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The dedicated and the committed: an examination of burnout within peer support for transgender, queer, and non-binary volunteers

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The dedicated and the committed: an examination of burnout within peer support for transgender, queer, and non-binary volunteers

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“The Dedicated and the Committed”:
An Examination of Burnout within Peer Support for
Transgender, Queer, and Non-Binary Volunteers
by
Shanéa Patrice Thomas

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

May 2021

Copyright 2021 Shanéa Patrice Thomas

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Dedication

To my two favorite strategic planners:

“We who believe in freedom cannot rest until it comes.”
Ella Baker

“We need in every bay and community a group of angelic troublemakers.”
Bayard Rustin

…and to those who are dedicated, and committed, to liberation of all people.

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Acknowledgements

What a joy it is to finally have the opportunity to thank and show love and gratitude to all
who have gotten me to this milestone!
First, I give great honor to the Universe and my Ancestors for helping me stay the course
and continue to breathe life and confidence into me along the way. Thank you to my committee
members Dr. Diandra Bremond and Dr. Kimberly Hirabayashi, and my committee chair, Dr.
Bryant A. Adibe. I am in deep gratitude for your time and energy toward my project and for
helping me reach my goal. I appreciate your wisdom, especially during these times. Also, a
thank you to Reginald Ryder, my student advisor, for seeing the goal when I couldn’t.
Thank you to my work community; all the many positions I have held over the years have
made me the practitioner and educator I am today. To my close circle of old and new friends and
family, my village from Lake Field Crossing to USC. Those who have cheered me on and always
called me Dr. Thomas, no matter what, because you saw that energy in me, even when I couldn’t
see it for myself. A special thank you, Dr. Angela Giles, for my cards of inspiration from the
beginning!
Mommy and Daddy, I said I would get my doctorate with my baby, and look at me now!
Thank you for allowing me to roam and find myself to reach the one thing I have always talked
about, being a doctor! I love you. Josh-i-wa! Thanks for watching ZeyZey when I needed it and
always pushing me to get to the end goal. I love you, too.
To Dr. Van Bailey. Apart from being your lover, you are also my hero. Thank you for all
that you have done in your career to pave the way for Black Queer academics myself. I am here
because of you. Thank you, I love you deeply.

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My Tater, my ZeyZey, my Zeyah. You have seen me fail on this journey and get back up
again. On the first day of my Immersion, you walked in with me, and the day after you were
born, you attended class with me. This degree is just as much yours as it is mine. Thank you for
being patient while Mommy had to write. Or when she went away for school. When you grow
up, please know this work is to help build a legacy for you. I hope you are proud of me. I love
you forever.
And for you who is reading this, however you stumbled upon it, thank you. You are
witnessing a dream that has been years in the making, and having you read it means my dream
has come to fruition. I hope you can take this information and apply it to work towards liberation
for all of us. And please…critique it, ponder over it, or find a way to take it a step further. Please,
because this work isn’t the end.
There will be more.

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TABLE OF CONTENTS
Dedication ....................................................................................................................................... ii
Acknowledgements ....................................................................................................................... iii
Abstract ......................................................................................................................................... xii
Chapter One: Introduction ............................................................................................................... 1
Introduction of the Problem of Practice ...................................................................................... 1
Organizational Context and Mission ............................................................................................... 2
Organizational Performance Goal ................................................................................................... 4
Related Literature: Burnout ............................................................................................................. 5
Importance of the Evaluation .......................................................................................................... 6
Description of Stakeholder Groups ................................................................................................. 8
Stakeholder Group for the Study ..................................................................................................... 9
Table 1 ....................................................................................................................................... 11
Purpose of the Project and Questions ............................................................................................ 12
Methodological Framework .......................................................................................................... 13
Definition of Terms ....................................................................................................................... 14
Organization of the Project ............................................................................................................ 15
Chapter 2: Review of the Literature .............................................................................................. 16
Three Dimensions of Burnout ................................................................................................... 16
Symptoms of Burnout ................................................................................................................ 17
Burnout on an Organizational Level ......................................................................................... 18
Stakeholder Group: Peer Support Counselors/Volunteers ............................................................ 19
History and Definition of Peer Support Services ...................................................................... 19
PSC Population of Focus: Transgender, Queer and Non-Binary (TQNB) People ........................ 21
Eliminating Stigma through Connectedness ............................................................................. 22
Minority Stress Theory .............................................................................................................. 23
Hendricks and Testa (2012) ................................................................................................... 24
Peer Support as TQNB Healing ............................................................................................ 25
Burnout, Peer Support, and Gaps in Research .............................................................................. 25
Burnout, PSC and Responsibility of Organizational Culture and Support ................................... 27
Individual Experience ................................................................................................................ 27

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Organizational ........................................................................................................................... 28
Bridging the Gap ....................................................................................................................... 30
Clark and Estes’ (2008) Knowledge, Motivation and Organizational Influences Framework ..... 31
Knowledge and Skills ................................................................................................................ 31
Knowledge Types .................................................................................................................. 32
Table 2 ....................................................................................................................................... 37
Motivational Influences ............................................................................................................. 37
Self-Efficacy .......................................................................................................................... 38
PSC and Self-Efficacy ........................................................................................................... 39
Attribution Theory ................................................................................................................. 40
PSC and Attribution Theory .................................................................................................. 40
Organizational Influences .......................................................................................................... 41
Gallimore and Goldenberg (2001) Cultural Settings and Cultural Models ........................... 42
Cultural Models ..................................................................................................................... 43
Cultural Settings .................................................................................................................... 43
Interaction Between Cultural Settings and Cultural Models ................................................. 44
Stakeholders, DCCH’s Cultural Model and Organizational Influence ..................................... 44
Stakeholders and DCCH’s Cultural Settings and Organizational Influence ............................. 45
Table 4 ....................................................................................................................................... 47
Conceptual Framework: Knowledge, Motivation, and Organizational Context ........................... 47
Description of Conceptual Framework ..................................................................................... 48
Figure 1 ...................................................................................................................................... 50
Summary ........................................................................................................................................ 51
Chapter Three: Methods ................................................................................................................ 52
COVID-19’s Effect on Study Practices ..................................................................................... 53
Participating Stakeholders ......................................................................................................... 53
Interview Sampling Criteria and Rationale (PSCs) ................................................................... 54
Data Collection and Instrumentation ............................................................................................. 56
Surveys ...................................................................................................................................... 56
Survey Instrument ................................................................................................................. 57
Survey Procedures ................................................................................................................. 59
Interview Protocol and Procedures ............................................................................................ 61
Data Analysis ................................................................................................................................. 64
Credibility and Trustworthiness .................................................................................................... 67

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Validity and Reliability ................................................................................................................. 69
Ethics ............................................................................................................................................. 70
Chapter: 4 Results and Findings .................................................................................................... 73
Participating Stakeholders ......................................................................................................... 74
Focus on Trans Identities on a Masculine Spectrum ................................................................. 76
Quantitative Surveys ................................................................................................................. 76
Table 5 ....................................................................................................................................... 77
Research Question 1: To what degree are the PSCs experiencing burnout? ................................. 79
Maslach Burnout Inventory™ Human Services Survey (MBI-HSS; 1981) Results ..................... 79
MBI-HSS’s (1981) Emotional Exhaustion ............................................................................ 79
MBI-HSS’s (1981) Depersonalization .................................................................................. 80
MBI-HSS’s (1981) Personal Accomplishment ..................................................................... 81
Areas of Worklife Survey (AWS; 2011) Results ...................................................................... 81
AWS’ (2011) Workload ........................................................................................................ 82
AWS’ (2011) Community ..................................................................................................... 82
AWS’ (2011) Control ............................................................................................................ 83
AWS’ (2011) Reward ............................................................................................................ 83
AWS’ (2011) Fairness ........................................................................................................... 84
AWS’ (2011) Values ............................................................................................................. 84
Summary .................................................................................................................................... 84
Knowledge, Motivation and Organizational Findings .................................................................. 87
Table 7 ....................................................................................................................................... 90
Research Question 2: How is the knowledge and motivation of the volunteers within the Peer
Support Program related to the possible impact of burnout experienced by volunteers? ............. 93
Knowledge Results .................................................................................................................... 93
Theme 1: Emotional Exhaustion and Factual Knowledge: “Overwhelmed and Depleted”. . 93
Theme 2: Depersonalization and Conceptual Knowledge: “Am I going to be misgendered
today?” ................................................................................................................................... 95
Theme 3: Low Personal Accomplishment and Metacognitive Knowledge: “It's my
responsibility to really hold space for them, to work through that, while I also have to work
through that myself.” ........................................................................................................... 100
Motivational Qualitative Results ............................................................................................. 102
Theme 4: AWS’ Community and Workload, and Self Efficacy Theory ............................. 102
Theme 5: AWS’ Control and Attribution Theory ............................................................... 108
Summary: Answering Research Question 2 ............................................................................ 113

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Research Question 3: What is the interaction between DCCH’s culture and context, and the
knowledge and motivation of the Peer Support volunteers? ....................................................... 115
Research Question 4: ................................................................................................................... 116
From the perspective of the PSCs, what could the organization do to improve support from PSCs
from the symptoms of burnout? .................................................................................................. 116
Organizational Qualitative Results .......................................................................................... 116
Theme 6: AWS’ Reward and Organizational Cultural Model Influence ............................ 116
Theme 7: AWS’ Fairness and Values, and Organizational Cultural Setting Influence ...... 118
Summary ...................................................................................................................................... 121
Chapter Five: Discussion ............................................................................................................. 123
Recommendations for Practice to Address KMO Influences ...................................................... 124
Introduction ............................................................................................................................. 124
Table 8 ..................................................................................................................................... 124
The PSCs need knowledge about the symptoms of burnout ................................................... 126
PSCs need knowledge of how minority stress around an TQNB-identity may influence
burnout ..................................................................................................................................... 127
PSCs need knowledge about one’s thinking about burnout symptoms and their experience as a
PSC .......................................................................................................................................... 128
Motivation Recommendations ................................................................................................. 130
Table 9 ..................................................................................................................................... 130
Self-Efficacy: PSCs believe they have the ability to support their clients .......................... 131
Attribution: PSCs believe successes and failures are within their control .......................... 132
Organization Recommendations ............................................................................................. 134
Table 10 ................................................................................................................................... 135
The organizational climate promotes a culture of affirming health and wellness care for the
PSCs volunteer .................................................................................................................... 135
The organizational setting exhibits support and care for burnout ....................................... 137
Integrated Implementation and Evaluation Plan ......................................................................... 141
Implementation and Evaluation Framework ........................................................................... 141
Organizational Purpose, Need and Expectations ..................................................................... 141
Level 4: Results and Leading Indicators ................................................................................. 142
Table 11 ................................................................................................................................... 143
Level 3: Behavior .................................................................................................................... 144
Critical behaviors ................................................................................................................. 144

