25. Supervision for Peer Workers
Emma Watson With thanks to Danny Bowyer, Stacy Cooper, Zoe Dodd, Ellie Manning, Gwen Morgan, Deb Owen, Julie Repper, Poppy Repper and Drew SzmitIntroduction
It is no secret that the success of peer support depends on the support provided to peer workers. This learning has been established over the past two decades, where peer worker numbers have steadily grown across mental health, physical health and social care settings. The early days of introducing peer support to these services helped us to determine best practice around what is needed, both from peer workers and from their supporters and supervisors.
Those first peer workers experienced considerable challenges because we did not have a sophisticated understanding of what helped and what did not. We did not know that well- thought through processes to support recruitment, training and supervision were vital, or what was most helpful to teams that were about to welcome peer workers as colleagues. We did not know that role clarity would emerge as one of the biggest predictors of success in non-peer led organisations. We did not know what good supervision should look like
for peer workers, or where it should come from, or that it would need to include support to overcome organisational/team resistance and discrimination – both for the peer worker within supervision and by working with team and organisational staff outside sessions.
Every professional group working in health and social care services requires supervision to be tailored to them, and peer workers are no exception. It is now commonplace
for supervision to be recommended as a possible solution
to some of the perceived challenges associated
with employing peer workers.
Despite this, peer support research has tended to focus more on recruiting and training peer workers than supervision and retention (Jorgenson & Schmook, 2014). A systematic review of the peer supervision literature in 2017 concluded that very little has been written on the topic (Martin et al., 2017). However, while there may be little published guidance, there is a vast amount of collective knowledge within organisations that employ peer workers. This has been developed by listening to what peer workers find helpful, and applying the values of peer support to supervision and reflective spaces.
This briefing paper seeks to bring together this collective knowledge. We will focus on the supervision that is provided to peer workers, which might be offered by senior peer workers, or by their non-peer line managers. Alongside this we will make a case for the importance of tailored supervision for peer workers, provide some examples of where supervision has been particularly successful, and explore what peer workers and their supervisors (peer and non-peer) need in order to succeed. We have used the term supervision throughout this briefing paper, although we are aware that co-reflection is a more fitting term to describe the collaborative, reflective space that peer workers benefit from. Supervision, supervisee and supervisor are the terms used within most organisations that employ peer workers. For the sake of clarity, this is language we will also use throughout the paper.
What is Supervision and why is it so Important?
While there are many definitions of supervision, we understand supervision within peer support to be a collaborative relationship between a peer worker, a fellow peer, a group of peers, or a non peer supervisor. The goal of supervision is the learning, development, and wellbeing of the peer worker. Much peer to peer supervision also has a co-learning quality where both/all parties are prepared to remain open and to learn from each other, regardless of who is in a more senior role.
In England, every staff group within health
and social care settings is required to receive supervision (NHS England, 2023; CQC, 2023).
It has been found that supervision benefits the person receiving it, and also improves the care they provide to the people they support (Snowden et al., 2017). There is evidence from other professional groups that over time, practitioners use the skills and techniques taught to them during training less frequently (Kavanagh et al., 1993), and this is often compounded by a lack
of supervision. It is well documented that peer workers experience challenges in working within clinical cultures that might lead them to change their practices in order to fit in (e.g. Adams, 2020). This can often be compounded by demands within their working environment that take them away from their distinct peer worker role to take on the responsibilities of other professional groups. As a relatively new part of the workforce, supervision for peer workers is even more important. Given the additional challenges that
peer workers often face, it is important that supervision is regularly provided, and is a helpful and open space. Supervision plays a crucial
role in the effectiveness of peer support and is thought to enhance the practice and wellbeing of the peer worker, increase retention, and decrease the possibility of co-option and dissatisfaction in work (Foglesong et al., 2022; Orwin, 2008). The overriding aims of supervision for peer workers include addressing the following areas:
Role clarity, including purpose, visibility and the peer identity
Wellbeing
The practice of peer support
The wider organisational context, including the impact of working cultures, and how to link peer workers into networks and collective knowledge
Learning through self-reflection
Progression and development of skills as well as of a career pathway
Peer workers may receive a variety of different types of supervision within their roles, and these may be provided by the same person or by different people:
Clinical supervision – focusses on a peer worker’s practice and helps them to develop their skills and reflective abilities.
Management/operational supervision – has a more administrative function and can include signing off leave or training requests as well as discussions about performance and reasonable adjustments. This is most often provided by
a line manager and is often combined with clinical supervision where these are provided by the same person.
