PEER SUPPORT FOR EMPLOYMENT

A PRACTICE REVIEW

May 2016

Written by Liz Sayce and Natasha Fagelman

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We would like to thank:

All members of the group of Disabled People’s Organisations and allies who have met on disability and employment with Disability Rights UK

Everyone who participated in the survey

Everyone who shared learning from their own practices

The Work Foundation

Public Health England, for supporting this project

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PEER SUPPORT FOR EMPLOYMENT

A PRACTICE REVIEW

EXECUTIVE SUMMARY

This report is based on a survey and interviews initiated to identify practice examples of peer support to help people secure, retain or progress in employment. It is a companion report to The Work Foundation’s review of research evidence on the same subject.

We conclude that the time is right to scale up and further test peer support for employment:

There is high demand for peer support from disabled people. Disabled people involved report that peer support for employment offers hope, new belief in possibilities, encouragement, role models, relationships of trust, a new balance of power, holistic support with connected life issues and a sustainable support network

There is an appetite to facilitate it from Disabled People’s Organisations and organisations in other sectors

Government is seeking new approaches to support employment of disabled people/people with long-term health conditions, to fulfil its commitment to halve the disability employment gap. Previous programmes like the Work Programme have had poor results with these groups. In health, the 5-year Forward View cites the importance of evidence-based patient-led initiatives, including peer support, for the future NHS

Peer support goes with the grain of wider social and economic trends. Forbes’ top business trends for 2016 include a connecting economy, in which successful business leaders create value by connecting customers (as with Airbnb or Facebook). It may be possible to create human value by mobilising the expertise of lived experience

The Practice Examples in this report show promising practice. There is some evidence for peer support generally demonstrating a positive Return on Investment: for instance, Self Management UK have found that for every £1 spent on self-management courses, £2.24 is saved in reduced health service usage1. Research finds positive outcomes from peer support generally: for instance, The Work Foundation cite one randomised control trial2 showing significantly improved employment for people accessing peer support. A

1 Self Management UK (2016) Cost effective for commissioners, better outcomes for patients

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literature review by Repper and Carter (2011) 3 found evidence that peer support workers in mental health services could lead to reduced admissions, an increased sense of independence and empowerment, and higher self-esteem, confidence, social connectedness and community integration. Peer support reviews on employment specifically show a range of positive results in terms of securing employment, self-employment and promotions, sometimes (as with Journey to Employment and the DR UK Leadership Academy Programme) with emerging evidence of cost-effectiveness

‘The most obvious trend is that outcomes tend to last longer because support, networks and strategies don’t just disappear on discharge – they can endure’

We identified over 50 practice examples (47 from our survey, plus examples shared outside the survey). Many were from Disabled People’s Organisations, which are founded on peer support; it is in their DNA. They are led by people with lived experience and include centres for inclusive living and impairment-specific, user-led groups. In addition we identified employment-related peer support offered by large charities, the NHS and Community Interest Companies.

The Practice Review discusses different approaches under the following headings:

Who is involved and benefiting? Peer support today is taking place both between people with very similar impairment experiences – and, seemingly more commonly, between disabled people whatever their impairment. We found examples of positive outcomes from both approaches, in terms of hard evidence of employment destinations and reports of increased confidence, feeling safe and encouragement to grow and develop. These programmes take place both in DPOs and other sectors.

Why? What is the purpose or purposes? We found promising practices of peer support focused specifically on securing employment (eg Job Clubs), retaining employment (eg support with Access to Work) and progression (eg Leadership Academy). Other examples focus on wider life outcomes of which employment is just one. Promising outcomes include jobs obtained and career progression, with some evidence of promising return on investment, as well as improved confidence and resolution of independent living issues

What? We identified one to one and group approaches, based either on pure mutuality or on ‘peer mentors or peer support workers’ supporting recipients. ‘It takes place physically, by phone or on-line, over different time periods. Investment in facilitation and training was thought crucial by participants.’

2 Kaufman, C L (1995) The self help employment center: some outcomes from the first year Psychosocial Rehabilitation Journal 18, 4, pp 145-162 3 Repper J and Carter T (2011) A review of the literature on peer support in mental health services. Journal of Mental Health 20 (4) 392-411

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Survey response

Peer support is not a single magic bullet: it may be one component of someone’s employment support (for instance, going alongside Individual Placement with Support).

The field of peer support for employment is still under-developed and under-evaluated, with a lot of activity being small scale and discrete. Below, we make 3 key proposals to ramp up effective activity so that the clear potential of peer support for employment is more fully realised. All could be led or co-led by Disabled People’s Organisations. DPOs have been particularly influential in developing peer support and are in a position to connect employment peer support to a range of other life issues, enabling people to overcome barriers (from debt to housing problems) that need to be addressed for the person to turn their life around.

1. Create a national Peer Support for Employment Network to share expertise, evidence and practice – involving DPOs, academics, commissioners and other providers. We suggest that this should be jointly convened by Disability Rights UK and The Work Foundation. Its first task should be to create a framework for practice and evaluation to help generate improved evidence.

2. To complement DWP’s Journey to Employment project, which is showing positive results from group-based approaches, we propose that government could next invest in testing peer mentoring delivered by disabled people in work to those out of (or in) work – to offer individual encouragement and role modelling

3. There is an opportunity with the Joint Work and Health Unit to encourage approaches that bring together objectives for health gain and employment gain. This would not be in the traditional sense of providing treatment so that people can work; often what people with permanent or fluctuating conditions need are strategies to manage work and workplace adjustments in the context of life challenges more broadly, from transport to social care. The purpose would be to encourage joint commissioning at local/regional level of peer support for both employment and health/well-being.

The time is right to build good practice and evidence on peer support to enable people living with health conditions or impairments to work to their full potential.

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Why Peer Support for Employment?………………………………………………….9

About this report Future trends Demand for peer support The roots of peer support – the role of user-led organisations Peer support in a range of organisations

What types of Peer Support Exist in the UK?………………………………..…….14

Definitions Gathering information Overview of activity and interest in peer support Different types of peer support

Who – who is involved in offering and benefiting from peer support?..............18

o Practice Example 1o Programmes supporting people with specific impairments or conditions

Why – what is the purpose or purposes?.............................................................25

Getting in o Practice Example 2o Practice Example 3 Retentiono Practice Example 4o Practice Example 5 Progressiono Practice Example 6 Wider purposes, beyond employment, beyond peer support aloneo Practice Example 7o Practice Example 8o Practice Example 9

What – what is offered, how and where?..............................................................39

Support group – based approaches One to one approaches Paid or unpaid Where does it happen? o Practice Example 10

Impact and Learning…………………………………………………………………..…48

Conclusions……………………………………………………………………………….54

Appendix……………………………………………………………………………..…....56

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WHY PEER SUPPORT FOR EMPLOYMENT?This review initially grew out of discussions held by a group of Disabled People’s User-Led Organisations convened by Disability Rights UK on disability and employment. In 2015 the group came to the view that if the government is to succeed in its commitment to halve the disability employment gap4 by 2020, then one core strategy5 could be ramping up peer-to-peer support, offered between people with lived experience of long-term health conditions or impairments.

The time is right to look at new approaches to employment support. A Green Paper is expected from DWP, linked to the government’s aspiration to halve the disability employment gap, and the 5-year Forward View cited the importance of evidence-based patient led initiatives, including peer support, for the future NHS in England.

Those participating in the initial discussions identified some advantages of peer support from their own and their organisations’ experience, including:

The power of learning from others who are facing (and may have overcome) challenges with employment when living with a long-term health condition or impairment

The sheer encouragement offered by ‘ordinary role models’ i.e. people the individuals can identify with, who are already working or progressing in their careers

The greater trust people experience when talking with someone in a similar position – rather than talking to a professional advisor or representative of the state. (The state can be a source of fear, viewed as more of a pressure than a support, given its powers to impose benefit sanctions for non-compliance with work-related activity)

The potential of peer support models to address employment in a holistic way alongside other life issues: for instance, enabling someone who is seeking work also to address problems with their housing, benefits, transport and health, so they can give their attention to employment aspirations knowing they are gaining control over other issues

The potential additional value for money offered by solutions based on networks, where the expertise and experience of people living with challenges is mobilised – reducing reliance on professional support alone.

4 The disability employment gap, currently running at over 30%, is the gap between the employment rate of disabled people and the employment rate of non-disabled people. The Conservative Party’s 2015 manifesto committed to halving this gap - https://www.conservatives.com/manifesto 5 Peer support – or any support – for disabled people is one necessary part of the strategy. The strategy also needs to address the labour demand side: for example, policy levers to increase actual opportunities for apprenticeships, jobs and self-employment; and changes to how work is structured, to make it more flexible to people experiencing widely varying disability-related barriers

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These themes are reflected in academic literature on peer support (see The Work Foundation’s Literature Review).

We wanted to establish the types of peer support in existence to achieve employment goals of seeking, retaining or progressing in employment and the extent of evidence available on their achievements.

About this reportIn order to give us a valuable employer perspective, the group of Disabled People’s Organisations (DPOs) decided to involve the Business Disability Forum, and also approached The Work Foundation as we wanted a partner with a strong focus on evidence.

Disability Rights UK and The Work Foundation then jointly undertook work to broaden understanding of the evidence and stimulate debate through:

A round-table jointly held in February 2016, involving DPOs, experts in employment and health, policy makers, academics and practitioners

A pair of reports: this Practice Review, based on a survey designed to identify current practices, conducted in Feb/March 2016, with follow-up interviews to gain additional information and practice learning; and The Work Foundation’s review of evidence from research

This Practice Review explores current UK peer support practices for people living with health conditions or disability, where this is geared wholly or partly to getting, keeping or progressing in employment. It identifies evidence and promising learning from a number of types of peer support in a number of settings. This report complements a literature review by The Work Foundation on peer support for employment.

Future trendsOur interest in peer to peer support went with the grain of wider social and economic trends. We live in a connecting economy. According to Forbes’ Top Business Trends of 2016:

‘Top performing businesses will focus on the value that comes from connecting customers’6.