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Table 12 ................................................................................................................................... 144
Required drivers .................................................................................................................. 145
Table 13 ................................................................................................................................... 146
Organizational support ........................................................................................................ 148
Level 2: Learning .................................................................................................................... 149
Learning goals ..................................................................................................................... 149
Program ............................................................................................................................... 149
Evaluation of the components of learning ........................................................................... 151
Table 14 ................................................................................................................................... 151
Level 1: Reaction ................................................................................................................. 153
Table 15 ................................................................................................................................... 153
Evaluation Tools ...................................................................................................................... 154
Immediately following the program implementation. ......................................................... 154
Delayed for a period after the program implementation ..................................................... 154
Data Analysis and Reporting ....................................................................................................... 154
Limitations and Delimitations ..................................................................................................... 155
Future Research Recommendations ............................................................................................ 157
Conclusion ................................................................................................................................... 159
References ................................................................................................................................... 164
Appendix A ................................................................................................................................. 181
Demographic Survey Items ......................................................................................................... 181
Appendix B - Handwritten Notes and Observation ..................................................................... 185
Appendix C: Flyer ....................................................................................................................... 186
Appendix D: ................................................................................................................................ 187
INFORMATION SHEET FOR EXEMPT RESEARCH ............................................................ 187
Appendix E: Semi-Structured Interview Questions and Notes Page .......................................... 191
Appendix F: Rating Scale for Post-Program Implementation ..................................................... 194
Appendix G: Data Analysis and Reporting ................................................................................. 197
(Rating Scale for Post-Program Implementation) ....................................................................... 197

x
List of Tables

Table 1: Organizational Mission, Organizational Performance Goal, and Stakeholder Goal…...11
Table 2: Knowledge Influence, Knowledge Types, and Knowledge Assessment……………....37
Table 3: Assumed Motivational Influences and Motivational Influence Assessment…………...41
Table 4: Assumed Organizational Influences and Organizational Influence Assessment………47
Table 5: Quantitative Results…………………………………………………………………….77
Table 6: In Vivo and Emotion Coding…………………………………………………………...87
Table 7: MBI, AWS, and KMO Categories, Interview Questions, Themes and Codes…………90
Table 8: Summary of Knowledge Influences and Recommendations………………………….124
Table 9: Summary of Motivation Influences and Recommendations………………………….130
Table 10: Summary of Organization Influences and Recommendations………………………135
Table 11: Outcomes, Metrics, and Methods for External and Internal Outcomes……………..143
Table 12: Critical Behaviors, Metrics, Methods, and Timing for Evaluation………………….144
Table 13: Required Drivers to Support Critical Behaviors……………………………………..146
Table 14: Evaluation of the Components of Learning for the Program………………………..151
Table 15: Components to Measure Reactions to the Program………………………………….153

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List of Figures

Figure 1: Conceptual Framework………………………………………………………………..50

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Abstract

This dissertation addressed the role burnout plays in impacting the well-being of Peer
Support Counselors (PSC) in community health organizations, specifically those identifying as
Transgender, Queer, and Non-Binary (TQNB). Within the TQNB population, they experience
factors of minority stress such as discrimination, rejection, and internalized transphobia in
society (Meyers, 2003; Hendricks & Testa, 2012). This combination of workplace stressors and
marginalized identity may lead to TQNB PSCs being more susceptible to burnout within their
work. Using the Clark and Estes (2008) KMO Gap Analysis, this study examines the
knowledge, motivation and organizational influences that may contribute to the experience of
burnout for PSCs. The researcher examined five TQNB PSCs and used both individual semi-
structured interviews of the PSCs and the Maslach Burnout Toolkit for Human Services,
including the Areas of Worklife Survey (AWS, 2011) and the Maslach Burnout Inventory™
Human Services Survey (MBI-HSS, 1981). The researcher used in vivo and axial coding, as
well as journaling with New World Kirkpatrick Model to plan, implement, and evaluation the
recommendations for the organization. The researcher suggested five recommendations in
structural shifts of the organization to accommodate for the needs of the PSCs to help alleviate
burnout: educational resources provided by the organization; consider identities when
constructing groups; consider scheduling as a method of maintaining wellness; consistent
supportive check in structures for PSCs; and considering the effects of COVID-19 and peer
support.

Keywords: peer support, LGBTQ, transgender, burnout, healthcare

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Chapter One: Introduction

Introduction of the Problem of Practice
This dissertation addresses the role burnout plays in impacting the well-being of Peer
Support Counselors (PSC) in community health organizations, specifically those identifying as
Transgender, Queer, and Non-Binary (TQNB). There is a rise in utilizing community, person-
and user-centered mental health (Ley et al., 2010), causing a decreased use of emergency
services and psychiatric rehospitalization by patients, and an increase in active participation in
treatment by clients, due to the help of Peer Support services (Gagne et al., 2018). Park et al.
(2016) state that people who volunteer within Peer Support programs use their own experiences
to utilize in treatment while managing their mental health.
Consequently, the evidence also highlights other factors affecting the PSCs, such as role
confusion at work, feeling overworked, and recurrence of their symptoms, can cause an increase
in burnout as well (Park et al., 2016). Within the TQNB population, they experience an
additional layer of negative psychosocial factors such as discrimination, victimization, rejection,
and internalized transphobia in society (Meyers, 2003; Hendricks & Testa, 2012). This
combination of workplace stressors and marginalized identity may lead to TQNB PSCs being
more susceptible to burnout within their work, demonstrating this is a problem that can arise in
organizations.
Addressing the problem of burnout with PSC is a professional responsibility that needs to
be taken up by organizations to show empathetic care, knowledge, and treatment of volunteers
doing therapeutic work at the level of clinically trained professionals (Elwood et al., 2011).
Organizations supporting those who volunteer their time to serve others within their community
around their issues in parallel with their own mission encourages a system of an ongoing

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commitment to the healing and well-being of those giving peer support services. With people
relying more on community modalities for mental health care, especially during the recent 2020
COVID-19 pandemic, there are more online opportunities for people to heal through reframing
community narratives and building peer support networks (Falkenburger et al., 2018).
Organizational Context and Mission

The organization that will serve for this study is D.C. Community Health (DCCH; a
pseudonym for anonymity) in the Metropolitan Washington D.C. area. DCCH started as the Gay
Men's V.D. (Venereal Disease) Clinic, in the basement of a church, according to the
organization’s website. When the AIDS epidemic was becoming prevalent in the early 1980s,
the organization opened an AIDS Evaluation Unit, recognizing DCCH as one of the first gay,
community-based medical unit in the country to treat the virus. Currently, the clinic has grown
into a healthcare organization that centers its aim around folks affected by HIV and AIDS, and
the lesbian, gay, bisexual, queer and transgender (LGBQ+T) population. According to multiple
sites and organizational information, DCCH has multiple sites located throughout the area,
including medical and research sites, and youth services. The CEOs are governed by two
separate boards of directors, where at least 51% community members, meaning people who
receive any care from the organization within the city and surrounding areas also have a role in
the center governance. The website also stated all services offered, including dental care,
medical, legal, and behavioral health services are for people of all identities.
Based on a website that tracks an organization’s progression over the years, the following
demographic information is based on about 20,000 clients who were served that calendar year.
To give an approximate demographic information about the population served through this
organization, first, in terms of age, the center mostly serves people who are between the ages of

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31-40, but serves youth populations (under 20), and the elderly as well. For race and ethnicity,
almost 40% of those being served are Black, with those identifying as white at about 37%. This
is followed by those who are Latinx, Native Hawaiian and Other Pacific Islander, and finally
Asian at 5%. The population includes about 53% identify as gay, lesbian or bisexual, three
percent “other” (outside of a heterosexual identity) in terms of sexual orientation. For those who
identify outside of being cisgender, about 1600 transgender and gender non-conforming
individuals were using services that year. For the purposes of this chapter, the information about
the demographics pertaining to sexual orientation and gender is important when making
connections around who the PSCs serve and who the organization centers in their establishment.
It is reported that the center sustains itself through revenue from health insurance, the
pharmacy owned by the center, as well as private donations. Many of DCCH’s resources also
come from grants, research funding, and community fundraising efforts. The organization
supports over 200 volunteers who assist in keeping the organization running in many
departments such as community-oriented events and Peer Support, Wellness Clinics, and Legal
Services. One example of a community event is the annual Community Walk, a day to support
the organization financially, as well as giving space to the remembrance and honor of people
living and dying from HIV and AIDS. For the Peer Support program, the volunteers offer free
short and long-term group and individual sessions. According to the organization’s website,
these volunteers who have experienced various life transitions are able to support peers without a
heavy clinical emphasis. On average, it is reported the organization was able to help over 200
clients in over 1500 encounters in 2017.
Along with the services and opportunities offered, the commitment to community health
and wellness is reflected in its statement when examining the organization's mission and

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purpose. The following mission statement is paraphrased from the organization's website to
maintain confidentiality: DCCH's mission provides to the community affirming wellness
services, specifically centering the needs of LGBQ+T people and those living with HIV and
AIDS. Through equality and inclusive practices, DCCH encourages everyone to live healthy
lives as well as love and connect with each other openly.
Organizational Performance Goal

For this study’s organizational performance goal, created by the researcher, is by 2021,
DCCH will implement new educational strategies and supports to improve volunteer well-being
and reduce the impact of burnout experienced by volunteers as they engage in the work of the
organization. The researcher’s intention upon creating the goal is to address the harm, conscious
and unconscious, that can come from the PSC’s personal experiences around identity coupled
within the Peer Support setting. The year 2021 was based on the amount of time it would be to
complete the study, examine its findings, then propose and implement it into the organization, if
approved. The researcher’s intention upon creating the goal is to address any potential harm
caused by burnout from a PSC’s experience through the organization, gathering information to
construct and implement supports within the organizational culture which encourages affirmation
and wellness. Clark and Estes (2008) find that when those who are in leadership support
“routine setting, translating, and communicating of performance goals”, improvement of
performance is achievable (p. 36). With this study, the organization encouraging the PSCs to
participate in educational strategies and supports around burnout allows the opportunity for the
organization to assist in reducing burnout’s impact. This affects the level of protection again
burnout by the organization for the well-being of the PSC. The researcher, the researcher’s

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dissertation chair, and senior administration will solidify benchmarks to track progress towards
the goal. The Board of Directors will also be utilized, if necessary, for input.
Related Literature: Burnout

