenge(s), and an openness to sharing their personal journey of recovery.

For the purposes of this study, three IYS centres reflecting geographically diverse communities (northern, urban and rural) were selected for study inclusion and supported recruitment. Non-peer service provider participants were recruited through internal Foundry email communications and directly at local centre staff meetings. Sampling was purposive and sought to include participants representing diverse professional roles. Participants were eligible if they met the following criteria: (a) they worked at a participating IYS centre in the delivery of health or social services, (b) they had been in their role for more than 3 months and (c) they were employed in a regular full-time or part-time position. Service providers who responded with interest were invited to participate in a 30–60 min semistructured interview, following the provision of written informed consent.

Data collection and analysis

Data were collected through individual semistructured interviews using a guide informed by the extant literature and developed in consultation with Foundry staff and YPSWs. Questions explored participants’ understanding of the YPSW role, personal experiences working alongside YPSWs and any perceived challenges with the YPSW role at their centre, while allowing participants to expand on role-specific and community-specific experiences. All interviews were conducted by the lead author via Zoom between August and December 2020. Interviews were audio recorded, transcribed and uploaded to NVivo V.12 to organise for analysis.³⁷ As per interpretive description, an inductive analytical approach was used, with data analysed using a constant comparison approach grounded in the research team’s disciplinary knowledge.³⁸ This process began with a thorough reading and re-reading of all transcripts with notetaking to support evolving analytical thinking. Preliminary analytical ideas were then constructed into broad codes, followed by a process of grouping recurring concepts together. These groups of data were then interrogated to make sense of patterns and relationships.²⁹ Integrity of the analysis was supported through reflexive discussions among team members (CD, EJ and SPB), noting and examining individual perspectives and values.²⁹ Finally, relevant patterns were reconstructed into themes facilitating interpretive thinking, reflecting and elaborating meaning.

Patient and public involvement

We collaborated closely with a centralised team within Foundry, including YPSWs, who were responsible for developing peer support standards and recommendations to guide practice. This team played an active role in informing research questions and data collection tools and guiding recruitment efforts.

Findings

A total of 11 non-peer service providers participated in an interview for this study. Most participants identified as women (82%) and were in full-time positions (64%). Participants from urban (n=3), rural (n=4) and northern (n=4) centres reflected disciplinary backgrounds in social work, counselling and nursing. Of these, 36% were responsible for the direct supervision of YPSWs (see table 1).

Table 1. Characteristics of participants.

		Total participants (N=11)	%
Gender Identity	Man	2	18
	Woman	9	82
Setting*	Urban	3	27
	Rural	4	36
	Northern	4	36
Employment status	Part time	4	36
	Full time	7	64
Role	Manager	2	36
	Nurse	3	27
	Counsellor	3	27
	Social worker	1	9
	Access/care worker	2	9
Experience at IYS centre	<1 year	2	18
	1–2 years	4	36
	>2 years	5	45

^*Urban, rural and northern settings are defined according to the Government of Canada.^{51 52}

IYS, integrated youth services.

Across interviews, participants identified integration and supervision of YPSWs as foundational to the successful implementation of peer programming within IYS. This was further delineated into three broad and interconnected themes: (1) Defining supervisory roles; (2) Envisioning role clarity and capacity and (3) Governance of peer support services. Details of these themes are elaborated in the following sections.

Defining supervisory roles: the provision of direct supervision in the context of youth peer support

Defining the nature of direct supervision of YPSWs by non-peer service providers (ie, regulated health professionals who are not required to have lived or living experience of a mental health or substance use challenge as a prerequisite for their role) was constructed as a theme. This supervisory role was perceived as beneficial for direct reporting processes and decision-making related to the YPSW role. However, all participants noted a need for the direct supervision role to be clarified to improve coordination, operationalisation and quality of the direct supervision of YPSWs across the IYS network.

