Provision of peer support at the intersection of homelessness and problem substance use services: a systematic \u2018state of the art\u2019 review

Joanna Astrid Miler,Tessa Parkes,Hannah Carver,Rebecca Foster

doi:10.1186/s12889-020-8407-4

Joanna Astrid Miler, Tessa Parkes + Show 2 more

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https://doi.org/10.1186/s12889-020-8407-4

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Abstract

BackgroundPeer support refers to a process whereby individuals with lived experience of a particular phenomenon provide support to others by explicitly drawing on their personal experience. It has been adopted in a variety of service contexts including homelessness, substance use, mental and physical health. Those who experience homelessness have some of the most complex intersecting health and social challenges. This ‘state of the art’ review provides a systematic search and synthesis of literature examining use of peer support models within services for people impacted by homelessness and problem substance use.MethodsA systematic search using six databases (CINAHL, SocINDEX, PsycINFO, MEDLINE, Scopus and Web of Knowledge) was conducted in August 2019 and identified 2248 papers published in English after the year 2000. After de-duplication and scanning titles/abstracts, 61 papers were deemed relevant. Three more papers (including one grey literature report) were identified via references, but two papers were later excluded due to relevance. The final 62 papers included studies conducted in five countries. A thematic analysis approach was used to compare and contrast the study findings and provide a synthesis of the main learning points.ResultsIn recent years there has been a substantial increase in research examining the utility of peer support yet there is significant variation across this field. Alongside profiling the range of settings, aims, populations, and main outcomes of these studies, this paper also provides an overview of overarching themes: the overall effectiveness and impact of peer-staffed or peer-led interventions; and challenges commonly faced in these roles. Five themes relating to the challenges faced by peers were identified: vulnerability, authenticity, boundaries, stigma, and lack of recognition.ConclusionsWhile our findings provide support for current efforts to involve individuals with lived experience in providing peer support to those experiencing concurrent problem substance use and homelessness, they also urge caution because of common pitfalls that can leave those providing the support vulnerable. We conclude that peers should be respected, valued, supported, and compensated for their work which is often profoundly challenging. Suggested guidelines for the implementation of peer involvement in research studies and service delivery are presented.

Highlights

Peer support refers to a process whereby individuals with lived experience of a particular phenomenon provide support to others by explicitly drawing on their experience of this situation
While we are aware that this is good practice for systematic reviews, and these criteria have been used in a recent systematic review of the effectiveness of peer support with those who are homeless [26], we chose not to do this due to the fact that a state of the art review aims to capture all the potentially relevant literature published on the topic of interest
Overview of included papers: primary topics of interest The studies included in the review were diverse in terms of their primary focus/themes of interest (Table 2). They ranged from interventions targeting specific populations, for example peer support with individuals with Human Immunodeficiency Viruses (HIV) ([45, 60, 63, 71, 75]), or criminal justice involved/experienced individuals ([39, 58, 65, 73, 76, 82]), to focusing on specific harm reduction interventions or practices, for example needle exchange programmes ([31, 68, 70]) or safe consumption sites ([32, 56, 57, 78, 86])

Summary

Introduction

Peer support refers to a process whereby individuals with lived experience of a particular phenomenon provide support to others by explicitly drawing on their personal experience It has been adopted in a variety of service contexts including homelessness, substance use, mental and physical health. Those who experience homelessness have some of the most complex intersecting health and social challenges. This ‘state of the art’ review provides a systematic search and synthesis of literature examining use of peer support models within services for people impacted by homelessness and problem substance use. Homelessness is a complex term with no uniform definition It encompasses a wide range of housing situations. With the aim of facilitating more meaningful international comparisons, Busch-Geertsema and colleagues [1] propose a global definition of homelessness where homelessness is conceptualised as ‘lacking access to minimally adequate housing’ (p.125)

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