• Airbnb is the largest global provider of accommodations – yet owns no buildings

6 http://www.forbes.com/sites/ianaltman/2015/12/01/top-10-business-trends-that-will-drive-success-in-2016/#157909c75571

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• Facebook is the largest media company – yet creates no content

The question we posed was: could employment support create human value through connecting people, rather than relying only on ‘provision’ of professional support?

We wondered whether investing in peer support might – rather like investment in companies like Facebook – unlock value: the value of disabled people’s contribution to each other and to the wider society and economy. We learnt from the RSA’s Connecting Communities programme, which explored the social and economic value of connecting people, from car lift sharing schemes to local sharing of skills to overcome isolation7.

Demand for peer supportPeer to peer support and mentoring are in high demand from people living with disability or health conditions. For instance:

Disability Rights UK surveyed over 500 disabled people on what had been -and would be - useful in securing employment. Only 12% had been offered peer mentoring, but 46% said they would want this (i.e. mentoring from someone who had faced similar barriers to getting or keeping employment)8

The Care Quality Commission’s 2015 survey of people using mental health services found 48% did not get information on support available from others with similar mental health issues but wanted it; only 24% definitely did get this. This unmet demand for peer support is much higher than – for instance – for talking therapies, where 47% got talking therapies, and only 25% said they did not but wanted them9.

The roots of peer support: the role of user-led organisations

‘We would state as a DPO providing employment support to disabled people that our entire service is 'peer support'

Survey response

Disabled people’s user-led organisations are founded on peer support: it is in their DNA. They are led by people with lived experience (with their Boards made up of at least 75% people with lived experience) and often staffed by a majority of people with lived experience. Their roots include:

7 https://www.thersa.org/discover/publications-and-articles/reports/community-capital-the-value-of-connected-communities/ 8http://www.disabilityrightsuk.org/sites/default/files/pdf/takingcontrolofemploymentsupport.pdf 9 http://www.cqc.org.uk/content/community-mental-health-survey-2015

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Local centres for independent or inclusive living, set up from the 1980s by disabled people to offer support with running your life, on your own terms: facilitating people to share experiences and learn – for instance – how others have used their personal budget or employed a personal assistant to live the life they choose and participate in society

Local impairment-specific user groups: for instance, mental health user/survivor groups, or groups of people living with HIV, or epilepsy, or learning difficulties. Many share stories and ways of solving problems, providing empathy and hope

National user-led organisations, both impairment-specific and wider; like People First England, National Service User Network and Disability Rights UK. Many publish stories and videos produced by and for disabled people, and offer advice lines staffed by disabled people, some specific to employment10

At the heart of these developments is mutual support and sharing experience.

In this review we found examples of DPOs running a range of types of peer support for employment, including job clubs to support people to get jobs, mentoring to support retention and programmes to support career progression (see later sections).

National Centre for Independent Living reported in 2008 on the range and quality of peer support activities to support personalisation in social care: DPOs have longstanding expertise in using peer support to enable people to pursue the lives they choose. 11

Peer support in a range of organisationsPeer support is also offered as an element of service by a range of other types of organisation, from the NHS to large provider charities, large employers to social enterprises. This review identified examples from a range of different sectors, covering public, private and third sector organisations.

10 Disability Rights UK student helpline - http://www.disabilityrightsuk.org/how-we-can-help/helplines/disabled-students-helpline DR UK guides and factsheets - http://www.disabilityrightsuk.org/news/2016/january/higher-education-2016-now-available 11 http://www.disabilityrightsuk.org/policy-campaigns/reports-and-research

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WHAT TYPES OF PEER SUPPORT EXIST IN THE UK?

Definitions

We define peer support as the support and help that people with lived experience of mental or physical health conditions or impairments give to one another. Support may be practical (e.g. information sharing), social (e.g. introducing people to new opportunities) or emotional (e.g. empathy, encouragement).

It may be group-based or one-to-one.

It can be based on informal sharing of experience, or more formalised structures: for example, peer mentoring (where a peer mentor offers encouragement and support to enable someone to develop) or support from a trained peer support worker (who may sometimes be further on their personal journey than the person supported).

Gathering informationDisability Rights UK ran a survey from 15th February to 31 March 2016, promoted through a range of voluntary sector and public sector networks, including via The Work Foundation and Disability Rights UK’s contacts (covering DPOs, charities, leaders in the fields of health and work, policy and academic contacts) and through social media. It was hosted on SurveyMonkey with a word version available on request. It had 67 respondents over this period. In addition some organisations sent information on their programmes: some of this has been pulled out in our Practice Examples, below. Finally we conducted interviews with selected survey respondents, to learn more about their programmes – and again these are included as Practice Examples.

Not all respondents answered all questions: where findings are reported below, the percentages represent the proportion of respondents to a particular question.

The complete survey is available at Appendix 1.

Overview of activity and interest in peer supportOf 67 organisations or groups responding to our survey 47 offered peer support to disabled people. In some cases this was a new initiative (less than 3 months old), but more often it was longstanding. Indeed, half of those responding to this question said peer support had been on offer for over 5 years. The organisations responding included DPOs, impairment-specific User-Led Organisations, community interest

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companies (CIC), disability charities, employers, and public sector organisations (e.g. NHS).

Many respondents reported a strong appetite for peer support amongst disabled people - confirming findings from national studies (see p11). For instance, Warrington Disability Partnership undertook a survey of 150 disabled people which found that they overwhelmingly identified peer support as something they would value and want to engage in; this prompted the development of the Warrington peer support programme. Those offering peer support reported a range of positive outcomes, including employment outcomes, improved health and well-being – and sustained improvements over time:

‘the most obvious trend is that outcomes tend to last longer because support, networks and strategies don’t just disappear on discharge – they can endure’

Survey response

For a fuller discussion of Impact please see pp44-47.

Only one organisation surveyed had discontinued a peer support scheme. Some schemes at or near the end of project funding were seeking ways to continue (e.g. Practice Example 8, where nearly half of those involved wish to carry on the scheme beyond its 14 week run and are actively seeking ways to do this).

Of 15 organisations that said they did not offer peer support, 7 said they hoped to offer it in future. Of those that did not intend to offer it in the future, the overriding reason was that the organisation was too small for such a scheme to be effective. No one stated a lack of interest.

In response to a question on whether any of a list of possible future networks or tools on peer support would be of interest, 79% said yes to one or more: a network of organisations involved in peer support (23 respondents), a toolkit (24 respondents) or updates with learning from other organisations (23 respondents).

This small survey has identified an appetite amongst organisations and groups to develop peer support and to develop their practice by learning from each other via organisational peer support. Whilst the survey was promoted through social media it did not reach the whole of (for instance) the NHS, the network of disabled employee networks in companies or all of the UK’s 165,000 charities. So we suspect the activity and interest reported here under-estimate their full extent.

One survey respondent was interested to know how peer support schemes link to Department of Health and wider government objectives, as this could be useful to grassroots organisations in coming together and securing investment.

‘A website which directs people to this sort of information - strategy, objectives, funding, case studies and so on – would be really useful’.

Survey response

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Different types of peer supportDifferent typologies have been used to map peer support and categorise evidence on it, for instance:

The Work Foundation, in their review of research for this project, have looked at different models of peer support for employment (support-group based, one-to-one mentoring, workplace based); and at different purposes (securing employment, retaining employment, progression)

NESTA, who mapped types of peer support more generally (i.e. not for purposes of employment) created a typology based on the questions of Who, What, Why, How, Where and When12

We have combined these approaches, using the core headings of:

Who? Who is involved in offering and benefiting from peer support? Why? What is the purpose or purposes? This maps against The Work

Foundation’s categories of securing employment, retaining employment and progression

What? What is offered, where and how? This maps against The Work Foundation’s categories of support-group based, one-to-one mentoring and work-based support.

The more detailed questions of how, where and when are described within the above headings.

12 https://www.nesta.org.uk/sites/default/files/peer_support_-_what_is_it_and_does_it_work.pdf

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Who? Who is involved in offering and benefiting from peer support?

We wanted to understand whether peer support programmes benefit people with particular impairments/health conditions, or disabled people more broadly; and whether they focused on people in particular life situations.

Chart from DR UK Survey, Feb 2016

Two thirds (67%) of respondents to the survey were involved in peer support by and for disabled people generally – not people with specific conditions or impairments.

Of the other third, most (29%) involved people with a particular health condition/impairment – ranging from broad categories (mental health issues, learning disabilities) to highly specific conditions (eg Myasthenia Gravis). The remaining few (9%) involved disabled people and non-disabled people around them (family, work colleagues); or were specific, for instance people living with mental health challenges who were researchers.

‘[Our purpose was]… to encourage greater reflection, improve confidence of workers, prevent people from leaving work, have more horizontal feedback in terms of the established hierarchy in academia and research’

Survey response

Some peer support involved people facing particular challenges, for instance:

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‘We are currently running a peer support project for the 14-16 age group for disabled people who are not in education or employment or training’

Survey response

Practice Example 1: Who for? For all disabled people

Organisation: Action on Disability and Work UK (ADWUK) (now part of WECIL)

Project Format and aim: The Advice Service and Work Club provide information, advice and support in the field of disability and work. Experienced disabled advisors work with individuals to identify and remove the barriers to participation in work, across all types of impairment and health condition.

Numbers of participants: over 800 per year, with a wide range of impairment experiences. The service is national, with a base in the South West. In 2015 the Advice Service took slightly more calls from people in work than out of work – and particularly from disabled people who were self-employed (perhaps partly because disabled people seem more likely than non-disabled people to be self-employed13, sometimes choosing it to create their own flexible working patterns). A small number of inquiries were received from employers and other organisations. The Work Club largely catered for job seekers.

Costs: The service has been project funded, with some corporate income.

Approach: The advice service, delivered by disabled people, offers advice most frequently on self-employment, job seeking, Access to Work and issues that intersect with employment, like transport and wider independent living. The Job Club offers drop-in support and courses, for instance on IT and iPad use.

Outcomes: A survey of people using the Advice Service found that 71% followed the advice given and 91% would use the service again. Although 33% said their situation was unchanged, some had achieved hard outcomes: 16% reported that they had retained employment and 11% that they had set up as self-employed. Comments from users of the service focused on the value of delivery by disabled people – and the trust they felt in its independence:

“Thought it was good. Best bit was talking to someone else who had a disability themselves and I found that empathy and understanding encouraging.”