Burnout in the twenty-first century has become the most significant occupational hazard
within the workforce, causing a complicated and sometimes disheartening relationship with the
world of work (Leiter & Maslach, 2005). Leiter and Maslach state that job stress within the U.S.
economy is 300 billion dollars in "sick time, long-term disability, and excessive job turnover" (p.
3). Within North America and Europe, the authors report the fastest-growing category in long-
term disability claims are stress, depression, and burnout. Burnout research, from the beginning,
has always been grounded in the experiences of the people (Maslach et al., 1996). Freudenberger
(1974) founded the concept of burnout and had expanded over the years with other professionals
such as Christina Maslach (1996, 2003). Freudenberger (1986) describes burnout as a
consequence of feeling overwhelmed and depleted while being committed to a job or task while
needing to "prove oneself" (p. 247). In his earlier work, Freudenberger (1974) believed burnout
first appeared based on the experience of “the loss of charisma of the leaders, and the let-down of
the clinic with disappointment” (p. 160). These experiences highlight the organizational
influences which play into the presence of burnout in the workplace (Maslach et al., 1996).
Being able to find ways to alleviate this experience of burnout does push organizations to
think about how to monitor and care for the well-being of an employee as a whole. To help
create understanding around how burnout appears in work environments, Maslach (2003) created
the Maslach Burnout Inventory (MBI), which was initially used in healthcare settings yet has
grown to address burnout in any occupation. It is a standard evaluative tool for burnout and
translated into various languages. Along with burnout, there are also conversations exploring

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what Maslach would describe as burnout's "positive antithesis" (p. 190), job engagement.
Energy, involvement and a sense of efficacy are a job engagement's dimensions, according to
Maslach, where employees reflect more vigor and dedication without the negative symptoms. In
the effort to stay concise, this study will only dive into the effects of burnout as opposed to job
engagement.
Freudenberger (1974) spoke of burnout as organizations losing the capability to meet the
workers' expectations well-being and can cause "psychic damage to the whole clinic" (p.160).
This damage can one challenge a person's attitudes, judgments, and perceptions while struggling
around the loss of motivation in their work (Freudenberger, 1974). Research found that
situational and organizational factors are usually the cause of burnout within workers as opposed
to individual ones (Maslach, 2003). In order to understand the severity of burnout as to how it
affects the process of service, this paper will use the studies of Freudenberger (1974), Steyn and
de Klerk (2015), Maslach (1996, 2003), and others to describe how burnout affects the helping
process and what are individuals and organizations doing to treat its symptoms.
Importance of the Evaluation

It is essential to evaluate the organization's performance in relation to their performance
goal to help determine what are the gaps in performance and what improvements can be made
within the program (Clark & Estes, 2008). Collecting information from the TQNB-identified
volunteers about their experiences within the peer support program will help give the researcher
an “objective view” of the progress made toward closing any performance gaps (Clark & Estes,
2008). The importance of peer support services has increased within the workforce of behavioral
and mental health services (Jones et al., 2019), expanding to other industries such as the jail and
prison systems, substance use, and medical systems (Myrick & del Vecchio, 2016). This growth

7
of peer roles within these various systems, offer ample services and support available over time
to reduce the symptoms, as well as accomplish goals (Gagne et al., 2018), both individually and
organizationally.
When expanding the understanding of factors such as minority stress with the TQNB
population in this work, it gives further understanding to policymakers, public health
professionals, and others in the therapeutic service industry an opportunity to create more
effective prevention, intervention, support, and assessment programs (Meyer, 2013). Though
there is not support programming specific to peer support with TQNB identities yet, there are
examples of organizations assessing peer support volunteers’ knowledge, skills and ability within
the field to build core competencies (Gagne et al., 2018). Gagne et al. (2018) reports
organizations such as the Substance Abuse and Mental Health Services Administration
(SAMHSA) have created in 2015 the “Bringing Recovery Support to Scale Technical Assistance
Center Strategy” initiative. The overall goal of this initiative is to help “inform peer training
programs, job descriptions, performance reviews, and career development of peer workers” to
inform readiness of practice within the field (p. 262).
For DCCH, it was beneficial to monitor and assess the mental well-being for PSCs in a
field, particularly where there is not a mandatory certification process or standardized national
training yet (Myrick & del Vecchio, 2016). This implementing support for the PSCs would be
ideal for DCCH to protect the mental health of their PSC by recognizing the symptoms of
burnout within their work before it becomes a more chronic issue. Creating spaces for PSCs to
access support resources in their work emphasizes the organization’s beliefs where their staff
should feel and experience safety, just as much as the people who are seeking services
(SAMHSA, 2014). This study could potentially place DCCH in the forefront of the movement

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in Peer Support, strengthen their Peer Support program, and aligns with their mission of
providing affirming community-based health and wellness services, especially those who
identify along the LGBQ+T spectrum.
Description of Stakeholder Groups

Four stakeholder groups directly contribute to and benefit from the achievement of the
organization's goal: DCCH’s employees (including administration), their volunteers, their Board
of Directors, and the patients. According to Lewis (2011), a stakeholder is a person or group of
people with stake in the organization’s process. Each group of stakeholders are necessary for the
success of the overall organization. First, the employees are those within paid positions who
carry out the mission of the organization medical, legal, dental, and community care. Next, the
volunteers who are the backbone of the organization, support patients connected to the overall
system. If the volunteers’ mental well-being and burnout levels are not taken into account, this
leads to a snowball effect by diminishing the quality of services given to patients due to the
volunteers feeling overwhelmed within the Peer Support Program. This experience alone is an
avenue that can lead to burnout involving all stakeholders within the program.
With the Board of Directors, their investment in completion of the organizational goal
lies in sustaining volunteers. One of the roles of the Board of Directors is committing to
upholding the quality of the organization through accountability. This is where creating
programs of improvement can be seen as business investments, as Clark and Estes (2008) states.
Clark and Estes state studies have proven investing in employees generates income, which is a
favorable business decision for the organization. Depending on the results of the study, using the
information about burnout rates and wellness can help create an assessment that will empower
the organization’s health and sustainability. Using this study to analyze the gaps in support for

9
the volunteers in the organization can, by Clark and Estes’ standard, start a conversation about
what is needed to close the gap as well as seeing if those aspects are available for use.
Stakeholder Group for the Study

Although a complete analysis would involve all stakeholder groups listed above, the Peer
Support Counselors (PSCs, as the volunteers are named within the program) within the Peer
Support Program, are the focus of the study. With the PSCs, this study has also examined those
who identify as transgender, queer, and non-binary (TQNB) to see how gender identity plays a
part in exacerbating symptoms of burnout. As TQNB-identified people live within a cis-
heteronormative dominate culture, if a person has a minority status and is within a stigmatized
social category within their environment, they will experience minority stress (Meyer, 2003).
Minority stress is the “excess stress to which individuals from stigmatized social categories are
exposed as a result of their social, often a minority, position” (Meyer, 2003, p.3). Founded from
sociological and social psychological theories, minority stress discusses how prejudice, stigma,
oppression and discrimination have adverse social effects on individuals and groups of people
with marginalized status. Meyer describes the social stress, which appears due to those various
psychosocial factors, can negatively affect a person's mental and physical well-being. Yet,
support groups for the LGBQ+T people are important to help increase styles of coping with
stressors in their environment (Scheer & Antebi-Gruszka, 2019). Peer support is an effective
way to help encourage a culture of health and can help dismantle oppressive and discriminatory
systems which can prevent a person from living in their full identity (Curtis, 1999, as cited by
Mead et al., 2001).
In choosing this stakeholder group, the researcher examined the emotional well-being of
PSCs using the Maslach Burnout Toolkit
TM
for Human Services and semi-structured interviews

10
as an assessment of symptoms of burnout to understand how the PSCs are affected within the
process. The responses from the stakeholder group will help the researcher determine what
elements should be included in the educational strategies and supports which will better help the
organization inform the PSCs about burnout for better recognition of symptoms so they can be
addressed. Examining PSCs as the primary stakeholder group in the study will help the
researcher, who created the goal, to understand the PSCs knowledge and motivational influences
around participating in the peer support program and the effects on their mental well-being. If
this utilizing this information can benefit TQNB-identified people who work within Peer Support
Programs community settings and organizations, formulating a level of connectedness amongst
the population will double as protection against minority stress (Shilo et al., 2015; Scheeh &
Antebi-Gruszka, 2019). The information will enlighten and further the implementing
educational strategies and support to help affirm the mental well-being of the TQNB-identified
volunteers, assisting in achieving the organization’s mission and overall goal.
The researcher has also selected this stakeholder group due to professional interest, as a
person who is in the Behavioral Health field. Examining how to help support the well-being of
those also within the researcher’s department expands the options of services for more client
capacity, but it also ensures emotional wellness for Peer Support to help aid in retention. The
researcher believed if the stakeholder goal is gaining information about the PSCs’ experience
with burnout, the organizational performance goal will have the information about their
emotional well-being to help implement new educational strategies and supports needed to
monitor the TQNB-identified volunteers. Knowing about the possible presence of burnout gives
the organizations the ability to fulfill their mission of continuing to provide affirming care within
the LGBQ+T community, for not only their patients, but also including its staff.

11
This knowledge about burnout is particularly important when placing COVID-19 in the
context of peer support services, organizations must understand that the “response to the
COVID-19 pandemic is a marathon, and not a sprint” (Wu et al., 2020, p. 823). Wu et. Al.
expressed the possible longevity of the global pandemic, though it is still early to determine the
social consequences. This means organizations are not yet sure what the long-term effects will
be, nor the emotional response experienced by providers over time. Gathering information about
the PSCs current experience of their mental well-being will also help DCCH plan for the
possible disillusionment phase which usually occurs with large scale disasters. This information
will be key in constructing educational strategies and supports to address PSCs experiences of
burnout within peer support services.
For an overview of the study’s overall organization performance and stakeholder goals,
please refer to Table I below:
Table 1
Organizational Mission, Organizational Performance Goal, and Stakeholder Goal

Organizational Mission Organizational
Performance Goal
Stakeholder Goal

DCCH's mission provides to
the community affirming
wellness services, specifically
centering the needs of
LGBTQ people and those
living with HIV and AIDS.
Through equality and
inclusive practices, DCCH
encourages everyone to live
healthy lives as well as love
and connect with each other
openly.

By 2021, D.C. Community
Healthcare will implement
new educational strategies
and supports to improve
volunteer well-being and
reduce the impact of burnout
experienced by volunteers as
they engage in the work of
the organization.

By 2021, at least 70% of
burnout symptoms
experienced by Transgender,
Queer, and Non-Binary Peer
Support volunteers will be
reduced by participating in
educational strategies and
supports held by the
organization.

