A total of 5191 records were screened, with 154 full-text articles examined resulting in the inclusion of 16 studies. Studies were conducted across 5 main countries including United States (n = 7), Australia (n = 3), United Kingdom (n = 2) with single studies conducted in both Finland and Singapore. Two studies were conducted across multiple countries including India, Israel, Germany, Tanzania and Uganda. Study designs were primarily qualitative (n = 13) and mixed-method inquiries (n = 3). Studies were appraised for quality and were rated as good quality (n = 11), fair quality (n = 5) and poor quality (n = 0). See Table 2 for quality appraisal.

From the 16 included studies four overarching themes were established including the provision of education and training, organisational readiness, structural adjustment, resourcing and support and demonstrated commitment to peer integration and recovery practice. Within these overarching themes, several sub-themes emerged including role clarity, recruitment and induction, leadership, championing, professional supervision and consistent inclusion which will be discussed in greater detail. See Table 4 for brief description of themes and subthemes.

Table 4 Themes and subthemesTheme 1: education and training

The provision of education and training was found to support integration of peer roles, appearing in 12 of the 16 included articles for this review. Educational approaches are documented in various formats including formal education sessions, the facilitation of open conversations, educational community events, role mapping and increasing employee’s exposure to the work and services peer workers provide. Increasing wider workforces’ understanding of the role was found, in several instances, to reduce employee resistance and discrimination, improve acceptance of the role and facilitate greater engagement with peer support workers and their services [33,34,35,36].

The provision of education was found to emphasise the value of lived experience knowledge, provided boundaries for peer workers, and assisted in managing non-peer employee expectations [34, 37]. Byrne, Roennfeldt [38] highlight the provision of education and whole-of-workplace training on lived experience roles is most beneficial when delivered regularly rather than a one off.

Further to the education of employees, research highlights the importance of ongoing training and education for peer workers supporting consistent improvement of service, continuous development of unique skillset and professional growth contributing to sustainability of peer roles [39, 40].

Organisations may support by providing opportunities to gain formal peer support qualifications, create or engage with further learning opportunities, support peers to develop and deliver training for colleagues and provide education on specific workplace policies and procedures to ensure effective integration into teams [41].

Theme 2: organisational readiness

Ensuring the introduction and integration of peer roles are well planned from the beginning, including clear and distinct role definition, in-depth knowledge of peer roles and practices, sufficient structure to the program contributed to successful integration [38, 42, 43].

Knowledge of previously documented implementation challenges and detailed pre-implementation planning ensures the organisation can adequately prepare and attempt to alleviate potential for negative outcomes [42]. As part of pre-implementation planning, organisations should consider the purpose of establishing and integrating a peer workforce, suggesting if organisations have clarity around their purpose, it will highlight the key areas for organisational development in supporting peer-based practices.

A key component of organisational readiness is consultation with existing staff prior to onboarding peer workers [28, 39, 40, 44]. This approach sees the need for organisations to address concerns of employees and key stakeholders and be conscious and empathetic to their emotions over the change process of introducing new professional staff to a team. This involves open and clear discussions of the role and the provision of education for fellow employees on the nature, role and responsibilities of the peer support position [45], further highlighting the need for organisations to maintain certain flexibility and willingness to make changes in response to feedback provided [46].

Subtheme 1: role clarity

Twelve studies highlighted the importance of clear and defined role descriptions provided both to peer support workers and their colleagues for the successful uptake of peer support roles and services. Providing clarity to the peer role was found to alleviate uncertainty and ambiguity for all stakeholders, improved peer confidence in their role and enable a smoother transition to acceptance and understanding of peer worker roles [34, 35, 45]. Crucial for this is acknowledging peer services can vary greatly between organisations, highlighting the importance of establishing and clearly communicating organisational needs and expectations of the role [34]. Further, the provision of a clear role description highlighting the uniqueness of the peer role was found to distinguish peer work from other services and find its appropriate fit within the team and service delivery [44].

Subtheme 2: recruitment and induction

The importance of meaningful recruitment and induction ties closely to the organisations need to be prepared to take on the new role. A clear understanding and consideration of the peer role ensures a more robust and thorough recruitment, seeing workers screened for the appropriate qualities and skills required to fill the role and needs of the organisation and service users [38, 47]. Several studies went further than this to highlight the importance of recruiting peer support workers with direct experience of the services they are being recruited to support [39, 48]. Research identified the need for consistent onboarding processes, including structured inductions, highlighting the need to find the best fit for the role as integral to the successful integration into the team [35, 43, 47, 48]. Further, introducing peer concepts for all workforce orientation was found to support integration and overall acceptance of the peer role [38].

Theme 3: structural adjustments, resourcing and support

In addition to organisation’s establishing readiness for the introduction of peer workers to service teams, ensuring adequate structural adjustments have been made to accommodate the peer role, the provision of resources to effectively undertake the role and ongoing support are crucial. This includes ensuring organisations are flexible and able to make reasonable adjustments for the role, recognising that peer workers shape the role based on their skills and expertise [34, 46]. Further, organisations introducing systems that provide specific information on peer workers including their areas of expertise and instructions on how to ‘book’ specific peers for service users [35].

Commitment to peer practice was demonstrated by providing equal access to opportunities for all staff including fulltime or ongoing work, access to resources (computers, desks, phones, patient records, transport) and staff benefits including annual leave and sick pay [34, 38, 39, 44]. Gates, Mandiberg [47] highlight that applying the same policy for all staff reduced segregation between workers and promoted the inclusion and acceptance of the peer support role. Organisations providing equal opportunity to fair and equal pay places value in the knowledge, expertise and services peer support workers contribute, facilitating inclusion in recovery orientated practice [38].