“It’s lovely that it’s independent, don’t ever go away as you are needed.”

13 Boylan and Burchardt (2003) Barriers to Self-Employment for Disabled People. This research found that 18% of disabled men and 8% of disabled women were self-employed compared to only 14% of non-disabled men and 6% of non-disabled women

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“Found the advisor to be transparent and welcoming, felt listened to and confident to call back.”

Action on Disability and Work UK surveyed those people who had stopped attending the Job Club. They identified 29 people who were seeking work (the remainder were mainly retired). Of the 29, 10 were in employment (just over a third). Comments included:

“Very helpful – obtained a job.”

“All helpful - had previously not used a computer”

Learning: Advice and support offered by and for disabled people seems to be valued for its independence, understanding of disability, empathy and trustworthiness. This may mean people do follow the advice offered, in an encouraging environment.

Programmes supporting people with specific impairments or conditionsSome peer support programmes are impairment-specific. For instance:

Positively UK:

Offers one-to-one peer support for people living with HIV, using a network of mentors who are living with HIV themselves and are trained to provide emotional and practical support around all aspects of living with HIV

Individuals are matched with mentors who have been through similar issues and can offer the support the individual needs

They also offer ‘talk groups’ for different groups, for instance gay and bisexual men, facilitated by staff and mentors

Positively UK is a local site for NESTA’s Realising the Value programme. They aim to demonstrate peer support as an effective person centered intervention in promoting health and well-being. The programme will be evaluated in terms of behavioural insights (whether and how peer support influences behaviour change), systems enablers and barriers, and economic analysis14

This initiative, like many peer support programmes, is not specifically designed to achieve employment outcomes – but covers all aspects of living with HIV so the evaluation may reveal outcomes relevant to employment

14 http://positivelyuk.org/realising-value/ and http://www.nesta.org.uk/project/realising-value

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Issues discussed by Positively UK include whether and how to be open about HIV at work

Recovery colleges aim to be transformational places where people living with mental health

challenges can learn and pursue their own journey of ‘recovery’ i.e. build a life of meaning

The colleges offer courses, co-produced and co-led by people with lived experience of mental health challenges and other expertise. Many offer courses on employment, alongside other topics. For instance, the Central and NW London Recovery College offers courses on Surviving and Thriving at Work, Managing Personal Information at Work, Job Applications and CV Skills and a ‘snapshot’ Introduction to Employment

Meddings et al (2015) evaluated evidence on Recovery Colleges and found that ‘despite methodological limitations, it has been consistently found that attendance at Recovery Colleges is perceived to be useful and to help people progress towards their recovery goals’; and that NHS service use is reduced. They conclude that the introduction of an explicitly educational (“learning”) model into mainstream mental health services seems to have ‘a profound effect on reducing the power differences inherent in traditional professional/patient relationships’15

Rinaldi and Wybourn (2011)16 reported that in the South West London Recovery College, almost 70% of participants had become mainstream students, gained employment or started volunteering. This College’s 2011-12 Annual Report17 showed 44% of attendees had a diagnosis of schizophrenia; 84% felt more hopeful for the future as a result of the course; and 75% were able to do things they wanted to do in life as a result of the course. Testimonials from the CNWL College include:

“Makes me feel positive about going back to work” Student feedback from ‘Work in Mind’ course18

“I am beginning to feel part of the world again”

“I have a purpose back in life”

15 Meddings S, McGregor J, Roeg W and Shepherd G, (2015) Recovery colleges: quality and outcomes, Mental Health and Social Inclusion, Vol. 19 Iss: 4, pp.212 - 221 http://www.emeraldinsight.com/doi/abs/10.1108/MHSI-08-2015-003516 Rinaldi M and Wybourn (2011) The recovery college pilot in Mertin and Sutton: longer term individual and service outcomes. SW London and St George’s NHS Trust 17 South West London Recovery College 2011-12. South West London and St George’s NHS Trust18 http://www.cnwl.nhs.uk/wp-content/uploads/CNWL-Recovery-College-Annual-Report.pdf

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“I would not have thought [it] possible, that I can live a full life despite ongoing difficulties, if I had not been a student here. I was able to see myself as a person not an illness. Before, the illness defined who I was”

“It is good to be with others who have had similar problems, which includes the peer trainer”

“Peer trainers made me feel safe”

“It is nice to know that there are other people with similar problems as you, the tutors, they understand the problems that you are going through”

“It felt a safe environment to learn in, the co-delivery”.

There were also benefits for the peer trainers, for instance: ‘I cannot believe I’m off benefits after 14 years and persistently interrupted work history prior to that. I am also developing a self-employed career in research, consultancy and some brokerage’.

Testimonials from the SW London Recovery College include:

‘Peer tutors were brilliant. Only someone who has gone through it can understand’

‘This place has benefitted me because I have not fallen into the medication trap as a consequence of frustration and boredom, but instead it gave me tools to do online studying and research to find myself and to become a productive member of society again, instead of a stereotyped hindrance that needs to be contained’

‘Change is always encouraged but never enforced and therefore a greatly empowering experience done through self-reliance, determination and the great support of the trainers within the College. I have met some amazing and inspiring people at various courses, most of whom have come a great distance in their lives and wish to grow further….’

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There is no evidence from this review on whether pan-impairment programmes are more valuable than impairment-specific programmes or vice versa. People certainly value specific learning from others facing near-identical challenges: for instance, comparing notes on which screen reading software works best for them, or how best to manage your MS. Where peer support is designed to help people manage their condition, meeting others with, for example, mental health issues, can help (although even here the differences between people’s experiences may be as great as the similarities).

However, when it comes to how to thrive at work, learning across different experiences is at least as valuable: for instance, Disability Rights UK’s Leadership Academy (Practice Example 6) finds that people gain from sharing stories on how to deal with being under-estimated, and whether and how to talk about your condition at work – whatever your impairment. A pan-impairment approach to supporting people’s journeys of independent living or employment can benefit from a very broad sharing of barriers and strategies for overcoming them.

Some organisations offer both wide and specific programmes: for instance, Self Management UK (formerly the Expert Patient Programme) started with largely generic health condition programmes and now additionally has more specific ones (e.g. for people with rheumatoid arthritis). Since a large part of their purpose is enabling people to manage their condition, the impairment-specific approach makes sense.

In summary, peer support today is taking place both between people with very similar impairment experiences – and, seemingly more commonly, between disabled people whatever their impairment. We found examples of positive outcomes from both approaches, in terms of hard evidence of employment destinations and reports of increased confidence, feeling safe and encouragement to grow and develop. These programmes take place both in DPOs and other sectors.

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Why? What is the purpose or purposes?We wanted to understand the fundamental purposes of peer support: for instance, to improve opportunities for employment, or well-being, or independent living.

Some groups and organisations responding to our survey focused purely on employment, for instance:

‘We assist people who use our service to retain current employment or access new employment opportunities’

Others focused on wider life opportunities and independent living:

‘We offer peer support to end social isolation, improve knowledge and skills for disabled people across Bristol and South Gloucestershire’

When asked what outcomes they were aiming for the responses broke down as follows:

General life satisfaction/well-being 87%

Good/improved health 63%

Getting employment/education/skills 73%

Staying in employment/education 40%

Progressing in employment/education 47%

(Percentages total more than 100% as some respondents aimed for more than one outcome)

Comments included that:

These outcomes are often linked, for instance:

‘The first 2 are essential building blocks to getting/ staying in employment’

All outcomes are underpinned by a commitment to independent living:

‘Greater independence, choice and control’

Specific outcomes are also important:

‘Improved understanding of living with an impairment’

‘Brokerage for support plans with the Council’

Some mentioned peer support for their own workforce.

Within ‘employment’ the programmes may focus specifically on getting in, staying in or getting on.

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Getting in

Peer support to enable disabled people to set up their own businesses is not widespread but appears to be growing – for instance, see the Inclusive Entrepreneur at http://centreforgendereconomics.org/inclusive-entrepreneurship-key-to-diversity-in-start-ups/ and the Disability Entrepreneurs’ Network at http://www.disabledentrepreneurs.co.uk/

Practice Example 2: Supporting Micro-Enterprises

Organisation: miEnterprise

Project format and aim: miEnterprise is a Community Interest Company, and a joint venture marketing cooperative based in Herefordshire whose members are learning disabled adults and young people who run food sector micro-businesses. All the members are share holders and have a controlling interest. All the micro-enterprises produce their own food products for sale, under the mutually supportive umbrella of the coop/CIC. They support each other and have targeted support in place to assist both in running their businesses and in growing their independence.

Numbers of participants: 8-9 people who are running or want to start their own businesses.

Costs: Member fees are covered by Direct Payments. All members are adults with learning disabilities, eligible for Direct Payments. Member fees are then used to pay initial & ongoing support costs of the individual micro-enterprises which are then run under the umbrella of the scheme. The beauty of the scheme is that the asset locked (CIC) nature of the project means that grants can be sought which benefit everyone. Large grants have provided mutual assets which everyone in the scheme can use, but which they would never have been able to afford or to acquire funding for on their own. Grants have gone towards furnishing a very well equipped catering-standard kitchen, complete with links to an on-site café, and a soon-to-be-reopened ice cream parlour.

Approach: Members are supported to set up their own micro-businesses under the scheme’s umbrella. Members have access to high-quality equipment in a professional atmosphere and a regular customer base. The coop is very proactive in helping it’s members to develop & market their products and share market knowledge (as well as providing business admin support). Members also take advantage of selling at local markets and to order. There’s a good level of collaboration and support for each other’s businesses. People who specialise in making a certain thing can go away for a week and make arrangements that someone will make & sell to their regular customers on their behalf; similarly, people with certain strengths can support others. A good example is evident in the work of the quiche-maker – she specialises in quiches, but another participant is excellent at pastry making, and he makes it and sells it on to the quiche-maker. There is pay-off for everyone along the way.

