29. Employing Peer Workers in Learning Disability Services
Emma Watson (Imroc), Lindsay Bowker (PCFT) Ashleigh Charles (Imroc),Sophia Christophi (Imroc), Remie Colledge (Coventry and Warwickshire NHS Partnership Trust; CWPFT), Stacy Cooper (CWPFT), Amy Dalton-Bates (CWPFT), Daisy Dexter (Imroc), Ruth Hodgkinson (CWPFT), Madiha Majid (University of Nottingham), Karen Scorer (CWPFT), James Stephens (Pennine Care NHS Foundation Trust; PCFT), Emma Stagg (PCFT) & Wioleta Wydrych (PCFT)With contributions from Kyle Withers (PCFT) and Maddie Wareing (PCFT)Introduction
This briefing paper explores how peer support workers (people who are employed to use their lived experience to offer supportive relationships with people using health services) might be introduced into Learning Disability (LD) services. In the last decade or so, we have learnt a great deal about peer support in mental health services, and the evidence base for these roles has grown, alongside a collective acknowledgement of their importance in services. However, the spotlight in this service area has left others in the dark.
The potential for peer support is almost endless; there are few groups who do not benefit from it. It is even reasonable to argue that the more marginalised and stigmatised an experience is, the greater the potential for peer support. The NHS 10-Year Plan (DHSC, 2025) emphasises the importance of personalised, community-based care, and to truly realise this vision, it's vital that peer support is also developed within learning disability services, where lived experience can offer a unique connection, trust, and insight that traditional models often miss.
In order to do this, we must take the time to understand how formal peer support is best offered among people with learning disabilities, who have traditionally been left behind or overlooked. This paper brings together evidence, real-world examples and emerging practical guidance, identifying the systemic improvements needed to ensure meaningful inclusion. The experiences discussed reflect both deep enthusiasm for peer support and the complex realities of embedding these roles into often rigid or inaccessible systems.
An easy read summary of this paper is also available on the Imroc website.
“I love helping those who can't help themselves. Because other people have helped me in the past, now it's my turn to help others. I do enjoy working with service users. When we started, we weren't sure what our role would be, and the team was not fully prepared for us. There were also some challenges with the equipment. For any Trust employing peer support workers, I'd recommend planning well, clarifying the role and preparing everyone in the office. Some reasonable adjustments, like headphones, could be helpful, but it's important to remember that everyone has different needs.”
- Kyle Withers, Peer Support Worker in Learning Disability Care Hub Team at Pennine Care NHS Foundation Trust
Why is it important to employ peer workers in learning disability services?
Evidence and Benefits
People with learning disabilities deserve to have their voices heard and prioritised when it comes to their care and support. Reports such as Care Quality Commission's "Out of Sight – who cares?" (CQC, 2020) and Baroness Sheila Hollins' (2023) report "My heart breaks – solitary confinement in hospital has no therapeutic benefit for people with a learning disability and autistic people" have brought national attention to the serious harms experienced by this community, including the use of solitary confinement, poorer life outcomes and significantly reduced life expectancy. Together, these findings highlight an urgent need for approaches that are inclusive, participatory, creative, and shaped by the needs of people with learning disabilities (Majid et al., 2025). These approaches should restore dignity, build connections, and place individuals at the centre of the systems that support them.
Peer support offers a powerful, community-driven response to these challenges. Peer support in Mental Health settings is well established, and autism peer support continues to gain recognition; the same benefits can extend to people with learning disabilities. While the experiences of autism, mental health challenges and LD are very different, all these experiences involve living with lifelong conditions and similar challenges, including social exclusion, stigma, and significant health inequalities. Peer support can begin to address these challenges by fostering mutual understanding, connection, and a sense of belonging from the outset. The benefits of LD peer support are not limited to the people who receive it. In the few studies that have explored peer support in LD communities, it has been found to benefit the people who receive it, as well as the peer workers themselves, and the organisations and teams that employ them.
Benefits to peer workers
Despite calls for inclusion, people with learning disabilities often encounter systemic barriers to full inclusion, and their contributions are frequently unrecognised or undervalued. Peer support roles offer a meaningful way to shift this dynamic. They equip individuals with the tools to offer mutual support safely and effectively, helping them understand their boundaries, recognise when and how to seek support, and build connections with peers who share similar values and experiences. In doing so, it can enhance confidence, identity, independence, foster personal growth, and promote the development of purpose, alongside practical and social skills (Ali et al., 2023; Kaehne & Beyer, 2013). Peer workers described the process of offering peer support as mutually reinforcing, contributing to their personal development while supporting others, creating a sustainable model of support that encourages ongoing participation, skill sharing, and community building (Strnadová et al., 2019).
