An extensive literature review performed by Advocates for Youth recently identified 28 programs that demonstrate the strength and capacities of peer programming in several arenas – from violence and crime prevention to substance abuse prevention and sexual health promotion. ^[1] At the same time, the research also identified peer programs with no positive behavioral or health outcomes. Why do some peer programs succeed while others fail? This paper attempts to identify the characteristics important to creating and maintaining a strong and successful peer-led sexual health program.

What Issues Are Considered Here?

The first task is to identify the critical, youth-focused aspects of successful peer programming. Although the literature review also identifies good programs for use with adults or children, ^[1] this paper focuses on programs targeting adolescents and young adults (ages 11 through 24). Why? Because normal and expected developmental changes throughout adolescence and young adulthood make some aspects of peer programming more important for youth than for other age groups. Of the 28 successful peer programs identified in the original literature review, 25 target adolescents and young adults. ^[1]

The second task is to choose one type of programmatic peer involvement. One researcher divides peer involvement into two types:

1) programs where peers offer support to one another within a group of equals; and
2) programs that designate some youth as leaders of the group by nature of their special training or roles. ^[2]

Twenty-one of the 25 youth-focused, successful programs identified by the literature review rely largely on the abilities and determination of trained peer educators (or counselors, facilitators, etc.) to improve the risk behaviors and health outcomes of a target audience* while four programs rely instead on social support among equals. ^[1] This paper focuses only on peer-led and/or peer-assisted programs rather than on mutually supportive groups of equals.

Although this paper is about how to create a strong and successful peer-led sexual health program for youth, it draws lessons and conclusions from both successful and unsuccessful programs, including those that address issues other than reproductive and sexual health. Of the 21 successful, youth-focused and peer-led programs identified in the literature review, 13 are directed at reproductive and sexual health while eight are not; ^[1] however, lessons can be drawn from all 21. At the same time, the research has also identified some less successful programs from which lessons may be drawn.

Experts raise the question of whether a peer program focuses on peer development or on peer delivery. ^[2,3] That is, does a program exist primarily to develop knowledge, skills, attitudes and pro-social behaviors in the peer leaders or to achieve these outcomes among members of the target audience? Of the 21 successful, youth-focused and peer-led programs identified in the literature review, all 21 aim at achieving positive behavioral and health outcomes among members of the target audience. Although research shows that peer leaders may benefit greatly from their involvement in peer programs ^[2,4,5,6] this paper focuses on peer delivery rather than on leader development, except insofar as leader development contributes to program delivery.

Another issue raised by the experts is the setting of peer programs. ^[2,3] Of the 21 successful, youth-focused and peer-led programs identified in the literature review, 11 are school-based ^{[7,8,9,10,11,12,13,14,15,16,17,18]} and 10 are community-based. ^{[19,20,21,22,23,24,25,26,27,28,29]} Because both community-based and school-based peer programs can be effective with adolescents and young adults, this paper pays careful attention to both.

Finally, experts continue to grapple with the issue of what might constitute a ‘peer’. The research into successful and unsuccessful peer-led and youth-focused programs shows that planners hold widely varying ideas of who exactly might be a peer to members of the target audience. One researcher noted that the notion of peer is tied to that of identity ... It helps to define that fateful pronoun, ‘we’, and to reckon with the patterns of inclusion and exclusion that it cannot but help to create ... Identities derive from a multiplicity of sources, including roles ... (such as being a mother or a father), group categories ... (such as those based on ethnicity) ... and experiences (such as having taken drugs). ^[6] In other words, age alone does not successfully define peers nor does gender, race/ethnicity, religion, sexual orientation, behaviors or achievements, considered alone. Thus, this paper does not attempt to define who might be an appropriate peer leader with a particular audience. Instead, the paper draws important points from the ways that programs – successful and unsuccessful – recruit, choose and train peer leaders.

What Is Peer Programming?

