This resource was developed for Project 100 by Margot Uden
Standard 1 of the National Standards for Peer Support in HIV states that: ‘everyone living with HIV should have access to peer support.’ Our response to this is the development of a resource accessible for anyone interested in setting up a peer support project for people living with HIV. You may be a clinic, voluntary organisation, informal group or individual.
By peer support we mean people using their own experiences of living with HIV to support other people living with HIV. The principle for setting up a peer support project will be the same for any setting. Therefore we are hoping that the resource will be useful to people and groups across a range of health conditions – both physical and mental.
The resource has been developed using Positively UK’s experience of developing models of peer support, peer mentoring and peer support training – most recently the Project 100 accredited Peer Mentor training. The intention of this resource is that whether you are developing a small scale, self-started grass roots project or a more formal peer support project within the NHS or voluntary organisation, you can adapt the model offered to your needs.
The National Standards for Peer Support in HIV defines peer support as ‘a relationship in which people see each other as equal partners and where the focus is on mutual learning and growth.’ This resource gives help and support to build a structure for peer support, but does not prescribe what your model might look like.
Peer Support and Peer Mentoring are often used as interchangeable terms, and are very similar. A Peer Mentor is also someone who has lived through an experience supporting someone new to that experience, however it generally refers to a one-to-one relationship.
Peer Mentoring is often used to describe more structured, one-to-one support over a period of time. The relationship has an agreed beginning and end with a focus on action planning and problem solving when going through a particular issue. Ultimately, a Peer Mentor will model positive behaviour and help create strategies which will lead to better self-management and wellbeing.
The way that people access and benefit from peer support ranges from one off, circumstantial interactions to entering into a more formal one-to-one relationship (Peer Mentoring), or structured group support:
In this resource we are suggesting a model for any kind of peer support, but generally that which involves something that is more than incidental. You may be an individual, keen to start a walking group for people living with HIV (or possibly another mental or physical health condition), or an NHS Sexual Health Clinic wanting to incorporate peer support into your service. This resource will help you build your foundations and allow you to be creative.
Different peer support models and projects will refer to the volunteers or employees delivering support in different ways. As this guide seeks to offer guidance to for people setting up a range of different types of support, using the term Peer Supporter acts better as an umbrella term for all types of peer led activity.
A Peer Mentor is also someone who has lived through an experience supporting someone new to that experience and generally refers to a one-to-one relationship, including self-management, action planning and problem solving. Peer Mentoring might be over a period of time when going through a particular issue.
We strongly recommend you refer to the National Standards for Peer Support in HIV in connection with this resource. The evidence of need, and impact of peer support for people living with HIV is well documented and clearly stated in the standards. In addition, the following important documents and research corroborates the evidence of the value of access to peer support:
With the help of voluntary sector partners, we will invest significantly in evidence-based approached such as group-based education for people with specific conditions and self-management education courses, as well as encouraging independent peer-to-peer communities to emerge.
What people do in their everyday lives – what they eat, how much they exercise and how far they follow medical advice – plays a significant part in their need for healthcare. At a time when the UK health system is under increasing pressure to deliver quality care and value for money, it is increasingly important to ensure that patients are supported to engage in managing their health.
Peer support has the potential to improve a range of welling outcomes, including patient activation, physical functioning, quality of life and social functioning.
There is evidence that peer support can make people feel more knowledgeable, confident and happy, and less isolated and alone…. Peer support may also encourage people to take more care of their health which, in the longer term, could lead to better health outcomes.
Peer support can contribute to Domain 2 – Enhancing quality of life for people with long term conditions
Peer support can contribute to Domain 2 – Health improvement. Objective: People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities.
1.2.1 – Psychological wellbeing on the agenda:
PLWH report not being asked questions relating to their psychological welfare by some clinicians. This is despite a large body of evidence showing a high prevalence of psychological difficulties associated with HIV infection. Difficulties include anxiety, PTSD, coping difficulties, sexual problems, suicide and neurocognitive problems.
Standard 9, Self-Management:
People living with HIV should be enabled to maximise self-management of their physical and mental health, their social and economic wellbeing, and to optimise peer support opportunities.
3.0 – Involvement of PLWH in decision-making:
Community organisations in the UK have been instrumental in providing a range of information resources for PLWH and peer support services…. working in collaboration with healthcare professionals. They are an important and essential adjunct to clinic-based services.
The prevalence of psychological distress among people living with HIV (PLWHIV) is substantially higher than that of the general population with PLWHIV twice as likely to be diagnosed with depression. HIV tends to be concentrated in vulnerable and stigmatized populations, who are already at greater risk of mental health problems than the general population. Psychological difficulties can also result from an HIV diagnosis and the challenges of living with the disease.
Whether you are setting up a peer support project within an existing organisation or starting from scratch independently; whether you have funding or are working with limited to no resources – you need to be clear about the reasons you are setting up the project. Setting up a peer support project is incredibly fulfilling, but it also requires planning and time – and at times it can be frustrating. There is no point investing either time or money for a project where there is no evidence of need and/or the target group is unwilling to engage. The following questions may help you to decide how to set your project up, and what it might look like:
Considering the above questions will help you better understand the time and resources you need to set up your project. It will also help you formulate your plan which you can refer to over the lifetime of your peer support project. Having a clear plan for your project is key to its success. A clear, easily understood and well-structured project has far greater chance of success and sustainability than something that is unstructured with no clear aim.
Tip: Your plan does not have to be over complicated – it just needs to be clear, to you and to your audience. A realistic plan that accurately describes what you plan to do, why and how you plan to do it and how much it will cost increases your chances of securing funding.
Getting to know what other services exist for people living with HIV in your area is vital. Establishing strong networks with the right people is key to help you deliver your project by:
There are the obvious organisations to consider for the development of your model. These will include:
If you are a clinic thinking of setting up peer support — click here
Sexual Health/HIV clinics are meeting with people both at the point of diagnosis, and at times offering ongoing care. Many clinics acknowledge the value of peer support and how it can be beneficial in helping reinforce health messages, increase adherence and help patients better understand their condition by talking to someone else experiencing the same or similar issues as them. Clinics are well placed to refer patients on to organisations offering peer support, or to work in partnership to develop peer support within the clinic, if the space and resource allows.