12
Purpose of the Project and Questions

The purpose of this project is to evaluate the degree to which the organization is meeting
the organizational goal of by 2021, DCCH will implement new educational strategies and
supports to improve volunteer well-being and reduce the impact of burnout experienced by
TQNB-volunteers. To evaluate the level of well-being within PSCs, this study will use a mixed-
methods approach by surveying burnout experiences within the PSCs, as well as use semi-
structured interviews. The analysis will focus on the assets in the areas of knowledge,
motivation, and organizational resources using qualitative and quantitative data to help inform
the study about the gap between the burnout experienced by TQNB-identified volunteers, and the
organization’s need to create educational strategies and supports to help TQNB-identified
volunteers. While a complete study would focus on all stakeholders, for practical purposes, the
stakeholder to be focused on in this analysis are the PSCs of the organization.
This study will examine the following research questions which will guide the evaluation
study are:
1. To what degree are the PSCs experiencing burnout?
2. How is the knowledge and motivation of the volunteers within the Peer Support
Program related to the possible impact of burnout experienced by volunteers?
3. What is the interaction between DCCH’s culture and context, and the knowledge and
motivation of the Peer Support volunteers?
4. From the perspective of the PSCs, what could the organization do to improve support
the PSCs from symptoms of burnout?

13
Methodological Framework

In order to capture the level of burnout as well as understanding the personal experiences
of the PSCs, which play a part in their quality of practice, the researcher employed mixed
methods using both individual interviews of the PSCs and the Maslach Burnout Toolkit
TM
for
Human Services. This includes both the Areas of Worklife Survey (AWS, 2011) and the
Maslach Burnout Inventory™ Human Services Survey (MBI-HSS, 1981). Using these two
methodological approaches focus on the experience of the PSCs within the program in their
natural setting (DCCH), collecting multiple pieces of data, analyzing data inductively and
deductively, and the ability to shift through emergent design (Creswell & Creswell, 2018). This
exploratory method aligns with the problem of practice and the organizational goal by finding
the cause of burnout within the volunteers. This information will help achieve the organizational
goal of creating and implementing new educational strategies to increase the PSCs’ well-being
and decrease symptoms of burnout, furthering the organizational mission of empowering those to
live healthy lives, particularly those a part of the TQNB population.
The researcher will use a modified version of the Gap Analysis from Clark and Estes
(2008), which examines the three factors employees need to achieve the goals set for the
organization and stakeholders: the knowledge and skills, motivation in goal achievement, and
organizational influences, including its cultural settings and cultural models. Needing to know
aspects of peer support that contribute to burnout, learning how people seek ways to validate
their identities in the field, as well as organizations' educational goals around affirmations and
wellness for the PSCs, are just some of the examples of the KMO influences structure the study.

14
Definition of Terms

To supplement an understanding of particular contexts, the following definitions will be
added to this section:
Cisgender – a person who is not transgender (GLAAD, n.d.), and whose gender identity
and sex assigned at birth are congruent with each other, based on a person’s experience within
their society and culture.
Burnout – An original concept by Freudenberger in1974 and expanded by researchers
such as Maslach (1996; 2003), burnout as a consequence of feeling overwhelmed and depleted
while being committed to a job or task while needing to prove oneself within that position.
There are three specific dimensions in which a person can experience burnout: emotional
exhaustion, depersonalization, and feelings of reduced personal accomplishment.
Gender non-conforming - This category of people are ones whose prescribed social
expectations associated with gender do not particularly match the person's assigned sex at birth.
(Webb et al., n.d.)
Non-Binary – This term describes people whose gender identity and/or gender expression
are not congruent with the societal and cultural binary categories of man or woman. Non-binary
people see their gender outside of those boundaries and may create other gender definitions
based on their personal experience (GLAAD, n.d.).
Queer – Once used as a word to harm and slander a group of people, Queer has been
reclaimed for some as a word describing people who are outside of the norm, radical in
existence, and an anti-assimilate foundation in politics (LGBTQIA Resource Center, 2019)

15
Transgender – a term that encompasses those whose gender identity and gender
expression differs from their sex assigned at birth (GLAAD, n.d.) within the society and culture
in which they inhabit.
Organization of the Project

This study is a five-chapter project describing exploring the presence of burnout within
the lives of TQNB PSCs, and understanding the knowledge, motivation, and organizational
influences will help achieve the organizational goal. Chapter One opens with the declaring the
problem of practice, an introduction to DCCH and the structure of the organization, emphasis on
the role and goal of the stakeholder, and finally closing with a preview of the project ahead.
Next, Chapter Two gives grounding to the study through a literature review, an explanation of
the Clark and Estes (2008) Gap Analytical framework, the study’s conceptual framework, and
the role of the KMO influences. Leading to Chapter Three, with the information about the
study’s research design, sampling techniques, and procedures. This flows into Chapter Four’s
explanations around the results of what was found (through data collection). Finally, Chapter
Five will use the information and analysis collected to determine recommendations around
practices that will support the achievement of the organizational goal.

16
Chapter 2: Review of the Literature

For Chapter 2, this literature review will examine the relationship between peer support
services and burnout. For this study, the specific population studied will be Peer Support
Counselors (PSC) who identify as and work those who identify as Transgender, Queer, and Non-
binary (TQNB) in the community health center, DC Community Healthcare (DCCH), in
Washington, DC. The review will start with a more in-depth explanation of burnout, then the
focus on the highlights of the history of the peer support field. Next, this paper will discuss the
experiences of TQNB-identified people, minority stress and the need for PSC services to aid in
healing. Finally, the section will close out with discussing the gaps in research on these subjects,
as well as a discussion of the organization's responsibility to combating burnout. Following the
general research literature, the review then turns to the Clark and Estes (2008) Gap Analytic
Conceptual Framework and, specifically, knowledge, motivation, and organizational influences
on PSC’s ability to implement treatment at DCCH.
Three Dimensions of Burnout
Based on Maslach et al.’s (1996) study, Steyn and de Klerk (2015) present three
dimensions of burnout a person can experience: emotional exhaustion, depersonalization, and
feelings of reduced personal accomplishment. For emotional exhaustion, which are both
physical and psychological stress, can have a person experiencing feeling worn out, helpless, and
hopelessness (Steyn & de Klerk, 2015). Maslach (2003) states that exhaustion is what
encourages the person working to emotionally and cognitively distance themselves in order to
have the ability to cope. Maslach also states in burnout studies that cynicism and exhaustion
highly correlate with one another. For example, Elwood et al. (2011) discuss how clinicians who
are treating trauma survivors, for example, may eventually experience PTSD and other chronic

17
trauma reactions from being consistently exposed to traumatic details from those whom they are
treating. Next, Steyn and de Klerk (2015) stated depersonalization is the interpersonal aspect
that affects making a connection with the person who is receiving the service through distancing
oneself. Finally, reducing one's feelings of personal accomplishment involves a level of self-
evaluation of one's thoughts and feelings, which are often perceived to be negative and of failure
(Steyn & de Klerk, 2015). Overall, these three concepts, according to Maslach show up in
different ways that are rooted in the state of the work and the work environment, whether it’s
exhaustion or cynicism from social conflict or an overload of work, or when there is a lack of
resources, a sense of self-efficacy emerges.
Symptoms of Burnout
Symptoms of burnout can be physical, mental, and behavioral. First, for physical
symptoms, Freudenberger (1974) finds that burnout can exist when a person becomes
hyperaware with their bodily functions. A person experiencing burnout can become fatigued,
experiencing stomachaches and headaches, along with a lack of sleep, shortness of breath, and a
weakened immune system (Freudenberger, 1974). Mentally and behaviorally, the risks are grim.
Freudenberger stated various symptoms that may seem to be grounded in anger: irritation,
frustration, and crying. Steyn and de Klerk (2015) also named depression, anxiety, and lack of
self-esteem as mental consequences of burnout. The person will start to examine themselves,
inward, thinking everyone is out to get them (Freudenberger, 1974), or they continue to make
mistakes on the job. Freudenberger’s 1974 article observed more extreme behaviors such as
substance abuse, risk-taking behavior through their work, and becoming "rigid, stubborn, and
inflexible" personality wise (p.161). Other responses to burnout observed are disillusionment
and a chronic negative attitude towards work (Dass-Brailsford & Thomley, 2012), feeling

18
overloaded and out of control with responsibilities, being aware of the small amount of financial
gain or reward, and feeling a loss of respect within the workplace (Salston & Figley, 2003). The
worker can also experience a loss of community amongst those who they are working with
within the organization (Salston & Figley, 2003). It is important to remember, in dealing with
situations that may increase burnout, burnout also feels different when a loss, such as a death, is
experienced by the worker. When coupled with grief and anger, burnout is more exhausting
(Freudenberger, 1974).
Burnout on an Organizational Level
Experiences of burnout also exist on an organizational level, where jobs witness
absenteeism, turnover, a decrease in job satisfaction as well as productivity, and a decrease in
quality of job performance (Steyn & de Klerk, 2015). Steyn and de Klerk stated job and
organizational characteristics are situational variables that are precursors to burnout, which
include dispositional factors, as well as dynamics in these relationships.
When considering the relationship of the worker, who are the people who are susceptible
to burnout? Freudenberger (1974) answers by pointing to those who are closest to their work
and community:
The dedicated and the committed. Those of us who work in free clinics, therapeutic
communities, hotlines, crisis intervention centers, women's clinics, gay centers, runaway
houses, are people who are seeking to respond to the recognized needs of people. We
would instead put up then shut up…with a bare minimum of financial compensation. But
it is precisely because we are dedicated that we walk into a burnout trap. We work too
much, too long and too intensely. (p.161)

19
Freudenberger admits that due to the well-meaning commitment of employees within
service positions, without the support of their organizations, it would be a detriment to their well-
being. Giving support and validation are cornerstones to peer support services. Organizations
giving the same support and validation back to PSCs is respecting and honoring the culture of
peer support work.
Stakeholder Group: Peer Support Counselors/Volunteers

History and Definition of Peer Support Services
Affirmation, community support, validation, and liberation have all been cornerstones in
the history of peer support services. An economic crisis, along with a system restructuring,
helped address the negative attitudes about mental health (Gagne et al., 2018). From the mental
health focus of the Alleged Lunatic Friends Society in England in 1845 by John Perceval
(Podvoll, 2003), to the development of peer support service models in Chicago by Dr. Abraham
Low in 1937, are some of the few points of history that set the stage for the increase of peer
support led help (Myrick & del Vecchio, 2016). Coupled with the rise of the consumer/survivor
movement beginning in the 1950s to the 1970s, patients, groups and individuals, took a radical
stance in asserting "a new entitlement to speak on their own behalf" (Tomes, 2006, p.722).
Tome stated these individuals reclaiming their power around their treatment process was inspired
by the movements which centered the roles of those who are marginalized such as the
antipsychiatry movement, and liberation movements such as the Black Power Movement,
Women's Liberation, and Gay Pride.
The collective thought from these movements was that within a changing and oppressive
society to marginalized people, individuals should accept their own uniqueness and differences
as opposes to seeing them as reason for involuntary and repressive treatments and confinement

