Organizational dynamics at a peer respite: A focused ethnography of an emergent strategy

ABSTRACT

A focused ethnography aimed to understand organizational dynamics affecting a state-funded pilot peer-operated respite in the Southwest region of the United States of America. Findings from 8 interviews with program directors and peer staff (N = 12), 2 focus group discussions with peer staff (N = 8), and field notes from 198 hours of participant observation indicated that staff experienced many organizational demands from the traditional public mental health system and different imperatives associated with the peer respite model as an emergent strategy. Within a context of resource scarcity and a lack of integrated social services, organizational issues related to program sustainability, peer staff accommodation, and peer staff’s confusion regarding the program’s intent became evident. Findings identified a gap in the literature regarding the peer respite model’s approach to hosting guests experiencing homelessness and confirmed other research on peer labor that indicates further systemic support is needed to improve work conditions. Implications of these findings and the organizational limits of a peer respite within resource-poor environments are also discussed.

KEYWORDS:

• Emergent strategy
• homelessness
• systems transformation
• peer respite
• peer support

Acknowledgments

The authors would like to thank Lighthouse staff and guests for their generosity and support of the study. We would also like to thank our reviewers for their careful consideration of this manuscript. Lastly, we would like to acknowledge our dedicated research assistants Max Aliprandi, Michelle Dea, Helen Nguyen, Amber Nguyen, Ifechi Ochi, Javani Patel, Sarah Patron, Erick Rangel, Kimberly Santander Segura, Shabeer Siddiqui, Christina Shibu, Ada Sison, Delaney Smith, Ian Wynne-Mobley, and RG Yamba.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. The crisis respite model was first piloted in the late 70s by psychiatrist Loren Mosher, who supervised and studied a 12-bed house staffed by peers and clinicians (Mosher & Menn, 1978).

2. Those who use such services are referred to as “guests” as opposed to “patients” in order to reflect the explicitly nonclinical therapeutic aspects of such facilities and their focus on mutuality, respect, and shared responsibility (See Croft et al., 2016).

3. In response to the closure of many public housing projects throughout the city and sustained efforts to criminalize homelessness, public-private partnerships enabled some development of permanent, supportive housing through a tax-credit voucher system; and like other cities in the United States, waitlists for these services were quite extensive.

4. Despite the slow recognition of Lighthouse within the LMHA, many if not most referrals eventually came from the LMHA, law enforcement on homeless outreach teams, social workers from local public hospitals’ emergency services, and former guests to those who were also experiencing homelessness, potential guests and those who referred them to Lighthouse—most of whom seemed to view the organization primarily as transitional housing.