GPs will also be seeing people living with HIV and are also well placed to refer patients into peer support. Social Prescribing is now becoming a part of many GP practices across the UK and recognises that social as well as medical aspects of long term conditions. It can be challenging and time consuming to cover all GP surgeries in a locality to promote peer support and to talk to staff about referring in to peer support. However, connecting with local GP surgeries, finding out whether they have Community and/or Health Navigators and promoting your project could lead to more referrals and more patients benefitting from peer support.
It is useful to know what national HIV organisations exist, and the kind of work they do. Some will focus on service delivery and support, others will have a campaigning and advocacy mandate. There may be national organisations with a presence in your area that it will be worth contacting. National organisations may have access to information and resources, and if they are involved in service delivery, could be a referral pathway or potential partner.
Local organisations supporting people living with HIV can vary from small to medium sized charities, to informal groups. It is useful to know if any exist, who they are and what they offer. There may be the potential to work together and share resources in order to deliver a peer support project, and to promote your project through them.
It is worth finding out what other organisations are in your area providing services that may be attracting people who are living with HIV. For people who are not open about their HIV status and who are concerned about disclosure, accessing HIV care and support directly can be difficult. However, they may be accessing other support such as mental health, domestic abuse, drug and alcohol or housing services and not be aware of the potential to access peer support. Regardless of whether or not HIV services exist in your area, increasing your profile among other local organisations is beneficial for your project and increases the potential to reach the people who would benefit from peer support. It also helps to raise awareness of HIV and educate the wider community on the issues for HIV today.
Peer support is valuable for people living with many different mental and physical health conditions. There is a long tradition of formal and informal peer support in mental health and peer support projects are becoming recognised in more services as a way of offering people the opportunity to get support from people with lived experience. There is a real benefit to your project in seeking out other organisations or groups in your area who offer peer support. The projects that you feel have a model you would like to learn from, or whose practice you respect and who are helpful can be a real support and mine of information for you while you are setting up your project. In some areas there are peer support networks where different organisations come together to share good practice, ideas and training. This can be a great asset for you and your project.
Knowing your way around the commissioning framework in your area, and who is responsible for commissioning services that your project may fall under is important. Knowing who key contacts are, and making sure they know about your peer support project may help with funding, and will put you on the radar. It is also important to know what funding is available. The funding landscape is tough, and there are many charities, social enterprises and community groups battling over an ever-decreasing pot of funding. Knowing what is out there, whether your project fits the criteria for funding, when deadlines are etc., will be key for the sustainability of your project.
Being clear about the shape and size of your project from the start is important. We have looked at some of the key strategic questions you need to ask already. Whether you are setting up one-to-one, group, online support or a mixture of types of support, you will need structure for your project. Sorting out the processes, policies and paperwork for a peer support, or indeed any project, is not as exciting as visioning and free thinking about the possibilities for peer support. However, if you ensure that your project plan is robust, you can be more creative and responsive as you have the structures in place. Having a robust project is different from being rigid – generally, good practice lends itself to being able to be flexible. To help you, we have included template forms, policies and procedures that you can download and adapt for your own use. No doubt if you are developing your project within an organisation you will – or should have – most of the procedures already set up and in place.
Having the right policies and procedures in place ensures that your project is safe, and that you are legally covered. You should ensure that anyone involved in your peer support project is aware of the policies that relate to the project, and where they can find them. A good place to outline what policies people involved in your project need to be aware of is in a project handbook.
The following are the minimum we feel are important for you to develop and the reasons why:
Wherever Peer Supporters are working alone, you need a Lone Working Policy and Procedure. Personal safety is a joint responsibility. You have a responsibility for assessing the potential risk for your Peer Supporters and for avoiding or controlling these risks. Your Peer Supporters also have a responsibility for taking care of themselves and the people that they are supporting.
Your policy will outline your responsibility as an organisation and what you do to mitigate risk and ensure your volunteers are safe. Your procedure will include instructions and any forms and actions that need to be completed before, during and after a lone working scenario. A template Lone Worker Policy and Procedure can be downloaded here.
The foundation of the peer support relationship is based on trust. One of the biggest features of one-to-one or group support is that people feel safe, and reassured that they can share information safely. A key feature for HIV peer support is that the Peer Supporter and other people in a group scenario may be the only people apart from clinical staff who know about a person’s HIV status. The fear of rejection and discrimination can mean that you are one of the first people to be trusted with a person’s story. This makes your approach to confidentiality key to the success of your project.
Everyone involved in your project needs to understand that confidentiality is between the individual and the organisation. It is also vital that people engaging in peer support are aware of what confidentiality means, and in what situations Peer Supporters might need to share information outside the one-to-one or group relationship.
The circumstances in which information might be shared outside the organisation would include:
It is good practice to be clear about the process by which information is recorded, where it is kept and the people who might have access. This helps everyone accessing your service feel safe and reassured.
You need to cover Confidentiality during training, and reinforce it during supervision with Peer Supporters. People being supported should also be clear on your approach to confidentiality during any discussions you have with them. You should ensure that any confidentiality agreements and other paperwork relating to this area is signed and kept safely. If problems do arise, it is important that you demonstrate that you have followed a clear procedure and that you can show that everyone involved in your project has been made aware of your policies and procedures.
You should think carefully about what information you hold and the reason you have it. You are likely to be holding information about your Peer Supporters and people accessing support and therefore need to make sure that you have a Data Protection Policy, and think about how data protection works in relation to your project. Whether you keep your information electronically, or as paper files you need to make sure you:
Any information you hold regarding volunteers and/or employees and the people you are supporting will be affected. For more information see the following websites:
There is often a great deal of uncertainty about what DBS checks are, and who needs them. DBS (Disclosure and Barring Service) Checks replace the CRB check. Previously, anyone working with Children or Vulnerable Adults would have to have a CRB check. In 2012, under the Protection of Freedom Act, things changed. The DBS check was introduced and now people are assessed as needing a check depending on the kind of activities they are engaged in during the course of their work or volunteering. These are called ‘regulated activities’ and defines activities that, if any adult requires them, leads to that adult being considered vulnerable at a particular time.
You can find out if you can apply to DBS check a role using the tool here.
You need to be aware that carrying out DBS checks for workers and volunteers who do not require them is a criminal offence. Eligibility for DBS checks is set out in the following legislation:
To be eligible for an enhanced level DBS certificate, the position must be included in both the ROA Exceptions Order and in the Police Act 1997 (Criminal Records) regulations.