Group supervision – a reflective space which can be made up of fellow peer workers or colleagues from within the same clinical team. It can be structured around a specific topic or incident, or unstructured.
Peer to peer supervision – many peer workers have access to formal and informal supervision from other peer workers. These
may be senior peer workers whose roles include offering supervision, or fellow peer workers who commit to reflecting together on their experiences.
All of the forms of supervision outlined above may be provided by a person in a peer role. However, within non-peer run organisations, where roles are often integrated into multi-disciplinary teams, it is more common for peer workers to receive their management supervision from somebody in another professional group. This can bring with
it both benefits and challenges, which we will discuss later in the briefing paper. Regardless of the type of supervision that is being offered, there are some values and approaches which have been shown to be most effective in underpinning supervision for all peer workers.
What does helpful supervision look like for peer support workers?
While any supervision may be better than no supervision at all, it is important to tailor supervision spaces to the needs of peer workers. Supervision must be:
Underpinned by the assumption that every person has the ability to heal, to grow and to thrive, if we provide them with a helpful relationship to support them to do this. This is the heart of
peer support, trauma informed and person centred approaches, and must be at the heart of peer to peer supervision. Therefore, supervisors must hold the belief that the people they supervise, as well
as the people that their supervisees support, have an innate capacity to grow as fully as they possibly can given the circumstances they are living within. Of course, this does not mean that we ignore the legal and ethical responsibilities that we work within but rather that, as much as possible, we bring an attitude of curiosity and hope to reflective spaces, rather than policing and monitoring. This approach is empowering for the peer worker and will support them to feel confident in their own abilities.
some things a supervisor might say that demonstrate this:
How do you know when things are going well?
What learning can you/we take from this?
What do you want to do about this?
What was your sense of the situation?
What is your instinct telling you about this one?
What have you already tried?
What has worked in the past?
Given what you know about how your team works, how do you need to communicate this?
Collaborative and aware of power imbalances. While peer to peer supervision is important (and we will explore this further later in this paper) peer workers receive supervision from a number of different people, who have varying degrees of power and seniority within their working environment. We cannot eradicate power imbalances, but we need to talk about them in sufficient detail so that both parties
feel comfortable with the way that power will be enacted within a supervision setting. We know from peer support that it is possible to offer mutual and emotionally safe relationships where one person holds more power than another, and supervision can emulate this. We believe that supervision is most successful where supervisors are willing to enter a relationship where both people are invested in reflecting without having an outcome in mind, and both people are prepared to have their understanding challenged by what they hear: it is a mutual learning space.
The peer worker and the person supervising them should take time to collaboratively decide
how supervision will be structured, and what styles of communication are helpful and not helpful. Supervisors may come with a well-developed style, based on their experiences of supervising other people. It is helpful to reflect on whether this style is suitable, helpful or in need of adjusting for each new supervision relationship. Peer to peer supervision can be free flowing or structured, using set templates or agendas that are agreed at the beginning of each session. The level of structure needs to be negotiated by the person offering and the person receiving supervision. Some level of structure is necessary within most organisational settings so that supervision is recorded and actions can be reviewed. This can be particularly helpful where there are differences of opinion or conduct issues which need to be navigated.
some things a supervisor might say that demonstrate this:
What kind of supervision/reflective spaces have you found helpful in the past?
Do you prefer structure or is it OK to move between topics freely
My approach can often be very direct, how would that feel to you?
I document our supervisions in this way...
If I had concerns about your wellbeing or your practice, I would always discuss these with you. I hope that we could decide together about what we need to do about this
Honest, courageous, unafraid of difficult conversations. It is easy to offer collaborative, strengths based reflective spaces to a peer worker who is thriving in their role. Celebrating successes and reflecting on why things are working so well is enjoyable and affirming for both the peer worker and their supervisor. However, good supervision must also turn toward difficult issues and openly discuss challenges within
the peer worker’s practice. Common concerns raised within supervision might relate to the peer worker’s wellbeing in work, or to some element
of their peer support practice. Depending on the supervisory relationship, it can be difficult to have conversations about either of these topics. Ideally a peer worker will have a wellbeing plan in place, or at least will have a shared understanding between themselves and their supervisor about what helps them in work. These may facilitate a conversation about their wellbeing, alongside a ‘development plan’ which might contain goals around peer practice, skills and progression routes.