20
(Tome, 2006). In the 1970s, people who were living with either a mental health concerns or
substance abuse disorder (or both) came together for self-help and advocacy to help improve the
level of mental health treatment offered on a direct and policy level. Tome stated the result was
creating deinstitutionalization and welfare policies, cost control and managed care, the creation
of advocacy groups, and the institution of community support programs. Ley et al. (2010) cites
the Department of Health (2005, 2006) reporting that in recent years, there has been a move,
particularly nationally, toward mental health services that are person-centered and user-led.
Mead et al. (2001) had seen that through consumer movement, peer support centers those who
seek social justice due to the marginalization of their culture. This support understands how the
issues that manifest within society, particularly around mental illness, are often social and
environmental and institutional in nature (Mead et al., 2001). With peer support becoming an
emerging practice, Ley et al. (2010) people are now empowering themselves to aim for better
care, which includes utilizing community support.
The definition of peer support within an organization will vary depending on the
organization's goals and needs. For this study, there is a definition from Mead et al. (2001), that
will help highlight the aspects of community, healing, and connectedness:
Peer support is a system of giving and receiving help founded on key principles of
respect, shared responsibility, and mutual agreement of what is helpful. Peer support is
not based on psychiatric models and diagnostic criteria. It is about understanding
another's situation empathically through the shared experience of emotional and
psychological pain. (p. 135)
Evolving over time, the job expectations of peer support workers can consist of a wide
range of responsibilities. Within a 2010 national survey of certified peer support specialists, out

21
of the 291 that responded, there were 105 different job titles named (Gagne et al., 2018). Again,
within this study, the researcher will use the title used for the volunteers in the DCCH’s program
Peer Support Counselors (PSCs). According to Gagne et al., there are four roles that a typical
peer support volunteer performs: connecting with the peer through their own lived experience;
mentoring, coaching, or teaching; linking to community resources; and facilitating the
achievement of recovery goals. Through these roles, peer support allows a person who is
willing to do the work to develop autonomy and community at the same time, modeling diversity
and centering the strength of the individual (Mead et al., 2001). This experience can become a
natural, affirming connection for those who are seeking care, especially if the individual does not
want to depend and feel pathologized by a medicalized system for (their) treatment (Mead et al.,
2001).
PSC Population of Focus: Transgender, Queer and Non-Binary (TQNB) People

Within this study, the researcher will be focusing on PSC who identify as transgender,
queer, and/or non-binary (see Definitions section), or TQNB for short. This study is choosing to
focus on those whose gender expression and identity are non-conforming to the societal
standards of gender in order to capture the experience of discrimination as a marginalized person
in a cis heteronormative society. Kattari and Hasche (2016) state that those who live
authentically in their gender expression which does not conform to societal gender standards of
the gender binary (i.e. men and women, masculine and feminine), are harassed and victimized
particularly within healthcare settings at higher rates. According to Lambda Legal's 2010 study
entitled "When Health Care Isn't Caring: Lambda Legal's Survey on Discrimination Against
LGBT People and People Living with HIV", in almost every category of the survey, the 4,916
TGNC (transgender and gender non-conforming) study participants report facing two to three

22
times more discrimination and barriers to care than lesbian, gay or bisexual respondents. Some of
these discriminatory experiences named by at least 70 percent of TGNC participants is medical
professionals rejecting the patient care, being physically rough and abusive, or using excessive
precautions during treatment, and use of abusive language (Lambda Legal, 2010). In healthcare
settings, people of marginalized identities may avoid getting treatment of any kind due to various
levels of discrimination. James et al.’s (2016) study exhibits that maltreatment in services has
led to about 23% of trans-identified respondents reporting due to fear, they avoid seeking the
healthcare they require.
Eliminating Stigma through Connectedness
When examining Peer Support Services and their use by TQNB people, these services
bring connectedness and community. According to Scheer and Antebi-Gruska (2019), LGBQ+T
people are particularly vulnerable to internalized stigma, increasing their interaction with events
that are potentially traumatic and can affect their self-worth and ability to seek support around
physical and mental health. This collectiveness helps combat the stigma around TQNB people
seeking and receiving services due to discrimination based on identity. Scheer and Antebi-
Gruszka (2019) have found that due to the stigma of those with an LGBQ+T identity, they are
more likely to be vulnerable to victimization. Meyer (2003) states that people whose identities
fall in social categories which are seen as minority or marginalized, are more stigmatized and
experience a higher level of prejudice and discrimination then those who are not marginalized in
their identity by society. Based on how many marginalized identities the person holds at once,
the level of prejudice and discrimination experienced in society may seem overwhelming,
especially if the person lacks adequate support.

23
Minority Stress Theory
A theory which explains the level of impact of stigma and discrimination is Minority
Stress Theory (MST) first created by Meyer (2003), and later expanded by Hendricks and Testa
(2012) to include more gender identities. Meyers (2003) describes three processes of minority
stress that are relevant to the experiences of lesbian, gay, and bisexual (LGB) people in
particular. It should be noted that these identities are sexual orientations and not gender
identities, but still force a certain level of discrimination within a cis heteronormative society.
The first, external, objective stressful conditions and events which are chronic and acute. The
second are the expectations of those events as well as the level of vigilance required. Finally,
minority stress is relevant to the experience of LGB people due to how negative societal attitudes
can become internal (Meyer, 2003). These processes are listed by Meyer in distal to proximal
order since the conceptualizations of stress "are most relevant to minority stress and because of
its concern with the impact of external social conditions and structures on individuals" (p. 5).
Meyer stated other studies have also included hiding one’s sexual orientation as a process which
is more seen as a proximal stressor because it is the internal psychological process of the person
experiencing it.
When observed in through research, three underlying assumptions were present through
people who experience minority stress: it is a unique experience by those who are stigmatized; it
is chronic and has stable social and cultural structures; and it is socially based and lies under
institutions, social processes, and structures (Meyer, 2003). Meyer concluded within their study
that the Minority Stress Model does explain those who experience an excess of social stressors
concerning stigma and prejudice have a higher prevalence of mental disorders. Meyer does
emphasize that in order to help cope with the experienced stigma, people will also have to

24
recognize the benefit of a person's agency and resilience. In order to help construct
interventions, Meyer suggests that researchers and policymakers use the Minority Stress Model
to help address both distal and proximal sources of distress.
Hendricks and Testa (2012)
As Meyer's (2003) work only mentions LGB people, Hendricks and Testa’s (2012) article
A Conceptual Framework for Clinical Work with Transgender and Gender Nonconforming
Clients: An Adaptation of the Minority Stress Model is a more poignant look at those who
identify as transgender and gender non-conforming (TGNC) as gender identities. Hendricks and
Testa (2012) names examples of when gender identity, gender expression, or sexual orientation
fall outside the spectrum of heteronormative gender expectations, discomfort can appear. Since
not all people who are along the trans spectrum exhibit binary gender roles or use gendered
languages around pronouns, there can be a constant experience of misgendering or dismissal of
identity, particularly with clinical work (Hendricks & Testa, 2012). When it comes to
therapeutic care, particular with clinicians, there are experiences within the setting that may
cause a rift in the clinician/patient relationship for TGNC individuals. What makes the Hendricks
and Testa (2012) article specific to the experience of TGNC people is the attention brought to the
discrimination, violence, and rejection related to their gender identity that occur towards the
community in increasingly high rates. In the Human Rights Campaign Foundation’s A National
Epidemic: Fatal Anti-Transgender Violence in America in 2018, in 2018, 22 transgender people
have been killed in the United States, where 82% were of color, 64% were until 35, and 55%
lived in the South (p.4). Due to trans people being exposed to victimization and discrimination
at high levels due to their varied spectrum of identity and expression, Hendricks and Testa

25
(2012) state how the Minority Stress Model illustrates how these social and environmental
experiences greatly affect the mental health and well-being of TGNC people.
Peer Support as TQNB Healing
Peer Support is a treatment modality that can be led and used by TQNB people to help
combat the existence of stigma in mental health treatment, along with using community to help
lessen the effects stated in MST. The main goal of Peer Support is to "responsibly challenge the
assumptions about mental illness and at the same time to validate the individual for who they are
and where they have come from" in a creative and non-judgmental way (Mead et al., 2001, p.
135). Peer Support allows people the opportunity to challenge each other respectfully, try new
behaviors, and even reach beyond one's personal experiences of self-concepts attached to stigma,
particular to mental health and disability (Mead et al., 2001). Focusing on TQNB identities in
the Peer Support field will allow the researcher to see how one’s identity plays a part in the Peer
Support volunteers quality of service and ability for the PSCs to maintain a level of well-being,
despite possible marginalized experiences that may affect one’s mental health and well-being in
overall society.
Burnout, Peer Support, and Gaps in Research

It is essential to mention the lack of research on the effect of burnout within peer support
and how the work emotionally affects the person's ability to complete their given task. Maslach
(2003) suggests "the primary reasons for the small number of such studies have been not a lack
of interest, but the major difficulties involved in designing an intervention, finding an
opportunity to implement it and being able to do longitudinal follow up studies" (p. 192). Due to
this lack of scope of individual focus versus situational or organizational, burnout research has
not contributed a wealth of information on the understanding of stress and health, as well as

26
stress and job factors (Maslach, 2003). Maslach states much of this information is from people
who are within the fields of social and organizational psychology, but also could benefit from
exploring healthcare to help expand perspective. Ley et al. (2010) state that studying peer
support is an emerging area with promise, but also needs further exploration into the narrative
and data held within peer support groups. Steyn and de Klerk (2015) cite Buunk et al. (2007),
stating even though identity-related variables usually give more information about burnout than
variables of jobs or organizations, there are few empirical studies center identity-related
variables in the development of burnout. There is also no work or research investigating the
processes of identity construction and enactment and how it contributes to the development of
burnout (Steyn & de Klerk, 2015). Steyn and de Klerk pointed out this gap in research means
that further examination will help gain a deeper understanding of this connection between the
construction and performance of a particular identity's role in burnout.
Resources mention the use of the self in therapeutic work, yet there are no significant
studies that reflect the emotional and professional consequences of using the self in therapeutic
work, especially for those who experience minority stress daily. One concept related to this
experience from the worker's point of view is countertransference. Berzoff and Kita (2010)
define countertransference as issues that are consciously and unconsciously inherent to the
therapist, but triggered when by listening to the experiences of the client. These reactions exhibit
a grey area in which clients uniquely modify their interactions with the therapist based on past
experiences, thoughts, and conflicts. Berzoff and Kita stated countertransference is seen as
communication without words, with the ability of the therapist and client to share their inner
process through intuition. The intersection in which the therapist crosses their client's mental life
and experience with theirs, Odgen (1994) cites this as a third space shared between them.