Peer workers can also develop a wide range of skills through peer training and experience, including group facilitation, problem-solving, and accessible communication (Ali et al., 2023). These skills not only enhance their effectiveness in peer roles but also increase their employability and independence. Peer-led support in LD settings has been described as an "emancipatory force", enabling individuals to reclaim their dignity, assert their agency, and reject the notion that people with learning disabilities lack insight or social abilities (Keyes & Brandon, 2011).
Benefits to people receiving LD peer support
One of the most distinctive strengths of peer support is the opportunity for connection for people with LD. Shared lived experience allows peer workers to build trust and connection with those they support in ways that traditional professionals often cannot. For people with LD, having a peer worker who genuinely understands the challenges they face, whether related to discrimination, loneliness, or self- esteem, is deeply validating (Ali et al., 2023). This has also been found in online LD peer support, where people receiving support reported that connection with others who had shared lived experience helped reduce distress, particularly among carers of young children who were uncertain about the future (Haber et al., 2025).
Having a peer worker offers people with LD a role model and shows them what they can achieve. Receiving peer support enables people to become peer supporters themselves, creating a continuous cycle of empowerment (Keyes & Brandon, 2011).
What people using LD services deem to be 'quality' care often differs from professionals, whose focus tends to be on organisational factors such as service delivery processes (Venville, 2015). Meaningful recovery for people with LD has been found to centre on interpersonal factors such as being understood, 'connectedness,' having valued relationships, social opportunities, an empowered identity, self- acceptance and confidence (Trustam, 2017). Peer support presents an opportunity for people with LD to foster connections, enable empowerment, and provide people with a learning disability with social opportunities/relationships that they themselves have identified as being important in supporting their wellbeing whilst using services.
It is likely that the presence of a peer worker can help put people with LD at ease during appointments with practitioners, enabling them to feel comfortable to have a voice within their treatment, to say no and disagree with practitioners and to say if they don't understand what practitioners say.
Benefits to teams and organisations who employ LD peer workers
Peer workers can play a vital role in fostering inclusive working environments, shifting attitudes within teams and highlighting the strength and value of shared experience by embodying possibility. In taking on visible and valued positions, peer workers with learning disabilities actively challenge stereotypes and stigma. Their presence can shift perceptions within teams, among professionals, people using services, and across the wider community.
Peer workers bring valuable insights into service design and the delivery of services. When working alongside other professionals, an LD peer worker can give immediate feedback when something might be confusing, helping practitioners communicate more effectively with the people they support. When involved as equal partners in service design, their lived experience allows them to identify gaps, challenge assumptions, and contribute to more accessible and responsive services (Ali et al., 2023).
Voice of Experience: Reflecting on the benefits of employing LD peer workers at Pennine Care NHS Foundation Trust
James Stephens, Peer Support Worker Programme Manager, Pennine Care NHS Foundation Trust
“When we first started discussing the prospect of developing peer support worker roles within Learning Disability services, I knew we were embarking on something important — but also something that would pose a range of serious challenges. However, it's been one of the key highlights of my own role to see these roles introduced and start to thrive.
One of the biggest challenges has been navigating a system that has not historically been built with people with learning disabilities in mind as colleagues, leaders, or change-makers. We've had to question long- standing assumptions about what 'capability' looks like, and adapt recruitment, training, supervision, and workplace culture so that our LD peers can blossom in the role. This takes time (probably more than you think!) and it takes commitment to ensuring that learning disability voices have a valued place as part of our service teams.
There have been moments when processes felt rigid, when peers needed more support than we first anticipated, and teams that needed additional support to adapt to the new role - but each challenge has pushed us ultimately to adopt a more inclusive, thoughtful approach.
It has taken time to embed the roles, working closely with service teams and other leaders, but the living experience of our LD peer workers brings a level of authenticity and connection that simply can't be replicated. They make conversations safer, make goals feel achievable, and help people with learning disabilities feel seen and reflected in the services they use.
For families, seeing a peer worker who has a learning disability succeed in their role can be profoundly hopeful. For staff, it challenges stereotypes and brings a fresh, humane perspective into the team which impacts positively on their practice. And for the peer workers themselves, the personal growth — the pride, the confidence, the sense of purpose — is fantastic to witness.