It is important not to avoid these difficult conversations within supervision. It is sometimes the case that staff teams who are less familiar with a peer worker’s role are cautious about addressing issues with the peer worker’s practice or wellbeing because different practices are an expected part of peer support, as is explicit lived experience. Some level of compromised practice or poor wellbeing in work may be accepted because of uncertainty about what peer support should look like, or because of fear of challenging somebody in a peer role. This is unhelpful to both the peer worker and the teams they work in. All staff members need feedback on their role, especially while they are finding their feet in a new position. Peer workers must be held to the same standards as their non-peer colleagues in terms of their conduct in work. Where this doesn’t happen, an honest conversation is needed. If supervision has already been established as a safe and collaborative space, these difficult conversations can be a little easier. It may also be helpful, where possible, to seek clarity about what is and is not expected of peer workers to inform these conversations. This can be linked to wellbeing at work plans or development plans where a peer worker has these in place, as well as to the competencies expected of a peer worker, or the job descriptions and codes of conduct that they work to. Some organisations have a central team of peer leaders or senior peer workers who can offer advice and assurance to managers and be part of conversations around wellbeing and conduct.
some things a supervisor might say that demonstrate this:
I am on your side, but this is what I’m noticing...
I have seen X in your practice and noticed that the impact has been X, what do you think is happening here?
I might not say this in quite the right way, but I am worried about...
I’m wondering what caused you to decide to do that? What has happening for you when you made that decision?
What do you think would have happened if another colleague had done the same? I have some concerns I need to share with you, I need to understand more about... Can you tell me more about...?
How does this fit with the values of peer support?Usually our team practices in a different way to what you’ve described, together we need to find a way to fit your approach into the team’s processes
I am hearing that your practice is being influenced by a more clinical approach, what is your sense of this?
The experiences of a peer supervisor within the nhs
Drew Szmit, Advanced Lived Experience KUF Development Lead
I have been providing peer supervision for around 5 years now. My support begins with making sure that people have protected time each month, in a safe and confidential space, to engage in co-reflective discussions. This is important if I want to build trust and enhance people’s skills, knowledge and confidence to prevent stress, burnout and losing the integrity of the peer worker role.
Maintaining the integrity of the peer worker role doesn’t come without its challenges. This is especially true if peer workers don’t receive supervision from an experienced peer worker, who understands the principles and practices of peer support services. This is because peer workers are often one among many other professionals, and they can often be asked to undertake duties which are out of line with the values of peer support due to a lack of understanding about the role. (Many of our peers have never worked in services before, and it can sometimes take months for them to receive their peer worker training. Without proper supervision, they can become confused about their responsibilities and engage in more traditional practises.)
Role-modelling the peer worker values in supervision is extremely important to me, too, as
I feel taking a collaborative, non-hierarchical, strengths-based approach is very effective in building someone’s levels of autonomy. This is because, as when working with the people who use our services, I embrace the concept that not everyone is the same and people have different ways of working toward a set goal.
The values of peer support also foster empathy, which further enable me to imagine what others might be thinking and feeling with regards to the challenges they face in their work. Exploring this, I share my own on-the-job experiences, skills and knowledge to relate to their experiences, and then I contribute to a shared process of generating solutions. Working
in this way provides a level of validation and decreases the dependency on me being the ‘expert’. I find this is important, as it empowers the people I supervise to believe in their own abilities to cope and respond to work challenges and thrive in their roles.
The approach isn’t always as easy as I would like it to be. I sometimes find it challenging to find the balance between encouraging people to be more autonomous and having to be more directive when it comes to saying no to things that would compromise the integrity of the role. However, I believe the key is in the way I convey the information, which is always in a clear, positive and compassionate way.
Supervision for peer workers and therapy
It is important to explore the differences and overlaps between good supervision and good therapy. We are often cautious with peer workers in offering them spaces within work which might be used as therapy, or which blur the boundary between their personal ‘work’ and their peer support work. There might be moments in supervision which have the feel of therapy, and might even bring about similar outcomes, so how can we be clear about what supervision is and what it cannot be? There might be moments in supervision which have the feel of therapy, and might even bring about similar outcomes, but both supervisor and supervisee must be absolutely clear that this is not therapy. While there can be some significant overlaps, what makes supervision different to therapy is:
• The context which it takes place in, which is the biggest indicator to a peer worker that the focus of reflections is largely related to work.
• The ‘contract’ or understanding between the peer worker and their supervisor, which might be established through a discussion about what each person expects from the other and what they believe they should be offering within the reflective space. This contract should be revisited when needed and should include an understanding about how supervision differs from therapy.
