"Understanding the journey from A to Z": centering peer support perspectives to unveil the mechanisms and power of peer support

Purpose - This study aims to gain insights from peer support workers (PSWs) on the unseen mechanisms of peer support work that may be applied to implementing a child and youth mental health peer support program in a children's hospital emergency department (ED). Design/methodology/approach - This study used a critical realist perspective with a qualitative research design. Eight participants, all PSWs in health, community and social services working with adults, adolescents and children, were recruited from Alberta, Canada. Data were collected through in-person semi-structured interviews and analyzed using Braun and Clarke's reflexive thematic analysis. Findings - The results generated interrelated patterns of meaning among PSWs that were grouped into three main themes: inside out and outside in, no one leaves empty-handed and sculpting health system softness. Research limitations/implications - All participants were trained by the same organization and may have similar understandings and approaches to the peer support role. Participants were predominantly of a similar demographic; thus, participants with minoritized identities may have challenges not represented. Practical implications - Using nontraditional staffing models in an acute center may facilitate a shift to meet the chronic and complex issues of the 21st century. Social implications - Youth peer support roles may reduce stigma by challenging stereotypes and myths, reduce social isolation and improve meaning, connection and belonging for individuals with mental illness who are often dislocated and disconnected from society. Originality/value - This study exemplified the positive impacts peer support could make by improving child, youth and family experiences; reducing stigma; providing hope and help; and embedding the recovery model directly into the ED.