Subtheme 3: professional supervision

Professional supervision was consistently noted across 8 of the 16 articles included in this review. Supervision was found to be effective in supporting integration of peer workforces noting that support from knowledgeable and informed supervisors assisted peers to set and maintain professional boundaries and contributed to feeling valued and accepted in their role [42, 45]. For supervision to be effective, research found that supervisors should have a sound understanding of the peer support role and lived experience workforce [33]. The supervisor should be supportive and champion the value of lived experience knowledge for consumers and the wider recovery movement and encourage role negotiation and development [33, 41]. Lived experience authors raised the context where peer workers often have supervisors who are non-lived experience workers and highlight the importance of ensuring access to peer led supervision for authenticity of practice [38]. Additionally, studies found the need for adequate training of supervisors to ensure they are appropriately supporting and advocating for peer workers [46].

Theme 4: demonstrated commitment to peer integration and recovery practice

An organisation’s ability to demonstrate commitment to peer integration and recovery practice was noted in various formats by all studies included in this review. Studies noted consistent inclusion of peer workers in teams– where the service is seen as an essential component of recovery and service delivery [38] and facilitates a culture where lived experience expertise is valued by the organisation [35]. Mancini [36] notes need for intentional integration strategies where organisation support and fully endorse the concept and philosophy of peer work and recovery practice.

Further, formal recognition of the peer support role and promotion as a distinct support was seen to legitimise and increase acceptance of the role [37, 41, 44]. Research suggests organisations can demonstrate commitment by supporting peers to access a wider peer network and by hiring multiple peer workers into the service [34, 40].

Teams who acknowledged individual strengths and competencies of peer workers, in addition to ongoing exposure to peer work found greater uptake/use of peer services and increased referrals into the service [42]. Organisations who outwardly displayed positive attitudes and encouragement for the uptake of peer services and invested in prior promotion and advertising of peer services were able to prepare workers and service users for the integration of the service, seeing greater engagement and integration of services [34, 40].

Differing levels of organisational support were reported across each of the articles, seeing the use of strong leadership, robust and inclusive organisational policy, championing of the peer support role and commitment to recovery practice as key approaches to successful integration of peer workforces.

Subtheme 4: leadership

Eleven of the sixteen included articles highlighted the importance of strong leadership for the integration of peer workforces. Studies noted the influence leadership has on creating an accepting workplace culture, providing stable working environments and promoting the value and necessity of the peer support role in supporting recovery-orientated practice [34, 43]. Strategies utilised by organisational leaders, as noted previously, include the provision of adequate resources, professional supervision, clear and consistent messaging and role clarity.

Leaders providing clear and consistent messaging through initial integration periods was noted as key to achieving employee commitment and buy-in, an integral component of creating an accepting and inclusive working environment [46]. Leaders consistently demonstrating commitment to peer work practice and articulating clear role and responsibilities was found to increase the likelihood of acceptance by existing employees by reducing stigma or possibility of workers feeling threatened by the new role [36, 46]. This is enhanced by placing peers in senior positions of authority at multiple levels of the organisation including management, executive and board member roles [38, 46]. This provides a clear standpoint for where the organisation sits in regard to the new role, promoting understanding, value and engagement and setting a standard for practice while simultaneously legitimising and justifying the role [46]. It also highlights the organisations commitment to recovery practice [48]. Franke, Paton [49] found that organisational leaders must lead by example to ensure consistent integration. Without support from management, peer support workers found they felt a greater burden of proving their own value to the team.

A key approach to integration included leaders using their platform to highlight the role and potential benefits it can provide to service users, increasing understanding and support from other employees [33, 46]. This was supported by Berry, Hayward [44] noting that the peer support role operates under a strengths-based model and provides leaders an opportunity to promote how unique and distinct the role is and how it differs from other support positions.

Subtheme 5: championing

In line with effective leadership as an approach for peer support worker integration is the concept of championing within the organisation. This promotes the unique characteristics of peer support and the distinct value of services whilst facilitating effective integration and acceptance into service delivery teams. This is supported through findings by Gillard, Edwards [37] who highlight that if the peer support role is not emphasized as distinct or unique from other existing support roles, there is little success in its adoption and integration. Championing the role can be implemented via several avenues within the organisation including through support from executive management, promotion of services filtered down through lower-level management or through the appointment of specific peer support champion [38]. The appointment of specific peer support champions are people who have significant understanding of the peer support role, who act as advocates and mentors and who have influence and respect within the workplace [42,43,44].

Championing through organisational support sees the increase of teamwork opportunities between peer workers and their colleagues, highlighting the unique and positive aspects of peer support. Championing as a strategy to positively influence peer support integration into service delivery stems beyond the education of fellow employees and has proven effective as a strategy to increase understanding and acceptance from mental health service users [33, 38].

Subtheme 6: consistent inclusion

Table 2 highlights the fourteen articles identifying the organisations commitment to recovery practice and inclusion of peer support services as a key component for successful integration. This is demonstrated through the consistent use of recovery language in practice, policy and mission statements to assist staff to embody and normalise its use [43]. Inclusion of peer support workers within the workplace increased colleagues exposure to peer support, ensuring increased visibility and accessibility to services, building trust between colleagues, increasing stakeholder buy-in, familiarisation and team cohesion [36, 39, 46]. Inclusion in all staff activities and processes further assisted the integration process, encouraging staff to see peer support as a professional role and a wider part of the team [35, 38]. Recent studies found integration of peer roles was further supported through initiating community and team activities such as working on collaborative projects or community education events to raise awareness of lived experience expertise and value it can bring to service users recovery journey [34]. Further, designated activities were found to shift stigmatizing attitudes toward mental health and assist in facilitating integration of peer services [35].