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The CEO of the scheme ran sessions in other parts of the country to get different groups involved doing similar things along these model lines, and he knows that at least one is now established and beginning to market it’s member’s services – a website development enterprise run by young men with Asperger’s. This group is member and family led and will use a commission model to go towards paying for support costs and mutual marketing, but the business is hoped to be self-sustaining with ongoing peer and family support.

Outcomes: Soft outcomes can clearly be seen – huge steps forward in confidence, and room for people to focus on what they’re good at and like doing. Hard outcomes include the fact that each person involved in the scheme either runs (is trading) or is preparing to run their own micro-business. The nature of the group means that there is an ongoing support requirement, which includes both peer support and facilitator support. The CEO believes that the model could be developed with pan-impairment groups or different impairment groups and could be run very successfully as a primarily peer-support based model making maximum use of the structure to share marketing, knowledge and seek grant investment in business equipment and facilities. At present, outcome reporting is quite informal, but more structured reporting is planned, so that the support workers have a better understanding of what people want out of the scheme and how best to help them in achieving that.

Learning: From the CEO’s perspective: the model works best if you pick one business area (food, website development, etc) and focus on that. He believes there is definitely scope to expand the scheme to enable more people to support each other, but the key is definitely having the right group of potential members to jointly develop the project and to select the type of enterprise and focus activity on obtaining funds for that. A scheme of this shape might have greater self-sustainability and lower member costs, as more people would be able to support each other and have less need for support workers. It can also overcome some of the disadvantages of self-employment like isolation and high initial capital outlay.Practice Example 2: Supporting Micro-Enterprises

Practice example 3: Journey to Employment (J2E)

Organisation: Multiple. The Office for Disability Issues has funded a number of local Disabled People’s Organisations to offer J2E – in 3 areas of England (Greater Wessex, Surrey and Sussex and South West Wales). Here we give examples of activities and outcomes from Spectrum in Hampshire

Project format and aim: People living with health conditions or impairments are offered access to a Job Club within a DPO, which offers peer support in job seeking and skills and takes a holistic approach, providing a range of tailored activities to enable people to develop individual action plans and improve their confidence and skills. Each J2E job club has a Community Employment Specialist (CES); someone with lived experience of disability, working both in the local Job Centre and in the Job

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Club. The Community Employment Specialist provides lived experience and a real understanding of the issues unemployed disabled people face in finding and staying in employment. They work alongside Jobcentre staff and provide advice on disability issues and insight into the main issues disabled people face. They also deliver a programme of employer engagement to help open up opportunities for disabled people to work, for instance securing work tasters and placements with small employers, thereby building their confidence in employing disabled people.

Number of participants: Spectrum supported 30 people in the first phase. A DWP evaluation is expected, which will report on numbers across the whole programme. DWP is planning an extension of J2E.

Approach: The approach involves personal mapping (e.g. previous skills and employment, independent living issues like travel, barriers and ways of overcoming them); employment support (e.g. job seeking, Access to Work, in-work support); developmental pathway (e.g. personal goals, gaining skills, coaching); peer support through the Job Club (encouraging people to support each other); and in-work support (mentoring, buddying). Spectrum’s approach is detailed here in their own words:

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The SPECTRUM J2E Job Club started in June 2015. We are running 7 overlapping and staggered Job Clubs with 8 – 12 participants in each. The Job Clubs run over 12 weeks with ongoing 1-2-1 and facilitated peer support as required throughout the Project.

The Job Clubs are run in our own fully accessible, serviced meeting and training centre, which includes an IT Suite that participants use for both IT skills training and for CV preparation, on-line job search etc.

We also have three local partner organisations, who are also User Led Organisations, who provide occasional additional specialist coaching for People with Mental Health Conditions, Learning Difficulties, and people on the Autistic Spectrum as required.

The Job Clubs are structured as follows:

Weeks 1 to 2 – Initial assessments and individual action planning

Weeks 2 to 5 – Employment support, mentoring and training

Weeks 6 to 12 – weekly Group Job Club sessions and ongoing 1-2-1 support and mentoring

Ongoing - Follow-up mentoring; facilitated drop-in and peer support group (‘Social Café’)

Each person develops an individual support and action plan with the Community Employment Specialist. They then select 2 or 3 areas of work to focus on, identify what resources they need to implement the action plan (including how much they need to commit to), identify individual training and coaching requirements and appropriate resources (e.g. local Skills Funding Agency funded courses, links with local colleges), as well as priorities for group training as part of the Job Club. A financial and benefit review is included, including ‘better off in work’ calculations.

Spectrum also supports people using the service with issues like housing, debt,

Outcomes: As at April 2016 DWP noted that users of this service tended to face significant barriers to employment – and that 31% by that point had secured employment.

Spectrum’s results showed that 50% had secured either employment, work placement or volunteering and that results were promising in relation to costs. Spectrum notes that DWP calculated that achieving 4 per cent job outcomes - which was the target they set for J2E (given that participants faced significant employment challenges) - would equate to spend per job entry of £10,375. This is cheaper than both Work Choice and the Work Programme. In reality far more than 4% job outcomes have been achieved (see above), so the cost effectiveness is much greater. We anticipate that DWP will publish evaluation results in due course.

DWP has collected testimonials from across the different J2E sites. For instance, one participant moved from unemployment first to being a peer mentor and then to employment, supporting older people. He said:

"J2E helped me to get my self-esteem and self-worth back. I thoroughly enjoy working with the elderly, I feel valued and I enjoy both my volunteering and my new job. If it wasn’t for the help of J2E and the CES and my work coach I wouldn’t like to think where I would be. Looking back now it’s all in the past and I am moving forward, I know that both the CES and work coach are still available for me if I need. I now know what I want to do and I get so much out of doing this work.”

Comments from participants in Spectrum’s programme included:

‘I suffer with depression, anxiety and stress. I haven't worked since March 2014 (18 months) because of this. Coming to the job club makes me feel hopeful of getting back on track as the support of people going through the same problems is beneficial and I hope getting IT skills will make me more attractive to employers’.

‘My time at the Job Club has not only been successful in helping me find and secure a job, it has also helped me greatly in building my confidence, meeting new people and opening my eyes to what I CAN achieve. The staff at SPECTRUM have gone above and beyond what I ever expected and it has been a real pleasure meeting them all and working alongside them. I finished my set time on the course however I still attend each week as the support and the relationships I have made will stay with me forever. I can never thank Ross and Ann enough for everything they have done for me and if I could start all over again I would. I could not have asked to have met a better group of people and would strongly advise anyone offered this fantastic opportunity to take it. Thank you.’

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The SPECTRUM J2E Job Club started in June 2015. We are running 7 overlapping and staggered Job Clubs with 8 – 12 participants in each. The Job Clubs run over 12 weeks with ongoing 1-2-1 and facilitated peer support as required throughout the Project.

The Job Clubs are run in our own fully accessible, serviced meeting and training centre, which includes an IT Suite that participants use for both IT skills training and for CV preparation, on-line job search etc.

We also have three local partner organisations, who are also User Led Organisations, who provide occasional additional specialist coaching for People with Mental Health Conditions, Learning Difficulties, and people on the Autistic Spectrum as required.

The Job Clubs are structured as follows:

Weeks 1 to 2 – Initial assessments and individual action planning

Weeks 2 to 5 – Employment support, mentoring and training

Weeks 6 to 12 – weekly Group Job Club sessions and ongoing 1-2-1 support and mentoring

Ongoing - Follow-up mentoring; facilitated drop-in and peer support group (‘Social Café’)

Each person develops an individual support and action plan with the Community Employment Specialist. They then select 2 or 3 areas of work to focus on, identify what resources they need to implement the action plan (including how much they need to commit to), identify individual training and coaching requirements and appropriate resources (e.g. local Skills Funding Agency funded courses, links with local colleges), as well as priorities for group training as part of the Job Club. A financial and benefit review is included, including ‘better off in work’ calculations.

Spectrum also supports people using the service with issues like housing, debt,

‘The J2E course gave me my confidence back that I had lost for so long with job searching, and made me feel so much more relaxed about upcoming interviews. Suffice to say, I got the job.’

‘It was refreshing to be part of a team again and to meet people that were in the same boat as me with finding work.’

‘Sorry for not being in contact as of late - been really busy with work still - I'm pretty much full time now and have been offered a permanent job and learning to drive now, so things are looking up. Thank you for all the help again, feel like my life's getting back to normal’.

‘I was quite nervous to begin with as I haven't worked in a group for a considerable time. Everyone was friendly and I settled in with ease. It felt more like friends helping each other.’

Learning: the sense from testimonials of being relaxed and becoming able to develop greater hope and confidence comes through repeatedly. This may be important to people’s motivation to act – to gain new skills, try new work, knowing they have peer support to back them up, ongoing when needed.

Retention

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From Spectrum: A is a young woman with scoliosis (curvature of the spine), wearing a body brace and in considerable discomfort. She had trained as an army cadet, had good qualifications, and hoped to pursue a career in physical fitness. However after several operations and deteriorating health this was no longer possible. She was inappropriately housed and finding medical solutions for her condition made it difficult to obtain employment.

After several weeks of working with A building her confidence we decided to support her by attending her consultant’s appointment with her, this included a reassessment of her needs and a targeted programme of physiotherapy. With our continued supported this gave her the confidence to apply for several jobs and within five months had secured a job with the Post Office, coming off benefits completely. She continues to keep in touch and share her progress.

Staff retention is a big concern for employers. The Business Disability Forum (2015) notes that UK employers spend £4 billion a year on staff turnover19.

The Office for Disability Issues supported a number of DPOs to offer peer support to make Access to Work applications, to enable disabled people to thrive and stay in work.

Practice Examples 4 and 5

Organisation: Multiple. Here we focus on 2: Breakthrough UK (Aspire scheme) and ecdp (Essex Coalition of Disabled People)

Project format and aim: 18 month project to provide peer support for making Access to Work (ATW) applications

Number of participants: At Breakthrough, 19 individuals were referred to the scheme; and over 50 employers engaged with across Manchester. At ecdp, 21 individuals were referred

Approach: In Breakthrough UK, disabled volunteers were trained as peer mentors who worked with and supported individual disabled people facing barriers in the workplace, focussing particularly on supporting people to complete Access to Work applications.