For example, some participants identified a lack of professional development opportunities focused on supervision of YPSWs. Moreover, all participants who had a defined role in supervising YPSWs reported they had not received any peer-specific supervisory training. These participants shared that a lack of role clarity was particularly challenging due to the size of their portfolios and competing job demands. Specifically, they noted limited time to develop relationships with the YPSWs or to understand the core competencies of peer support, impacting their ability to adequately assist the YPSW role. For example, one participant who held a supervisory role acknowledged that peer support is complex, and that “zero” training was provided to equip them for this role (SP.11). Another participant at the same centre without a supervisory role shared, “There’s no formal training for this, how the [YPSWs] should be used, or how they should be integrated into the team” (SP.10). Overall, many of the participants expressed a need for a comprehensive orientation and education materials to better prepare them as supervisors of YPSWs.

Opportunities to develop structured and comprehensive training opportunities for both the YPSWs and other service providers working across the IYS network were identified. For example, because YPSWs are themselves navigating a mental health recovery journey, a few participants noted that supervisors should be able to understand how patient acuity and diagnosis might affect or potentially trigger mental health deterioration for a YPSW so that the supervisor can plan accordingly. For example, one participant recalled:

What I saw previously, anyways, was… when somebody did have a difficult meeting or was triggered because they weren’t getting that support, it either went the wrong way or resolved, but a lot of times it ended up in [the YPSW] getting sick. Then, instead of looking at this other whole aspect of what could be done to support them, it was just like, “Oh, you know, maybe they weren’t far enough along in their own journey.” (SP.05)

Other participants commented on the need for informed decision making when it comes to YPSWs’ client assignment, including one who shared:

There’s been a couple of challenging clients for sure and… I hope [YPSWs are] not feeling out of their realm. Now the new [YPSWs] that come on, I would be hesitant to suggest high-risk people until [they are] a little more experienced. (SP.06)

While lived experience of a mental health or substance use challenge is a prerequisite of employment as a YPSW, having a mental health and/or substance use diagnosis was not limited to peers. Some non-peer service providers shared that they themselves live with a mental health condition and noted that maintaining their mental health is also a critical part of their role. These participants shared that when direct supervisors have their own lived experience with a mental health condition, they are well positioned to provide oversight to YPSWs. Indeed, many participants suggested having lived experience as a prerequisite for all direct YPSW supervisors, as it would help position them to identify further needed supports to ensure the success of peer support services.

Finally, among participants who identified that direct YPSW supervision was part of their operational or clinical role, a few noted the challenge of balancing this role with urgent clinical demands in an IYS setting. For example, one participant shared, “The previous [YPSW] who was here, he probably got most of his [supervision] support actually from the other [youth] PSW, just because I wasn’t able to do it because I was overwhelmed” (SP.05). However, it was also suggested that when the responsibility for direct supervision shifts to another peer, it contributes additional workload challenges for peer colleagues and contributes to further tensions. Participants explained that when direct supervision represents one of several operational responsibilities, it creates the potential for it to be deprioritised. As one participant explained, “I think that [YPSWs] require a lot more [time]… they would benefit from a lot more direction” (SP.11). This participant further noted that expectations for professional performance need to be communicated to YPSWs but suggested that this requires the direct supervisor to have a foundational knowledge of the core competencies and role of YPSWs.

To summarise, all participants acknowledged the importance of direct peer supervision of YPSWs. However, many noted a need for more training for non-peer service providers and operational support to balance workload while growing the capacity of the YPSWs on the team.

Envisioning role clarity and capacity

Most participants described a need to have YPSW role clarity, including scope of practice, as well as a map of professional development opportunities for growth and capacity development. Some participants identified a need for a peer support practice lead across the IYS initiative who could support two main goals: (1) bring clarity to the YPSW role and (2) work with YPSWs to prepare them for practice within IYS and direct professional development over time. Focus on these two areas was seen to hold the potential to guide the development of peer support standards and best practices for this growing profession within the IYS context.