• The content of supervision, which may occasionally be deeply personal, but is most often focussed on the practice of peer support work. When personal lived experience is raised , it can be linked back to wellbeing in work, or its use within peer support
More Models and Approaches
The past 30 years have seen an abundance of models to describe the components of supervision in health and social care settings. While some more generic supervision models have been applied to peer support (Phillips, 2021; SAMHSA), it is more worthwhile to explore those models which have been developed specifically in relation to peer to peer supervision.
Co-reflection
Intentional Peer Support (IPS) was the first collective to establish a distinct approach to support the reflective process of peer workers. Their ‘co-reflection’ approach emphasises
the importance of modelling the peer support relationship and fostering a learning environment, using the cycle of learning, reflecting and practicing. They have identified four tasks of co-reflection:
Connection – remaining open and curious, and aware of moments of disconnection
Understanding worldview – aware of our own assumptions, perceptions, privilege and judgments and how these impact co-reflection
Mutuality and mutual responsibility – appreciating the worldview of others, and offering and receiving feedback; committing to the co-reflection relationship
Moving towards rather than away from – developing a shared sense of where a peer worker wants to go; holding each other accountable; reflecting on the co-reflection relationship
Co-reflection can be used formally or informally, with whole teams or with individuals. IPS offer co- reflection training, as well as drop in co-reflection spaces for peers who may not have access to peer support communities within their place of work.
Imroc peer supervision triangle
Imroc have developed an approach to supervision for peer workers which begins by establishing a strong foundation within supervision relationships. This includes clarifying expectations, boundaries and goals. Our supervision triangle rests on this foundation and includes three components:
Reflection – including establishing mutuality, co-learning and having challenging conversations within a safe relationship
Restoration – sitting with distress, exploring resilience and moral injury within peer support
Development – understanding the peer identity and how this might change/drift, setting goals and exploring opportunities to learn, progress and develop their career.
Imroc’s peer- Informed supervision training:
A supervision training that is informed by Peer Values and the Peer Support Worker experience within organisations – Poppy Repper, Learning and Development Programme Lead, ImROC and Ellie Manning, Peer Supervision Training Lead.
In early 2023 we co-produced an updated Peer Supervision Training course, incorporating feedback and insights from the past two years of delivering this training. Our diverse co- production group included peers, peer supervisors, those with lived experience of peer supervision, and individuals from clinical backgrounds. We emphasised the broader context in which peers operate, recognising the importance of understanding the systemic challenges Peers face within large organisations like the NHS. This approach aligns with Peer Support as a social activist movement and reinforces our commitment to allyship and opportunities for non-peer workers to stand alongside peers.
The group chose to rename the training ‘Peer-Informed’ Supervision training so that it was fully informed by Peer Values, and opened discussion to explore the lived experiences
of non-peer supervisors that can enhance but differ from those of Peer Support Workers. The training centres the unique insights of Peer Support Workers and the importance of recognising these distinctions for effective supervision.
Overview
The Peer-Informed Supervision Training consists of six comprehensive modules designed to equip supervisors with the knowledge and skills needed for effective peer-informed supervision. The training begins by exploring the importance of understanding the context that peer workers are working in, including understanding their role, addressing stigma
and discrimination and creating psychological safety when beginning with supervision.
We practice the skills involved in co-reflection and explore how we can make co-reflection restorative, especially following challenging experiences within work. We highlight the
need for peer informed supervision to have a developmental element for both supervisors and Peer Support Workers, and we use practical activities to encourage personal and professional growth. Allyship, safety and mutuality are central to peer informed supervision, and these concepts are embedded throughout the training.
Vision
The Peer Informed Supervision Training is designed to be collaborative, supportive, the Peer Support values are reflected on throughout, and the tone is rooted in Peer Supporters as activists within the system. The course emphasises the importance of understanding the unique challenges faced by peer support workers and the need for supervisors to adopt an allyship approach. The training is both practical and reflective, aiming to equip supervisors with the skills and knowledge necessary to provide a supportive and development-focused environment.
Evaluation
Participants felt they gained a solid understanding of peer supervision, with high scores indicating they felt capable of offering effective, compassionate, and peer-informed supervision post-training. The training also positively impacted participants’ views on using their own lived experiences, and their understanding of the progression needed from providing peer support to offering peer supervision.