For everyone involved this process hasn't always been easy, but it has been extremely worthwhile. Our learning disability peer workers are helping to change lives, reshape services, and remind all of us of what true inclusion looks like. As part of the support provided to our LD peers, it has been invaluable to have the experience and hard work of our Senior Peer Support Workers, Wiola Wydrych and Emma Stagg. They have been an integral part of the positive development of the roles, both through effective supervision and supporting the peers' clinical teams.”
Possible challenges around employing peer workers with learning disabilities
It is undeniable that the prospect of employing peer workers who have a learning disability conjures, for many people, reasons why this would be difficult or impossible. The fears often expressed are rooted in concerns about systemic unpreparedness and a lack of training or structured guidance, rather than any unwillingness to include peer workers. The challenges that are encountered are similar to those experienced in mental health settings when employing peer workers, but it seems that in LD settings, these challenges are even greater because of the additional support needs that people with LD might bring, as well as the stigma and low expectations about what they may be able to contribute. People working within services often have a protective instinct in relation to the people with LDs that they support and aim to minimise risk and exploitation in vulnerable populations. This can bring with it a risk of creating barriers which further perpetuate discrimination and health inequity. Not including people with lived experience of LD propagates the idea that people with learning disabilities are less able, vulnerable and require protection. Importantly, most people, especially those working in LD services, show a strong desire to "get it right" because they recognise the value that peer workers bring.
Some common fears include:
Lack of Understanding of the Peer Role – role clarity remains a concern for peer workers within mental health services, a context where peer worker roles have been established for 15 years. The relative newness of peer support in LD services means that staff within these services are unlikely to fully understand what employed peer workers are there to do. This can create blurry expectations and a risk of teams trying to fill the peer workers' time rather than develop their role meaningfully.
Concerns About Boundaries – staff may have some questions about peer workers who are currently using LD services, or who have previously received care from these services, as this might contribute to confusion about professional and personal roles, as well as the boundaries that peer workers may establish with the people they support. While this challenge has been navigated from time to time in mental health peer support settings, it is more likely to emerge in LD settings where people are more likely to receive ongoing or even lifelong support from their care teams.
Fear of Saying or Doing the Wrong Thing – there may be some uncertainty about how to support colleagues with a learning disability in a respectful and effective way, or worry about causing offence or getting it wrong. Colleagues may also be unsure about how best to communicate in a way that everyone, including LD peer workers, will understand.
Capacity to Offer Support – the recognition that peer workers who have an LD are more likely to need higher levels of support to find their feet in their roles might leave staff feeling overwhelmed or unequipped, especially without dedicated support roles in place. It may also blur the distinction between colleague and 'service user' for team members and LD peer workers.
Concerns About Risk and Responsibility – staff may have questions about what kind of duties are appropriate for peer workers, and how much independence they should be working with. There may be uncertainty about which processes to follow if a peer worker needs more support at work, as well as how to raise concerns.
Worries About Accessibility Gaps – employing peer workers who have a learning disability is likely to highlight that systems like IT platforms, recruitment portals, transport routes, and policy documents are not accessible for everyone. This may bring with it concerns about how to bridge those gaps or adapt processes to make them more accessible and requires understanding and support from senior managers with HR and recruitment teams. Adjusting the peer worker training is a crucial initial step in supporting LD PSWs, and Imroc's approach to this is described in a case example later in the paper.
Preparing Teams to work with a LD peer worker
"I feel really good and positive about my role as a peer support worker. I'm making a difference to service users, and I feel accomplished. Before we started, the interview was quite nerve-racking and a bit much to process. Having more structure and clearer information from the job advert would be helpful. The induction to our job was anxiety-provoking for everyone—we didn't know what to do, and the staff didn't know what we should be doing. I recommend that other Trusts employing peer support workers meet with teams beforehand, so everybody knows what peer support workers are walking into. We've handled challenging situations and large meetings where we had to manage anxiety, but we've done really well, and we always get good feedback. I value putting people first while always aiming to be kind and fair in the workplace."
Maddie Wareing, Peer Support Worker from Learning Disability Care Hub Team at Pennine Care NHS Foundation Trust
A major part of employing LD peer workers is ensuring that they are employed in a welcoming and accessible environment. As it is true in mental health peer support, the team culture plays a huge role in determining the success of peer support workers within services. Working with teams serves two purposes: firstly, to ensure understanding and awareness of the peer worker role; equally important, to enlist them in developing the role, drawing on their experience and insights into how the role could have maximum impact.