At its most basic, peer programming aims to affect the social norms of a group through the influence and role modeling of other members of the group. Peer programming, or peer education, peer helping, peer counseling, or peer facilitating as well as a variety of other terms, generally has meant that professionals – whether educators, program managers, health care providers, youth development specialists, or others – have decided to affect a target population by harnessing the potential power of its peers. Peer programs have been designed to encourage attitudes, knowledge, behaviors and outcomes that a community considers desirable, to discourage attitudes, behaviors and outcomes that a community considers undesirable, or to accomplish some of each. ^[1]

By its nature, peer programming includes and values the experiences and attitudes of non-professionals, especially those of the target audience and the community. This experiential and interactive component is at least as important as the attitudes and knowledge of admitted professionals. Successful, youth-focused and peer-led programs identified in the literature review are always participatory and interactive. Several also focus on empowering disadvantaged and marginalized youth. ^{[1,14,19,20,21,24,25,26,27,28]}

Why Do Some Peer Programs Fail?

Two British researchers identified seven reasons why peer programs sometimes fail. ^[30]

1. Lack of clear aims and objectives for the project ... A project which does not have clearly stated aims and objectives cannot demonstrate that it has been successful because it will be unclear what it was originally hoping to achieve. ^[30]
   
   
   
2. Inconsistency between the project’s design and the outside environment ... Project design will be governed by: (i) the target group for the intervention ...; (ii) the subject area/s of the project; (iii)... the financial and human resources available; (iv) the timescale for the project; and (v) the setting for the project. ^[30]
   
   
   
3. Lack of investment in peer education ... Clear investment in peer education should be made in terms of human and economic investment and peer education should never be viewed as a cheap or easy option for the delivery of health promotion. ^[30]
   
   
   
4. A lack of appreciation that peer education is a complex process to manage and requires highly skilled personnel ... Project designers have frequently made mistakes ... because there is no accredited training course ... to enable an individual to become a skilled project manager... It is frequently the case that peer-led work is tacked onto a worker’s other responsibilities. The range of skills required to initiate, manage and sustain quality work should not be underestimated. ^[30]
   
   
   
5. Inadequate training and support for peer educators ... It is essential that [peer educators] ... undertake their work through structured supervision, preferably with male and female staff members... Training offered to peer educators should be consistent with the end task. Who actually trains peer educators will also be important and there is research to suggest that using peer educators from previous years to undertake the training work can be invaluable. ^[30]
   
   
6. A lack of clarity around boundary issues and control ... The balance between empowerment and control is not an easy one to manage. Many people assume that young people will be automatically empowered by being involved in peer education... This is not the case. Empowerment is a process which occurs over time and involves gradually giving increased responsibility to the peer educators... Boundary issues in peer education are complex. Boundary issues are both professional and personal between the peer educators, the project manager, and the target group. Issues which must be addressed include socializing on a personal level, how support is offered, how sexual attraction is dealt with, and professional conduct. ^[30]
   
   
   
7. Failure to secure multi-agency support – The most successful peer education projects will be those which seek involvement from a broad range of agencies. ^[30]

What Contributes to a Strong & Successful Peer-Led Sexual Health Program?

1. Carefully Select and Train Staff to Manage the Program. Staff is usually only a few years older than the potential peer educators and target audience. Staff members assigned or hired to manage the project should:
   
   a) Enjoy working with youth;
   
   b) Include males and females if the target audience is of both genders or of the same gender as the target audience, if the target audience is only females or only males;
   
   c) Lack any criminal or misdemeanor history of sexual predation;
   
   d) Be of the same or similar ethnicity and socio-economic background as the target youth;
   
   e) Speak the language of target youth and prospective peer educators, whether that be street lingo or ethnic argot or Spanish, French, Vietnamese, or Hmong, ASL (American sign language), etc.;
   
   f) Be gay, lesbian, bisexual or transgender, if the program targets GLBT youth;
   
   g) Be flexible, especially regarding time commitments to and expectations for the program; and
   
   h) Receive extensive training in: project management; conflict resolution; facilitation; communication; the chosen program or curriculum (if any); fund-raising; setting boundaries; confidentiality; dealing tactfully with community stakeholders; and issues related to the prospective program and target audience.
   