Clarifying the YPSW role

Participants from across the three IYS centres shared challenges with understanding the boundaries of the YPSW role. Some considered the role to be flexible and guided by a peer’s particular strengths (eg, their ability to connect with disengaged youth, provide harm reduction education, share experiences with a specific mental health diagnosis) and the needs or goals of the youth clients. For example, one participant shared, “[YPSWs are] kind of like the 9-1-1 of [our centre]” (SP.06), conceptualising the role as contributing to managing various crises that arise. However, others conveyed less confidence in understanding how to best engage YPSWs in the delivery of services. Such challenges were compounded by a recent transition at the time interviews were conducted, resulting from COVID-19 health protection restrictions, to include a hybrid service delivery model wherein both in-person and virtual services were available at each IYS centre in this study. This contributed to a new work culture that limited informal opportunities for YPSWs to connect with other IYS service providers and to convey their strengths and responsibilities. Participants shared that within the IYS initiative, “there was no formal learning” (SP.07) about the role of YPSWs. If service providers wanted to grow their understanding, “it would be through other avenues” (SP.10) and driven by their own initiative. For example, one participant explained that they had joined a professional interest group, external to their IYS centre, to better understand the role of peer support. While they found it beneficial, it required their own personal time and resources. Moreover, such external opportunities do not address gaps in understanding that contribute to confusion and, potentially, the misuse or underutilisation of YPSWs in IYS settings.

In the absence of YPSW role clarity, different expectations of YPSWs and their related practices emerged. For example, preferences concerning how YPSWs should document their actions in clients’ health records were mixed. Some believed that because the teams were small and held frequent care planning meetings, documentation beyond high-risk concerns was unnecessary. Others described that YPSWs at their centre always document in the health record, even if just to report that a client attended a therapeutic group. As one participant explained:

If they were running a group or facilitating something… [documenting] how [the client] participated… [allows] that open communication. So, as a provider, [if] I wanted to see if this individual was engaged, let’s say, with any rehab programming during the week, I can see that. (SP.09)

Indeed, while some participants expressed that documentation of peer support activities was unwarranted, others felt that capturing the full spectrum of intervention in the health record was beneficial and used this information to inform their practices. Concerns were also raised about YPSW’s access to medical records. For example, one participant shared, “If you’ve had access to that patient’s chart, that sort of put you power level-wise, it sort of put you on a different position” (SP.10), which could result in an unbalanced relationship between youth clients and their YPSWs.

Beyond needing further clarity on the YPSW role and related practices, some participants identified the need to strengthen YPSW referral pathways. For example, most participants described an informal process whereby service providers approached YPSWs with requests to connect with a youth client. As one participant shared, “We’re sort of intertwined in our clinic. If I need anything, I just walk to their door” (SP.09). Although this suggests strong peer integration within the IYS team, it also illustrates the ways in which peer support may be undervalued. As one participant described,

As far as referring people to a [youth] peer support worker, I’ve never done it. I mean, it’s never been part of our workflow… if people are wanting to connect with the [YPSW], it would often be through like the front desk. (SP.10)

This participant elaborated that there was no formal process for service providers to refer to peer support directly. Despite these strains, all participants expressed a genuine appreciation for the role of peer support in IYS and described meaningful benefits among their team, for youth clients and within the broader community.

Equipping YPSWs across the IYS initiative

In addition to articulating the need for clarity of the YPSW role in youth mental health settings and the development of consistent peer support practice standards or protocols, some participants expressed interest in innovations to centralise peer support leadership. These participants noted that a leadership position would be useful in building and equipping YPSWs and their direct supervisors to better support integration of peer roles across the IYS initiative. As one participant noted:

Having people report to them directly, being responsible for doing all of the strategic pieces around peer support work and how we deal with it in the [IYS] centre and how we are trying to expand that out to the community. So, we’ve got always a million ideas for peer support work and, you know, I think this [type of role] can be really key in helping make sure we’ve got the right people to do the work [and] that we’re kind of getting it right. (SP.05)