Enhanced checks with children’s and/or adults’ barred list check(s)
To be eligible to request a check of the barred lists, the position must be eligible for an enhanced level DBS certificate and be specifically listed in the Police Act 1997 (Criminal Records) regulations as being eligible to check the appropriate barred list(s).
What is disclosed by the different types of DBS check is outlined below:
|Information||Basic Check||Standard Check||Enhanced Check||Enhanced + Barring Check|
(reprimands & warnings included)
(if police deem relevant)
(if police deem relevant)
|Inclusion of Childrens’ Barring List||Yes
|Inclusion of Adults’ Barring List||Yes
As Peer Supporters may be working one-to-one, services may consider that a DBS check is desirable, despite the fact that they are not carrying out a regulated activity as defined above. In this case a risk assessment of the role should be undertaken. Carrying out a risk assessment will demonstrate the potential for harm should the role be abused. Therefore, as part of good safeguarding practice, a DBS check should be carried out. An example of a risk assessment for Peer Supporter roles can be found here.
If you are setting up your project as part of an organisation that already carries out DBS checks for employee and/or volunteer roles, you will be able to use your current processes for this purpose. If your organisation does not currently carry out DBS checks or you are setting up from scratch, you will need to contact an umbrella organisation to have checks carried out on your behalf. There will be a charge involved.
You can find more information about DBS checks on GOV.UK here.
However you decide to proceed with DBS checks, you should either have a DBS policy and procedure, or cover this topic in your Adult Safeguarding Policy and Procedure.
Positively UK use the following service for DBS checks: DDC Due Diligence Checking.
Peer Support projects generally need a safeguarding policy. Safeguarding is about prevention as well as reacting to issues and circumstances that may arise. It means ensuring that policy and procedure runs through the organisation to ensure the protection of vulnerable children and/or adults wherever possible. If A Peer Supporter suspects abuse, or has abuse reported to them, you need clear guidelines and procedures for action and support. Everyone involved in your project needs to be aware of your policy regarding safeguarding and their responsibilities in relation to it. You should cover safeguarding in your training and induction and ensure that Peer Supporters know what to do in the event that they need to raise a concern.
If your Peer Supporters are employees, they will be covered by your organisation’s Human Resources (HR) policies and procedures. A volunteer policy, although not a statutory requirement, is good practice and sets out a statement of your commitment to your volunteers and your expectations of them. Whilst volunteers will be expected to adhere to organisation policy such as Health and Safety, Safeguarding, Lone Working and Equal Opportunities, they are not employees and your HR policies do not relate to the time they give to the organisation.
For this reason, a volunteer policy serves to set out your approach in relation to areas such as:
(this list is not exhaustive)
Your volunteer policy will ensure that there is a delineation between volunteer and employee. It ensures that volunteers are not expected to adhere to the same policies as employees in relation to areas such as sickness absence, maternity/paternity, disciplinary, capability, annual leave, remuneration. Whilst this may seem obvious, there is case law where the line between employee and volunteer has been blurred and volunteers have been able to prove that they were effectively employed but were being treated less fairly than actual employees.
Whilst a clear policy will set out your position and approach to support and management of volunteers, a handbook for your Peer Supporters is an opportunity to offer a more tailored ‘manual’. Your handbook will echo your volunteer policy and include information particular to the Peer Supporter role. If you work as part of an organisation that recruits volunteers for a range of roles, a generic document (volunteer policy) and specific information (Peer Support handbook) will be particularly useful. If you work only with Peer Supporters, you may be able to produce a document that combines the policy and handbook. Your handbook should also direct Peer Supporters to the particular organisation policies that affect them.
Having a clear Equal Opportunities Policy demonstrates your group or organisation’s commitment to equal opportunities and non-discriminatory procedures and practices. It also reinforces your commitment to valuing diversity and difference. Your policy should be up to date, regularly reviewed and made available to everyone involved in your project.
Whilst volunteers are not protected by anti-discrimination employment law, there are two very important reasons you should have a policy that covers your approach to equality and diversity even if everyone involved is a volunteer:
Health and Safety is most commonly associated with bureaucracy and seen as a barrier to activity. It is often overlooked as the term would not seem to commonly apply to activity such as peer support. However, taking practical steps and thinking in advance about your project and the welfare of anyone who is part of it can save problems later on. For a peer support project, there could be various health and safety considerations. If you are setting up the project within an organisation, you should check that your policy covers the activities you are involved in. If you are setting up from scratch and using/hiring venues, you need to make sure that they have policies covering all aspects of health and safety as part of your risk assessment.
The main piece of legislation relating to health and safety in the workplace is The Health and Safety at Work etc Act 1974. Although your project may be mainly, or solely run by volunteers and operate from another premises, you still have a general legal responsibility to take care to avoid injury to people. Legally, your group has a duty of care to your Peer Supporters and other people accessing your services. This means you should do everything you can to protect people from harm. Part of your procedures should include a risk assessment form that you complete when starting new activities and an incident form. This way you can demonstrate what you do to mitigate risk in your project, and how you respond when accidents occur.
The recruitment of Peer Supporters for your project is key to its success. This is where building good relationships with key stakeholders in your community will have an impact. Recruitment can be challenging. The number of people living with HIV who are ready, and have the right qualities to be a Peer Supporter may be relatively small in your area. By its nature, HIV lends itself to secrecy and guarded disclosure. Therefore hiring a hall, advertising a recruitment day in your local paper and waiting for people to walk in off the street is unlikely to be very successful. The more likely routes for your Peer Supporters to find you are through the clinics and organisations you have promoted your project to. You should plan your strategy for recruitment, and be creative!
Being a Peer Supporter is a more specialist form of volunteering that requires a certain set of skills, knowledge and experience. It also requires a certain type of person with particular personal qualities. Unlike any other form of support, peer support requires a person to pull on their lived experience to help another person move on with their life. In HIV peer support, Peer Supporters have to be able to disclose their status again and again, each time they meet someone new, or start a new group. They must be able to understand what is and isn’t appropriate to share and when to share it. Peer Supporters need to understand that their role is to support and allow people to open up in an environment where they know they are truly understood and listened to. Given that your Peer Supporters will be alongside people who may at times be vulnerable, adopting safe and robust recruitment practice is not just advisable, but your responsibility.