   
2. Secure Financial Support. It is important to secure financial support at least for the first two years before beginning a peer-led program. Local businesses and foundations, community-based organizations and community health facilities may provide important monetary and in-kind support for a peer-led sexual health program. With their financial and in-kind support may also come the type of interagency political cooperation and support that will help to keep the program going. (See also Involve the Community, below.)
   
   
3. Involve Youth. Involve adolescents in designing, implementing, maintaining and evaluating the peer-led sexual health program. Youth’s involvement from the outset can help designers to:
   
   a) identify the youth most in need of a peer-led sexual health program;
   
   b) clarify the rationale and mission of the program; and
   
   c) create something that will have ‘traction’ with the target audience.
   
   Depending on the setting for the program and its prospective audience, involved youth might be those who use the community center, participate in sports or other after-school activities, are pregnant or parenting, have dropped out of school, speak out at assemblies or other gatherings, and/or are known for traits of courage and leadership. The youth involved in the program design may or may not later want to participate as peer leaders. Regardless, their contributions will be invaluable for planning an excellent program and in identifying other potential peer leaders. Remember that involved youth should not be taken as ‘tokens’ or as spokespeople for all other community youth. The can speak only for themselves and, perhaps, for their friends. It is critically important to include youth at every step, listen carefully to their recommendations, recompense them for their time and expenses, ensure that they don’t go hungry during meetings, and treat them with the same courtesy accorded to involved adults.
   
   
4. Involve the Community. Involve parents and other community stakeholders – such as faculty and administrators of schools, business and health professionals, politicians and media, health care providers and youth-focused community programs – in identifying the goal(s) and the objectives of the peer-led reproductive and sexual health program. Enlist their input and support for prospective activities; but, be careful that community adults don’t take over the program because this will undermine and damage or destroy the program. Community adults need not be involved in all aspects of the program’s design and operation; but their cooperation and support is critical to putting a peer-led sexual health program into operation and to keeping it running. For example, consider the difficulties of starting and maintaining a community-wide contraceptive access program for teens without first getting the support of parents and other stakeholders. And of course, for school-based programs, the support of parents, teachers, administrators and local politicians is essential.
   
   
5. Identify the Target Audience. Consider targeting a naturally occurring peer group, such as sports teams and school or community clubs. Such groups already have interests in common and may be easier for peer leaders to work with, if peer leaders come from the ranks of the group. Sometimes, the target audience will be fairly well-known to program planners; sometimes it will not. For example, an inner-city, school-based, peer-led HIV prevention program might target students whose ages, race/ethnicity, socio-economic circumstances, and risk situations are fairly well known to other students, teachers, and administrators. At the same time, students, teachers, and administrators may be almost completely unaware of how intensely their school needs ‘safe space’ for gay, lesbian, bisexual and transgender youth ^[31] or how urgently male students need access to completely confidential sexual health services. ^[32] A community-based organization intending to reach out to street youth for the first time might have much or little factual knowledge as to the ages, gender breakdown, sexual orientation, race/ethnicity, circumstances, health issues, educational background, and risk behaviors of young people living on the streets and in shelters. Identifying the characteristics and needs of the target audience is the province of the needs assessment. See below.
   
   
6. Conduct a Needs and Assets Assessment. The needs and assets assessment should be designed to identify unmet needs of the target audience. Even when planners think they know the target audience, they should still utilize a needs and assets assessment because it can uncover issues which the planners didn’t realize affect the target youth. It is important to be completely clear about the circumstances of the target audience, because these circumstances will help:
   
   a) identify the rationale and purpose of the peer program;
   
   b) assist in defining its goals, objectives and activities; and
   
   c) determine the characteristics needed in its peer leaders. In addition, the assets portion of the assessment will identify the talents and abilities of those chosen to be peer leaders as well as the reproductive and sexual health assets offered by the community, such as youth-friendly clinics and pharmacies.
   