It was suggested that such a position focus on championing peer support services and ensuring that other demands do not overshadow peer programming. Additionally, some participants recommended that the role could facilitate YPSWs’ career progression, sharing:

So, what are we doing to help support those peers to get that same kind of support so that they can feel confident to start taking other steps to start applying for other jobs?… [Ideally, the IYS initiative] would develop some sort of pathway for peers… I really would like some sort of process, some pathway for [YPSWs] so that they could step into other positions. (SP.11)

Indeed, some participants expressed that the IYS initiative ought to be supporting YPSWs in developing their skills and confidence to transition into new opportunities as they age, such as returning to school or pursuing other employment opportunities. A peer support leadership role was thus framed as a mechanism through which to encourage YPSW potential, while also creating a more sustainable and embedded role for ongoing peer support education, training and mentorship.

In summary, many participants described an opportunity for the IYS initiative to support mentorship, professional development and evaluation of youth peer support services, extending beyond the current provisions by direct supervisors. Participants implicitly and explicitly identified that a centralised lead for peer support could help to clarify the peer role, develop documentation standards, support teams to develop workflows and create an avenue for local sites to innovate and initiate new peer support opportunities.

Governance of youth peer support services

In addition to suggestions regarding direct supervision and the creation of peer support leads, governance was prominent across interviews and was framed as best coming from an agency external to the IYS initiative. One perspective was that governance of youth peer support services should itself be peer-led. As one participant shared, “[The] role is meant to be peers, which is very different from [just saying] that you’re an employee” (SP.11). This participant highlighted the complexity associated with integrating peer support into healthcare services wherein biomedical knowledge and professional regulations are privileged. They shared that if the integration of peer support were governed by an external peer-led agency, the initiative’s structure would naturally allow for some necessary separation.

Other participants also described potential benefits of peer governance external to IYS delivery, as well as suggestions for how such an agency could support the YPSW role. For example, a few participants recommended that an agency could advocate for the provision of a mandate for direct supervisors to have lived experience of mental health recovery and encourage protected time for weekly supervisory meetings to build relationships and integration. Further, participants recommended that an external peer-run agency could ensure access to peer-specific education or continuing professional development opportunities, helping to support peers in transitioning to other health or social service roles. One participant shared further justification for an external agency in light of ongoing change within the IYS initiative:

I think as staff change and [as] leadership changes over the years, you know, the priorities [have become] more clinical, and are clinically based. And so, it’s easy to lose sight of like why things were set up in the first place and then, you know, things just run by themselves in some ways. (SP.10)

For this participant and many others, there was a belief that a peer-led governance structure would help maintain a peer support mandate amidst periods of shifting priorities within the IYS initiative.

However, not all participants shared this perspective. For example, one participant expressed that the IYS initiative was making strides toward improving its internal governance for YPSWs and that moving to an external governance model could lead to negative implications for peer support integration. Moreover, internal governance was positioned as allowing for the IYS initiative to make decisions regarding how to best structure and use YPSWs in their local centres. For example, one participant who was a direct supervisor shared that they leveraged the internal governance to make a decision to post YPSW jobs as 1-year contracts. They felt this allowed the YPSW to gain valuable experience, receive training and build their resume to support them in transitioning to longer-term employment or schooling. They shared:

When we first started, [YPSWs] were just hired, and we didn’t have terms. But then it became apparent that our [YPSWs] were not gonna leave. And they would be here for a long time. And I felt that was not the goal of peer support, and it wasn’t fair to other kids in the community that wanted to give it a shot ‘cause we’re the only peer support in town. And so, as [YPSWs] left [their positions], we hired on new people on one year terms. (SP.02)

These short-term contracts further eliminated concerns at the centre about peers ageing to the point that they could no longer be considered ‘peers’ in the context of their youth clients. For this participant, IYS centres maintaining control over the structure of their YPSW contracts was a strength. However, some centres intentionally employed senior YPSWs who hold ongoing contracts, with the goal of retaining organisational capacity for the YPSW role.