Ecdp trained 18 access specialists to offer support with Access to Work to disabled people across Essex, matching people depending on issues including impairment and particular needs.

Outcomes: In Breakthrough UK, 6 peer supporters were recruited and trained. They worked with 19 referrals to the scheme who made 10 applications to Access to Work, with 8 being successful. Examples of people supported by Breakthrough UK through this programme have been highlighted to other national projects as examples of good practice.

The ecdp programme was evaluated by Office for Public Management (OPM). 14 applications were made to Access to Work, of which 9 were successful. The evaluation concluded that many would not have been able to make the applications without the support. The project changed clients’ attitudes about what support was available to assist people to achieve fair working conditions. They found that having support from a disabled peer was incredibly important to clients - someone who understood the process they were going through provided clients with the understanding, confidence and motivation needed to apply for ATW. Peer support also made many clients feel more at ease with their own impairment. The project helped people build networks of support; and had developmental benefits for the peer access specialists.

19 http://businessdisabilityforum.org.uk/about-us/news/state-of-the-nation-report-retaining-and-developing-employees-with-disabilities/

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“Great to know I had support when I needed it, could ring when I needed it, rather than fixed appointments – a bit like having a friend - not just an advisor, when you were having a bad day you could ring, get support, and that approach was really valuable.” (ecdp service user)

Learning: Whilst numbers are low, peer support with Access to Work appears to have several benefits, including securing Access to Work, encouragement and support networks.

Progression

Organisations committed to harnessing and developing the best people focus on not missing the talent of people living with health conditions or impairments. Some organisations – for instance, the Cabinet Office, BBC and Channel 4 – have set targets to improve the senior representation of disabled people in their organisations. See for example Disability Rights UK’s report for the Cabinet Office on barriers to progression in the civil service and how to overcome them, including through the power of leadership programmes led by disabled people, and networks of disabled colleagues to share support.20

The Business Disability Forum (2015) notes nonetheless that targets for progression and disability lag behind targets on gender, ethnicity and progression: only 8% of employers they surveyed had targets on disability. Just 25% of private sector organisations - and 20% of public sector organisations - had role models who were open about their own experience of disability or health conditions within the organisation.

Practice Example 6: Leadership and Career Progression

Organisation: Leadership Academy Programme (LAP), Disability Rights UK

Project format and aim: The LAP is a leadership programme accredited by the Institute of Leadership Management, run by and for people with lived experience of disability or health conditions. It accepts a cohort of delegates from different sectors each year, matches each person with a mentor and runs a series of programme days over the course of the year to enhance leadership skills. The aim is to support disabled people in work to move into more senior positions, or more generally to make positive changes to how they work that benefit themselves and their organisations. Mentors and employers also gain from the experience and the scheme has had very positive outcomes.

Numbers of participants: 12-20 delegates per year; similar number of mentors

20https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/416858/ Disability_Rights_UK_final_report.pdf

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Costs: In the first pilot year, there was no cost to the delegate or to the employer as the pilot programme was supported by a grant from the Esmé Fairbairn Foundation. From the second year, delegates/employers were asked to pay for a place on the scheme, at a level comparable to similar leadership programmes. These payments cover all training days, accessibility and support requirements, the salary of the course coordinator and the accredited training deliverers.

Approach: Delegates are recruited across a variety of industries in the public, private and non-profit sectors. Delegates are paired with mentors who volunteer their time to offer peer support directly to an individual, either on the basis of relevant lived experience of disability or relevant work experience. Mentors attend several training days over the course of the year to prepare them to support the delegates. There are four programme days for delegates which focus on developing personal and leadership skills, building confidence and finding ways to expand experience and see disability as a unique advantage. Between training days, delegates are expected to work towards projects and goals set to enhance their skill set, based in their own organisation. At the end of the year, the delegates present their projects, ‘graduate’ and complete a full feedback questionnaire.

Outcomes: Extremely positive outcomes have been reported for the scheme. Of the first year cohort, all but two reported either moving ahead in their career, securing a promotion or pay rise or acquiring a new job or qualification. Mentors have also reported positive outcomes, with some saying their mentees have inspired them to make changes to their own lifestyles or careers.

Learning: As a result of feedback from year 1, enhanced training and support for mentors has been included in year 2.

The cost of the programme is in line with similar career development programmes; however, not all organisations can afford it and opportunities for bursaries are being explored. Results suggest significant gains for individuals, at acceptable cost to employers; and a sustainable model. It has potential benefits for both individuals and employers. The fact that the scheme exists across organisations, sectors and industries means that it offers excellent opportunities for cross-learning. Disability Rights UK has also offered more bespoke input to specific organisations.

‘During my time in LAP, I was able to change my mind-set and improve my communication and analytical skills, this proved invaluable as I was able to apply for jobs I didn’t think I could get and ultimately gained promotion twice in 6 weeks. I am living proof that LAP works.’

Wider purposes, beyond employment, beyond peer support alone

Many DPOs, and some wider organisations, offer peer support that either simply starts from disabled people’s priorities (so could focus on anything) or seeks

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outcomes in terms of health and well-being. Within these broad approaches employment may surface as one significant issue.

Some DPOs make explicit links between employment support and wider independent living support, recognising their inter-dependence. If you are homeless, or deeply in debt, you may not have the practical or emotional resources to seek employment. DPOs are often well-placed to offer peer-based support across people’s life issues.

Some organisations have peer support as one strand in supporting people’s employment and independent living aspirations.

Practice Example 7: Independent Living and Employment

Organisation: Breakthrough UK (Pathways and Pre-Pathway schemes), a national organisation based in Manchester

Project format and aim: One strand of work (Pre-Pathway) is designed to support people towards independent living, while another (Pathway) supports those already in control of their independence to move towards employment. Pathway runs for 10-12 weeks. Both the Pathway and Pre-Pathway schemes form part of wider employment support services. All are based on peer support in the sense that the whole organisation is a DPO, led by disabled people. The Pathway and particularly the Pre-Pathway programmes are based on facilitating peer support.

Numbers of participants: Pre-Pathway – 10 clients; Pathway – open to everyone using Breakthrough UK’s Employment Services (191 people in 2014-15)

Costs: costs are covered through external funding. The DPO exists to run these courses and find contractors who can deliver services. It is difficult to break down exactly what supporting one individual costs in this case.

Approach: Goals and aspirations are identified in an initial meeting with participant and coordinator, as are barriers to independent living and employment. A learning and action plan is developed and the participant then moves into one of two streams. The first stream is about maximising the participant’s ability to live independently, empowering them to improve their own health outcomes and independence. The second stream is about preparing for employment, moving into in-work support. Participants have regular one-to-one sessions with their employment officer, who may or may not be a disabled person themselves. Further peer support can be found in the group/training sessions.

Outcomes: 191 clients supported in one year; 18 moved into paid work; 100 took part in voluntary work, training or education. In the Pre-Pathway programme, 83% reported increased motivation and 80% increased confidence. In a broader ‘Talent Match’ employment support programme (also part of their portfolio) 91% of participants felt a ‘big increase’ in their progression; 100% of participants felt their job

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searching skills were improved and 90% felt their aspirations and motivation had been increased.

Learning: Facilitated peer support is just one part of Breakthrough UK’s programmes – and the combined impact of peer support with other approaches is thought very important to achieve objectives. At the same time, as a DPO, the leadership by disabled people means all work is infused with peer support. Linking employment support to wider independent living support has been found critically important.

Changes to programs have been implemented along the way. These have included improving/changing the content and separating peer support groups/sessions for participants with learning disabilities to ensure accessibility. It has been noticed that participants with mental health issues prefer one-to-one on the whole and it tends to take longer for them to feel confident with group sessions.

Practice Example 8: Peer support to improve general life outcomes

Organisation: Warrington Disability Partnership

Project format and aim: 14 week scheme, aiming at positive health outcomes and general life improvement

Numbers of participants: 54

Costs: always had low costs – including staff time, venue and communications. A learning room at the centre has been refurbished as an informal drop-in centre.

Approach: Weekly meetings, held as social drop-ins. 3 out of every 4 weeks run like this, with the 4th week being dedicated to a guest speaker coming in to discuss topics chosen by participants. Run by 2 members of staff under the label of ‘experts by experience’ and supported by volunteers. Further matching of staff members with scheme participants adds value to the scheme by creating an environment for one-to-one advice.

Outcomes: Some jobs have been reported, as well as improved confidence, new coping strategies, increased knowledge and understanding. Positive health outcomes have also been reported by many scheme participants. 24 of the cohort want the scheme to continue and will be running their own version of it going forward. The partnership is now developing a database of individuals that GPs can refer people to who can offer personal support.

Learning: the peer support scheme was commissioned as a result of a survey of around 150 disabled people at an annual event last June. Overwhelmingly, people said they would be interested in an informal group led by people with similar experiences to themselves. The ongoing networking and links with general practice suggest a potential for sustainable, ongoing support.

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There are also examples of wider peer support in impairment-specific organisations. The National Survivor User Network is an umbrella body that brings together user-led mental health groups and organisations. They co-ordinate Peer2Peer, a user-led peer support network which exchanges good practice, develops and supports innovative and authentic peer support, and facilitates joint learning, understanding and partnership working. They have a range of publications on peer support.

Practice Example 9: peer support across whole services

Organisation: The mental health charity Together, a national organisation.

Project format and aim: Together supports peer support. They train people to act as peer supporters and provide the infrastructure they need to deliver this support safely and confidently.

Number of participants: Together is a national charity, and has peer support co-ordinators in a number of areas. In 2015/16, they offered support in 26 locations, reaching over 200 people via their peer support scheme.

Costs: Return on investment analysis is in progress, in relation to the peer support that is available to people using Together’s supported living services in Hampshire. Early indications are that there is a positive return on investment in relation, for example, to reduced use of health services.