   Some researchers assert that, in order to keep peer leaders involved and enthusiastic, it is necessary to invest in the careful and ongoing work of identifying the needs of the target population and the talents and abilities of the peer workers. ^[33] The first needs and assets assessment will be essential at this point. Other needs and assets assessments will be necessary over time.
   
   
7. Recruit the Peer Leaders. Choose peer leaders carefully. Their commitment is imperative. Peer leaders must be committed, both to the program and to providing positive role modeling to their peers. ^[34] Enthusiasm and energy are also vital to the program’s success. It is very important to remember that peer means equal. To whom will members of the target audience feel equal? That is, who will appear to targeted youth as someone who understands their culture, background, aspirations and problems? Or to look at it another way, where does the power lie?
   
   Between equals, there is little or no power imbalance. Between people who are unequal, there may be a significant power imbalance, whether due to differences in age, socio-economic status, political status, race/ethnicity, gender, educational level or other factors. Peer leaders need to be in balance with their target audience. Age is not enough, by itself, to determine who should be chosen as a peer leader. Both successful and unsuccessful programs have relied on same-age peers. At the same time, college students are unlikely to be viewed by high school youth as ‘peers.’ ^[35] Youth as old as age 22 are unlikely to be seen as the ‘peers’ of seventh graders. ^[36] Students who are failing academically are less likely to believe that honor roll students can understand their problems than they are to accept others who have struggled but are now doing better academically. Drug using youth may be able to trust and relate to peers who once used drugs and now are clean; but, they are unlikely to trust the “don’t do drugs” message of peer leaders that they know to be using drugs. ^[34] And low-income black and Latino youth are unlikely to see youth who are well off – whether white, black or Latino – as peers who can understand ‘where they are coming from.’
   
   Selecting youth who will make good peer leaders can be an exacting task. Leaders may come relatively easily from naturally occurring groups of youth that are in the habit of working together, such as sports teams, senior Scout troops, or youth that regularly play ball together at a community center, etc. On the other hand, if the target audience is a school class or some other arbitrarily grouped bunch of youth, then selecting peer leaders will be more complex. Youth chosen as sexual health peer leaders should be:
   
   a) From the same general background, ethnicity and socio-economic circumstances as the target audience;
   
   b) Able to address reproductive and sexual health issues in a non-judgmental and open-minded way;
   
   c) Enthusiastic about the mission of the program and willing to commit a significant portion of their free time and energy to it;
   
   d) No more than three to four years older or perhaps the same age, but on no account younger than the target youth;
   
   e) Able to give the time to: being trained; meeting frequently with supervisor(s); facilitating activities for their target audience; speaking to media; meeting with community groups, such as school or foundation boards; planning new activities; and attending additional training sessions; and
   
   f) Committed to doing as they will encourage members of the target audience to do.
   
   In addition, it may be an asset if peer educators have a history similar to those the program will address. That is, they may have a history of using drugs, having been subjected to physical, emotional or sexual violence, having had STIs, having been pregnant, etc. The important point will be that they have changed their behaviors to align with their values and no longer use drugs or suffer violence without protest or have unprotected sex, if that is their history.
   
   
   
8. Plan for Ongoing Recruitment and Training of the Peer Leaders. In the nature of peer-led programs, peer leaders ‘age out’ or lose their enthusiasm or get involved in other activities that take up their time and energy. It is important to get a time commitment from youth who want to be peer leaders. Nevertheless, life happens (especially during the teenage years) and replacement peer leaders will be needed. Consider that a teen’s parents might break up or move or that the teen might become eligible for a sport or program he/she really wants. Peer leading cannot become involuntary servitude. So despite their commitment at the outset, peer leaders will move on and need replacing, perhaps even before the first year is out and certainly as time goes by.
   
