Volume 52   Number 2 Spring 2019

Self-Help Interest Group

Written by Tehseen Noorani, University of Durham

Peer Bridgers: A Distinctive Kind of Peer Provider Connecting Homeless People to Collaborative Housing ad Self-Help Support Groups at SHARE!

Written by Elizabeth G. Hartigan, Ruth Hollman, and Jason Robison, SHARE! The Self-Help and Recovery Exchange

The principles and practices of member-run mutual-help groups or self-help support groups have been increasingly adapted into new forms of mental health peer provider roles.  An increasing number of US states sponsor peer provider credentialing programs that are reimbursable by Medicaid, and mental health consumers are frequently being employed as peer providers in consumer-run services and in professional, clinical, and rehabilitative services (Myrick & del Vecchio, 201; Salzer 2010).

This article describes the Peer Bridger, a distinctive (or unique) peer support staff role. We describe examples of how Peer Bridgers are used in several sites and emphasize how Peer Bridgers are being distinctively used at SHARE! the Self-Help And Recovery Exchange in Los Angeles, California. Peer Bridgers at SHARE! have been evolving since 2005 and represent a promising practice that, based upon preliminary information, offers the potential for becoming an important evidence-based practice.

A Peer Bridger is someone with lived experience who provides a 'bridge' for a person transitioning between life situations, places, and/or identities. Examples of critical transitions are from homelessness to housing, incarceration to the community, locked mental health facility to the community, and/or unemployment to employment. For the SHARE! Collaborative Housing project, bridging is distinctive in that it also includes offering support in the form of: a) self-help support groups; b) opportunities to learn to live collaboratively with others; and c) participation in the democratic management of the shared housing.

Ideally, Peer Bridgers get to know the person they are bridging before the person transitions to the new setting or situation. By disclosing their similar lived experiences, Peer Bridgers normalize the fears, concerns and feelings that people in the new situation have. Peer Bridgers connect people to self-help support groups, and may themselves attend self-help support groups alongside newcomers, to model effective interactions within groups. While only 70% of SHARE! Collaborative Housing residents actually attend self-help support groups, the impact of those who do is to make the houses more functional, as people bring benefits from the groups to the house, such as learning to listen and problem solve effectively. The Peer Bridger uses recovery planning to empower the person to move forward and function as a supporter and a role model, sharing their experience, tools and skills to make the transition successful.

Peer Bridgers first appeared in the Peer Bridger Project, developed by the New York Association of Psychiatric Rehabilitation Services in 1994 as part of their mission to help people transition out of psychiatric hospitals into the community in a manner that circumvented the revolving door phenomenon.  Until then, 50 percent of people would get readmitted to the hospital within a year. By 2008, the Peer Bridger Project had reduced this to 29 percent (NY Peer Bridger Project, 2012).

Peer Bridgers have been utilized in several mental health programs. The Housing First model, launched at Pathways to Housing New York, found that with the use of Peer Bridgers, 80% of people maintained housing over two-years, compared to 30% for people who received traditional housing services (typically shelters and transitional housing, with access to permanent housing if they complied with program requirements) (Tsemberis et al, 2004). As a progressive program model, the philosophic premises, service structure, and empirical support of Pathways to Housing New York's Housing First model have led to its increasingly widespread dissemination (Stanhope & Dunn, 2011).

Peer Bridgers are also using Critical Time Intervention (see, which helps vulnerable people during times of transition in their lives by strengthening their network of support in the community. In a study of Peer Bridgers supporting people exiting New York psychiatric hospitals with time-limited care coordination, participants increased their use of outpatient services over 12 months and decreased hospital use compared to a control group (Nossell, 2016).  Peer Bridgers supported veterans in the MISSION-VET treatment program, serving as role models and a source of encouragement and support (Rodrigues, 2011). Peer Bridgers implementing Critical Time Intervention in Brazil and Chile are currently under study (Stastny, 2012; Baumgartner, 2012). Peer bridging those leaving psychiatric hospitals has been shown to improve symptom severity, functioning and employment (Franx, 2008). A two-year study at nine Canadian hospitals found that the length of hospital stays was reduced due to peer bridging (Forchuk, 2015).

SHARE!’s Model of Peer Bridging

Established in 2005, SHARE! Collaborative Housing uses Peer Bridgers to support more than 600 people a year in its housing program. The purpose of the approach is to maintain a high degree of recovery orientation, where recovery is defined as “a process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential” (SAMHSA, 2012). Participants maintain housing and are supported in pursuing personal growth and change through self-help support groups, and pursuing their personal idea of success, which often includes education and/or employment.