27
With the use of the theories self-efficacy and attribution theory, and information collected
from this study, the researcher will be able examine how burnout appears amongst PSCs. This
information will allow the researcher to help the organization implement educational strategies
and support to address symptoms of burnout within the TQNB-identified volunteers.
Burnout, PSC and Responsibility of Organizational Culture and Support

Burnout can significantly affect workers if not attended to directly and left to fester
within the workplace. Ley et al. (2010) discussed that when PSCs did not feel supported or
encouraged in their work by other professionals, it affects their morale within the organization.
Various articles support that a way to bridging the gap between burnout and lessening the
experience of those within peer support programs is to address care organizationally. This
section will explore the level of care needed for PSCs when symptoms burnout appear, and how
to take care of it when it appears individually and within the organization.
Individual Experience
The experience of burnout can have consequences on an individual level, as well as an
organizational one (Steyn & de Klerk, 2015). When these symptoms manifest within the
working environment, Freudenberger (1986) emphasizes it is both the staff person and the
organization who have to take responsibility to recognize and address, when burnout is present.
Individually, trauma clinicians and service providers are encouraged to engage in professional
and personal activities that will encourage rest (Elwood et al., 2011). Elwood et al. (2011) state
for therapeutic professions, advocacy for prevention and treatment resources, and increasing
awareness for the group to help alleviate symptoms of secondary traumatization within their
work. Freudenberger (1986), in their original text, echoes many of these suggestions to help
better care for the well-being of therapeutic staff members. First, Freudenberger primary means

28
of self-care include eating well, exercising, taking days off when needed, and including some
form of relaxation technique such as meditation and imagery, or even assertiveness training can
benefit. Based on Dass-Brailsford & Thomley's (2012) study on crisis workers and their
experience of secondary trauma, the recommendations for care for the workers resonates with
many of the studies which spoke to additional training and education, yet here, leaned into the
need for self-care. Dass-Brailsford & Thomley stated, "this research shows the value of self-care
in mitigating the effects of secondary trauma. Clinicians worked hard and played hard, a good
recipe for restoring energy and motivation" (p. 49). Improved and intentional communication in
the form of in-house support groups, learning to set boundaries and say no when overburdened,
and appropriate supervision are keys to combating burnout within workplaces (Freudenberger,
1986). Salston and Figley (2003) found in their study of those working with traumatized people
that over 35% have at least one coping skill that alleviates some of the symptoms experienced.
These activities included diet and exercise, seeking emotional support from other people, and
spiritual support and guidance (Salston & Figley, 2003).
Organizational
Based on the research, organizations would be able not just support their workers but
help them thrive in the programs they are leading with educational and therapeutic support.
From here, it would be the organization's job to look for further funding, run additional trainings
and workshops for the workers, and creating a strong support network amongst the PSCs in order
to help combat feelings of burnout and build an appreciation for the PSC in the workplace (Ley
et al., 2010). Mead et al. (2001) describe peer support training as an ability to develop a level of
tolerance for discomfort as those participating in the program explore the dynamics in the
relationship. Offering resources, groups, activities, and opportunities, Mead et al states, allowed

29
those participating within a peer support center focus on those getting treatment allows reshaping
when thinking about treatment, especially within the realm of mental health.
When considering what could help improve the well-being of PSCs, Ley et al.'s (2010)
article lists some suggestions based on their study which evaluated an exploratory course for
those providing intentional peer support (IPS) services. This course lasts over five days with
two-one day refreshers over two and five months. In terms of what helped, outside of the
workers appreciating review on baseline materials (rereading the manual, review of
terminology), since aspects in the rooms around personal connection help as well. Through the
training it was discovered that a lack of emotional and professional support was a hindrance to
the organization. Issues mentioned were: development, supervision, lack of support to build
confidence, lack of time and care for their health, as well as the inability to provide funding (Ley
et al., 2010). Mead et al., (2001) speak to the lack of funding to peer support programs, along
with states not investing in a peer support center or research dollars. This reluctance in financial
support exhibits a lack of commitment to the presence and success of available peer support
services.
Elwood et al. (2011) also suggested that organizationally limiting work time and
extending the time for self-care is key to preventing burnout. Solutions proposed are decreasing
the number of cases per worker, while increasing supervision and support time, as well as a
vacation for the staff member and mental health and online services. Elwood et al. stated that
when implementing strategies at the organizational level should be well-researched and contain
knowledge about both the risk and protective factors.

30
Bridging the Gap
Freudenberger (1986) warns individuals and organizations which ignore the symptoms of
physical and emotional symptoms of burnout, coupled with ongoing pressure and stress, which
may eventually be "self-destructive" to the worker (p. 250). The stress within the environment at
work, along with the constant shifting of social, economic, and ethical dynamics in an institution,
causes an increasing strain with people and their relationship to work (Leiter & Maslach, 2005).
Though Leiter and Maslach (2005) allude to organizations either being on board with changing
to accommodate the health of workers or exploiting people without concern, Freudenberger
(1986) emphasizes it is both the individual and organization's responsibility to combat burnout.
Freudenberger (1986) states, "If the signs of stress exist, the staff person has a responsibility to
take care of him/herself and program administrators have a responsibility to call it to [their]
attention as well as to offer assistance in overcoming burnout" (p. 250). With burnout affecting
the individual and organizational quality of the workers, solutions should propose how to help
improve work production and mental well-being.
Though an older text, Freudenberger (1974) also names some suggestions that may help
prevent burnout, which can be applied today. One way is improving the “monotony of work"
(Freudenberger, 1974, p.162), by mixing up duties of the employee’s job, preventing those
individuals from doing the same thing repeatedly. Another method is keeping track and creating
boundaries around the time spent at work as well as respecting time off taken to take a break.
Freudenberger (1974) stresses in their article that "time off means time off" (p. 162).
Organizations can use training to help determine a healthy level of intention and motivation
around their job commitment as an education tool. It is also beneficial to have opportunities to
share with other coworkers' thoughts and feelings for social support, as well as increasing staff to

31
help spread the wealth of work amongst a larger group of people. Finally, Freudenburger (1974)
suggests participating in physical activity and mental health care such as meditation and yoga
can manage the level of burnout experienced by employees within the workplace.

Clark and Estes’ (2008) Knowledge, Motivation and Organizational Influences Framework

Due to the evaluative nature of this study, the Clark and Estes (2008) framework will
examine the PSC experience within the organization through the perspective of KMO
(knowledge, motivation, and organizational). Through this problem-solving process, the Clark
and Estes (2008) framework in this project will help structure learning how the PSCs are in
connection with the organization's goals and being able to use theory, literature, and previous
organizational information to help name the assumed performance in KMO. The next section
will reveal how the stakeholder-specific KMO assumed influences relate to the experience of the
stakeholders in the organization.
Knowledge and Skills
To help join together the concepts of enhancing the PSCs knowledge and skills in order
to help address the issue of burnout. Clark and Estes (2008) explain there are two conditions in
which enhancement in knowledge and skill are required: For those who are unsure how to
accomplish the performance goals of the organization and preparing to problem solve when
future challenges arise (Clark & Estes, 2008). Clark and Estes (2008) suggest solutions for each
are information and training for the first requirement and a need for "continuing and advanced
education" (p. 58) for the second. This study will apply the second requirement due to the gap of
information about PSCs experience with burnout. Since there is uncertainty if a problem exists,
collecting the information about burnout and PSCs will help the researcher conclude future

32
challenges and experiences by PSCs. This means research-based continuing and advanced
education about the aspects of burnout, along with personal experiences of the PSCs, would be
an option. The outcome of the assessment of knowledge and skills will supplement the final
product of implementing new educational strategies and supports designed to reduce burnout and
improve volunteer well-being.
Knowledge Types
Before examining the knowledge influences connected to the Peer Support volunteers, it
is helpful to provide a brief overview of the knowledge types. Based on Krathwohl's (2002)
examination of Bloom's Taxonomy, there are four parts of the knowledge dimensions: factual,
conceptual, procedural, and metacognitive. These parts of the knowledge dimension also play a
part in problem-solving. First, with factual knowledge, concepts, and generalizations are used as
building blocks made of bits of information (Estes et al., 2011). These facts, which are verifiable
and applicable to a single example, also "cannot be predictive of future events" (Estes et al.,
2011, p.23). For example, a factual statement would be Frida Kahlo's Blue House was made into
a museum in 1958 (Trujillo, n.d.). People can conclude the Blue House, such as it will always be
the house that was inhabited by Frida Kahlo, but facts also do not ensure the house will always
be standing in its present spot. To use this type of knowledge for problem-solving and
developing a skill is using the essential elements of information and getting acquainted with it
(Krathwohl, 2002). Such as the information about the Blue House can help one develop a
roadmap to the house or acknowledge to establishments by Latinx people through recognizing
historical landmarks.
Conceptual knowledge is "the interrelationships among the basic elements within a larger
structure that enable them to function together" (Krathwohl, 2002, p.214). Concepts create

33
labeled categories from grouping factual data (Estes et al., 2011). Concepts allow a more
straightforward process for those who are learning information to see similarities and
differences, making categorizing them into classification, principles, generalizations, theories,
models, and structures (Krathwohl, 2002). An example of this is taking various foods and
separating them into fruits and vegetables. In problem-solving, creating categories for like-
minded items allows teachers to make a better structure for students to learn specific information
to make it more meaningful for them (Estes et al., 2011).
Next, taking information such as methods of inquiry, how to use skills, algorithms,
techniques, and methods and constructing them into how to do something is procedural
knowledge (Krathwohl, 2002). Taking information is particularly crucial to problem-solving
because it emphasizes the steps needed to take to perform a task. In order to learn something,
there are three steps required: "the steps for completing the task (know that), how to complete the
steps (know-how), and when to implement the procedure (know when)" (Estes et al., 2011, p.
25). With problem-solving, these three steps are critical in helping learners determine when they
can use these skills. For example, if Johnny is learning how to make a sandwich, he will need to
know what steps are required, how to complete them, and then what appropriate times are there
to make a sandwich.
Finally, metacognitive knowledge centers one's cognition, focusing on awareness of the
learner's ability to think, as well as their strengths and weaknesses as well (Krathwohl, 2002;
Estes et al., 2011). Estes et al. stated that metacognitive knowledge "is the most generalizable
knowledge students can possess because it is the basis on which the learner controls the act of
learning" (p.27). In problem-solving, leaders use metacognitive knowledge to function
independently apart from where the learner had gotten the information from initially. If Sara