Approach: Together offers supervision and support from a paid Peer Support Coordinator who themselves has experience of mental distress. People with lived experience of mental distress play the lead role in developing their approach to peer support, including designing and delivering peer support training, and developing ways that peer support works in practice across Together. Though the peer support each person gives or receives is unique and tailored to the individuals involved, all of Together’s peer support follows a set of core principles. These principles have been decided collectively by service users and Peer Supporters as part of a Peer Support Charter. These principles are at http://www.together-uk.org/peer-support/ and include being yourself, hopefulness, mutuality, solidarity, reducing stigma and equality and empowerment.

There is no specific emphasis on employment but some people set and achieve employment-related goals through peer support.

Outcomes: following participation in peer support, 92% of service users in Hampshire had improved confidence; 73% felt more able to manage their mental health; 67% felt more in control; 83% had an improved social life and support network and 83% felt more accepted. There were also significant gains for the peer

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supporters: 60% were in education/training, 40% were volunteering in other roles, 40% were applying for jobs, 20% were now in part time work and 20% were now in full-time work.

Learning: It is possible to integrate peer support into the work of a provider charity and results appear positive. This includes promising employment outcomes for the peer supporters.

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WHAT? WHAT IS OFFERED, HOW AND WHERE?We wanted to understand more about the nature of peer support offered.

Chart from DR UK Survey, Feb 2016

Respondents to a question in our survey asking how they would describe the peer support on offer most commonly reported either one to one peer support (83%); or small peer support groups (3-9 people) (83%). Larger groups (10+) were also offered, albeit less commonly (30%).

Peer mentoring was offered by 43% of those responding.

Face to face support (73%) was more common than telephone (60%) or on-line (37%) – although sometimes these were used in combination.

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The specific model of Job Clubs (where job seekers meet for mutual encouragement and learning as they seek employment) was offered by 20% of respondents and Disability Employee Networks (where disabled people in work network for mutual support and learning) by 17%.

Other approaches mentioned by individuals were:

Self-employed individuals’ network, offering mutual support amongst people running their own businesses or working freelance

The Inclusive Entrepreneur programme, offering development and support to disabled entrepreneurs and people involved in start-ups

Where organisations offered more than one approach, they usually formed part of the same service package (in 67% of cases) rather than being separate programmes (33%).

It was rather more common for peer support to be offered by a peer mentor, facilitator or peer support worker (78% of respondents) than for the peer support to be entirely mutual, with people at the same level helping each other (44%) – but these figures total more than 100% because often the model involved both:

‘It is a combination of both – people helping each other but with support from workers’

Survey response

Most commonly, training and guidance was provided for people offering peer support or mentoring. The frequency of support varied from regular meet-ups with contact in between, to ad hoc contact, sometimes on-line or by phone.

Chart from DR UK Survey, Feb 2016

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‘It happens on a regular basis as part of normal activity rather than a special meeting’

The length of time people are involved in the peer support was most commonly not time-limited (67%) – although some programmes were for a set length of time, for instance:

‘It’s not time limited but meant not to be open-ended. Aim is to help people become more in control’.

Costs varied according to the type of support on offer. Comments included:

‘We have Lottery and tender (LA) funded posts’

‘Costs include staff time, venue and communications’

‘Investment in infrastructure came largely from grant funding and ongoing support is roughly comparable, or a bit higher, than independent day services but it is specialist support with good outcomes and we work with people who need ongoing support. For other groups we think it may be possible that peer support allied to grant investment could be very cost effective’.

Support group-based approaches

Several of the Practice Examples above make use of support-group approaches: for instance, the Job Clubs offered by Action on Disability and Work (ADWUK) and the Journey to Employment Job Clubs offered by Spectrum and several other organisations. Group approaches also exist in some workplaces, through Disability Employee Networks (see below).

Some groups are purely mutual, but more often they are facilitated by someone who themselves has lived experience. Often that person is a paid staff member, but they may be a trained volunteer.

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The available evidence suggests that these group-based approaches can offer valuable mutual support, encouragement and exposure to different experiences and ideas – in relation to seeking work, retaining work and progression.

On retention: the Practice Examples show that some people who gained work dropped back in to the Job Club for further support, since it offers an ongoing and sustainable support network.

On progression, the Disability Rights UK Leadership Academy Programme (LAP) included mutual group learning, and networks of ‘alumni’ of the Programme have chosen to keep in touch and continue to offer mutual support.

Often group-based approaches are combined with one-to-one approaches: the Journey to Employment programme includes buddies and mentors; the LAP includes individual coaching and mentoring. This combination may be useful to ensure a group does not subsume individual interests or settle into a comfort zone (for instance, people who are out of work losing the sense of what is possible in the world of work).

One-to-one approaches

Disability Rights UK’s LAP has deployed both coaching and mentoring, alongside programme days, to enable individuals to set their own very personal goals and achieve them. Over 80% of participants in 2015 achieved their career goals, and evaluation suggests the individual coaching and mentoring were significant in that success.

In this programme, there is one who offers the coaching/mentoring and another who receives. This enables the individual to focus purely on their own development, with support from someone who has lived experience of disability but may have advanced further in their career, or already overcome challenges the individual is grappling with. Many peer mentoring programmes are based on this approach, for instance Positively UK (see above).

Another approach is buddying or purely mutual peer mentoring. This has the empowering effect of turning everyone into someone who offers support. It needs to be managed carefully to ensure both people gain fully.

In considering whether group or one to one support is best, or both, the decision needs to be co-produced with disabled people, as respondents to our survey made clear:

‘We have offered more group sessions rather than 121 in homes as this has been what users have reported back as works.’

‘We realised we had to separate peer support groups/ sessions for our clients with learning disabilities to ensure accessibility Clients [sic] with mental health issues

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prefer 121 on the whole and it takes longer for them to feel confident with group sessions’

Paid or unpaid?

The Practice Examples above have all involved paid staff – whether as peer mentors, peer support workers, or co-ordinators who train and support volunteers. Experience of those working in the field of user-led and self-help groups and buddying suggests that they are not sustainable without an infrastructure of training and support. Volunteers can be an important part of the programmes, but not the only part. Costs need to be carefully considered when establishing peer support programmes. Typically DPOs had income from local commissioning or Big Lottery or Trust funders. Respondents to our survey wanted toolkits and mutual learning to help specify training, standards and good practice.

Where does it happen?

In user-led organisations

Many of the Practice Examples cited in this report are based in user-led organisations. Comments from participants suggest the importance of the perceived independence of these organisations: they help people feel safe and encouraged, not controlled or contained (see comments in Practice Examples above).

‘As a disabled people’s organisation peer support is the thread that all our work is built around and enables our organisation to support people effectively. Our organisations are experts in peer support and the positive impact it has on people’s lives. This should be formally recognised and invested in by government’

On-line

One of the Journey to Employment projects is a virtual Job Club – involving avatars that people design to support themselves and others.

There is a potentially huge on-line community of disabled people, as highlighted by Disability Rights UK in its seminar ‘Affordable’21 on alternative economics, and by Scope in its ‘Extra Costs Commission’: both suggested disabled people could come together as a community to share experiences and drive down costs of independent living22. As yet, on-line communities tend to be fragmented.

There are a number of on-line networks through which people offer each other support in an informal way and several apps in development through which people can share experiences of overcoming access and other barriers. For instance:21 http://www.disabilityrightsuk.org/membership/conferences/affordable-economy-includes-disabled-people22 http://www.scope.org.uk/Get-Involved/Campaigns/Extra-costs/Extra-costs-commission/Full-Report

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‘The Klinefelter's Syndrome Association is run by a very small group of volunteers so we don't really have the man-power to do anything much. However we do have various Facebook groups through which members help one another. We also have a Helpline but we find the internet options are more widely used’

Disabled people are significantly less likely to be internet connected than non-disabled people so on-line support will not be available to all. Informal networks may not be enough for people struggling with practical and emotional barriers relating to employment. But there is potential to test well-facilitated on-line peer support, offered by and for disabled people, as a complement to face-to-face and telephone support.

In mainstream charity or public sector services

The example of Recovery Colleges and the charity Together’s work to integrate peer support into day-to-day service support shows that mainstream organisations can implement effective peer support programmes. However, both have worked with independent user-led organisations. This can help increase trust: people may have more trust in an independent user-led organisation than in a statutory organisation or large charity (especially if they have had experiences such as being compulsorily detained by statutory services under the Mental Health Act). These comments from respondents to our survey explain this dynamic:

‘We find more information is disclosed in peer support than to professionals’

‘We think wider trends like the sharing economy and the growth in social enterprise offer potential for peer support groups but some proposed changes to benefit regulations (cuts to the ESA WRAG rate will make some people in the Support Group fearful of engaging in any work activity including peer supported employment); and the impact of austerity on social care funding could deny opportunity to those with higher support needs. We have noticed a drop in supported employment ambition or capacity to support the agenda in local authorities grappling with austerity. We have noticed increased interest in peer support approaches from families with disabled young people or older adults who are disillusioned with traditional services and limited supported employment opportunities’

Establishing trust and confidence in a peer support approach needs to be carefully thought through. Partnership approaches are often particularly helpful, to offer an independent user-led input to design and delivery.

In the workplace

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The Business Disability Forum (2016, see above) notes that staff disability networks in workplaces are a good strategy for encouraging more visibility of disability within an organisation: they can help with cultural change, moving from disability being a problem or a burden to demonstrating the unique value and wide talents that disabled people bring to organisations. This type of culture change can enable people to be themselves and to throw off the sense of carrying a ‘secret’ - and research suggests that this can improve well-being and productivity23.

The Business Disability Forum notes work done by Barclays: their disability network Reach held a conference focused on addressing the career development ambitions of employees with disabilities.

Practice Example 10: a network of disability employee networks

Organisation: Multiple: at least 300 disability employee networks, in private and public sector organisations including Fujitsu, Imperial College, Health & Safety Executive, Office for National Statistics, Eversheds, Barclays, Accenture, Transport for London, Herbert Smith Freehills, HSBC, House of Commons, BT, RBS, ATOS and Remploy. PurpleSpace links them up with each other and allows sharing of advice and best practice.