It may be helpful to work with learning disability services, including senior leadership and local teams, in initial conversations. This helps raise awareness of the potential of peer worker roles and identify allies within teams and across learning disability services who would be supportive of introducing peer support within their working context. These initial conversations will establish the teams that are most supportive of and suitable to include LD peer workers, enabling more detailed discussions to begin in these areas. Key elements of these discussions might include:
Raising awareness about peer support, sharing hopes for what a peer worker may bring to an LD service
Exploring whether teams are suitable in terms of the amount of contact they could facilitate between peer workers and the people they would support, as well as the geographical location of the team base.
Sharing concerns or fears about introducing peer support and making time to work through these collaboratively so that practical solutions can be built into the planning process
Discussions about key responsibilities of the peer worker role, what they will be expected to do and where they can access support or mentorship. Within this, making time to explore how the peer worker role differs from other roles within the team. This might inform the development of the peer worker job description, which the whole team can feel some ownership of (see the following section for more detail)
Identifying resources (including support for travel and ways to make working environments more accessible) and supervision structures, as well as induction processes for peer workers
Considering how comfortable the team may feel working alongside someone who is also under their case load, giving serious thought to what boundaries this may require and if it feels comfortable for everyone involved. There is also another element to it. People with learning disabilities usually know other people with learning disabilities in their local area, through schools, local VCSE services, and so those places are their own safe spaces where they engage in social activities. LD team members fear taking those spaces away by asking PSWs to support people there, but also blending their social life with work, as many people who use LD services also visit those places. On one hand, it could be seen as a benefit, as when a peer support worker may know some of the people under the LD team, they may even help them to feel more connected to the service, but on the other hand, it clashes with standard safeguarding rules and practices. There may be specific conversations about confidentiality that would be helpful to plan with peer workers regarding these situations.
Collectively thinking about any unwritten workplace rules which might need to be made explicit or to be reinforced, as well.
Working with teams should be an ongoing process and should not end when a peer worker is successfully employed. Having a working group, made up of team members, service level colleagues, and experts in peer support development, will continue to guide the development of the role as the peer worker establishes themselves in the team.
Voice of Experience: Leading the team and the implementation of the LD Peer Support Worker role in an Assessment and Treatment Unit
Ruth Hodgkinson, Highly Specialist Occupational Therapist Activity Coordinator Team Lead, and Peer Support Worker Manager Coventry and Warwickshire NHS Partnership Trust.
“Brooklands Hospital provides low and medium secure hospital care, as well as an assessment and treatment unit, specialist Autism unit, and a children's unit. People are admitted for a period of assessment and rehabilitation, with a length of stay which can vary from months to years. Access to activity may be reduced while in hospital due to the secure physical environment and incorporation of risk management (Perkes et al., 2015). Some patients may not have permission to leave the building or have access to the internet. The activities team at Brooklands Hospital strives to optimise opportunities for meaningful engagement in activity, unlocking the benefits on individual's health and wellbeing (Wilcock, 1998). Yet, we know that forensic institutions can contribute negatively on individuals, including reduced self-belief and integration with society (Farnworth et al., 2004).
We hope that the LD peer support worker could contribute to improving a person's self-belief, through the values of peer support work for example, inspiring hope for the future. By sharing their own lived experience and discussing their own meaningful activities in the local community, it is hoped that peer support workers can also help the people they support to remain connected with the social and cultural factors that are outside of the hospital setting. In addition, co-production and developing activities for people while they are in hospital, which correlate with the opportunities in the community, could further contribute to improving societal integration.
Incorporating peer support work with the activities team at Brooklands seemed an obvious choice. The activities team received training from Imroc, including an introduction to what peer support work, in particular LD peer support work, is, as well as the values and anticipated benefits to the people they support. This sparked discussions, with questions and concerns raised during the training and following it. Safety of the peer support worker, helping them develop appropriate relationships, fears around peer workers oversharing, and inspiring realistic hope for people they support were the main concerns raised. Using a problem-solution focus, the team suggested ways to address these concerns. As this change in practice was implemented, open communication and a safe space for curiosity was fostered. Quality improvement tools were used, and the topic of peer support work was discussed frequently.