   
   
9. Identify the Rationale for the Program. The rationale is the argument as to why a peer-led sexual health program is being contemplated. It also is critical for grant-writing and other efforts to obtain the monetary and non-monetary support essential to running a peer-led program.
   
   One researcher identifies several less-than-useful rationales for peer programs, including: credibility of peers; that peers can create new norms among themselves; that peers may deliver content in a less intimidating manner than adults and use language that is better understood; and that peer-led programs are easier to implement. ^[2] Cost savings is another frequently mentioned rationale. Yet, none of these is an adequate reason for creating a peer program. Each may be an uncertain reason, at best, and untrue, at worst. For example, peer leaders will lose their credibility if they indulge in the very behaviors they discourage among their peers. Or, program youth may not consider the ‘peer leaders’ to be their peers at all due to differences in socio-economic background, race/ethnicity, age, gender, and/or life experiences. Finally, peer programs are not easy to implement and maintain, and they are not cheap.
   
   There are several appropriate and important rationales for peer-led sexual health programs. These include, but are not limited to the following. Peer-led programs may successfully:
   
   a) Empower marginalized and disadvantaged youth to adopt healthier attitudes and behaviors in order to achieve a healthier and more successful future. ^{[19,20,21,22,23,24,25,26,27,28]}
   
   b) Address critical issues that undermine the reproductive and sexual health and the future of a community’s youth. ^{[7,8,9,17,19,20,22,23,26]}
   
   c) Encourage peer leaders to adopt healthier attitudes and behaviors and to work toward their own successful future. ^[2,4,5,6,19]
   
   d) Encourage in-school youth to adopt healthier attitudes and behaviors. ^{[7,8,9,10,11,12,13,14,15,16,17,18,21,29,34]}
   
   e) Encourage out-of-school, homeless, and/or runaway youth to adopt healthier attitudes and behaviors. ^{[19,20,21,22,23,24,25,26,27,28]}
   
   The rationale is the argument, broadly speaking, for establishing a peer-led sexual health program.
   
   
10. Identify the Purpose of the Program. Related to and flowing from the rationale is the purpose of the peer-led program. While the rationale is the broad argument for establishing a peer-led sexual health program, its purpose includes who is to be targeted by the program and what issue is to be addressed. For example, the rationale might be to empower disadvantaged youth to adopt healthier attitudes and behaviors in order to achieve a healthier and more successful future. The purpose of the program might then be to address the reproductive and sexual health attitudes and behaviors that contribute to high adolescent birth and STI rates among low-income youth in the community. Thus rationale and purpose are closely entwined but are not identical. At its simplest, the purpose is the mission statement for the program. As such, the purpose guides everything that follows, from setting goals, objectives and activities, to choosing an effective program or curriculum (if any), recruiting and training the peer leaders, operating the program, and deciding about types and frequency of evaluation.
    
    
    
11. Set the Program’s Goal(s). Have clearly articulated and attainable goals. For example, where the rationale is to empower disadvantaged community youth, and the purpose of the program is to address reproductive and sexual health attitudes and behaviors that contribute to high rates of adolescent births and STIs, one goal could be to significantly reduce the adolescent birth rate in the community within three years. Another might be to significantly increase teens’ use of reproductive and sexual health services, including STI testing and treatment, within two years.
    
    
    
12. Choose an Effective, Science-Based Program or Curriculum. Visit http://www.advocatesforyouth.org/for-professionals/programs-that-work for lists, descriptions of and links to effective, science-based programs If necessary, alter or tailor the program to match more specifically the target audience and goals of this prospective program.
    