It can feel daunting to think about how to recruit Peer Supporters effectively and safely. However, with a well thought through, creative plan you can be more confident that you have the right people in place to offer good quality support.
The following guidelines will provide a framework that will help you to ensure consistency. They are not prescriptive, but if you follow the principle you will ensure effective, safe recruitment.
What qualities should your Peer Supporters have? The National Standards for Peer Support in HIV outlines the competencies that Peer Supporters need for each of its standards. Mostly, competencies can be developed through training and experience. There are also personal qualities you will be looking for in terms of assessing people wanting to be Peer Supporters:
People with good self-awareness will be more reflective of their practice, more open to feedback and aware of their strengths and weaknesses. Good self-awareness means that Peer Supporters are able to grow and develop in their role as they understand where they need support and further development. Peer Supporters are in the unique position of providing support because of their lived experience. Therefore at times they may need support themselves, and they must have the self-awareness to know when to ask for it.
Peer Supporters must be able to assess when it is appropriate to share their own experience – if at all. A common issue in any kind of peer support is people in the support role taking up too much space with their own experiences, rather than using their shared experience to empathise and listen. The person being supported is looking for a space to open up and be listened to by someone without judgement who has really stood in their shoes.
Supporters who have a sensitive approach will better understand confidentiality and boundaries. In peer support in particular, the boundary lines are thinly drawn and move all the time. A Peer Supporter may be supporting someone they were in clinic with the day before, or who they have been in another group with. They may have mutual friends, or go to the same social spots. None of this excludes them from supporting each other, but does mean it is important to understand and think about boundaries all the time. It also demands that Peer Supporters have the sensitivity to understand the importance of confidentiality.
Peer Supporters also need to be able to listen and feedback sensitively. They are not advisors or counsellors, but they may be suggesting action or posing questions to gently guide people to think about their life or behaviour in a particular way that could promote change.
The recruitment, training and support of Peer Supporters takes up resources – both time and money. In terms of commitment, you want people to be committed to the role and to be able to give a certain amount of time to it. The best Peer Supporters are clear about the time they can offer, clear when they cannot offer time and deliver on what they have said they can do.
You cannot make, and should not be pressurising Peer Supporters to stay with your organisation for a certain amount of time. However, you do want to attract people who want to commit to the project over a period of time. It is reasonable to suggest that you would like an initial commitment of six to twelve months. You cannot enforce this, but by talking about this during the recruitment process, people start to think early on about whether or not they are ready to commit.
Flexibility is not just about when your Peer Supporters are available, it is also about who, how and where they will offer support. All Peer Supporters will have boundaries of their own, and this is fine. However, someone who is only willing to support working women, one-to-one, in a particular room, on Wednesdays at 3pm – will be difficult to match to a mentee regardless of their skills and other qualities that may make them very suitable for the role.
Developing practice, reflecting on experience and identifying where further learning or support is needed is a key part of being a Peer Supporter. The training and development does not end as soon as the peer support relationship begins. Peer Supporters need to keep their knowledge and practice up to date to be able to be effective and make a positive impact.
There are areas of skills and knowledge that you would expect Peer Supporters to have some understanding of – but that can be developed in training. For HIV peer support, you will be looking for people with the potential to develop competencies including:
The above competencies feature in The National Standards for Peer Support in HIV as part of the toolkit for effective Peer Supporters. Download a copy here.
For your project, you will decide what competencies your peer supporters need, depending on the type of support you are offering and the activities involved. You may find that you do not need or want to include all of the above competencies. These are intended as a guide only for good practice.
You should know what your Peer Supporters are going to do at the project planning stage and this needs to be clear in your recruitment strategy. The kind of peer support you are intending to offer will affect the skills and experience you are looking for. You need to recruit appropriately and according to need. If your support is online only, you will need people with the accompanying IT skills. If you are only developing group support for MSM, you will be hoping to attract people in this category. If you are hoping to develop both group and one-to-one support, you will want people with both group facilitation and one-to-one skills. If your project is going to be delivered in a range of settings, your Peer Supporters will need to be able/willing to meet with people in, for example, community spaces. Clarity regarding your project is a recruitment tool; the clearer you are at this stage, the more likely you are to attract the right type of people and the less work you will have to do at this stage.
You will need a clear role description to give to people interested in offering peer support at application stage. This does not have to be a complicated document – in fact a concise document (no longer than two sides), clearly written is not only easier to read, but more likely to be read. A template role description can be found here.
You should also include a person specification. This defines the role and outlines what you need. It also helps you in your recruitment as it will include a set of criteria for the role that you can use as part of your assessment.
You need to design an assessment process for people applying to be Peer Supporters. You may decide to have one-to-one or group interviews. However you decide to carry out your assessment, you should make sure that it is consistent, i.e. the same for all candidates. Your assessment exercises and questions should be designed against the qualities, skills and experience you have decided you are looking for in your Peer Supporters. You should also record your assessment for each candidate and keep it with candidates’ records.
Whatever your project is like, you should have some kind of assessment. Wherever possible have two people assessing candidates. Not only is this easier for note taking, but two people offers a more balance observation of the candidate. As your programme develops you could use Peer Supporters to help with assessment, if you feel they have the skills and qualities to do this. This a good use of resource, a development opportunity for your Peer Supporters and is valuing the people helping to deliver your project.
Be clear with the candidate about the purpose of the interview, what you are going to do during the interview, whether/when they can ask questions. The assessment process is not a trick, the more transparent you are with your candidates you are about what you are looking for, the more honest they are likely to be in answering your questions.
Put the candidate at ease – they may be very nervous as becoming a Peer Supporter could be a big step for them. Make sure they know how formal/informal the interview is, your expectations and what you are looking for.
Ask open questions and give the candidate plenty of time to answer.
Make sure your body language and eye contact with the candidate reassures them that you are listening to them.
Feedback regarding the assessment process is important. If your candidate has done well at interview and is going to be a Peer Supporter, tell them what went well and the reason you want to proceed. Let them know if there are areas you feel they will need to work on and reassure them about how you will support them – training, supervision etc. It is equally important to feedback to candidates who have not been successful. Again, tell them the reason why you do not want to proceed. If you think they could be a Peer Supporter in the future, tell them what they need to do to be successful in the future. If you feel that they do not have the qualities or potential to be a Peer Supporter, signpost them on to other organisations or types of role that you think may be more suitable.
