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This reflects a broader challenge: defining peer support. With
many different definitions or versions of peer support, it is no
wonder that clients are often unclear about what they may re-
ceive.
Clients called because they needed immediate help, and usu-
ally had a pre-identified problem and desired concrete advice
and direction. They hope to talk with someone who is objec-
tive and experienced and often wish for their conversations to
remain confidential. Separate from interviews with peer sup-
porters, program managers hold that it is important also that
clients talk to a live person. Peer supporters report that the time
for them to establish rapport with a new client ranges from one
to four phone calls.
Peer supporters identified three types of clients. Some need
urgent and specific help with something. Nevertheless, they
may resist professional treatment and so the peer supporter
may need to address this resistance and then facilitate refer-
ral. Others need time to talk about what’s going on, including
concerns that are related to both behavioral health problems
and cultural issues. Peer supporters described a third group as
those who want to be “checked up on” although it is probably
better to describe these as seeking ongoing follow-up and sup-
port, and to be “checked in with,” rather than being “checked
up on” with its connotations of surveillance and even mistrust.
This may take the form of ongoing support for those who have
dealt with a problem. Also, consistent with the theme of this
paper, the knowledge that someone is “interested in me” and
“keeping track of me” conveys support and may combat isola-
tion.
As many other studies have shown, peer support is related
to a wide range of benefits. Clients stated that their experi-
ences with peer support were different than experiences they
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■ MAY 2018
had with traditional medical and mental health providers. Not
viewed as “a sterile provider,” unique advantages of a peer sup-
port relationship include the ability to connect on a personal
level and receive practical, constructive advice from the per-
spective of someone with shared experience. Peer supporters
also offered unconditional support with no judgment or pres-
sure attached. Clients described their peer supporters as being
real, understanding, compassionate and good listeners.
Perhaps most important among these observations is a
theme that cuts across all of them: Presence and “being there”
are not the result only of “saying the right thing,” but rather are
based on a broad range of features of the peer support pro-
grams. These include, for example, the IT resources that facili-
tate smooth reference to a previous call by a peer supporter an-
swering the phone at 2 a.m. who may never have talked to the
client. They also include the arrangements that support rapid,
often same-day referrals as well as the training and supervision
of peer supporters. Presence is clearly a feature of programs as
well as the peer supporters who implement them.
Qualitative and quantitative data from the telephone peer
support services add support and broader illumination of the
importance of “being there” in peer support interventions. Cli-
ents’ as well as peer supporters’ observations describe the im-
portance of shared cultural experience, of a nonjudgmental and
accepting atmosphere, of support that makes little demand on
clients doing something to earn or maintain services but largely
takes them as they are and, as in the case of voicemail, main-
tains contact and communicates caring and availability even
when clients, for any of many reasons, go for extended periods
without utilizing services. Quantitative data show high average
contacts per client, 12 total across all programs, but that these
include both a substantial portion of voicemails as well as com-
pleted calls, attesting again to the communication of availabili-
ty as a part of support, not merely an attempt to schedule it. d