Bridging the Gap: Towards a theory of peer-support worker integration within early intervention psychosis services

Peer Support Workers are increasingly recognised as integral components of person-centred care provision within mental health services globally, and their presence within early intervention services is expanding. The benefits that peer support workers provide are well established, but less is known about how to quickly and effectively integrate them within early intervention services to maximise their role. This study explored barriers and enablers to effective implementation of peer support worker roles in early intervention services, through multi-stakeholder perceptions and insights involving service users, peer support workers, and clinicians. A qualitative, multi-site study within an NHS Foundation Trust in the North-West of England was employed. Semi-structured interviews with 18 participants across the three stakeholder groups were conducted, with Normalisation Process Theory guiding the collection and interpretation of participant data to identify barriers and enablers. Data were analysed thematically using a six-phase, deductive approach. Four core themes and nine sub-themes emerged from collated participant data, providing context across Normalisation Process Theory constructs. The four core themes related to: Navigating Uncertainty and Discovering Value, Building Engagement through Trust and Relatability, Structural and Relational Conditions Shaping the Functions of PSWs, and Recognising Impact in the Absence of Formal Structures . Effective integration in this context is underpinned by dynamic, relational factors. A theory of integration and logic model were developed to support policy and implementation efforts. These emphasise the need for comprehensive onboarding and evaluation mechanisms, and consideration of sustainability for these roles. • Presents multistakeholder perspectives on Peer Support Worker service integration • Features lived-experience led research using Normalisation Process Theory • Emphasises inter-relational dynamic barriers and enablers to integration success • Develops a new theory and logic model to support implementation efforts