Boundary Crossing as a Guide in the Implementation of Peer Support Interventions in Mental Health

Implementation of peer support interventions in mental health settings requires a number of boundary crossings, particularly when such interventions are being integrated into existing models of care. The literature suggests that the implementation of peer support interventions needs to be better articulated in order to understand how to implement them successfully. This article describes the application of an implementation framework to two peer support interventions to understand the role of boundary crossing during the implementation of these interventions. Researchers used the Consolidated Framework for Implementation Research to categorize barriers and facilitators of implementation. The two peer support programs described include the Welcome Basket, implemented in a hospital setting in Canada; and Project Connect, implemented in a community setting in the United States. We conducted interviews and focus groups with key stakeholders to understand how boundary crossing facilitated or hindered implementation. The results highlight the successes and difficulties that arise when implementing a peer support intervention within a medical and a community setting. Boundary crossing was a common challenge throughout implementation, including the integration of peer services with other allied staff, working alongside the medical model, and having community-based interventions within mental health centers. Key facilitators for implementation included having clearly defined roles for peers, a responsive team environment, and flexibility to allow for boundary crossings to occur. Results suggest that boundary crossing can be a potential barrier when implementing peer support interventions, but is necessary for intervention success.