    
    
13. Determine the Frequency and Types of Evaluation. Evaluation is not optional. It is an important and integral component of peer-led programming. In the nature of peer-led programs, the target audience ‘ages out’ as current youth mature and younger teens move up to take their place. What worked last year or the year before might no longer be as effective or as interesting to potential peer leaders or to members of the target audience. Situations change. Challenges arise. Ongoing evaluation is the key to keeping the program successful, exciting, appropriate and pertinent. If we want to keep peer programs fresh, vibrant, relevant and connected, it is critically important that we look carefully and often at their results and their context. ^[33] It is also critical to plan for annual needs and assets assessments to identify:
    
    a) new needs as the target audience matures and is replaced by younger teens moving up; and
    
    b) the abilities and talents of newer peer leaders and new community assets.
    
    Plan for:
    a) Process evaluation to monitor the program’s operations;
    
    b) Outcome evaluation to monitor the program’s successes in meeting objectives and fulfilling its activities;
    
    c) Impact evaluation to monitor how closely the program is nearing achievement of its goals; and
    
    d) Needs and assets assessments each year to keep the program relevant and lively.
    
    
    
14. Determine the Objectives for Achieving the Goals. The objectives are important and so is flexibility. The objectives set for the first year of the program might change in later years as ongoing evaluation and needs and assets assessments dictate. However for the first year, such objectives might include:
    
    a) Recruiting and training 10 peer leaders;
    
    b) Identifying and advertising two youth-friendly clinics in the community that are able and willing to dispense or prescribe contraceptives and to perform free or low-cost STI testing for low-income sexually active youth;
    
    c) Creating a speakers’ bureau;
    
    d) Creating four social media avenues for answering youth’s questions and sharing accurate information about:
    a) contraceptives, including condoms;
    b) STIs and STI testing and treatment; and
    c) teenage parenthood;
    
    e) Creating a ‘hip’ local, youth-focused webzine;
    
    f) Creating two two-hour workshops on contraception and condoms, one for older youth and one for younger teens;
    
    g) Offering workshops at least every six weeks across one year; and
    
    h) Reaching out to local youth with information on STI testing and treatment.
    
    
15. Determine the Activities Necessary to Achieving the Objectives. Activities necessarily flow from and support the objectives. Activities should be defined only for the first year. Process evaluation, peer leaders’ input, and repeat needs and assets assessment may identify the importance of different or changed activities. However, the first year’s activities might include:
    
    a) Peer leaders’ canvassing local pharmacies to identify those that stock the widest variety of contraceptives and condoms and where pharmacists clearly understand the importance of maintaining youth’s confidentiality;
    
    b) Peer leaders’ developing and maintaining blogs, a webzine and other social networking sites;
    
    c) Peer leaders’ developing, offering and facilitating at least 16 workshops to share information and skills related to consistent use of reliable contraception and correct use of condoms;
    
    d) Peer leaders’ developing at least six PSA (public service announcement) media messages about youth-friendly contraceptive services, including family planning clinics, community clinics, and pharmacies and placing them in local media, such as radio and television stations and on the social networking sites; and
    
    e) Peer leaders’ developing an outreach kit and outreach protocol as well as a schedule for safely canvassing areas where community youth congregate.
    
    Note: Activities should be defined and measurable. They should also be flexible. As the peer leaders work at the activities, they may find that some are time-consuming and little used or that some are even more valuable than they had imagined. Peer leaders need to be able to re-craft activities to meet the needs of the target audience and also to maximize the use of peer leaders’ own talents and abilities.
    
    
16. Supervise the Peer Leaders. Supervision needs to be continuous and ongoing, but not incessant. As the peer leaders gain experience and confidence, they may naturally take on more responsibility. But they should not be left entirely on their own. In a community-based setting, supervision may mostly entail daily or weekly meetings with peer leaders and detailed reports of their activities. Yet, on-site, regular, announced and unannounced visits by supervisors are also important to ensure that peer leaders are handling their responsibilities well and competently and that they are not overwhelmed. For school-based programs, supervisors will probably be required by school board policy to remain in the classroom, albeit silently and unobtrusively, during the peer leaders’ work with the program. But if not, supervisors should still make regular, planned and unplanned visits in the classroom.
    