Most participants reported an increase in self-confidence and overall enjoyment of the training, with many recommending it to their peers. Participants were able to effectively consolidate their learning into practical activities, such as setting up supervision agreement plans, demonstrating the real-world application of the training.
The training sessions were described as safe spaces where participants felt comfortable to share openly and engage in meaningful discussions. Mutual support among participants was a key theme, with many instances of trainees supporting each other throughout the training.
Testimonials:
‘The training helps me to gain new insights and understanding. The group session and interaction were eye opening experience. Trainers guide session well. Life changing.’ Trainee
‘I felt that this training gave me the skills to conduct any supervision with more compassion and effective use of self. The tools we were given were really useful and I enjoyed the use of reflection.’ Trainee
‘Delivering the Peer-Informed Supervision Training has been an incredibly rewarding experience. Our vision is for all Peer Support Workers to receive peer-to-peer supervision. However, we recognise that this is not always possible, and it is vital to equip non-peer supervisors with a peer-informed approach. As trainers, we have seen firsthand the transformative impact of integrating Peer Values into supervision practices. We have had the privilege of guiding both peer and non-peer supervisors through this journey, facilitating deep and meaningful discussions. It has been inspiring to see non-peer supervisors gain
a profound understanding and respect for the unique insights of Peer Support Workers. Our role as trainers is to ensure that even when peer-to-peer supervision isn’t possible, the supervision provided remains informed by the experiences and values of Peer Support Workers. This approach not only bridges gaps but also fosters a more empathetic and supportive environment. It is fulfilling to witness the commitment and enthusiasm of the supervisors we train, knowing that our work contributes to a more inclusive and effective supervision landscape.’ Imroc Peer Trainer
There are overlaps between co-reflection and ImROC’s triangle approach. Both focus on learning together, acknowledging our personal biases or preconceptions, establishing a mutual relationship with clear expectations and being prepared to challenge each other. There are also overlaps between these approaches and the components of ‘good’ supervision as perceived by all allied mental health professions, which include creating a nurturing, empathic climate, empowering a supervisee to take increasing responsibility for their practice, being flexible, attending to the supervisory relationship, being strengths based, and offering clear feedback (Spence et al., 2001). There is some clarity then, about the important elements of supervision for peer workers, and we have an emerging sense of what good supervision might include. There remains a question about who is best placed to offer supervision, and whether supervisors can and should always be people within lived experience roles themselves.
The differences between peer and non-peer supervision
An NHS peer worker
Working on an acute ward within an NHS Trust means that I get 3 types of supervision: peer, clinical and managerial. All three are completely different in nature and I get benefits from them all individually. Ward based supervisions are held with Clinical Team Leads monthly and managerial with our Ward Manager every 3 months. However, I am fortunate enough to have an amazing support system on the ward and I am able to approach them for support whenever. Ward based supervision is more structured and about the role, safeguarding, upcoming leave, problems and also about aspects of wellbeing. Whereas peer to peer supervision is based more informal with focuses on wellbeing, openness about struggles, being supportive of one another and sharing achievements.
I often find clinical and managerial a bit more intense even though they are with people I trust and get along with really well. I can easily go to the team members who hold the supervisions outside of the allocated supervisions with no anxiety, but as soon as it’s a formal supervision I tend to freeze up. This is completely different within a peer to peer supervision, whether
that is group or 1:1. I attend the hospital based peer to peer supervision group monthly which is a group of peers who do the same or very similar roles in the same hospital, along with
a member of the Trust peer development team. When I go to the peer to peer supervision I feel no anxiety whatsoever. I know that there are people there who do similar roles and often relate to the experiences I have in my work.Peer to peer supervision is a place of safety with people where bonds build quickly with shared experiences and also lived experience in some form too. Some peer supervisions
I will come in with something that I really feel I need to share and get some support for, whereas others I tend to sit back and actively listen and be alongside the person who needs support at that time. We generally identify who needs what support in check in where each person will share how things are and often the group can tell if someone is in need of being heard and supported. The facilitators are also part of the group and whilst they may kick the session off and offer support outside of the group peer support setting, they are very much included in the meeting and there does not feel like there is any sense of hierarchy.I do think having all three forms of supervision is important. If I didn’t have clinical supervision or managerial I would feel less part of the team and less able to have the confidence to speak up. Peer to peer supervision is incredibly good for the soul and also grounding me back into the peer role that can sometimes be hard to maintain on a ward environment. It is like recharging the batteries and reminding me what is important and why I really love and value the peer role.