There will be different ways you can attract Peer Supporters to your project. Before you decide on your recruitment strategy, ask yourself some questions that will help you decide how and where you will recruit, and your message:
It is likely that many of the places that you may recruit Peer Supporters from, will also be a route of referral for people needing support. Referrals will come from a variety of sources, some of them will be the same people you have talked to in the development of your project (see – Establishing networks in your community click to link).
Any opportunity you have to talk about your project is another potential Peer Supporter or person able to access support. Giving presentations to staff in clinics, local organisations, GP surgeries… anywhere you think there is potential for people living with HIV to access information and services, is an opportunity to find future Peer Supporters and people looking for support. Talking to local newspapers or on local radio is also a great way to reach out. There may be local programmes that your target group would be likely to listen to, for example Brighton’s community radio station, Radio Reverb hosts a weekly ‘HIV Happy Hour’. Writing articles and short pieces about your project is also a great way to promote what you are doing and attract enquiries.
You need to plan what you are going to talk about to make sure you are promoting everything you want to about your project. Hopefully you have the chance to talk to a wide range of people and organisations. Whoever you are talking to, you need a consistent message. Writing a statement or press release for your project that everyone involved in promoting the service can refer to ensures that key points are being covered whenever you talk or write about it.
If you are promoting your project and you are a current Peer Supporter, you need to think about your audience and your disclosure. Disclosing your HIV status as a Peer Supporter in a safe space is different to talking about your project on a radio show, in a local paper or to a group that is not closed. You are the best person to decide what you want to disclose about yourself but make sure you think about this before you promote your project in the community. Talking this through with peers/colleagues first can be useful, even if you think you know what you want to do! See also ‘Dealing with Referrals’
A robust recruitment process is essential to help you make an informed decision, based on what you observe as well as what you hear from people who want to become Peer Supporters. In assessment you are looking for people’s potential to be competent and to develop the personal qualities you are looking for. Peer Support Training is the first step towards developing those competencies.
Project 100 – is the accredited Peer Mentor Training programme currently delivered by Positively UK and funded by The Monument Trust. This national training project will finish in 2019. After the end of the project the materials will continue to be available.
Initial training should really be designed to follow on from assessment. Therefore your training should help participants think about their personal qualities and the extent to which they are:
The above competencies feature in the National Standards for Peer Support in HIV as part of the toolkit for effective Peer Supporters.
You want your Peer Supporters to be motivated to keep their knowledge and skills current. During this initial training, encouraging your Peer Supporters to stay up to date with developments in the sector will ensure they can confidently:
You will tailor your training programme depending on the type of peer support project you are developing. Different types of support will demand different approaches and the development of skills and knowledge that can be tailored to each situation. This includes:
Group work is very different from one-to-one support and demands a different set of skills. Considering how groups work, what effects the way a group of people interacts and the roles and behaviours that people in groups take on is important for Peer Supporters supporting groups. Facilitating a group of people is not for everyone. Peer Supporters who are competent and confident working one-to-one will not naturally be good at group work. It is therefore important to practice facilitation skills and think about issues such as conflict resolution, mediation, group management, dealing with contra behaviour, group confidentiality and boundaries and equality of contribution.
If your project involves this type of support, you will need to provide further training that covers the above competencies for group support.
Again, the above competencies need to be considered in light of having no face to face contact. Telephone support means that Peer Supporters cannot rely on their body language to show that they are engaged and listening. Moreover they cannot judge their mentee by looking for non-verbal clues. The potential for distraction, interruption and technical failure are much higher. Building confidence can be challenging when you are not working face to face, as both Peer Supporter and person supported have to trust that what is being said without visual clues. This is similar for online support, where additionally Peer Supporters will be typing their responses – where meaning and nuance can be misunderstood and difficult to convey. An information sheet for telephone support can be found here.
If you are working as part of a larger organisation where resources for training currently exist, you may already have similar training programmes that you can adapt and style for Peer Supporter Training. If you are a small group, and this is the first training you have delivered you may want to get support to help you structure your course. Positively UK has a track record in providing comprehensive, Core Peer Support training for people living with HIV accredited by the OCN (Open College Network). We encourage you to contact us to talk about our resources, what support we can offer you and to find out about peer support networks in your area.
Your initial training course should be part of ongoing assessment of your newly selected Peer Supporters. You should use core training as an opportunity to continue to observe participants and be transparent about this. You should offer time for one-to-one contact during training so that you can give feedback on progress and offer safe space for participants to share their concerns and queries. Peer Support training can bring up difficult feelings and thoughts that participants may not have anticipated. It is therefore important for you to offer support if this happens.
As a result of completing training you may find that a participant decides that the role is not for them. You may also find that you decide, from your observation of their progress during training, that they are not suitable or quite ready to be a Peer Supporter. Considering and offering alternative opportunities to volunteer and learn will support the participant to develop the necessary skills.
Accreditation for Peer Support Training acknowledges the commitment people have made to their learning and demonstrates their competency. It increases the credibility of your project and your Peer Supporters, giving them a qualification that they can use within and without your programme.
Positively UK participants complete an OCN (Open College Network) module to gain accreditation for their learning on the core training. This is an online module that includes completing a number of written exercises that are then marked by an independent body. The certification is generic – i.e. not specific to HIV. This is beneficial to participants in that it does not share their status, and means that they are certificated to offer support in other areas where they may have lived experience.
Induction should form part of the initial training your Peer Supporters receive. Organisation induction is a practical, information based session where newly training Peer Supporters learn about you.
Organisation induction can usually be covered in a half day session, and its intensity will depend on the size of your organisation.
Initial training for Peer Supporters is only the start of their development. Once they start to actively support people living with HIV they will ‘try out’ what they have learned in training and start to develop their skills and knowledge, through their experience. Part of developing a successful Peer Support project includes ensuring that you have a model for supervision, follow on training and Continuing Professional Development (CPD).
Supervision is a term used in clinical care to describe the process of reflecting on practice. It is an opportunity for practitioners to think about their skills and knowledge and how they can be developed to improve, in this case Peer Supporter practice. Supervision should therefore be used as a space to encourage Peer Supporters open up and be able to explore their progress and how they feel. It is not a space to tackle issues – this should be dealt with separately, in debrief or one-to-one meetings, or as soon as the issue arises. Supervision should be a collaborative process that enhances the development of the Peer Supporter. It ensures that the welfare of the Peer Supporter, and therefore the mentee, is maintained. It should be a structured activity that involves observation, evaluation, feedback and the facilitation of self-assessment. It is also an opportunity for the Peer Supporter to acquire new knowledge and skills through problem solving and exploration with the person supervising, or with the wider group of Peer Supporters, where Group Supervision is the model used. In short, supervision should not be prescriptive, and should encourage Peer Supporters to look at all options for problem solving.