In summary, concerns about the governance of peer support services within IYS draw attention to the importance of establishing infrastructure to support peer programming and to consider the strengths of various models to further operationalise a YPSW vision.

Discussion

In recent years, youth peer support has emerged as a promising initiative within youth mental health services^{39 40} and yet there remain substantial evidence gaps to inform practices and support service providers in best implementing and integrating this role within their clinical contexts.¹⁴ In this study, we contribute to addressing this gap, exploring how the role of youth peer support is experienced by non-peer service providers employed in IYS. Importantly, we identified several opportunities to strengthen the provision of peer support while better supporting the health and well-being of YPSWs, non-peer service providers and youth clients.

Our findings complement and extend the findings of prior research conducted within IYS in Australia, which has focused on the importance of youth peer support supervision from the YPSW perspective.⁴¹ This research also identified direct supervision as critical to the success of the YPSW role, while our study offers new insights to operationalise this supervision, including establishing appropriate training and professional development opportunities for direct supervisors and employing direct supervisors who also bring lived and living experience of recovery from mental health or substance use challenge(s). These recommendations align with findings from research conducted in the USA that explored direct supervision of peer services in adult mental health settings.^{12 42} In addition to lived experience, other scholars have noted that those working in supervisory roles would benefit from direct experience as a peer support worker.⁴³ The organisation Intentional Peer Support notes that prior peer support employment may cultivate expertise through co-reflection—a collaborative, reflective practice where peers engage in mutual exploration of their experiences and shared learning.⁴⁴ This practice has been identified as a valuable supervisory skill within peer support and an important pathway for career development.⁴³ In short, available research suggests the need for a coordinated approach to peer supervision, where unique insights, feedback and guidance complement traditional hierarchical structures. Researchers have found that when healthcare leaders are exposed to and understand peer work, they demonstrate greater acceptance and commitment to the peer workforce, including the creation of dedicated peer management positions.⁴³ Several national and international organisations offer training for service providers working in direct supervisory roles with peers in adult mental health contexts. For example, the National Association of Peer Supporters (USA) offers training and credentialing for peer supervisors, and the Mental Health Coalition of Australia offers a 2-day training for people with lived experience who wish to become peer supervisors within their organisation. Support House, an organisation providing supportive housing services to people living with mental health challenges in Ontario, Canada, offers an online supervisorial training endorsed by Peer Support Canada (A. Dunning, personal communication, September 2022). However, many youth-serving agencies are new to operationalising the supervision of YPSWs in their settings. Moreover, because YPSWs may be early in their recovery journey and experiencing employment for the first time, there may be unique competencies to consider, as well as intentional efforts needed to support peers’ evolving professional development needs.^{45 46}

Service providers shared challenges with understanding the scope of the YPSW role. Importantly, the variability in how service providers are conceptualising the YPSW role creates opportunities for different expectations to emerge, a situation that has also been identified in research conducted in adult settings.²⁷ The creation of a learning pathway for service providers to become more acquainted with the role of peer support has been suggested as helpful⁴⁴ and may also benefit YPSWs within the IYS.

Globally, there is a policy commitment from some countries to reinforce and sustain peer support by strengthening accountability mechanisms in governments.⁴⁷ However, unlike other health and social care professions, peer support governance, particularly training and certification processes, has largely been left to individual organisations or local agencies to implement and develop independently. As a result, the approach remains uncoordinated and there is a pressing need for governments to support the adoption of peer support roles, including youth peer support, in order to promote consistency, safety and quality. In BC, Canada, Foundry is leading the development of the YPSW role in IYS. In 2018, Foundry developed and launched the province’s first youth-specific peer support worker curriculum. Aligned with the direction of the nationally recognised organisation Peer Support Canada, the opportunity exists to establish a provincial YPSW advisory council to provide guidance and governance for youth peer support services. Importantly, such a council could provide a platform for the various people and organisations engaged in peer support to participate in dialogue to advance best practices and promote ongoing development in the field.