peer and non-peer supervisors
A peer supervisor is a person with lived experience who has extensive experience as a peer worker (Peer Work Hub, 2021). They can
sit external to an organisation and be contracted to provide supervision, or they may sit within organisations but outside of clinical teams, for example within an HR or workforce development department. They may also work within the same clinical team, but in a more senior peer worker role. A peer supervisor should be able to directly relate to the experience of working in a peer role, based on their own experiences of doing so. A non-peer supervisor is a person with a different professional background, commonly nursing, psychology, social work or occupational therapy. They often sit within the same team as the peer worker and so can share their perspective on team dynamics and help a peer worker fit into the team’s processes. While they may have a good understanding of the value of the peer support role, this is not consistent across supervisors, many of whom do their own research on peer support to prepare themselves as a supervisor. Non-peer supervisors may also be external
to a clinical team, and therefore able to offer a different perspective on the peer worker’s experiences.
A lack of positions for peer leaders and a shortage of peer supervisor roles means that it is commonplace for peer workers to be supervised by non-peer colleagues. This is especially the case within larger organisations where peer workers are employed in relatively small numbers and remain a new addition to the workforce.
This has resulted in a model of supervision for peer workers that is incongruous with the rest of the mental health system, where nurses are regularly supervised by nurses, psychologists by psychologists, and so forth. These professional groups have also argued for the importance of receiving supervision from within their profession, rather than from somebody with a different background and philosophy (e.g. RCN, 2019)
The relative newness of the peer worker role means that the level of understanding a supervisor brings could be low, and supervisors may not always be aware of what they do not know. The Depression Bipolar Support Alliance (2010) found that almost all the supervisors
that they surveyed felt that they had a good understanding of the peer worker role, but that only 64% of peer workers believed that their supervisors understood what they do. While supervisors can take much learning from the peer workers they supervise, some level of understanding is important at the beginning of peer support relationships. The supervisor’s understanding of the peer workers role has been found to strongly impact on job satisfaction for the peer worker and helps to establish a good relationship between the peer worker and the rest of their team. Where the peer worker’s supervisor is also the team leader, their knowledge can help establish peer support within the team and build working relationships between peer workers and other professions (Kuhn et al., 2015).
A survey of 837 peer and non peer supervisors, across 46 US states found that peer and non peer supervisors differed in three ways; their beliefs about what knowledge is required of supervisors, their understanding of the peer worker role, and their belief regarding the competency of peer workers (Fonglesong et al., 2022). Non peer supervisors emphasised the need for a working knowledge of peer support, the need for greater role clarity, and the responsibility of monitoring the mental health of peer workers that they supervise. Conversely, peer supervisors believed an insider knowledge to be important, as well as an appreciation of the organisational context that surrounds a peer worker which contributes to a lack of recognition and an increased emotional burden for peer workers. The peer supervisors in the study believed that their responsibility was to discuss self-care, work/life balance, and burnout with peer workers, rather than personally monitoring the peer workers’ mental health.
There are challenges associated with peer provided supervision and supervision provided by other professional groups. Peer supervisors may have detailed experience of a peer worker role, but have less knowledge of organisational processes, or less experience in offering supervision. Alternatively, non peer supervisors may lack experience or knowledge of peer support and may take a more clinical/ direct approach to supervision. While none of these issues are insurmountable (and it isn’t to say that these issues are true in every case) the importance of training for anyone supervising a peer worker is clear. Despite the centrality of supervision to clinical practice, very few supervisors have received any formal training in supervision skills (Spence et al., 2001). This may be especially true for supervisors of peer workers, who may not have received training in a values based approach to supervision which is most supportive of peer workers. If the supervision skill set is in need of development across the whole mental health and social care workforce, we need to be clear about the usefulness of a peer support approach to supervision for all members of staff.
The experience of a non-peer supervisor
Gwen Morgan, Operational Lead & Clinical Nurse Specialist, Notthsc
Having a peer support worker within the team was, and is, a very new experience. The very fact that someone working alongside you is consciously using their lived experience of mental ill health and recovery does serve to force you to think more deeply about how processes are followed, how people are managed and most significantly to me, how they are supported and supervised.
The role of managerial supervision is two-fold in that it serves to monitor quality, expected standards and strive to meet the high expectations in care delivery to our service users and their families but also that it can embrace openness, honesty and allow for discussion and planning around keeping well and seeking support when needed.