Supervision is not debriefing. You should debrief with your Peer Supporters after each session to check in. The regularity with which you offer supervision depends on your resources, but you need to make sure that you fulfil the commitment you decide to offer. You should write up notes and action points from supervision meetings and give a copy to the Peer Supporter.
Being an effective Peer Supporter for people living with HIV includes being up to date with developments in healthcare, and the external environment. You want your Peer Supporters’ knowledge to be current. This not only enhances their skills and knowledge but ensures better support for mentees. CPD should be discussed in assessment and initial training. While you want your Peer Supporters to be motivated in this respect, you also need to encourage this aspect of their development. In addition, signposting to other courses, events, articles and websites that you come across will indicate your expectations and model what you do to keep up to date and relevant. Recording any CPD activities that Peer Supporters engage in will demonstrate for them and you their personal development. This is useful as an evaluation tool for you, and your Peer Supporters have a record that they can use for future applications for work or further training.
Initial training is really the start of a Peer Supporter’s learning. You may have additional training that Peer Supporters have to attend for compliance reasons – e.g. Health and Safety updates. There will also be follow on training that you want to offer to build on Peer Supporters’ experience, interest and expertise. You should use your one-to-one, supervision sessions and group meetings with your Peer Supporters to help you gauge what additional training and learning to offer/advise. By approaching learning and development collaboratively and finding out what people say they want as well as who you think they need, you are likely to get better engagement from Peer Supporters.
Follow on training can be costly if you rely on external facilitators and boring for the participants if it is always you delivering courses! Rather than always pulling together a course to address a training need there may be alternative ways to keep the learning of the group relevant and up to date:
If you have identified a learning need together that can be addressed as a group – come together as a group to meet the need. You may have Peer Supporters who are particularly interested in a certain area or topic who want to research and lead a learning activity. Encourage it – taking responsibility for learning is part of developing self-confidence.
Depending on the size of your organisation you may have e-learning modules that staff use already. This can be a more cost effective way to deliver certain types of training but may not suit people who are not confident with technology or have particular learning needs. For Peer Supporters with particular interest, there may be e-learning modules that they can follow. Some e-learning courses are free. MOOC (Massive Open Online Courses) offer a huge range of learning opportunities free of charge that tackle a range of issues and ideas.
It is worth finding out how whether there are other similar organisations in your area that offer training and learning opportunities that you could benefit from. Potentially you could partner with them to pool resources, share training programmes and save costs.
It is worth finding out what free training and learning exists in your area. Some groups will get funding to run courses and workshops that have a benefit to people and groups from other third sector organisations.
Ongoing learning is part of CPD. You should take every opportunity to encourage and facilitate Peer Supporters to enhance their skills and knowledge which in turn will increase their confidence and self-esteem. However, be mindful that if your Peer Supporters are volunteers you cannot insist that they attend a particular training event unless it is part of a statutory obligation of your organisation.
In this section we will focus on one-to-one support. As well as managing your Peer Supporters, you need to think about how you will support the people using your service. Your contact with people who want support will be mainly at the beginning (referral) and end (feedback and evaluation) of their relationship with your organisation/group. Your Peer Supporters will have most contact and will build rapport with them. You will assess people, match them to Peer Supporters, monitor the progress of the relationship and evaluate with them as their interactions come to an end. You should also be available should someone have any issues or queries regarding their support.
People will hopefully come to your project from a variety of sources from word of mouth to clinical referrals. You need a process to deal with self-referrals and referrals from other agencies that is accessible, easy to communicate and easy to manage.
You will need to confirm that people who approach you personally are who they say they are. This needs to be handled sensitively, and in a way that does not make people feel interrogated. A simple method would be to ask for clinic details and the medication you are taking on your referral form.
Again, you want your pathway for referral to be simple, clear and safe. Making it as easy as possible for clinicians, GPs, Social Workers to refer to you that does not take too much time is important. You want people to want to refer into your service.
For both self and external referrals, you want your pathway to be efficient. Think about the following:
You should arrange to meet the person as soon as possible after referral, whether by a third party or in person. The longer the gap between referral and meeting, the more likely people are to disengage. Your initial meeting is an opportunity to gather more information about the person wanting support, assess their suitability for peer support and sign post them to other services if peer support is not suitable for them for now.
It is at this point that you build a picture. While it is important not to pry, you need to find out enough to assess whether being matched to a Peer Supporter is appropriate, and who will make a good match for your potential client.
These questions help you and the potential client assess their readiness for support. If you feel that the issues they are dealing with are not within the remit of a Peer Supporter, at this point you can signpost them to a service or resource that might better meet their needs. Deferring support does not mean refusing it – one-to-one peer support is likely to have better outcomes if it comes at a point where the mentee identifies themselves that they are ready for change. Peer Supporters can help with the outcomes of issues, but not with the issues themselves. For example, a mentee who is struggling to get out and socialise as a result of depression related to their HIV can be supported by a Peer Supporter to set personal goals and make action plans for how they will start to re-engage. The Peer Supporter cannot counsel the mentee through the depression itself.
Mary was referred to the Peer Support Project at The Sussex Beacon from the Lawson Unit. She was a sex worker, sofa surfing and was addicted to crack cocaine. She was in an abusive relationship and was not engaging well with the Lawson Unit, the clinic supporting her with her HIV. The hope was that a Peer Supporter would be able to help her with her adherence as she was not taking her medication regularly. However, given that her addiction was affecting her ability to maintain contact with services and attend appointments, it was felt that at first she should get support from drug and alcohol and social services. One-to-one peer support would be more appropriate and more likely to yield positive results once she had got help to stabilise her addiction and could attend a meeting.
Will was referred for Peer Support as he was newly diagnosed and it had come as a complete shock to him. In his initial assessment meeting he was very positive about the future and said that he had made a lot of friends with other people living with HIV so was getting a lot of informal support. He listened to the information about the programme but felt that it was not for him. The Coordinator signposted him to other groups in the area and gave him information about the service, encouraging him to get in contact again in the future if he felt he would benefit from some more focussed support.