Following the recruitment of a senior peer support worker, the development of the peer support worker service has accelerated. Published research into peer support work in LD services was reviewed, and although minimal, the recommendations were considered in the design of the service. Peer support workers and activity coordinators will collaborate to provide opportunities for individual choice and participation in activities, which in turn, will enable the core values of peer support work to be offered. For example, reciprocal discussion may occur while playing a video game together, or hope could be inspired through a shared interest in sports, or a peer support worker may introduce a person they're supporting to a community project which they may participate in during and after being in hospital. It is hoped that through mutual understanding, and a strengths-based approach, the combination of activity engagement and peer support work will build supportive relationships, empowering the people they support to discover a brighter future ahead.”
Considering and tailoring peer worker roles in LD settings
As well as preparing teams, it is important to consider the elements of the working environment which may present barriers or be excluding for PSWs who have a learning disability. Although mental health and learning disability services strive to be accessible to the people who access them, there are still so many elements which present barriers to people with LD employed in them. Taking time as a team to consider these before an LD peer worker faces them is an important step toward making these systems more accommodating.
Areas of the PSW role:
Practical Tasks: Including checking emails, using digital systems, managing calendars, or navigating NHS IT platforms. These tasks may require extra time or specific adaptations. Similarly, extra time to navigate public transport may be needed, along with alternative arrangements where travel by public transport is not practical. These alternative arrangements may have a financial impact on the team that employs a peer worker, and there are potential funding sources which may support this (see 'reasonable adjustments' section, below).
Accessing Supervision and Support: Initial assumptions about the level of independence that PSWs can work with need to be adapted based on individual PSWs abilities and needs. LD PSWs will likely require more frequent, tailored, one-to-one support with everyday aspects of the role, including travel planning, communication, and accessing IT systems.
Accessing Training: Much of the mandatory training for staff within NHS Trusts is not adjusted to the needs of people with learning disabilities, which can make it confusing and time consuming. That brings a question of safety, if some of the training is provided to ensure the safety of people using services, does a lack of understanding of the topic pose a risk? Another difficult system to access is the 'patient record' or note writing systems used within health and social care services. The systems themselves, as well as the training required to use them, can be difficult to understand and inaccessible, especially for people with LD.
Possible solutions include making time for LD peer workers to debrief with practitioners after supporting people so that practitioners can add the notes to the system on their behalf, or employing a peer facilitator whose role would be to support with training and updating patient records. Funding for support may be accessed internally where available, or externally, through offers including Access to Work. In terms of wider training, additional supervision from a peer supervisor or a manager could be used to support peer workers to complete their mandatory training. In the long term, working with training teams to make adjustments to training material would ensure that it is accessible to all abilities.
Communication with colleagues: Peer workers may have concerns about not understanding organisational language or processes. In addition, they may worry about "bothering" others with questions or may avoid certain tasks. Lack of confidence may present a huge barrier to PSWs in LD services, who may have received messages throughout their lives about people's perceptions of their abilities. Teams being reminded to use less jargon can be helpful, as well as having a safe space where peer workers can ask questions they may be worried about asking for fear that they 'should already know'.
Developing the PSW Role: There are several elements to the PSW role which LD peer workers must navigate with the support of their team. They may be using the services that employ them or may have used them in the past. This introduces complexity to their identity and to how their colleagues may perceive it. This is a key topic to discuss during the team preparation conversations.
Role Clarity: related to developing the PSW role is ensuring that everyone has a shared understanding of what peer workers should and should not be expected to do within their role. Being perceived as contributors to 'involvement' practices rather than as colleagues is likely to endanger the success of LD PSW roles, and lead PSWs themselves to pull back from their teams or feel sidelined. Both PSWs and their teams will undergo a process of establishing and understanding role boundaries, confidentiality, and appropriate supervision practices.
Navigating the Working Environment: The physical working environment may need some consideration in order to accommodate LD PSWs and maximise their potential. Some office spaces may be part of a community hub or have additional meeting rooms where PSWs can meet the people they support. If this is not the case, PSWs may be required to spend much of their time navigating public transport to meet the people they support, and their visibility to them will be more limited.
The barriers that PSWs may face when working within mental health and learning disability systems are in no way insurmountable. We need to be aware of the challenges but not intimidated by them. There are several examples of successful PSW roles, and some emerging best practice.
Voice of Experience: The Benefits of Employing LD PSWs from a Service Manager Perspective
Lindsay Bowker, Interim Service Manager HMR Learning Disabilities Team, Pennine Care NHS Foundation Trust
“I have seen our peer worker make a real difference to the lives of the people we support. For example, we had a lady we were supporting around cervical screening. She was reluctant to engage in this invasive procedure but the kind and supportive nature of our LD peer support worker, reflecting on lived experience, allowed the person to weigh up the benefits and challenges of having it done. She realised that, although invasive, it would be a painless and relatively quick procedure that would ensure she was able to stay healthy. She decided to go ahead with the appointment with support.