34
wants to complete the task of making eggs, she will go back into the knowledge she already has
to apply it to the task, think and reflect about the knowledge she possesses, and use it for
strategic planning for the next time.
After reviewing the four types of knowledge dimensions, there will now be an
examination of how PSCs use three of those knowledge influences to complete the stakeholder
goal. The three in the discussion are knowledge about awareness of the contribution of burnout
in a Peer Support setting, knowledge of aspects of minority stress as TQNB identified people,
and knowledge about one's thinking about burnout symptoms and the effects of peer support
work. Here, the researcher will also review which knowledge dimension the influence belongs
in, and why it is important to name the category.
Knowledge Influence 1: Knowledge about Symptoms of Burnout (Conceptual). The
volunteers need knowledge about the symptoms of burnout. Not all PSCs have standardized
therapeutic training compared to mental health specialists, but the main focus of these groups is
prevention. SAMSHA stated when focusing on aspects of whole health and resiliency of the
client/patient, peer providers are skilled in self-management, and promoting health and longevity
(2018). In those settings with other patients and clients, the PSCs are responsible for their well-
being.
Freudenberger (1986) also warns that burnout occurs when workers have are workaholics
and are engrossed so much in their work, that they refuse to rest and recharge their energy.
Workers should evaluate whether they themselves have changed or shifted due to the lack of rest,
and give one self’s permission to relax and have fun. Freudenberger suggests a level of self-
introspection from the workers about resistance to being flexible and staying rigid: "…because

35
the more inflexible one becomes, the less able one is to ask for help or to delegate responsibility.
This only increases the vulnerability to burnout" (p. 250).
Clark and Estes (2008) state that often people are unaware of the lack of knowledge and
skills around a particular subject, at times exhibiting poor communication and not sharing
important information to the organization. This may mean PSCs may not be aware of how to
express their concerns about burnout if they are not aware of what they are. Hence, with the first
knowledge influence, this study will examine PSC’s knowledge about symptoms of burnout in
order to achieve the stakeholder goal of reducing burnout symptoms experienced by the PSCs
within their work. In order to assess this knowledge influence, PSCs will identify at least two
aspects of burnout experienced as PSCs within the program.
Knowledge Influence 2: Knowledge about the Aspects of Minority Stress Effect on
TQNB People and Burnout (Conceptual). The second knowledge influence that will examine
the amount of knowledge held about the aspects of minority stress that may bring symptoms of
burnout to TQNB people. Moss (1973), as cited by Meyers (2013), explained how a person of a
minority status consistently interacts with the society they live in, they are gathering a
construction of how the world will treat them. Meyers discussed in the context of those who are a
sexual minority are more likely to experience conflict within the dominant culture that they live
in due to the constructed social norms. Though there is not thorough examination of how sexual
orientation or gender influence burnout, Viehl and Dispenza (2015) gather since sexual
minorities experience stressors that are related to their identities, mental health professionals that
are TQNB will most likely experience work place stigma than their heterosexual colleagues.
Oppression and discrimination amongst sexual minorities also have been associated with higher
ratings of job burnout, along with a greater level of psychosocial distress. Negative experiences

36
around identity within the workplace can ultimately affect a person's health and well-being
(Meyers, 2013).
For TQNB-identified PSCs, knowing how aspects of minority stress around an TQNB-
identity may influence burnout can give insight to the PSC's state of health as a gender minority
within the workplace. In order to assess this knowledge influence within the study, PSCs will be
able to name at least one related psychosocial stressor in relation to burnout.
Knowledge Influence 3: Knowledge about One's Process around Burnout and
Effects of Peer Support work (Metacognitive). The last knowledge influence is the knowledge
about one’s thinking about burnout symptoms and their experience as a PSC. Rueda (2011)
echoes the earlier sentiments of Krathwohl (2002) and Estes et. al (2011), saying metacognitive
knowledge is “the awareness of one’s own cognition and particular cognitive processes” (p.28).
In order to achieve the stakeholder goal of assessing PSCs for symptoms of burnout, they must
acknowledge that they experience burnout in the first place. In order to assess the PSCs
consciousness around burnout and its effects on them as a PSC, the PSC have to be conscious of
the process of burnout and be able to reflect on their experience at the time. Being able to reflect
on one’s experience metacognitively, according to Rueda (2011) is a strategic behavior when
wanting to examine any “contextual or conditional” aspects that may influence the problem
(p.29). Steyn and de Klerk (2015, p. 3) citing Pine (2002), "…burnout develops as a result of
thwarted attempts to establish personal meaning through work”. Pine (2002) comments that
burnout is grounded in “people's need to believe that their life is meaningful, that the things they
do, and consequently they themselves, are important and significant" (p. 123). This statement
reminds this study that burnout can also seep through if the person is not aware or grounded in

37
their purpose. Within the study to give further context to the lived experience of a PSC and
burnout, the PSCs will be able to name and reflect at least one experience of burnout.
Table 2

Knowledge Influence, Knowledge Types, and Knowledge Assessment

Knowledge Influence Knowledge Type (i.e.,
declarative (factual or
conceptual), procedural, or
metacognitive)
Knowledge Influence
Assessment
Peer Support Counselors
(PSCs) need knowledge about
the symptoms of burnout.

Conceptual PSCs will identify at least one
aspect of burnout experienced
as PSCs.
PSCs need knowledge of how
aspects of minority stress
around an TQNB-identity
may influence burnout.

Conceptual PSCs will be able to name at
least one related aspect of
minority stress in relation to
burnout.
PSCs need knowledge about
one’s thinking about burnout
symptoms and their
experience as a PSC.
Metacognitive PSCs will be able to name
and reflect at least one
experience of burnout.

Motivational Influences
In order for a learner to feel encouraged and maintain consistency around engaging in
cognitive processes, they need motivation (Mayer, 2011). Mayer stated motivation helps start
and uphold goal-directed behavior using four components: personal, activating, energizing, and
directed. It is vital to examine motivation in learners because it is one of the reasons information
gets processed and applied to complete tasks. For example, academic motivation, as described as
Mayer (2011), states have a reflection "in the amount of effort a student exerts to make sense of
the material—that is, to engage in the appropriate cognitive processes of selecting, organizing,
and integrating" (p.39). Motivation helps synthesize cognitive processes from start to finish.

38
In order for the PSC to complete their stakeholder goal of assessing for symptoms of
burnout to assist DCCH in supervising the delivery of peer support services, this study will
uncover what motivates the PSC to provide affirming community-based health and wellness
services, in conjunction with the mission of the organization. In studying providers who work
with survivors of traumatic events, Salston and Figley (2003) found that over 45% of their
population enjoyed their work. The most positive aspect being "witnessing client resilience and
personal growth, collegial support, and a sense of importance of services provided" (Salston &
Figley, 2003, p. 168). Within this section, through theory, literature will be reviewed that will
focus on the motivation-related influences that are pertinent to the achievement of the
stakeholder goal. Two theoretical perspectives, self-efficacy theory and attribution theory, will
be used to analyze possible motivations of the stakeholders. This section will apply the
theoretical perspectives and illustrate the stakeholders' use of these theories to complete their
tasks as PSC.
Self-Efficacy
The theory of self-efficacy “is the belief in one’s own ability to successfully accomplish
something”, showing that people will attempt things they are good at, and will not attempt things
if they do not (Hayden, 2009, p.7). Even though tasks can be seen as difficult, people who have a
strong sense of efficacy will believe those tasks can be mastered, and should not be avoided.
Hayden stated building one’s self-efficacy requires one to test their own perceived obstacles and
weakness, and lead with the belief of mastering the task at hand. Rueda (2011) states that those
who have a higher self-efficacy, “greater belief in their own competence, and higher
expectancies for positive outcomes will be more motivated to engage in, persist at, and work
hard at a task or activity” (p. 41). Self-efficacy is also influenced by four factors: mastery

39
experiences (successfully completing a task), vicarious experiences (observing the achievements
and disappointments through a similar person’s experiences), verbal persuasion (being verbally
encouraged to complete a task successfully), and finally, somatic and emotional states (anxiety,
stress, fear and other somatic states give clues to success or failure when performing a task).
Hayden stated these four aspects of self-efficacy overall affect our behavior.
PSC and Self-Efficacy
For the PSCs within the organization, believing they have the ability to support their
clients will help positively influence their service delivery. In reflection of the four factors listed
above, in order for PSCs to feel as though they have the ability to support their clients, they will
hopefully exist in states of well-being while providing service. First with mastery experience, in
order for the PSC to gain confidence, Hayden (2009) suggests practice. This could look like
asking and divvying out PSCs opportunities to engage in peer support. Creating a schedule of
their duties gives responsibility. This can also be monitored by staff to make sure the duty is
completed. For vicarious experience, PSCs can reflect on the experiences of witnessing other
people who have given service to clients and name times when those PSCs have supported
clients. Verbal persuasion for PSCs could come from the Peer Support Supervisory Team, who
is able to give feedback on their observations when PSCs provide service to clients. Finally,
with somatic and emotional states, leaning into the bodily reactions experienced when speaking
about their ability to give support to clients is important since “emotional arousal affects self-
efficacy” which affects the decisions people make (Hayden, 2009, p.9). In order to assess for the
motivational influences, this study will use two surveys (Maslach Burnout Toolkit
TM
for Human
Services), and a semi-structured interview to allow PSCs to confidently reflect on their ability to
support clients within a peer support setting.

