December 5, 2023
Update, Spring 2024: Based on many of the best practices identified in this Issue Brief, CHDI has developed a new Peer Support model for middle and high schools and is currently piloting the new model in Connecticut. Learn more about the pilot here.
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The emotional well-being of students is a pressing concern for schools, particularly since the onset of the COVID-19 pandemic. Schools have increasingly recognized the important connections between behavioral health*, academic functioning, and school climate. Nearly 70% of Connecticut students in 2021 reported that their mental health was “not good” in the past month, and only 25% of these students accessed needed supports and services.1 Similar national trends have been observed for behavioral health and exposure to adverse childhood experiences (ACEs), which are linked to higher rates of behavioral health concerns and suicide.2,3
In 2022, Connecticut advanced peer support programs as a strategy for supporting student behavioral health by passing Public Act 22-47. The legislation required the Department of Children and Families (DCF), in collaboration with the State Department of Education (SDE), to develop a “peer-to-peer mental health support program” and make it available to schools and youth-serving organizations in the state (Section 34-35). To help the state implement the peer support program, CHDI conducted a review of 20 school-based peer support program models and summarized common elements across these approaches (see Figure 2).4
This Issue Brief examines peer support models as an innovative strategy schools can use to support student behavioral health and improve school climate within a Comprehensive School Mental Health (CSMH) approach. It also summarizes CHDI’s review of peer support models and includes recommendations for state policymakers and school districts to incorporate and sustain effective peer-led support programs in schools.
During adolescence, a growing sense of identity and autonomy often result in seeking more support from social networks (e.g., peers) and less from family or caregivers.5 Adolescents increasingly turn to classmates and friends for support, advice, and to talk through difficult experiences. Evidence suggests that these types of peer supports can protect against stress, depression, anxiety, and suicidality, and promote self-esteem, mental health, and optimism.6
Peer support programs can equip students with:
School-based peer support programs are modeled from the peer support programs in clinical settings for behavioral health, which are used as an adjunct to traditional behavioral health services, and have been found to significantly improve outcomes for recipients.7,8 These programs involve identifying peer leaders to educate and bring awareness about behavioral health and to provide informal support to peers who may be experiencing distress until they can access more formal support or services. It is important to note that peer leaders in school settings are not acting as therapists or providing professional advice, but instead provide general information and support as a peer and explain and offer connections as needed with formal services or resources, such as a counselor or trusted adult.
Research on peer support programs in clinical settings has shown significant benefits in health and mental health outcomes for the recipients and the peer leaders, and the benefits may be particularly promising for participants with marginalized identities. These programs increase access and trust by allowing for more flexibility to address individual needs (e.g., being able to offer services during hours that are more convenient to participants), providing opportunities for direct engagement in their own care, and enhancing community partnerships and communication).9 Similar to clinical peer support models, school-based programs have also shown moderate success. Students who serve in peer leader roles indicated increased mental health literacy, knowledge about available resources, confidence in referring their classmates to resources, and sense of self-esteem.10,11 For students who receive peer support or participate in program events, research demonstrates positive outcomes in quality of life and self-confidence.10,12 Additionally, there is evidence to suggest that peer programs are better suited to target the student body as whole (i.e., universal prevention), as opposed to singling out students who may be deemed “at risk”, to avoid unintended negative effects on mental health.10 No current research was identified that examined the effects of school-based peer support programs on equity or disparities for students by race, ethnicity, gender, LGBTQI status, or related factors. The emerging evidence suggests that peer support programs should be included in CSMH approaches.
Schools are a natural setting to support behavioral health and well-being because most children attend school. Using a CSMH approach to address students’ behavioral health needs can also improve students’ academic outcomes and school climate. In 2018, CHDI partnered with the National Center for School Mental Health at the University of Maryland to develop a CSMH framework for Connecticut policymakers and school districts (Figure 1).13 A key feature of this CSMH approach is to build a network of tiered supports between school programs, behavioral health service providers, and community resources, and build strong partnerships with families.14 This process is typically guided by a needs assessment, such as The School Health Assessment and Performance Evaluation (SHAPE) system, to identify strengths and areas of improvement for supporting student well-being. Peer support programs can be implemented within a CSMH approach to support student well-being and connect students with additional services as needed.
To help the state develop and implement the peer support program called for in Public Act 22-47, CHDI conducted a review of 20 school-based peer support program models and summarized common elements across these approaches (see Figure 2).4 These programs often include training school staff and administrators on general mental health topics and how to support students who may be struggling. Additional training for the adult advisors and peer leaders, who are often identified through self-nomination or peer/teacher nomination, typically includes information about behavioral health, recognizing signs and strategies to support someone in distress, communication and listening skills, coping skills, and knowledge of available local and national resources.
Peer leaders are tasked with creating a student-led campaign to raise awareness about behavioral health, warning signs, coping skills, and send encouraging messages to reduce stigma about seeking help or accessing services and supports. These campaigns might include messaging and posters, social media posts, assemblies and information presentations, and/or other activities developed by the peer leaders to increase knowledge and promote open conversations about behavioral health. Many of the programs reviewed only briefly addressed substance abuse prevention as a component of behavioral health or did not mention substance use at all.
In addition, peer support programs provide a unique opportunity to support equity and anti-racism. Utilizing a participatory approach to intervention, in which students are directly and actively involved in the planning and implementation processes, allows perspectives about their own experiences to be heard and included.15 Peer leaders are often influential or well-known students representing a range of social and demographic groups to ensure they accurately represent the broader student population and may understand unique struggles based on students’ backgrounds. Additionally, these programs present an opportunity to include direct information about how students’ identities can intersect with behavioral health, such as experiences of racism or discrimination.
Figure 2. Connecticut Peer Support Program Components and Timeline
There were only three programs reviewed that included most or all of the components mentioned above and had detailed materials, implementation supports, and evidence of effectiveness: the Michigan Peer-to-Peer program, Sources of Strength, and HopeSquad. CHDI is developing a Connecticut Peer Support Program modeled after the key components found in other existing programs, particularly the Michigan Peer-to-Peer program because it addressed mental health and well-being in addition to suicide prevention (see Figure 2).
The following recommendations provide guidance for incorporating and sustaining peer-led support programs in schools:
This Issue Brief was prepared by Mackenzie Wink, Ph.D., and Jason Lang, Ph.D. For more information, visit www.chdi.org or Mackenzie Wink at mwink@chdi.org.
*The term “behavioral health” describes a broad spectrum of concerns related to the emotional and behavioral needs of students, including well-being, resilience, mental health, and substance use prevention.
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