Another example is, our LD team wished to identify if there was a need for some training package/resource that might support the people we work with around online safety in relation to the various social media sites. Our LD peer support workers have developed some resources around staying safe around specific apps and are developing a survey to collect data from the LD population locally.
I won't deny that it was difficult at the beginning, but the team have adjusted, and our LD peer workers are now extremely valued members of the team, bringing a whole different perspective to our service delivery.”
Emerging Best Practice in Employing LD Peer workers
Taking a strategic approach
Based on the small number of organisations that have so far employed or begun the groundwork to employ LD peer workers, it is clear that successful employment begins with a strategic plan. Using a senior peer worker, or someone with experience supporting peer workers in other settings, can be helpful. This person would bring dedicated time to the development of an LD peer worker role and would act as a champion, bringing people together and sharing the belief that the role will be a success. Beginning with teams where there is already support for the idea of LD peer support is a sensible approach, and using Oliver McGowan trainers as lived experience allies can also enhance the direction of the process. The key to ensuring support is including whole teams in planning and decision making, and not just people in highest positions within LD services. This embeds team perspectives and ensures that practical considerations are taken into account, as well as offering opportunities for everyone to fully understand what peer support workers can do and how valuable their role is.
Voice of Experience: LD Peer Support from a Strategic Perspective
Stacy Cooper, Recovery Lead at Coventry and Warwickshire Partnership NHS Trust
“At Coventry and Warwickshire Partnership Trust, we aspire to have lived experience roles within all of our multi-disciplinary teams to co-deliver our core services, including our Learning Disabilities and Autism care teams. An opportunity arose within an Inpatient transformation project to introduce our first LD PSWs, and this was championed by many senior leaders throughout the organisation.
Some leaders were keen for roles to be recruited to quickly, while others wanted to ensure the new roles were embedded with care and careful consideration to ensure success. Via a slower more thought-out approach, and having a few well timed opportunities (bespoke Imroc training), we were able to train 4 people in the first LD PSW training and also had a blessed opportunity to employ an experienced senior PSW specialist in this area.
This senior PSW role helped to make our recruitment pathways, training and support accessible. We have still a way to go but with our current hindsight I would have gone at an even slower pace and prioritised thoroughness over speed to ensure everyone's experience is a positive one.”
Recruitment processes
Gain the support of HR colleagues from the beginning so that they can consider which routine processes present barriers and how these could be changed for recruitment to be accessible. Access to work advice could be offered at this early stage to people interested in the posts.
Similarly, work with Occupational Health colleagues so that they are aware of the plans and able to accommodate/explore reasonable adjustments relating to people with learning disabilities.
Scope out employment programmes (e.g. Access to Work) which may be able to offer additional support to LD peer workers.
Draw on the expertise of individuals or organisations which have successfully supported people with a learning disability and find out lessons learnt, if possible, before advertising posts.
Use inclusive, accessible materials such as easy-read job descriptions and person specifications.
Share the job advert beyond the NHS jobs site in places that potential candidates are likely to check.
Host informal pre-application sessions and coffee mornings to explain roles, reduce anxiety, and encourage applications.
Allow flexibility during interviews, including inviting support persons, visual prompts, or alternative formats.
Ensure job hours are matched with realistic role expectations, and that PSWs have enough time in their working hours to develop their role, complete training and access support.
Keep communication channels open throughout the recruitment process to provide clarity and reassurance.
Provide sources of support and advice relating to benefits and money management.
Training
Make all mandatory and optional training accessible through flexible delivery, varied formats (e.g. large print, audio), and simplified language. Face-to-face and 1:1 training approaches may be needed. Review what training is absolutely essential for the job role and how this can be made accessible, ensuring that training takes into account potential past trauma.
Provide plain-English explanations for key peer support concepts such as mutuality, reciprocity, and boundaries.
Allocate sufficient training time within contracted hours, avoiding overload.
Offer tailored alternatives or modifications to standard training frameworks like the Care Certificate.
Develop easy-read guides to support completion of learning activities and promote confidence. Work in time during the induction process to talk about training and any additional needs related to applying it.”
Voice of Experience: Imroc's approach to Training LD PSWs
Daisy Dexter, LD Peer Support Training Lead, Imroc
“We know from our work and experience that the learning disability community evidence some of the most unrelenting positivity and resilience. We know that people with learning disabilities can overcome the negative narrative that exists in society, we know that we can support this community to shape and direct their futures and gain better outcomes.