Peer Bridgers at SHARE! are employees who have met the standard requirements for employed peer staff; this consists of being in successful recovery from their relevant issues, and presently attending self-help support group meetings. They receive ongoing training in SHARE!’s approach to Peer Bridging and in the SHARE! Peer Toolkit— the relational dynamics, developed by Executive Director Ruth Hollman - the 2016 recipient of SCRA’s Distinguished Contribution to Community Psychology Practice Award. SHARE!’s Advanced Peer Specialist training, which includes three courses, is funded by the State of California.

SHARE! tracked participants in SHARE! Collaborative Housing with serious mental illness and found that 26% found employment within a year. Participants also showed high rates of pursuing higher education, family reunification and volunteering. 98% maintained their housed status even after they moved out.

One of the difficulties in implementing Peer Bridging is the lack of suitable training. There is a lack of studies comparing peer training of any sort with outcomes in the people served.  Many peer certification programs do not teach best practices in peer services, relying on what should work rather than what actually has been shown to work.  SHARE! has had difficulties with Peer Bridgers who want to pass into the Case Manager role, as it more familiar and also wields more power. Acknowledging the widespread confusion about best practices in Peer Bridging (Henwood, 2011), SHARE! trains staff and aspiring Peer Bridgers in the most effective traits of Peer Bridgers using the following matrix.


Critical Ingredient of Peer Bridging

Examples of High- fidelity Peer Bridging

Examples of Low-fidelity Peer Bridging

Integrating Support

Integrates the practical parts of the change with their own experience in similar change which includes their feelings, hopes, challenges, etc.

Focuses on problem-solving rather than the person and their feelings, hopes, and fears.

Respecting Differences

Recognizes the individuality of the person they are working with and supports them where they are.

Expects the person they are working with to have the same worldview and/or needs as they do or did.

Peer Role

Sees their primary role as helping the person decide what is important to them and connecting the person to natural supports in the community.

Sees their primary role as solving the person’s problems and connecting them to professional services.

Relationship building

Prioritizes the relationship with the person they are working with.


Struggles to build an authentic relationship with the person. Uses professional boundaries.

Respect and Dignity

Takes a journey with the person being served to provide them with unconditional love and support. Sees themselves as similar to the person they are serving and looks for strengths and positives.

Sees the person as needing guidance or supervision, rather than as an equal. May use judgmental language.


Case study

In September 2016 a 40-something Hispanic woman with a history of domestic violence walked into one of SHARE!’s self-help center and found out about SHARE! Collaborative Housing. She had been living on the streets and occasionally in shelters for three years. A month later she decided to move in to a house in Long Beach, CA. She met with her Peer Bridger the next day and together they filled out the SHARE! Plan for Success. Her 5-year goal was to be “working, have good relationships with family, have GED.” She was referred to and attended Alcoholics Anonymous, Co-Dependence Anonymous and Recovery International support groups. She was estranged from her two daughters and her siblings. She described herself as “hopeless.” She had no income. She moved in with a Rapid Rehousing Subsidy from the local housing authority. While she was connected to health care, she was not receiving mental health services. Her Peer Bridger connected her to mental health services and benefits, so the next month she began paying her own rent. She had lost her driver’s license for having too many tickets and with the help of her Peer Bridger came up with a plan to get her license back, including going to court, paying some fines and doing community service. She got her license back. She decided that she wanted to be a Drug and Alcohol Counselor, so she and her Peer Bridger researched school options and she went back to school to get her GED and enrolled in a certificate program at the local Community College with financial aid. After three semesters, she decided she did not want to be a Drug and Alcohol Counselor, so she took a job as an Administrative Assistant who also did bookkeeping. Her self-help support groups kept her sober, taught her boundaries and how to have better relationships, so soon she reconnected with her two adult daughters. That in turn led to her reconnecting with her siblings as well. She bought herself a car. Her new boyfriend is loving and not at all abusive. She says, “SHARE! Collaborative Housing was the start of everything I wanted in my life. I am so glad that now I know how to take care of myself.”

The underlying critical ingredients of Peer Bridging, such as respecting differences, relationship-building, respect, and dignity have been documented (Henwood 2011). They are the foundation of SHARE! Collaborative Housing Peer Bridging. In this report, SHARE! has demonstrated its commitment to using evidence-based practices to inform its programs. The fact that Peer Bridgers are not used more widely suggests that providers are not keeping abreast of our evolving understanding of effective peer service provision.


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