    
17. Train, Train, Train the Peer Leaders. One-time training, even for several days, is inadequate. Peer work involves facts; but much more importantly, it involves skills. Peer leaders are change agents. One researcher wrote that peer programs have been effective in changing social norms ... Perhaps the most significant effects of peer education are in establishing standards for acceptable behavior. When youth have a role in developing social and group norms for protective health behaviors, they also serve as positive role models for change. ^[33] One cannot be an agent for change unless one has valuable skills, and these skills require ongoing training to hone and perfect. Such skills include:
    
    Facilitation – Peer leaders must be able to facilitate open discussions and experiential activities. One of the most important aspects of peer programming is its interactive and experiential methods. So, peer leaders must be able to organize, clarify and stimulate such activities without lecturing and without controlling the process or the outcome.
    
    Communication – Peer leaders must be able to speak clearly and to listen actively. They must understand how to give positive feedback, encourage positive input from participants, hear participants’ objections, and incorporate everyone’s contributions.
    
    Negotiation – One of the most important skills that peer leaders impart in sexual health workshops is that of negotiation. They share these skills both through activities directed specifically at practicing negotiation and also by demonstrating the skill as they facilitate workshops and other activities. For example, adolescents can find it very difficult to negotiate protected sex with a partner, especially one they do not know well. ^[37] By participating in role-plays and by observing how the peer leader negotiates normal participation issues, members of the target audience learn how they, too, can negotiate various situations of life.
    
    Control – When necessary, peer leaders must be able to take control of what is going on. They must be able to:
    a) defuse tense situations;
    b) ensure that each person is following the guidelines that the group established in the beginning; and
    c) maintain a feeling of safety for each and every participant.
    
    Role Modeling – Through all their work with their target audience, peer leaders demonstrate or actively role-model the skills of facilitation, communication, negotiation and control. One author linked role modeling to helping adolescents and young adults to integrate their attitudes with their skills in making decisions, solving problems, and communicating with others. ^[33]
    
    Identifying healthy norms – Peer leaders provide opportunities for the target audience to identify the norms prevalent in their family, community and social circles. Peer leaders also assist the target youth to articulate these norms. One of the most important things that peer leaders can do is to assist youth to be clear that “what ‘everybody’ is doing” is almost always a myth and a destructive myth at that. When teens understand this, they can more clearly distinguish genuine norms from mythical norms. Clearly identifying the norms by which youth live helps them to be clear about how their behaviors reflect or fail to reflect their values.
    
    Clarifying values – Peer leaders provide many opportunities for members of the target audience to clarify their individual values and to check, privately or aloud, how their actions mirror or fail to mirror those values. In this work, peer leaders neither condemn nor praise; they listen. They listen and they repeat back what they have heard. They listen and they ask for clarification. They listen and they ask for feedback from other participants.
    
    Living up to their word – Peer leaders must also identify their own norms and values and correlate these norms and values with their own behavior. ^[38] To encourage other youth to adopt new norms and new behaviors while continuing to engage in unhealthy behaviors is false and can be destructive to the program and to the peer leader’s value to the program. So, peer leaders must also be clear about their own norms and values and how their behaviors correlate with these norms and values. It is a matter of honor and honesty. This is, at bottom, the most significant commitment that peer leaders must make to the program and to the youth targeted by that program.
    
    
18. Rely on Strategic Planning. Evaluation is entwined with strategic planning. At its heart, strategic planning is an ongoing process of deciding what activities and programs constitute the highest and best use of peer educators (or counselors, helpers, etc.). ^[33] Evaluation identifies programs’ strengths and weaknesses. Strategic planning determines the best way to rely on and utilize those strengths and to avoid or address the weaknesses.
    
    
19. Don’t Reinvent the Wheel. Much is already known and published about successful peer-led programs. In 2010, the National Association of Peer Program Professionals released a document outlining the standards and ethics entailed in any high-quality peer program. http://www.peerprogramprofessionals.org/publications/publications/standards/ includes a checklist for the process of planning, implementing and maintaining a peer program, a description of items on the checklist, and a code of ethics for peer-led program professionals and the peer leaders.
    