Our experience with LD peer support training began after supporting some trainees with an LD through our autism peer support training course. While the trainees were able to access the course and gained learning, trainers reflected that these students would have had a better experience if they were able to access training which was tailored to their learning pace and needs. As a result of this, Imroc took the decision to co-produce peer support training specifically adapted to fit the needs of people with LDs.
Through our co-production work, we established that the approach to Peer Support Worker training for adults with Learning Disabilities should begin by building an environment that it is: safe, accessible, inclusive, experiential, reflective and embeds learning through repetition. The training involved 10 sessions over the course of 14 weeks. We built in time for students to reflect on what they were learning with a mentor, who was one of the course trainers. We aimed to keep group size small (8 students), to enable each student to have space to ask questions and offer reflections. The group training sessions were supported by a visually accessible power point presentation which was available throughout the learning via an online learning portal.
Imroc's 8 core principles of peer support are: mutual, reciprocal, non-directive, recovery focused, strengths-based, inclusive, progressive and safe (Repper et al., 2013). For the purposes of an accessible training, we tempered these principles so that they hold more meaning for people with an LD whilst retaining the original message. Each training session was based on one of the values, made accessible to the LD students:
Sharing, Learning, Respect, Strengths, Growth, Safety, and Connection
To complete the course, we included an introductory session where students could get to know each other, and a session exploring what peer support is at the beginning of the training. We finished with a reflective session at the end to bring together learning and explore the idea of moving into LD peer worker roles. Throughout the course, we re-visited what is, and what isn't part of the learning disability peer support worker role.
We decided that the most accessible form of assessment for students would be via continuous observation in the classroom, noting new learning during reflective conversation in group discussions and through 1:1 with their mentor. This took the pressure off students to provide a written assignment. Question and answer and verbal feedback was woven into each learning session to check understanding, embed it further and support gaps in knowledge. This method of assessment had a beneficial effect on the wider class peer group giving students an opportunity to grow and develop in a safe space. There were structured tutor meetings at two points during the course to allow time for reflective conversations and support, and to ensure all course tools were understood and being used to maximum benefit.
Because this training was new for Imroc, we built in an evaluation, focusing on these areas:
Accessibility and experience of the training – did learners find the training accessible and easy to understand?
Impact on learners – did learners experience a change in attitude or confidence? Did the training have an impact on their work, for example did they feel more able to employ peer support skills or advocate for others? Or if they were not in peer worker roles, did the training help learners feel more prepared for these roles.
We endeavoured to make the evaluation as accessible as the LD peer support training, building in more processing time for trainees when we asked for their feedback, and offering support for them to articulate their feedback in different ways.
The trainees reported that the training helped build their confidence in peer support. In particular, they enjoyed the use of PowerPoints and activities and enjoyed learning new things. They said that it met their expectations, aligning with their peer support roles and allowing them to practice relevant skills during the programme. One trainee commented that they enjoyed how the group helped each other when practicing peer support skills.
"I feel excited for the future." (Peer support Trainee)
"Happy and excited for what's to come next." (Peer support Trainee)
Organisations that supported trainees to take up a place consistently highlighted the flexibility, strong communication channels, and responsiveness to feedback within the peer support training. The approach taken by the LD peer support training lead was described as 'exemplary', particularly in adapting the training structure to suit the needs of those involved, offering shorter sessions over a longer period, and distilling the key elements of peer support.
Reasonable adjustments
Conduct individual access needs assessments before the role begins and review them regularly.
In England, Access to Work and other employment programmes can be used to connect PSWs with ongoing support.
Help peer workers prepare for Access to Work assessments by supporting them to describe needs and current support accurately.
Don't wait for Access to Work – provide interim support immediately (e.g. travel support, buddy systems).
Clarify roles for support staff, supervisors, and peer coordinators/senior PSWs to ensure joined-up assistance.
Anticipate common challenges around transport, IT, environment, and communication.
Employment practices
Clearly communicate expectations around supervision, confidentiality, and professional boundaries in accessible formats.
Adjust HR policies such as absence or return-to-work procedures to make them understandable (in very plain English) and inclusive. Beyond this, working with HR colleagues to raise awareness of how best to support people with LD in work may be needed so that leniency and flexibility can be built into how peer workers are supported.
Offer consistent, reflective supervision tailored to the peer role.