I have tried to embrace the Trust’s ethos around kindness and civility and have found myself particularly mindful, in my supervision of our PSW to always be as open as possible around any potential challenges they might encounter such as being triggered by certain events and situations. I have endeavoured to not allow this to dictate supervision too heavily and it can, at times, be difficult to get the balance just right. I have found that I offer supervision more frequently to our PSW than to other clinicians. In a busy, community, clinical team environment where colleagues are ‘out and about’ seeing their patients, there is often little time to reflect or check things out with others and it can be an isolative world, it has felt right to offer a slightly higher level of support. I’m still learning how to do this well. Finding the balance between providing support and ‘check in’ whilst allowing autonomy and freedom is sometimes a tricky position to navigate.
Best practice
We suggest that the following approaches should be used when supervising peer workers:
Training for people supervising peer workers in peer specific supervision approaches
Whether supervision is being offered by a peer or a non peer supervisor, it is clear that supervision training is essential. For peer supervisors, it will enable them to translate their peer support skills into the context of supervision. For non peer supervisors, it will ensure a good understanding of the peer role and its values, and the approaches which are most helpful in supervision.
A systematic review of 29 documents, manuals, credentialing standards, and guidance specific to peer worker supervision identified 25 core competencies needed by people who supervise peer workers (Martin et al., 2017). These were ranked by frequency of identification, with the most frequently mentioned competencies including a thorough understanding and support of the peer role, championing and advocating for peer support and working within a recovery orientated philosophy. Any training in supervision should encompass these competencies.
Access to some form of supervision from a person in a peer role
While non peer supervisors may be able to provide much of the support that a peer worker needs, access to peer to peer supervision is also important. Supervision from a senior peer worker enables peer workers to reconnect with the values of peer support, and provides an embodied experience a peer support relationship, where both parties have lived experience of recovery as well as being a peer worker. A peer supervisor should role model the peer support skills that we expect from peer workers, providing an example of an empowering, safe and mutual relationship that can be taken back into the peer worker’s practice.
Any organisation that employs peer workers must invest in employing peer supervisors as an essential part of supporting the peer workforce. Where there are no senior peer workers within an organisation that can provide supervision it can be sought externally, e.g. from neighbouring organisations or from national providers of reflective spaces for peer workers, including IPS and ImROC.
Ongoing support for people supervising peer workers
Any supervision relationship has the potential to challenge a supervisor’s skills and knowledge. For non peer supervisors, it is helpful to have access to a peer support lead, or senior peer support team who can offer continuing support around the peer worker role, usual practice within their organisation and particular challenges as they arise.
Peer supervisors may have questions around contracts, reasonable adjustments or the wider organisational context. A supervisor, a contact within HR, or a peer support lead where possible, should be available to support peer supervisors to develop their knowledge and assure them as their supervision skills grow.
There needs to be open communication between peer and non peer supervisors where a peer worker has access to both, and this should be negotiated with the peer worker so that everyone is aware and comfortable with the way that information is shared
Different supervision options and a tailored approach for peer workers
Ideally, a peer worker should be able to choose what form of supervision they find most helpful, at least to some extent. While there may be elements that are less negotiable (e.g. who provides line management supervision) others may be open to discussion. A new peer worker could be offered mentorship by another member of their clinical team or may have access to peer group supervision which might be their preference over one to one peer to peer supervision. While it may not always be possible to offer different approaches, particularly where peer workers are employed in small numbers, many organisations encourage peer and non peer staff members to request supervision from colleagues they find supportive with the agreement of their line manager.
Clarity for peer workers about what supervision they can expect and from who
The many different forms of supervision that are available to peer workers can be quite confusing. Even the term ‘supervision’ can
be difficult to understand for peer workers who are new to working in health service settings. Taking time to explain what is meant by supervision and the different forms that will be offered is helpful where peer workers do not have a prior understanding of this. Where there is a peer and a non peer supervisor, a three way meeting can be a helpful way of establishing what a peer worker can expect from both people and offer space for the peer worker to express their preferences for a particular approach within both types of supervision.
Clarity for teams about what supervision is essential for peer workers to thrive in their roles
Where peer workers are new to a team, it is always important to share information about the role and to ‘prepare’ the team to support a new member of their workforce. Part of this preparation should be a conversation about the supervision that peer workers receive. Confusion about why a peer worker has additional peer to peer supervision can breed resentment from other staff members who receive less supervision or support. Within overstretched teams, it may also be perceived as unnecessary duplication. This can lead to difficulties for peer workers in being able to attend peer supervision. Discussions with the whole team about the peer worker role can help address these concerns, offering teams a better understanding of the need for peer to peer supervision and an appreciation of what peer workers bring to a multi professional team.