Once you have assessed that someone is suitable for support, you need to gather information that will help you match them to a Peer Supporter. There are some practical factors to take into account, such as if they have a preference for the gender (or other demographic detail) of their Peer Supporter, times they are available for support; if the support is in the community, where they live. There is also some more general information about the person that will help you think about the kind of match that might be most successful – and it is not always immediately obvious:
Troy was referred to Positively UK for one-to-one peer support. He was a gay man who was on the party scene. He had not been too specific about the type of person he wanted support from, but it happened that there was a Peer Supporter available with very similar social interests to Troy. It was felt that this would be a really good match. After a couple of meetings, the Peer Supporter met with the Coordinator and surprisingly fed back that the sessions were not going well. They simply did not get on. The Coordinator followed up with Troy and after chatting found out that he loved art and visiting art galleries. The Coordinator had another Peer Supporter, a woman, who also loved art and other creative pursuits – not so keen on partying! They were matched and the outcome was great. They got on well and really connected through their similar interests. Not only was the Peer Supporter able to support with some of the issues that Troy was facing, she was also able to encourage him to engage in the activities he enjoyed other than partying and had neglected.
You will need to ensure that as well as gathering and recording the information you need on your referral/assessment form, that you give the person engaging in peer support the information they need. This will include:
In many cases, apart from setting up meetings for people seeking support and Peer Supporters, you may have minimal to no contact with beneficiaries as their primary contact is their Peer Supporter. However, people should know who to contact and how to get in contact if they have any queries or concerns during their engagement with the programme. You will therefore be relying on your Peer Supporters to feedback to you regarding the mentee.
Following up with people at the end of their engagement with one-to-one peer support is an opportunity to hear from them. Getting their view of their experience of Peer Support will help you to:
Setting up peer support meetings – the amount you are involved in the logistics of one-to-one meetings depends on where the meetings are taking place.
If meetings are being held in your organisation, you will need to make sure a room is booked and that someone is available to check in with the Per Supporter at the end of the meeting. Ideally the meetings should be held in office hours and in some organisations there will be no facility for out of hours meetings. If you are offering out of hours meetings you will need to check your organisation policy regarding out of hours working. You will need to make sure there is a key holder on the premises and your lone working policy will become relevant. You will also need a mechanism for debrief after the meeting.
If meetings are held in the community, it may be that your Peer Supporter arranges the meetings with the person they are supporting and then informs you. You need to know when the meetings are happening for health and safety reasons, and for monitoring purposes.
The most efficient way for Peer Supporters to feedback is electronically. However, you therefore should ensure that there is a way for all Peer Supporters to be able and willing to do this. If Peer Supporters do not have access to a computer or tablet, you will need to think how you will make this form of feedback possible without it becoming onerous.
Paul was matched with someone who he arranged to meet in a café that was suitable for one-to-one meetings. It was big and airy and the seating was such that conversations could not be overheard. Paul and the Coordinator visited the café to do a quick risk assessment, and have an introductory meeting with Dan, who was going to be supported by Paul. The meetings were arranged by the Coordinator and if there were problems, the message would be sent through the Coordinator. Paul was happy to use his laptop to record the meetings. The Coordinator sent him the forms used for recording one-to-one meetings electronically. At the end of each meeting, Dan and Paul would agree together the action points to take away. Paul would then email the notes to the Coordinator at the end of each meeting. No names or information that would disclose any identities was included in the notes, nor was there any logo identifying the nature of the organisation. Initials only were used to identify both Paul and Dan on the forms and in the body of the email.
Debriefing has been mentioned throughout this section. It is not the same as supervision. Debriefing with your Peer Supporters is a way to pick up any issues arising from their one-to-one meetings that you may need simply to note or monitor together, or to follow up. If a session has been particularly intense, it may be that the debrief is just a chance for the Peer Supporter to off load. It may be that your Peer Supporter wants to check that they have followed best practice. You will want to make sure that sessions are running smoothly, that they are working together towards positive outcomes and to pick up any issues that may arise as soon as possible. If the Peer Supporter is meeting mentees in your premises, then getting together at the end of a session is generally straightforward to organise. If they are in the community or meeting at a time that you are not available, debrief can be by phone, or email. Most important is making sure you have checked in.
Debrief sessions can be an opportunity for you to feedback, if it is appropriate. You want your Peer Supporters to be open with you and share their positive and challenging experiences of supporting someone else who is living with HIV. If Peer Supporters ask you for your feedback or thoughts during debrief, then you have an invitation to give your perspective. If they are describing an interaction that you feel is not best practice or raises a feeling of concern, then it is an opportunity to ask further questions and give some guidance. However, unless there is a serious concern arising, or a safeguarding issue that needs an immediate response, be cautious about giving too much unsought guidance. Peer Supporters will stop sharing if, every time they debrief with you, you tell them they should have done something different!
This is not debrief or supervision – one-to-one meetings are an opportunity to check in over a longer period, ideally up to an hour. If the resource and time is available, holding a one-to-one meeting with Peer Supporters bi monthly is a good opportunity to follow up with outcomes from debriefing sessions, check in and iron out issues or concerns that may be arising on either side. These meetings should be noted and a copy of the notes given to the Peer Supporter.
Peer Support of any kind – one-to-one, group, distance, face to face, paid or unpaid adds an additional nuance to the management of boundary lines. The delineation is not as clear as it is in any other type of support. The supporter has the same lived experience as the person seeking help and it is the sharing of these experiences that makes peer support such an effective intervention. In Peer Support for people living with HIV this means that both parties may come across each other in clinic, socially or at other support groups. They will be privy to very personal information about each other. Given that boundary lines will shift over the lifetime of the support, this is an area that you need to continually support your Peer Supporters with. Encouraging openness and honesty during debriefing and one-to-one meetings will help you and your Peer Supporters manage the shifting nature of boundaries in Peer Support.