    Note: the role of peer leaders is, in this NAPPP document, limited to ‘peer helping’. ^[39] For information on successful peer-led programs, visit advocatesforyouth.org
    
    
20. Advertise the Program. It is very important to advertise the program to the potential audience and the community. If peer leaders put a lot of work into something that is seriously under-used, they will quickly lose interest and the program will fail. Do not assume that “everyone knows about it” or that advertising is unnecessary. Be inventive about reaching youth and adults. Schedule interviews for the peer leaders with local radio and television media. Invite media to participate in a peer-led sexual health activity. Arrange for peer leaders to give a press conference to announce the evaluation results as well as the results of the latest needs assessment and to talk about new, continuing and unmet needs among the community’s youth. Perhaps one or more of the peer leaders would be interested in being a press spokesperson or media director. Provide media training or seek out others who can provide such training for the peer leaders.
    
    
21. Encourage the Peer Leaders. Encourage the peer leaders to enlarge their talents and to work toward a brighter future. Provide regular training that hones their skills. Praise them for their accomplishments and provide constructive criticism, as needed. For in-school youth, work with administrators to ensure that youth receive credit for their work. Encourage out-of-school youth to continue their education and to get a job. Encourage all the peer leaders to create a resumé listing their valuable skills and accomplishments.
    
    
    
22. Continue Fund-Raising. Peer-led programs are not nearly so inexpensive as many adults hope or assume. As long as the program runs, there will continue to be expenses related to peer leader stipends, recruitment and training costs, supplies, media materials, food, and evaluations. Expect every meeting or training with the peer leaders to include food and drink at the expense of the program. Use evaluation findings, new needs and assets assessments, and media interviews in fund-raising. Begin with local businesses and community-based organizations; but don’t hesitate to reach out to state and national foundations where the program meets their grant guidelines. Enlist volunteer help from someone whose profession is grant-writing and/or fund-raising.
    
    
23. Justify the Program. This is related to advertising; but it is also different. Justifying the program means standing up for it and what it is accomplishing. This may mean making presentations at school board and parent-teacher meetings. It may mean addressing the city council or county commissioners. It definitely means crediting the program and the peer leaders for what it and they have accomplished. Ask the peer leaders to speak. Ask members of their target audience to speak. Bring in evaluation data. Never lie. Acknowledge mistakes and what remains to be done. Most of all, don’t be shy about giving credit where it is due – to all the involved youth and the community.
    
    
24. Continue as in the Previous Year or Programmatic Cycle, beginning from #15 above.

Conclusion

Peer-led programs can be very successful in encouraging other youth to adopt healthier sexual health attitudes and behaviors. To be successful, youth-focused peer-led sexual health programs must have a clear rationale, an unambiguous purpose or mission, clearly articulated goals, objectives and activities, and consistent, ongoing evaluation. But, most critically, they must involve youth at every point in their design, implementation, operations, maintenance and evaluation. Peer leaders must be thoughtfully recruited, carefully chosen, and highly trained. Their training will improve their knowledge and, most of all, hone their skills in facilitation, communication, negotiation, control, values clarification and norm identification as well as in role modeling. It will also give them the insights and commitment to be clear about their own values and norms and to be agents for change. The ultimate goal for all youth-focused and peer-led sexual health programs is to improve the reproductive and sexual health of adolescents and young adults. Programs’ success or failure is measured by how nearly they achieve that goal.

Researched and written by Sue Alford, MLS
Advocates for Youth © August 2011

References

*For purposes of this paper, these programs will always be referred to as ‘peer-led’ although in actuality programs may vary greatly in how much responsibility is entrusted to the peer leaders. Some programs may, in fact, be ‘peer-assisted’ instead of ‘peer-led.’

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