Flexible supervision arrangements based on the peer worker’s working hours
For a full time peer worker, it might be possible to accommodate three different forms of supervision, especially where clinical and management supervision are provided in the same meeting. However, for a part time peer worker, accessing so much supervision may present too much of a time pressure. In these situations, negotiating the best frequency and duration of supervision is important. Peer to peer supervision could take place every six or eight weeks or could be shorter in length, taking the form of a more regular morning check in. Supervision should enhance the peer workers confidence in their role and feel like an accessible and meaningful space for the peer worker. Too much supervision can be as unhelpful as too little.
A strategic approach to supervision for peer workers – the experience of sussex partnership foundation trust (spft)
Deb Owen, Peer Support Lead
When SPFT created a peer support lead team for the organisation, one of the main aims was for more peer to peer supervision for its expanding workforce. This had been a sharp rise
in the number of roles; from 12 in 2019 to 42 in 2021 (and now 70). In 2021 two senior peer coordinators were recruited to join the Peer Support Lead, and a core part of their role is to:
Offer peer support workers/specialists supervision and support, including with wellbeing at work, development and reflection on the impact of the role. Provide regular and accessible group supervision spaces for peer support workers, based on locality or service, using reflective practice techniques.
At first the senior peer coordinators offered regular 1-1 peer to peer supervision to all peer support staff (6-8 weekly), in addition to their line management and caseload supervision in teams. Monthly group reflective spaces were also provided to all, structured by a theme the group decided on and using the wise crowd technique to explore issues (drawing on the peer informed supervision training from ImROC).
In 2022-23 the team reviewed the groups’ attendance and feedback, and decided to set up more local ‘huddles’ for peer workers connected by service or locality. The aim was to allow more connections and influence over local service development. The huddles also provide space for specific training to meet that group’s needs and development, such as note taking or safeguarding. In this way, we also hoped to increase skills of collaborative working and ownership of solutions.
The size of the workforce by this point meant the one to one peer supervision model had to adapt. It continues to be offered regularly for those new to role and in the first 6 months, but then by request for those who require more mentoring and reflection.
Often issues for peer to peer supervision arise from clinical team work, such as role drift, lack of qualified staff, clarity around risk, referrals and measurement of outcomes. Because of this, we invested in more resource and time co-working with managers, with the goal of increasing their capacity to support and develop the peer workforce. We launched a Manager’s Guide to offer clarity for best practice. It covers accessible, inclusive recruitment processes, guidance for role clarity, joint reviews and appraisals, support for wellbeing, and measurement of outcomes and impact.
We have drawn from the existing model of professional (clinical) leadership in SPFT to create an aligned but bespoke model of peer leadership. The structure for peer to peer supervision relies on mentoring as well as non-directive models to enable own solutions and inspire hope. By building capacity and resilience, it mirrors peer support itself. The following feedback to a peer supervisor from a supervisee encapsulates the potential impact of this approach.
You have helped me develop in the following ways:
Authentically investing time and attention in our working relationship by getting to know me, my story; by establishing a safe space of vulnerability, honesty and aspiration, through which we communicate and work openly.
Informing me of different types of available training that can help me to progress in the direction that I want.
Being flexible to my developing understanding of myself, my professional and wellbeing needs.
Using your experience and specialism in employment to help me map a realistic and more patient route to success.
Being a role model of how a Peer acts (professionalism, networking, holding compassion and humanity at all times)
Lobbying to get me access to a range of training opportunities, including securing funding for me (from my service) to train whilst I worked on the Bank.
You have helped me to re-discover my own talents, proficiencies and areas for development in a constructive and supportive manner.
Conclusions
We know that lack of good supervision can impact the wellbeing of peer workers, lead to burn out and role confusion, increase co-option of peer support, decrease job satisfaction, lead to a higher turnover of peer workers and the potential loss of peer worker services in teams that are not able to provide adequate support. Non peer supervisors are a common feature of peer support within large non-peer run organisations, and so it is important that we are clear about the approach to supervision that is needed for peer workers. Using an approach to supervision that is informed by the values of peer support and ensuring that everyone who supervises peer workers has received some training in these is vital. The values, knowledge and understanding that a supervisor holds, both in relation to their responsibilities and to the role of a peer worker can play a defining role in the success of peer support within their organisation.
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