Project format and aim: Disability Employee Networks exist for mutual support and learning amongst disabled and other colleagues and as a resource for organisations. Some employers, like BT, have set up impairment-specific networks as well, for people living with mental health and other challenges. Many networks link with wider equalities networks. PurpleSpace is a leadership development and networking hub for disabled employee network / resource group leaders. Network leaders from all sectors and trades across the UK are eligible for membership. Together the leaders learn the skills needed to deliver high-performing networks. Through their membership they pool experience to co-produce cost-effective tools that deliver meaningful change.

Numbers of participants: Over 300 Disabled Employee Networks (DENs)

Costs: Different companies invest differentially in their networks, in terms of staff time and direct costs. Membership of Purple Space costs £300 per year per individual, with discounts available for multiple individuals from the same organisation

Approach: PurpleSpace is a professional development hub of advice and information for network leaders and their members. PurpleSpace works by supporting organisations to become disability confident from the inside out, sharing best practice and developing disability-positive cultures. Members range from leaders of Disabled Employee Networks and resource groups, disabled employees

23 Frost S (2014) The Inclusion Imperative: How Real Inclusion Creates Better Business and Builds Better Societies

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wanting advice on career progression while managing disability or health conditions at work and non-disabled allies who want to know about supporting the PurpleSpace agenda.

What they offer:

Networking and learning exchange opportunities with other leaders of Disabled Employee Networks and Employee Resource Groups.

Resources and professional development packages for Disabled Employee Networks and Employee Resource Group leaders

Practical advice from disabled employees for disabled employees about the ‘art of the possible’ when managing disability at work at the same time as managing career progression.

Engaging success stories about disabled people at work. Inspiration from change agents who have introduced and advanced the

disability agenda within their organisations. Quality signposting to external organisations and resources. The chance to be part of a movement of disabled people who are proud to

use the #ourdisabilityconfidence hashtag

Outcomes: The number of networks is growing all the time. The networking scheme run by PurpleSpace allows for an exchange of best practice, resource sharing and mutual support, and the cross-organisational nature of the network encourages creativity and lateral thinking. At present there is no collated hard data on the impact of DENs but both businesses and employees report benefits from the investment of time and money.

Learning: As a result of learning from the networks, PurpleSpace and Equal Approach are partnering to deliver a bursary scheme to develop leaders in government departments and agencies. A number of publications have been produced to support people who want to develop DENs.

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IMPACT AND LEARNINGThe Work Foundation evidence review notes that peer supporters ‘can promote hope and belief in the possibility of recovery, empowering the individuals they work with, increasing self-esteem and self-management, as well as social networks’.

They found evidence of positive outcomes – coupled with gaps in research. For example, one randomised control trial24 found that employment support that included peers delivering individual job-seeking support, support and graduate groups had significantly more positive employment outcomes than a control group receiving no peer support. Those receiving peer support were significantly more likely to be working, significantly less likely to be unemployed looking for work and significantly less likely to be unemployed and not looking for work.

The Practice Examples in this report show promising practice. There is some evidence for peer support generally demonstrating a positive return on investment: for instance, Self management UK have found that for every £1 spent on self-management courses, £2.24 is saved in reduced health service usage25 . Research evidence finds positive outcomes from peer support generally: for instance, a literature review by Repper and Carter (2011)26 found evidence that peer support workers in mental health services could lead to reduced admissions, an increased sense of independence and empowerment, and higher self-esteem, confidence, social connectedness and community integration.

The peer support programmes that support people with employment show a range of positive results in terms of securing employment, self-employment and promotions, sometimes (as with Journey to Employment and the DR UK Leadership Academy Programme) with emerging evidence of cost-effectiveness. If peer support can reduce hospital use, it may also be able to generate return on investment through improving employment rates – more cost-effectively than (for instance) the Work Programme or Work Choice. This is not to argue that peer support should be the only service offered to disabled people seeking or trying to retain work: it is one highly promising tool. It may be one component of someone’s employment support (for instance, going alongside Individual Placement with Support).

In this review a number of themes came up repeatedly on the benefits of peer support:

24 Kaufman, C L (1995) The self help employment center: some outcomes from the first year Psychosocial Rehabilitation Journal 18, 4, pp 145-162 25 Self Management UK (2016) Cost effective for commissioners, better outcomes for patients26 Repper J and Carter T (2011) A review of the literature on peer support in mental health services. Journal of Mental Health 20 (4) 392-411

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The value of the empathy and learning gained from peers - people who have ‘been there’

Increased hope for the future, sometimes overturning a sense of having ‘given up’

Encouragement to try new approaches Increased confidence and self esteem A different culture from more traditional services A new balance of power – that enables people to act, rather than feel

contained or controlled

Our survey also found promising signs of impact.

In our survey, 82% of respondents said they monitored outcomes. All those with monitoring in place bar two reported at the very least that there have been positive soft outcomes. These two are too new for any outcomes.

79% stated that they had reported hard outcomes, like getting jobs, qualifications or promotions; negotiating workplace adjustments or re-skilling. For example:

‘Most or [sic] our members are trading, or working towards, as self-employed’

‘We have to achieve hard outcomes because our services are contracted to achieve jobs, apprenticeships etc.’

‘Many participants have retained jobs they may have lost or have moved into employment’

‘Training modules completed to enable them to better support peer support volunteers. 125 service users have gone on to become volunteers for the organisation over 5 years’

‘Participants have been supported into paid employment and with volunteering opportunities and training’

‘Trained and became volunteers in our organisation. Participation in further training courses (internal and external) and ongoing support and mentoring has then allowed progression to paid employment. Staff members in our organisation all began as

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volunteers and we have had other volunteers gain outside employment in a variety of organisations’

92% stated that they had reported soft outcomes, like improved confidence, higher aspirations or improved health.

‘I may have left my current job if I had not had peer support. I was feeling insecure and overwhelmed by a change in job and peer support felt very reassuring, helped encourage me to ask for disability adjustments which made the workplace more accessible, and were emotionally supportive when I had a new diagnosis of a chronic health condition within my first few weeks at work’

‘1000 plus have reported increased confidence and communication skills and reported ability to live more independently with less reliance on statutory services’

‘Increased self-confidence, independence, sense of purpose, sense of achievement, assertiveness, ambition and something to develop’

‘Still being evaluated but some now running peer groups’

‘More participation in community issues. Better qualifications, skills and improved mental and physical health as well as increased confidence. More friends and participation in leisure activities’

‘Increased confidence and employment security’

‘Improved wellbeing Improved physical mental and emotional health Increased confidence’

‘Improved confidence, learned coping strategies, increased knowledge and understanding’

‘Our organisation’s ethos is based on peer support, our focus on peer support for young people has led to an increase in involvement of young people across the

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organisation. Increased employment opportunities, volunteering opportunities and involving young people as Trustees’

We do not yet have sufficient evidence to distinguish clearly between outcomes of different approaches to peer support but there is enormous learning from practice that could be further investigated through research and evaluation.

In our survey, most respondents wanted to participate in a network focused on peer support for employment. This would be a powerful way of collating evidence as it develops, and enabling organisations to inform each other about promising practice and existing evidence that can be built on.

Learning

Many organisations had learned from peer support and implemented changes in their organisation as a result, for instance:

‘We have established several new community groups and are developing more. We have also developed a life coach post for more long term bespoke support. We are also working with National Autistic Society in regard to services for autism. We have also adopted some new partnership protocols for working with other agencies. Joint data base and reporting formats etc’.

‘Peer support improves communication and gives a voice to quieter individuals more ideas are expressed and this facilitates positive change’

‘Following the success of our Peer Support project, our organization has recognised that in order to build a strong community of disabled people it is essential to provide a peer support service. This has now been included in its new strategy, published at the end of last year.’

‘Embedded into the aims of the organisation’

‘Our organisation believes that Peer Support is a helpful and inclusive approach to running a service which is of benefit to everyone. It is important to embed the approach in all aspects of our work’

‘introduced other services like webchat’

‘We have developed training tools for employers and are in the process of setting up a peer support group for IT skills’

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CONCLUSIONSThis Practice Review finds promising peer support practice in relation to securing, retaining and progressing in employment, for disabled people generally and for people living with specific impairments. There is high demand for peer support from people with lived experience; numerous (if sometimes isolated) examples of peer support - particularly in user-led organisations; promising evidence of impact and early indications of social return on investment – with a need for further evaluation; and considerable learning and appetite to share and pool expertise, with significant numbers wanting a network to be established.

This is important in the context of:

Proposed changes to employment support commissioned by DWP and more widely, with the 2016 Green Paper

The commitment in the NHS 5-year forward view to effective user-led services and the new emphasis on integrating health and employment services, including through the Joint Work and Health Unit in Government and the potential of devolution to bring services together in new ways.

Powerful themes of hope, confidence and achievement come through from a range of sources and types of peer support – based on the empathy, learning and encouragement that come from people who have ‘been there too’.

Disabled people’s user-led organisations have been particularly influential in developing peer support and are in a position to connect peer support in or around employment to a range of other life issues, enabling people to overcome barriers (from debt to housing problems) that need to be addressed for the person to turn their life towards hope and participation – including in the world of work. Peer support also takes place in workplaces, in charities and in the NHS.

The field of peer support for employment is still under-developed, with a lot of activity being small-scale, developed in isolation and under-evaluated. We make below 3 key proposals to ramp up effective activity so that the clear potential of peer support for employment is more fully realised:

1. Create a national Peer Support for Employment Network to share expertise, evidence and practice – involving DPOs, academics, commissioners and other providers. There is a clear appetite for this. We suggest that this should be jointly convened by Disability Rights UK and The Work Foundation. Its first task should be to create a framework for practice and evaluation, to help generate improved evidence. NESTA should be invited to be involved in this network, to ensure synergy with their own network on peer support for improved health/well-being

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2. To complement DWP’s Journey to Employment project, which is showing positive results from group-based approaches, we propose that DWP should next invest in testing peer mentoring delivered by disabled people in work to those out of (or in) work – to offer individual encouragement and role modelling. This could be built into DPULO J2E development and/or invested in as an innovation to be tested and scaled. There is expertise and evidence to build on – for instance, from the DR UK LAP and Positively UK (see above) – on issues such as mentor training, matching and support. There is currently rather more practice evidence on group-based than individual approaches and this would help enhance the evidence base. Links with employers and Disability Employee Networks could be used to engage disabled people in work with the programme (for instance, some employers have agreements about the number of hours of volunteering their employees can undertake)

3. There is an opportunity with the Joint Work and Health Unit to show leadership in encouraging approaches that bring together objectives for health gain and employment gain. This is not in the traditional sense of providing treatment so that people can work (an approach that for many people misses the point: if you have a permanent or fluctuating condition, often what you need is not treatment so much as strategies to manage work and workplace adjustments in the context of life challenges more broadly, from transport to social care). Rather the purpose could be to encourage joint commissioning at local/regional level of peer support for both employment and health/well-being. This would recognise that if people living with long-term health conditions and impairments who obtain peer support start to have hope and to contribute to society, the gains for them can be immense; and the return on investment may go beyond reduced NHS use (important as that is) to the value of more people entering, staying and progressing in employment (with all the advantages to the UK economy and society that this would bring)

The time is right to build good practice and evidence on peer support to enable people living with health conditions or impairments to work to their full potential.

