8 Guiding Principles for Peer Support Programs in High-Risk Organizations

This guest post is by Dr. Tracey Varker. Tracey is a research fellow at the Australian Centre for Posttraumatic Mental Health and specializes in mental health of emergency services personnel, among others.

Peer support programs have emerged as standard practice for supporting staff in many high-risk organizations – that is organizations which routinely expose their personnel to potentially traumatic events such as emergency services, rail services, and the military¹. Despite their increasing popularity and implementation across a range of high-risk organizations, the published literature mostly comprises descriptive studies, often with small samples and cross-sectional designs, or longitudinal designs without comparison groups².

Although direct evidence relating to peer support is lacking, there is an emerging body of research which shows that boosting and protecting social support can increase an individual’s capacity to deal with a traumatic event³. As such, peer support represents one attempt to operationalize social support within high-risk organizational structures.

Using a well-established method of enquiry that canvases opinions of experts in a particular field (the Delphi method), we surveyed a group of 92 international experts and peer support practitioners from 17 countries. In doing so, we were able to develop eight guideline recommendations on peer support for high-risk organisations (for full details see Creamer et al, 2012).

These recommendations should not be interpreted rigidly but, rather, should be implemented as appropriate to the specific context of the program. We also hope that since there is currently an absence of objective empirical evidence of peer support in improving psychosocial outcomes, that these recommendations will assist in the establishment of properly designed and controlled research trials.

Key Recommendations

  1. The Goals of Peer Support: Peer supporters should: (a) provide an empathetic, listening ear; (b) provide low level psychological intervention; (c) identify colleagues who may be at risk to themselves or others; and (d) facilitate  pathways to professional help.
  2. Selection of Peer Supporters: In order to become a peer supporter, the individual should: (a) be a member of the ‘target population’, (b) be someone with considerable experience within the field of work of the target population, (c) be respected by his/her peers (colleagues), and (d) undergo an application and selection process prior to appointment that should include interview by a suitably constituted panel.
  3. Training and Accreditation: Peer supporters should: (a) be trained in basic skills to fulfil their role (such as listening skills, psychological first aid, information about referral options); (b) meet specific standards in that training before commencing their role; and (c) participate in on-going training, supervision, review, and accreditation.
  4. Mental Health Professionals: Mental health professionals should: (a) occupy the position of clinical director, and (b) be involved in supervision and training.
  5. Role: Peer supporters should: (a) not limit their activities to high-risk incidents but, rather, should also be part of routine employee health and welfare; (b) not generally see ‘clients’ on an ongoing basis but should seek specialist advice and offer referral pathways for more complex cases; and (c) maintain confidentiality (except when seeking advice from a mental health professional and/or in cases of risk of harm to self or others).
  6. Access to peer supporters: Peer supporters should normally be offered as the initial point of contact after exposure to a high-risk incident unless the employee requests otherwise. In other situations, employees should be able to self-select their peer supporter from a pool of accredited supporters.
  7. Looking after peer supporters: In recognition of the potential demands of the work, peer supporters should: (a) not be available on call 24 hours per day, (b) be easily able to access care for themselves from a mental health practitioner if required, (c) be easily able to access expert advice from a clinician, and (d) engage in regular peer supervision within the program.
  8. Program evaluation: Peer support programs should establish clear goals that are linked to specific outcomes prior to commencement. They should be evaluated by an external, independent evaluator on a regular basis and the evaluation should include qualitative and quantitative feedback from users. Objective indicators such as absenteeism, turnover, work performance, and staff morale, while not primary goals of peer support programs, may be collected as adjunctive data as part of the evaluation.

With regard to specialized mental health treatment, see also the Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder.


¹Levenson, R. L., Jr., & Dwyer, L. A. (2003). Peer support in law enforcement: Past, present, and future. International Journal of Emergency Mental Health,5, 147–152.

²Campbell, J. (2005). The historical and philosophical development of peer-run support programs. In S. Clay, B. Schell, P. W. Corrigan & R. Ralph (Eds.), On our own, together: Peer programs for people with mental illness (pp. 17–65). Nashville, TN: Vanderbilt University Press.

²Solomon, P. L. (2004). Peer support/peer provided services: Underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal, 27, 392–401. doi:10.2975/27.2004.392.401

³Norris, F. H., & Stevens, S. P. (2007). Community resilience and the principles of mass trauma intervention. Psychiatry, 70, 320–328. doi:10.1521/psyc.2007.70.4.320

Creamer MC, Varker T, Bisson J, & et al. (2012). Guidelines for peer support in high-risk organizations: an international consensus study using the Delphi method. Journal of traumatic stress, 25 (2), 134-41 PMID: 22522726

6 thoughts on “8 Guiding Principles for Peer Support Programs in High-Risk Organizations

  1. Really interesting stuff. I think it’s particularly pertinent to police serivces. Anecdotally, it seems that they’re often so enmeshed in their own subculture that the thought of confiding in an outsider is something unthinkable, particularly if the trauma they experienced involved some less-than-up-to-protocol actions made.
    Thanks for bringing this up – I’ll defintiely be looking into some of this research.

  2. Thanks for this fascinating piece – we certainly know that by and large, peer support also works well for journalists who also prefer to speak ‘to their own’. Ensuring appropriate confidentiality is important as that can certainly bring any peer support programme undone. Well done, and congrats. to all authors.

  3. Thank you for this very interesting blog: has anyone read “The gift of fear” (Gavin de Becker) which is on a similar topic? Thanks for your key recommendations – they help a lot!

  4. Its really interesting that emergency services (e.g. SES) are ‘mandating’ peer support following a critical event – given the often lack of training for those that supply this ‘service’. It shouldn’t be forgoten that being asked to debrief after an event can itself be traumatic and potentially damaging, especially when the service provider has a limited skillset (as unfortunately is often the case). Psychological first aid and self awareness development are very important, but mandated peer support seems to involve governing bodies being seen to do ‘something’ when and if litigation begins – when the research does not support this type of intervention

    • I am not a fan of mandatory peer support or crisis intervention post-high stress events either.

      Quality training (I prefer the international standard – the International Critical Incident Stress Foundation: http://www.icisf.org) is an absolute must for anyone charged with responding to same.

      Careful choosing of peer supporters is also crucial. That is to say that if you train someone who is seen as a “jerk” within their agency, you simply have a trained jerk. Nobody wants that.

      Lastly, in Mississippi, we have a peer support privilege bill which guarantees privileged communication status to any of the interventions offered to emergency services (see http://www.usaleaps.org). This has proved a tremendous help to a unique subculture serving others.

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