Key skills and challenges in one-on-one peer support for older adolescents and young adults with serious mental health conditions

<title>Abstract</title> <bold>Background </bold> Peer support for older adolescents and young adults has become increasingly available as a formal mental health service. Alongside this increasing availability has been a steady accumulation of studies examining the potential for peer support to lead to positive outcomes for peer support users. However, a consistent refrain from the literature on peer support is that research and practice are hampered by a lack of theory-based models that specify the activities and skills of specific peer support roles, and describe how skillful practice is linked to outcomes. As part of a larger study intended to help fill this gap, the current study aimed to define and validate a set of key skills and related challenges in one-on-one peer support for older youth and young adults. <bold>Methods</bold> The study engaged peer support specialists (PSSs) and peer support users (PSUs) from first episode psychosis (FEP) and non-diagnostic-specific (NDS) programs across the United States in a series of discussion groups focused on the activities, skills and outcomes of effective peer support. Qualitative analysis of the discussion group material led to the specification of six general skill areas and, within each of these, a series of sub-skills and key practice challenges. In a second phase of the study, the PSSs reviewed a document describing these, rated the importance of each of the skills and challenges, and provided open-ended feedback on wording and conceptualization. Based on feedback, wording of practice skills and challenges was finalized, and a set of related organizational challenges connected to each skill area was added to the document. <bold>Results</bold> All of the mean importance ratings for sub-skills and challenges were above 4.25 on a 5-point scale for which 4 = <italic>very important</italic> and 5 = <italic>extremely important</italic>. PSSs from FEP and NDS programs provided similar ratings for sub-skills and challenges, with a few exceptions. <bold>Conclusions</bold> The final document produced from this study contains information about skills and challenges that has similarities to other studies of PSS skills, but also has unique features. Results from the study have practical implications for training, supervision and organizational development to support the PSS role.