Ending the one-to-one relationship can be difficult for both parties in a peer support relationship. As part of the matching and assessment process you should have been clear about the number of sessions you will be offering. However, given the mutual understanding that can develop in a peer support relationship, letting go can be difficult for both parties. This is part of moving on and your Peer Supporters may need support with this. Ideally, by setting and reviewing goals and working together towards ultimately moving on, the end of the relationship will be a feeling of success and optimism for what comes next. The times that you may need to give extra support will be when things do not go so smoothly:
Sometimes the peer relationship does not work. In this case you may need to intervene to help both parties come away from the experience feeling ok. Depending on the reason for the break down, you may decide to try and re-match so that support can be ongoing. You need to monitor this scenario. If a pattern emerges where either a Peer Supporter or someone being supported continuously asks for a new person to work with, it may be that the Peer Supporter is not suitable to offer support or the person to receive it.
It is not unusual or surprising that if a peer support relationship works well it is because there is a certain chemistry. This can mean that both parties feel like a friendship is forming. You need to encourage your Peer Supporters to be open and honest about this. If they decide they are friends – or even something more than friends, they must tell you before they are using their one-to-one sessions to conduct some sort of personal relationship. Once you know, you can end the peer support relationship with no harm to either party.
This situation can be difficult for Peer Supporters to be objective about. Sometimes people will simply stop engaging. This can be for a variety of reasons; the time might not be right, other issues may take over, they may have got what they need and don’t want any more support, they may simply not like it. You may never find out why someone stops engaging with your programme but most important is that the Peer Supporter does not internalise and blame themselves.
Talking through next steps is part of ending the relationship. Peer Supporters should be discussing with the person they have been supporting what they will do with what they have worked on during the sessions they have had. Putting together an action plan for the 3-6 months after the end of the sessions will help the supported person think about how they can continue to benefit from the peer support they have received. Signposting people is an important part of moving on, not necessarily to other HIV services but also to organisations, projects, training etc. that may be of benefit depending on the goals that they have set. Talking about the next steps can form part of the final sessions that the Peer Supporter and person being supported have together. Both parties need to be active in this conversation, and it may be that part of their final meeting is to research together what the supported person can do to continue to work towards the goals that they have set.
Peer Support Groups tend to be run as drop ins, and do not have a start and end point in the same way as one-to-one relationships do. Sometimes people may start attending a group and move on to one-to-one support – or vice versa. Attending a group may be part of the step down from a one-to-one peer support relationship, or it may be that a group meets the need better than individualised support.
Peer Supporters who are suited to group facilitation may be interested in this type of support. Most groups will include semi structured activity – for example a guided discussion or discussion and informal, open discussion. Given the more fluid nature of a group, facilitators need to be happy to work with the uncertainty that having a group of people together can bring. Considerations for Peer Support Groups include:
Best practice is for two people to facilitate a group. For practical and safety reasons, having two facilitators means that the group will run more smoothly. Facilitators need to be able to commit to arriving before the group starts to set up, keep the group on topic and to time and to tidy up at the end. They need to ensure that they are prepared with all the resources they need. Just as for one-to-one, they need to debrief with you at the end of the group highlighting what went well, any concerns and what they want to do next time. You will also rely on them to gather information about the number of people attending and any comments/feedback that will help with evaluation of the group.
You will be likely to promote your group in much the same way that you promote one-to-one support. However, accessing group support would not require the assessment or referral process in the way one-to-one support would. You will need a way to check someone qualifies for group support, but you will not take them through the same individual assessment as you would for one-to-one support.
Just as for one-to-one support, participants must sign a confidentiality agreement and adhere to ground rules when they first join a group. Although it can feel a bit laboured for the facilitators, it is really important to re visit ground rules at every meeting and ensure that everyone is signed up to the same standard of group behaviour.
If the group will be meeting in a space outside your organisation, just as for one-to-one support, a risk assessment should be carried out that includes checking the insurance, health and safety and rules of the premises. It is also important that signage to the group does not undermine confidentiality i.e. does not reveal that the group is an HIV Peer Support Group. Participants need clear information, with the name of the group in any communication they receive so that they feel reassured that they are coming to a safe environment.
This is important to be kept to a minimum and as for one to one, should not disclose any personal information about the people attending. If the group is running off site, there will need to be a mechanism for ensuring that any paperwork is returned to you at the end of session.
Ideally facilitators should spend some time at the end of a group meeting to debrief together and share thoughts on the session. This can then be fed back to you with any issues or concerns.
People attending the group need to have details of who they can contact in the event that they have a complaint or query about the group. You need to be willing to help the facilitators if they have problems in the group that they are struggling to deal with, or they feel is beyond their remit. This could include dealing with a participant that is causing disruption to the extent that it is not safe for them to continue attending, or handling issues arising relating to the organisation that they feel you should address.
If your project has grant funding you will likely have of data and information gathering specified by the organisation funding you. However, you also will want to understand the impact and effectiveness of your programme on your Peer Supporters and people using your service. Positively UK has produced a comprehensive tool designed to provide evidence of the value of peer support. The tool is available here and staff at Positively UK are keen to engage with you to build a picture nationally how peer support impacts on the lives of people living with HIV.
Evaluation can feel burdensome. It is yet another activity to find resource to complete and can feel like it is taking up the time that you need to effectively run your project. In addition, evaluation is hard to gather, especially if you are relying on you Peer Support volunteers to gather it for you. It is not for lack of will, but often evaluation will be forgotten as for the Peer Supporter, the priority is to help other people living through similar experience – not tick boxes and fill in forms. Therefore, making sure that you note any piece of feedback or comments that you hear about your project from your Peer Supporters, people they are supporting or other people who observe the work you are doing is really important. It is also important to make sure you count! Note every meeting and group that takes place including the numbers of people attending so that you are gathering both qualitative and quantitative data about your project. Avoid asking for detailed feedback too often as it undermines the quality of the information you are gathering.
You know your project best — do not be afraid to discuss the reporting and information gathering mechanisms with funders during the lifetime of your project and make changes.
Don’t over evaluate — only gather the information you need. Better to have less good quality information rather lots of meaningless data, that you have to manage. Gather one-off and incidental information and feedback so that you build a picture of your project from the point of view of a range of stakeholders. If someone tells you that they have been told your project has had a positive impact, note it down and date it.
Be creative in your evaluation techniques — does it always have to be a form? Can you gather images/pictures that demonstrate what you are doing? Can you use audio or video to record information?
Make sure you count everything you can — numbers of participants, numbers of groups, numbers of interactions etc.
Set up a system for recording data and feedback systematically — avoid getting to end of year report or grant application deadlines and scrabbling around to find information you need in piles of evaluation forms or data in several different spreadsheets.