Youth-to-Youth–Peer Workers in HIV/AIDS Youth Programs: A Peer Development Guide

Section 6: Summary and Conclusions: Program Lessons Learned

HRSA/HAB's SPNS Adolescent Care Projects learned many useful lessons about both peers’ and adults’ respective roles in adolescent HIV prevention and care services in the past five years. While each project’s findings vary depending on the specific roles peer and adult staff play in service delivery, several of the findings are common among all of the projects. Clear communication, consistent expectations, support in the form of supervision and training, maintaining boundaries, and the ability to listen well are just some of the prerequisites of a successful youth program involving peer staff. Non-peer staff and other adults need training (in youth development, sensitivity, mentoring, diversity, and advocacy), support, and ongoing feedback.

This section summarizes common lessons learned among the Adolescent Care Projects regarding the needs of peer and adult staff in the development and delivery of adolescent HIV services. Key challenges encountered by both youth and adult staff, often in similar service settings, also are presented. Finally, elements necessary to develop successful youth health programs that utilize the invaluable support of peer staff are discussed.

Youth involvement in HIV and other health related programs targeting young people is a viable and necessary means to help end the spread of HIV among youth and young adults. With this notion in mind, however, program coordinators and health care professionals must work hard to identify and address a very basic, yet overlooked, set of needs for peer staff in their programs.

• Support and supervision of peer staff is an extremely time intensive enterprise. Some of the most effective staff development is a result of partnering between youth and adult staff in program design. Peer staff recruitment should always prioritize a thorough assessment of skills and aptitudes, and individualized professional development plans will sometimes need to include basic vocational counseling and job skills training.

• Comprehensive skills assessment and appropriate ongoing training for peer staff should include, but not be limited to, the following issues: HIV/AIDS information and basic knowledge of adolescent health; program development skills, including goal setting and timeline development; overview of agency mission and key services; diversity and cultural sensitivity; professional boundary setting; and other topics specific to peer tasks and job responsibilities.

• There are many roles for youth to play and an equal number of opportunities for them to excel and develop professionally. Therefore, peer staff must be given clearly defined roles and responsibilities.

• Many peer staff are often hired from an agency’s target population and, therefore, require extensive emotional and practical support. Programs that utilize the support of youth who are currently or have at one time experienced high-risk living behaviors need to develop formal systems of support for these peers to address personal concerns or issues that may interfere with their job. Mentoring with an adult or experienced peer is a good way for peer staff to receive this support.

• The youth voice and perspective should drive the services of all youth-focused programs. Successful programs always facilitate relationships with peer staff that provide them with the opportunity to voice their concerns and opinions.

Adult staff play an equally important role in the development and delivery of appropriate youth services and programs, especially for programs that involve peer staff. Adult program staff also have a unique set of needs in the process of supporting their younger colleagues.

• Adult staff should have experience or receive training on the following topics: conflict resolution; youth sensitivity and youth culture(s); cultural diversity; leadership skills; youth development; and consensus building skills.

• New issues and constantly changing environmental trends have an impact on the health and wellness of all youth. Adult staff need to always gather information from the youth that they work with and research the latest health issues confronting youth and young adults.

While all peer staff offer a wealth of life experience and unique personal perspectives about their needs and the needs of other young people, many peers lack the necessary professional skills, including program development and time management skills. By the very nature of their age and limited life experiences, their new roles as peer staff are their first opportunities working in a professional environment, whether it is in a hospital, community clinic, or small non-profit agency. No matter what the particular work setting is, peer staff encounter a number of challenges that must be addressed with sensitivity, patience, and time.

• Open communication and respect where both youth and adults value what the other is saying and where the input given by both parties is equally considered in program evaluation and planning.

• Limited skills and life experience.

• Lack of trust in and resilience towards adult staff and community partners.

• Finding a voice within the adult community that is respected and well received.

• The ability to clearly communicate messages to adult staff to receive their support and assistance in achieving goals.