Practical recommendations

To strengthen youth peer support models, several key improvements are needed based on our findings. First, role clarity is a priority and would benefit from standardised learning pathways for non-peer service providers and the promotion of coreflection practices to foster mutual understanding. Second, supervisory capacity could be strengthened by employing supervisors with both lived experience and peer support employment backgrounds, and by offering formal training through recognised organisations. Third, YPSWs—many of whom are early in their recovery and employment—need flexible, supportive environments and structured professional development opportunities, including mentorship. Improved governance is also essential. Establishing provincial or national advisory councils and adopting consistent certification and supervision standards would help ensure service quality. Additionally, peer documentation practices must be addressed. Health services organisations should explore how documentation could be managed through shared approaches that reduce power imbalances, while recognising legal and professional requirements. Finally, the lack of formal referral pathways to peer support workers is another critical gap. Without clear processes for connecting youth clients to peer services, peer support may remain underused. Developing these pathways is essential for improving access, visibility and the appropriate integration of peer support within the broader IYS model. Organisational and cultural change will be necessary to sustain these efforts; this includes fostering leadership exposure to peer work and integrating peers into decision-making processes to authentically reflect lived experience in service development and delivery.

Limitations

This study provides rich insights from a heterogeneous sample of service providers at IYS centres across urban, rural and northern settings in BC, Canada. Nevertheless, several limitations to the study warrant discussion. First, because data collection occurred during the COVID-19 pandemic, virtual interviews were used, with inconsistent internet services resulting in some participants having to turn off their cameras, making it challenging to observe, and therefore interpret, visual cues. When this occurred, clarification was sought through follow-up questions to mitigate the potential for misunderstandings. However, it should be noted that this interview setting may also have provided participants with a greater sense of security within which they could provide authentic insights.⁴⁸,⁵⁰ Second, given the IYS study context, there is the possibility that participants may have responded to interview questions in a manner that was more favourable than their actual experiences. To address this concern, the study was framed as being conducted independent of Foundry and efforts were made to protect the confidentiality of participants and the experiences they shared. Third, this study did not directly involve YPSWs in data interpretation, analysis or dissemination. This was primarily due to limited resources. Future research could more thoughtfully integrate their contributions within the interpretive description framework to enhance the depth and relevance of findings. Finally, this study was conducted in the early stages of establishing the IYS model in BC. Future research would benefit from the inclusion of longitudinal qualitative designs that capture the ongoing experiences of participants across disciplines and additional IYS initiatives. Such an approach would strengthen the transferability and broader implications of our findings. Despite these limitations, this study reflects a diversity of IYS contexts, representing northern, urban and rural communities, all at various stages of programme development. It further includes perspectives from a professionally diverse group of non-peer service providers. This intentional diversity contributes to valuable knowledge that can be used to address concerns and create new opportunities for YPSW supervision, role clarity and integration.

Conclusions

According to non-peer service providers, YPSWs have an important role when IYS initiative structure, training and supervisory support exist to integrate YPSWs within the core model of care. Notable differences in training and supervision needs for YPSWs, as perceived by non-peer service providers, were identified. While a general approach to training and supervision may be de-stigmatising, given that age and lived or living experience of mental health or substance use challenges are a prerequisite for employment, building a training and supervisor model to better prepare YPSWs to thrive across IYS teams is critical. As the IYS model scales across Canada, standards for how best to integrate YPSWs within the overall team are needed. Clarity of roles and responsibilities will highlight the value added by YPSWs in this setting to improve outcomes and experiences of youth clients and YPSWs, while improving the efficiency and quality of IYS care.

Data availability statement

Data are available on reasonable request.