Introduce a peer coordinator or senior peer worker role to provide day-to-day guidance, advocacy, and administrative support.
Engage teams early in planning to ensure buy-in and clarify how peer roles fit into wider service delivery.”
Voice of Experience: Reflections from a Senior Peer Support Worker supporting the Development of LD PSW roles
Remie Colledge, Senior Peer Support Worker, Coventry and Warwickshire Partnership Trust
“This reflection has been written within the first two months of my role as a Senior Peer Support Worker (SPSW), working within Learning Disability and Autism Inpatient Services. My role has been introduced prior to the recruitment of Peer Support Workers (PSWs) with a Learning Disability.
It has felt essential for the SPSW post to be embedded prior to the recruitment of LD PSWs. Introducing peer support within the environment that I am working within is very new. Therefore, it has felt crucial to begin by developing relationships and working together with colleagues to build a solid foundation and a shared understanding of what peer support is, and what it is not.
For example, seeking out opportunities to share information with colleagues and teams about LD peer support, but also encouraging open, honest, safe, and reflective conversations, welcoming and listening to people's different ideas, questions, and any concerns. Alongside this, I have gradually been role modelling intentional sharing of lived experience to support the familiarisation of the ways in which LD PSWs might work. My aim has been to develop hope and belief in the potential of LD peer support within this space and a network of allies as we move forwards.
The following are reflections of the benefits of embedding the SPSW role:
Role clarity and belonging: As a SPSW, I have focused on laying foundations for peer support and role clarity. An immense value of peer support is that we offer different perspectives and ways of working. My role is not about moulding LD PSWs to fit into a specific team culture, but to support their wellbeing, development, and growth, and to ensure we are working together, guided by the values and principles underpinning peer support. I aim to support each LD PSW in an individual way to navigate the environment in a way that respects their own working style and strengths, whilst we build connections with the wider team.
Accessibility: I have had the opportunity to support the co-production of recruitment processes for LD PSWs, drawing on previous learning of working alongside colleagues with a learning disability. For example, co-creating an accessible job description. This will continue onto the interview and induction processes, and creating an accessible, well-paced and supportive induction process.
The following are reflections of the challenges I have experienced, and how I have/ or how I plan to overcome these:
Planning and co-production, but avoiding assumptions: Co-producing how we can work alongside people is an important part of moving forwards. This will enable us to best support people, in a way that works for them. I am a neurodivergent person with lived experience of inpatient mental health services, and professional experience of supporting colleagues with a learning disability in the workplace. I do not have lived experience of a learning disability and therefore listening and learning from colleagues with a learning disability and people we support will be fundamental to how I work as a SPSW.
Whilst I continue to build a shared understanding of LD peer support and listen to colleagues and people we may work alongside, the current challenge is how far do we proceed with the planning of the peer support vision and offer, prior to peer support workers with a learning disability being in post. It is a fine balance of planning, whilst not making assumptions about what peer support could look like, and the opportunities and/or the challenges we might need to overcome.
Limited Information: I have spoken about the importance of building a shared understanding of LD peer support and introducing the ways in which we work. However, as we are introducing peer support into a new space and employing peer support workers with a learning disability, there is limited information, case studies or evidence about how this could work. I have adopted a transparent approach to these unknowns and feel this has encouraged open dialogue and opportunities to talk through any concerns with a focus on solutions and collaboration.
By taking the time to carefully navigate the next few months I can support the introduction of LD peer support workers, but equally, the time we invest and work we can do to make recruitment processes, practice, and policies more accessible, has the potential to have a ripple effect across the lived experience workforce and wider organisation.”
Conclusion
Employing peer workers in learning disability services presents an important opportunity to build more inclusive, empathetic, and responsive care environments. Their presence alone can highlight gaps in accessibility, challenge existing structures, and encourage deeper reflection on what equitable support looks like. But success depends on thoughtful planning, flexible systems, and a willingness to learn from experience.
Rigid organisational processes must adapt to accommodate peer roles meaningfully. Challenges faced by peer workers often reveal broader systemic issues that, when addressed, improve conditions for everyone. Real inclusion takes more than good intentions, it requires action, investment, and humility.
This work is ongoing and deeply worthwhile. With each new peer role, we learn more about how to build services that reflect and respect the people they support. The journey is not without difficulty, but the value of listening, co-creating, and investing in lived experience is undeniable. With continued reflection and collaborative effort, peer roles in LD services will continue to grow stronger, become more embedded, and more impactful over time.
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