Despite many more years of formal training and education, life experiences and professional growth, adults are not the experts on the individual experiences of youth. While adults were once youth themselves, their cultural surroundings and risks when they were young differ greatly from the social issues confronting today’s youth. Evolving family dynamics, AIDS, community violence and drug prevalence, immigration, and an ever-changing political agenda and economy impact young America in many different ways. Adult staff must strive to acknowledge and address these differences when working with youth. This process poses a variety of challenges that demand thoughtfulness and an understanding and appreciation of what it is like to be a young person today.

• Communication barriers with peer staff due to differences in age, ethnicity, youth culture, economic class, and education.

• Keeping peer staff motivated and preventing them from burnout as well as physical and emotional harm.

• Balancing the roles of authority figure and supervisor with that of a supportive colleague.

• Measuring the success of programs when adults don’t design them.

Successful youth programs, whether their purview is HIV prevention or youth leadership development, require that both peer and adult staff play equal roles in the design and implementation of services. In order to pave the way to a brighter future where youth are allowed to advocate on behalf of their own needs and voice their concerns and unique perspectives to community leaders and decision-makers, today’s peer-based programs must include the following tenets for success:

• Ability to facilitate effective youth and adult partnerships in the design and delivery of services.

• Involve peer staff integrally in the program evaluation plan development and collection processes.

• Establish and mandate appropriate safety nets and boundaries for both youth and adult staff.

• Commit an incredible amount of time and patience into the maintenance of a peer-based program.

• Promote healthy youth development not only for clients, but also among peer staff.

• Assess skills and aptitudes, educate and facilitate ongoing training for youth around issues specific to their responsibilities, such as HIV or substance use information, computer competency, leadership development, and facilitation skills.

• Facilitate ongoing training and development for adult staff around youth diversity issues, conflict resolution, youth development, and other issues relevant to the program’s goals and objectives.

• Establish systems by which peers can get support from other peers.

• Encourage flexibility among both peers and adults to take into consideration the unique needs of one another.

The youth health programs that appear to make the most positive and lasting differences are those that enhance adolescent development⁷. Successful programs promote healthy youth development among not only their clients, but also among their peer staff. Competence, Connection, Character, and Confidence, known as Little’s "4 C's^"8 should all be integrated into the individual development plans of peer staff involved in any health promotion program. Successful development plans for youth staff always demonstrate:

• Competence building in areas that improve the quality of a youth’s life, such as special vocational or academic skills, and a sense of being able to contribute to his or her community;

• Connection of youth to others through caring relationships manifested in mentoring, supervision and coaching, and leadership opportunities presented within the workplace;

• Character through values that give meaning and guidance to youth, such as boundary setting, honesty and respect, self integrity, and appreciation of others;

• Confidence building opportunities to increase self-esteem and a sense of self-worth through setting and meeting professional and personal goals.

Since adult staff in adolescent HIV service and health promotion programs play an equally important role as supportive partners and mentors for peer staff, they too require ongoing training, thoughtful supervision from upper management, and feedback from colleagues. Adults that share the belief that youth are the experts of their own experiences and needs, and are assets in program planning and implementation, have the potential to make a difference.

HRSA/HAB's SPNSs’ belief in the importance of youth-centered and youth-driven programming complemented by adult support and mentoring has become widely accepted among adolescent HIV service programs nationwide. Other health-focused programs that prioritize youth leadership, healthy adolescent development, effective adult-youth partnerships, and proper attention to staff training and development will be able to deliver more meaningful, representative, and accessible services to their young clients.

Footnotes

7. Blum, W. M. Health Youth Development as a Model for Youth Health Promotion., Journal of Adolescent Health., 1998;22:368-375.

8. Little R. What’s Working for Today’s Youth: The Issues, the Programs, and the Learnings. Paper presented at an ICYF Fellow’s Colloquium, Michigan State University, East Lansing, 1993.

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