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APPENDIX

Full survey resultsThis survey ran from 15th February 2016 to 28th March 2016. It was hosted on SurveyMonkey with a word version available on request. It had 67 respondents over this period. Not all respondents answered all questions; most questions had a response rate of around 50%.

Some people responded to our requests for information without filling in the survey. Unfortunately, their data are not represented in the findings below, but some responses have been pulled out for Practice Examples.

Q1. Does your organisation currently offer peer support for disabled people?

Yes – 47 (72.31%)

No – 18 (27.69%)

Q2. Has your organisation offered peer support in the past?

Yes – 0

No – 15 (100%)

Q3. Does your organisation plan to offer peer support in the future?

Yes – 7 (46.67%)

No – 8 (53.33%)

Q4. Why is your organisation not planning to offer peer support?

Difficult to Organise – 1 (25%)

Lack of Interest – 0

Too expensive – 1 (25%)

Lack of Infrastructure – 0

Organisation too small – 2 (50%)

One comment – ‘not our role. We offer legal advice’.

Q5. If you do currently offer or have ever offered peer support, is/was it for a particular impairment group, or for all types of impairment?

Pan-disability – 23 (65.71%)

Particular impairment group – 10 (28.57%)

Other – 3 (8.57%)

Responses on who is being supported include – people with mental health difficulties, people with LDD/autism/Aspergers, people with MS, people with Charcot-Marie-Tooth disease, people with CMS/LEMS, Myasthenia Gravis

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Q6. What is/was the purpose of your peer support?

Our organisation supports its own members/employees to stay within it – 9 (31.03%)

Our organisation provides peer support to help people enter other organisations/places of employment – 20 (68.97%)

Many survey respondents noted that they offered peer support by dint of being DPOs but that they were also in many cases running specific peer support schemes, and as such, do both.

Q7. How long has your peer support scheme been running? (if your peer support scheme has ended, please answer the questions as best you can)

<3 months – 2 (6.45%)

3-6 months – 1 (3.23%)

6months-1 yr – 1 (3.23%)

1-2 years – 6 (19.35%)

2-3 years – 2 (6.45%)

3-5 years – 4 (12.90%)

5+ years – 15 (48.39%)

Q8. Why was the scheme set up?

To help people within the organisation – 12 (41.38%)

To help people outside of the organisation – 19 (65.52%)

In response to a particular need – 15 (51.72%)

Because it was felt to be worth trialling – 5 (17.24%)

Q9. What sort of outcomes is the peer support aiming to achieve?

General life satisfaction/well-being – 26 (86.67%)

Good/improved health – 19 (63.33%)

Getting employment/education/skills – 22 (73.33%)

Staying in employment/education – 12 (40.00%)

Progressing in employment/education – 14 (46.67%)

Additional replies – greater independence, choice and control; improved understanding of living with an impairment

Q10. How would you describe the type of peer support on offer?

One-to-one support – 25 (83.33%)

Small groups (3-9 people) – 25 (83.33%)

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Larger groups (10+ people) – 9 (30.00%)

Online support – 11 (36.67%)

Face-to-face support – 22 (73.33%)

Employee network – 5 (16.67%)

Job club – 6 (20.00%)

Mentoring – 13 (43.33%)

Telephone support – 18 (60.00%)

Additional responses – self-employed individuals network; workforce retention programme The Inclusive Entrepreneur Programme

Q11. How do the types of support you’ve selected interact?

They’re all part of the same package – 20 (66.67%)

They exist as separate services – 7 (23.33%)

Other – 3 (10.00%)

Additional responses include ‘we tend to offer the same model to all clients (disabled people) which can include all five elements ticked. The client will utilise different parts of the ‘package’ at different times on their journey to work. The constant throughout the journey is the 121/face to face support from thier [sic] allocated Employment and Independent Living Advisor’; ‘client that we work one to one with are given the option to attend peer support, however, attendees of peer support (job retention) need not be clients on our caseload’; ‘advocacy service &welfare service’

Q12. How does your peer support scheme work?

It’s entirely mutual – people at the same level helping each other – 12 (44.44%)

It’s delivered by a peer support worker, facilitator or mentor – 21 (77.78%)

Additional comments include – ‘it’s delivered by a helpline advisor’ and ‘it is a combination of both – people helping each other but with support from workers’

Q13. Does it involve any of the following –

Peer matching – 9 (36.00%)

Training – 20 (80.00%)

Guidance – 20 (80.00%)

Associated pay – 0

Named benefits – 2 (8.00%)

Q14. How much support is available?

There are regular meet-ups and as much additional support as required – 15 (53.57%)

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There are regular meet-ups but no/little additional support available – 5 (17.86%)

There are ad-hoc meet-ups as required – 11 (39.29%)

Other – 4 (14.29%)

Additional responses include ‘we run one-off workshops while funding is available and 8 week courses, also based on available funding. Additional support may be in the form of one to one meetings with a case worker but only for those who are clients within the service’.

Q15. Is there a defined period for which support is available?

Yes (eg the scheme is 12 weeks long, with 1 session a week) – 4 (14.81%)

No (participation in the scheme can be for as long as you like) – 18 (66.67%)

Both types of scheme are available – 5 (18.52%)

Additional responses include ‘no time limit but meant not open-ended’; ‘membership for people requiring additional support depends on social care funding (direct payments) but so long as this continues so can membership’.

Q16. Are different schemes available for those with different experience or who require different support?

Yes, there are several different schemes available – 15 (53.57%)

No, everyone uses the same scheme – 13 (46.43%)

Additional responses include ‘the scheme is flexible to fit the needs of the users’; ‘at the moment we are interested in exploring the potential for people with less, or no, need for paid support who could use peer support and shared resources’;

Q17. What sort of costs does running the support scheme incur?

It’s free – 6 (23.08%)

It has always had some low costs – 3 (11.54%)

It had a higher set-up cost but is now low-cost – 2 (7.69%)

It had a low set-up cost but is now moderately costly – 2 (7.69%)

It had a higher set-up cost and is still moderately costly – 4 (15.38%)

It is quite costly – 3 (11.54%)

Don’t know – 5 (19.23%)

Prefer not to say – 1 (3.85%)

Additional responses include ‘lottery and tender (LA) funded posts’; ‘costs include staff time, venue and communications’; ‘investment in infrastructure came largely from grant funding and ongoing support is roughly comparable, or a bit higher, than independent day services but it is specialist support with good outcomes and we

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work with people who need ongoing support. For other groups we think it may be possible that peer support allied to grant investment could be very cost effective’

Q18. Do you have outcome monitoring or evaluation in place for users of the scheme?

Yes – 23 (82.14%)

No – 5 (17.86%)

Q19. If not, why not?

Expense – 0

Scheme is too loosely organised – 2 (66.67%)

Scheme does not have a set framework – 2 (66.67%)

Additional responses include ‘we don’t specifically monitor the peer support dimension, I’m guessing because it’s a relatively small scheme at the university. However, there are job satisfaction, workplace environment, professional development etc monitoring forms which we complete regularly.’; ‘aiming to set a framework and deliver to agreed objectives’; ‘we conduct informal appraisals but membership tends to be long term and stable rather than over a specific period and so much happens informally as a normal part of activity’.

Q20. Have participants reported any hard outcomes, such as getting jobs, qualifications, promotions etc?

Yes – 19 (79.17%)

No – 5 (20.83%)

Comments include mentions of being required to achieve hard outcomes in order to retain contracts; achieving or retaining employment; upskilling and reskilling; volunteering and training; securing/negotiating reasonable adjustments; self-employment. Those that did not report hard outcomes noted it was mainly the newness of the scheme/lack of reporting.

Q21. Have participants reported any soft outcomes, such as increased confidence, improved health, higher aspirations etc?

Yes – 23 (92%)

No – 2 (8%)

2 comments were that the scheme was too new for any outcomes. All other comments noted significant improved confidence and self-esteem, less social isolation, higher aspirations, more community involvement, improved mental health, improved physical health, greater ability to live independently etc

Q22. Have you noticed any trends or outcomes that have not been reported on by participants/peer support workers?

Yes – 1 (3.70%)

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No – 17 (62.96%)

Comments on positive outcomes outnumbered those noted in the survey response – these included ‘the most obvious trend is that outcomes tend to last longer because support, networks and strategies don’t just disappear on discharge – they can endure’; ‘more information disclosed than to professionals’; problems with employers have been noted a number of times

Q23. Have you implemented any learning or made changes to your organisation as a result of peer support schemes?

Yes – 18 (69.23%)

No – 8 (30.77%)

Comments included the development of new policies and procedures, introduction of additional services, refurbishment/redevelopment of social spaces, development of training tools for employers

Q24. Please use this space to tell us more about your organisation and its approach to supporting people

Comments mainly included descriptions of the aims of the various DPOs responding to the survey

Q25. Would anything from the below list be of interest to your organisation?

A network of organisations involved in peer support – 22 (61.11%)

A toolkit for running/implementing a peer support scheme – 23 (63.89%)

Updates with learning from other organisations – 22 (61.11%)

None of the above – 7 (19.44%)

Q26. Can we contact you again for follow up questions?

Yes – 18 (58.06%)

No – 13 (41.94%)

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