By Ruby Atesoglu
“Indeed sometimes the process of creating space may mean getting out of the way or removing bureaucratic barriers…” notes Cormac Russell (2022, p.180). How do we as service providers and program developers integrate this understanding in practice? As we are forming our understanding of what it means to create space as community developers and organizers, the notion of peer support has become more prevalent in community practices and in social research literature, acting as a bridge between service providers and service users (Tseris, 2019). Increasingly, we have also been observing the emergence of co-production in programs and settings where peer support co-exists with service providers. Co-production brings together peers with lived experience and service providers, community researchers, and decision-makers to achieve reciprocity and quality service provision (Fang, Poon, Fisher, Duong, & Lee, 2024). Peer support initiatives and co-production processes represent an effort to bring together peer groups with lived experience of a particular problem that service providers are interested in engaging further with.
The impacts of peer support have been demonstrated in a variety of settings. In particular, peers play a large role in providing empathy, understanding, and acceptance to the people they support (Marshall et al., 2020; Rathod et al., 2021; Sochos & Smith, 2023). One of the reasons this happens is due to the nature of peers’ background that professional service providers do not share with their service users. Thus, peer supporters have a cultural capital available to them by virtue of their direct lived experience (Annand, Platt, Rathod, Hosseini, & Guise, 2022). However, legitimacy of peer support from an organizational perspective has been questioned, leading to the increased professionalization of peer support (Gardien & Laval, 2018). This professionalization legitimizes peer support as a form of service delivery and knowledge production, while at the same time restricting the role of peers (Akerblom & Ness, 2022; Gardien & Laval, 2018). This is often because peer workers end up being expected to fill the role of a professional service provider, leading them to have less flexibility to choose from alternative sources of support, and instead must follow directives (Akerblom & Ness, 2022). With all these benefits and considerations of peer support, it is also important to account for the nature of peer work that may lead to negative experiences. Peer support on its own also implies a bi-directional relationship as peer influence can occur both ways; positive peer influences and interactions can be extremely helpful while negative influences can set someone back (Alschech, Taiwo-Hanna, & Shier, 2020). The power of peer support therefore does not lie in its purely positive impacts on communities, but on our ability to consider the range of outcomes peer support brings. Vitally, this power speaks to the complexity of peer work based on lived experience.
Co-production is a matter of choice; not every service is co-produced by virtue of being received or engaged with by users (Brandsen, Honingh, Kruyen, & van Geffen, 2023). The root of co-production therefore lies in its literal sense where it represents a service or program produced with equitable input from groups of service users and service providers. Co-production happens when there is a shared objective and everyone’s skills are equally valued, but this does not negate power imbalances (Harris et al., 2022; Tseris, 2019). Specifically, the existence of a peer group in the same space as a professional organization with monetary and bureaucratic resources poses a significant power imbalance between these groups. The process of co-production can still be perceived as being lead or directed by the service providers or professionals rather than peer groups (Amann & Rubinelli, 2017). Therefore, it is important to establish trust between the service providers and the peer group by working with a lived experience peer facilitator (or multiple facilitators) that can help the organization enhance cultural responsiveness (Fang et al., 2024). This makes co-production an intentional and active practice.
Therefore, there are several lessons we can learn from the inclusion of lived experience peers in a co-production process. Primarily, due to the nature of their lived experience, peers are holders of knowledge and wisdom that service providers and decision-makers may simply not have access to. The way peers choose to share their story must be supported insomuch as they feel it authentically represents them. Moreover, the holistic approach we take to value lived experience means that we must accept its complexities, not just its benefits. Because we engage in co-production as a choice and not as a by-product of service creation, we are also called on to assess the power imbalances that may occur in an organizational setting with peer groups. In this way, we are underlining our commitment to accounting for the limitations of collaboration, bureaucracy, and professionalization.
Having laid out what we can learn from the peer support principles of co-production, it is important to bring our attention to how we may implement this process. Lived experience is at the heart of co-production, which brings with it a certain level of vulnerability on part of the peer groups that hold that lived experience expertise. Sharing one’s experiences of services with professional groups and organizations can be a difficult decision due to a straining of trust between these service users and providers in the past. Peer groups’ primary motivation to improve the quality of these services therefore cannot be the only driver of the co-production process; the service providers must also have a motivation to engage in the improvement of their services. However, this should not come at the cost of exploiting the peer groups’ narratives and lived experience. There is a fine yet important balance to be struck between the involvement of peers in the decision-making process and avoiding the extractive nature of doing so as much as possible. Redistribution of power to avoid extracting knowledge and effort in this way is challenging because of the nature of relationships in society between institutional forces and community members (Wilson et al., 2018). In the co-production process, we are called on to be cognizant of the desires and comfort levels of peer groups that we are working with.
Therefore, our approach to co-production must go beyond offering “a seat at the table” for peers with lived experience. Offering implies a top-down invitation to join a table that was not created with the involvement of the community in the first place. According to the way that we are attempting to conceptualize co-production, the table itself, whatever shape or form it takes, is constructed from scratch with those peers with lived experience. It is not a matter of including those with lived experience in an oppressive structure, but an effort to establish a new structure collaboratively. To steer ourselves towards a bottom-up approach, it is vital that our starting point is hearing from community members with lived experience. How do they navigate the services and programs space? What do they advocate for? How do peers with lived experience connect with each other? Importantly, what can their lived experiences tell us about the state of the programs and services their peers are asked to access? As community developers, organizers, and service providers, we have a responsibility to tackle these questions to honour and work with lived experience.
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