40
Attribution Theory
Attribution Theory was first conceived in the late 1950s by Fritz Heider (Hayden, 2009).
Heider’s interest was in psychology and interpersonal relationships and believed that people
want to understand other’s behaviors and want to understand why they exist as well as what is
the motivation for such behaviors. Whether it is caused by internal factors or external situation.
The theory has evolved over time through research, presenting the on-going thought of how does
a particular behavior affect the success or the failure of an outcome, and to what do we attribute
the influence of the outcome? Hayden says a reason why it is important to understand what to
attribute to the outcome because it helps decide whether someone should continue to participate
in the behavior that caused it, albeit positive or negative. With Attribution Theory, there are also
three aspects of cause identified in Hayden’s text: locus of control, stability, and controllability.
Locus of control speaks to where the person feels as if the control they have in their lives are
external or internal, stability is at which the level of consistency the cause is, and finally
controllability determines if some causes can be changed, controlled or none of the above. It
allows humans the ability to notice patterns through their varied experiences, and make decisions
based on those outcomes.
PSC and Attribution Theory
In the context of the PSCs, they want to be able to give the best service they can give to
the group and individual participants, and a part of being able to own that experience to
determine what will make it successful, and what will make it fail. Helping the PSCs understand
where they have the most influence within a group setting as a facilitator will allow them the
opportunity to make the decision around what they are doing is helpful, or not. When it also
comes to their identities, experiencing past negative experiences may color the way TQNB-

41
identified PSCs interact with other people, making external factors such as discrimination and
oppression aspects to determine how people choose to connect within the group. In terms of
motivational influences, this study believes that PSCs believe their successes and failures, as it
relates to their peer support duties, are within their control. In order to access this influence
within this study, PSCs will identify at least one way they felt they have failed, and one way they
have succeeded within their peer support duties. The PSCs will also describe in each of those
scenarios how much control they had in the outcome.
The table below (Table 3) speaks to the motivational influences and the assessment that
applies the two theories listed above and how one in this study will measure the motivation by
the stakeholders.

Table 3

Assumed Motivational Influences and Motivational Influence Assessment

Assumed Motivation Influences Motivational Influence Assessment

Self-Efficacy Theory: PSCs believe they have
the ability to support their clients.

PSCs will be confident that they can identify
at least one way they believe they support
clients.

Attribution Theory: PSCs believe their
successes and failures, as it relates to their peer
support duties, are within their control.

PSCs will identify at least one way they felt
they have failed, and one way they have
succeeded within their peer support duties.
The PSCs will also describe in each of those
scenarios, the amount of control they had in
the outcome.

Organizational Influences
Through the existence of an organization’s cultural settings and cultural models, one can
analyze its culture in general (Gallimore & Goldenberg, 2001). Gallimore and Goldenberg

42
(2001) cite Tharpe and Gallimore (1988) describing cultural settings as "the social furniture of
our family, community, and work lives…" (p. 72). In thinking about DCCH's history in
Washington, DC, the organization's mission has continued to grow roots and continues to exist
as a staple healthcare in the city. This section will later explore how factors such as visual
representation, medical protocols, and community events exhibit the organization's cultural
setting and cultural model. Braunstein et al. (2014) explain that these are aspects of bridging
cultural practices that create routines and repertories in people. This bridging also allows the
institution to shape its own functional system.
For cultural models, on the other hand, focuses more on the cultural practices and the
common mental schema within the organization (Gallimore & Goldenberg, 2001). Braunstein et
al. (2014) shed light on how bridging cultural practices denote various grounded practices within
institutions. These grounded practices allow theorists to recognize any roots of social changes
that are occurring.
Gallimore and Goldenberg (2001) Cultural Settings and Cultural Models
In order to explore further how organizational culture impacts the knowledge and
motivational influences within DCCH, this study will be examining the cultural models and
settings of the organization. An organization’s culture can be analyzed based on the cultural
settings and cultural models that exist in it (Gallimore & Goldenberg, 2001). Cultural settings
are concrete and include the organization’s employees, their tasks, how and why tasks are
completed, and the social context in which their work is performed. Within this study, the
researcher will be examining what are the cultural models, cultural settings and organizational
influences that need to be examined in order to answer the study’s research questions, and
support the organizational performance goal. Through Clark and Estes (2008) KMO Gap

43
Analysis Framework, this study will identify whether the PSCs have access to the knowledge,
motivational, and organizational support in order to achieve the organizational performance goal.
The organizational performance goal states by 2021, DCCH will implement new educational
strategies and supports to improve employee and volunteer well-being and reduce the impact of
burnout.
Cultural Models
While incorporating behavioral, cognitive and affective components, cultural models are
normative understandings of how the world should or ought to work (Gallimore & Goldenberg,
2001). Within organizations, cultural models evolve over time, sharing ways to perceive, think
and store “possible responses to adaptive challenges and changing conditions” (Gallimore &
Goldenberg, 2001, p.47). These challenges within the environment could be interpreted as what
is of value, ideal, what is worthy of repetition or should be eliminated, as well as defining any
rules and the purpose of the interaction from the start. Often, to those within the organizational
environment, these cultural models are not tangible and can be unnoticed within the
organization, which could make them difficult to measure (Rueda, 2011). Yet, Rueda stated, if
someone is intentional in observing and assessing behaviors, policies, and practices, a specific
context can be created from the responses once has received.
Cultural Settings
For cultural settings, on the other hand, Gallimore and Goldenberg (2001) spoke about
cultural settings as smaller aspects of action or relationship that manifest within an organization
for sustainability over time. Cultural settings are the visible, concrete aspects of the
organization: classrooms, administrator’s offices, community spaces, etc. (Rueda, 2011). Rueda

44
stated these spaces are also places where behavior can be observed so consideration can be made
around specific context and understanding.
Interaction Between Cultural Settings and Cultural Models
How do the concepts of cultural settings and cultural models play into each other? Rueda
(2011) states “while cultural settings can impact behavior, cultural settings are also shaped by
individuals and groups—who operate with cultural models that impact their own behavior” (p.
57). For example, individuals within an organization hold within themselves the cultural models
which give information to dictate behavior, thought and affect in the space, yet the cultural
settings are the outcomes of these thoughts and behaviors. Braunstein et al. (2014) explain that
these are aspects of bridging cultural practices that create routines and repertories in people in an
organization. This bridging also allows the institution to shape its own functional system
(Braunstein et al, 2014). Cultural models and cultural settings go hand in hand, creating dynamic
processes which encourages a reciprocal relationship between the two (Rueda, 2011).
Stakeholders, DCCH’s Cultural Model and Organizational Influence
What specific stakeholder factors show up within DCCH’s organization within cultural
models? First in examining DCCH’s mission, two themes that appear: one, any service within
the community health care center will be affirming to the client, and second, the lives of
LGBQ+T and people living with HIV (and AIDS) are centered in the care they offer. These
themes would be considered cultural models since these are themes, or mental schemas, that
should to be exhibited within the organization by individuals. Rueda states that within
organizational settings, cultural models give structure to the shape of the organization through
values. With DCCH, the expectation to provide affirming care, and centering the lives of
LGBTQ and people living with HIV and AIDS are ingrained in the culture, and how services are

45
provided. This is where cultural settings are useful as more tangible manifestations of the model
(Rueda, 2011). In reflection of the cultural model of the organization, this study will be
examining the Availability for Affirming Health and Wellness Care, as the organizational climate
promotes a culture of affirming health and wellness care for the volunteers, per its mission. In
relation to the stakeholders and the stakeholder goal, DCCH’s cultural model assumes the level
of wellness the PSCs have during their duty. In reflection of the organizational mission, if DCCH
encourages healthy lives and affirming wellness services, this experience should also be granted
to the PSCs as well as those getting services from the clinic. In order to understand how this
shows up in the organization, the study will use semi-structured interview questions to have
stakeholders identify at least one way the organizational climate promotes a culture of affirming
health and wellness care for the PSCs, as well as quantitative surveys to explain the relationship
to organization.
Stakeholders and DCCH’s Cultural Settings and Organizational Influence
Within DCCH, there are cultural settings that exist in the organization, building a level of
visibility of its mission and the population it serves. The cultural setting also allows the
organization to give honor to its original history and mission. First, there are visual
representations of solidarity as cultural settings within the organization. The website showed the
company's logo contains a collection of colors, assuming as a rainbow representation, usually
associated with gay culture (Morgan, 2019). DCCH has also named some of their buildings
representing prominent figures who have made strides within the HIV movement, whether
through visibility, or philanthropy. Both examples of cultural settings within the organization
signal commitment to the LGBQ+T community through representation and symbolism.

46
Another example of cultural settings within the organization, as well as a commitment of
the organization acknowledging wellness is the organizational staple of the annual walk to
support those living with HIV and AIDS. This event was created over 30 years ago as a
fundraiser and to give awareness of the growing crisis. This event is closely tied to the
organization's name and purpose, and for employees and volunteers alike as well as community
members. The annual Community Walk is an opportunity once a year to come together in
partnership to raise awareness and be in communion with people who share an experience or
identity.
From a cultural setting perspective, two specific factors may be at work to explain the
cause of organizational problems within Peer Support programs: (1) there is a lack of
information of how affirming care is provided specifically to PSCs and (2) there is a lack of
information about how the needs of TQNB-identified people show up within the Peer Support
program when they are PSCs. In order to explore these concepts to answer the research
questions, this study will examine the cultural settings influence of acknowledging affirmation
and wellness for PSCs. The study will ask questions to the stakeholders to find out how the
organizational setting exhibits support and care for burnout. In semi-structured interview
questions, stakeholders will identify at least one way the organization supports the PSCs around
burnout. This information will allow the researcher to understand what cultural models the
organization needs to incorporate in order to meet the needs to the PSC.
The table below (Table 4) speaks to the organizational influences and the assessment
applying the cultural settings and cultural models above. This organizational assessment will
also reveal how the cultural settings and cultural models are measured in the study.

47
Table 4
Assumed Organizational Influences and Organizational Influence Assessment

Assumed Organizational Influences Organizational Assessment

Cultural Model Influence 1- Availability for
Affirming Health and Wellness Care: The
organizational climate promotes a culture of
affirming health and wellness care for the
volunteers.

In semi-structured interview questions,
stakeholders will identify at least one way
the organizational climate promotes a culture
of affirming health and wellness care for the
PSCs.

Cultural Setting Influence 2 - Acknowledging
Wellness for PSCs: The organizational setting
exhibits support and care for burnout.

In semi-structured interview questions,
stakeholders will identify at least one way
the organization supports, and could support,
the PSCs around burnout.

Conceptual Framework: Knowledge, Motivation, and Organizational Context

Conceptual frameworks, according to Maxwell (2013), are visual or written structures
constructed by the researcher. These frameworks lay out a plan of the what, how, and why,
when formulating a study. This framework, whether complete or incomplete, collectively
reflects the aspects, expectations, and beliefs which informs the research design to help "assess
and refine your goals, develop realistic and relevant research questions, select appropriate
methods, and identify potential validity threats" (Maxwell, 2013, p. 39). At the end of the study,
Maxwell assumes the framework will be used to justify the researcher's efforts. For this study,
the researcher will be looking at knowledge and motivational influences within an organizational
context. In order to understand the knowledge and motivation of the stakeholders, one must
explore how they all interact within the organizational dynamic, though it implies they are all
independent of one another. With the guidance of four research questions, the conceptual
framework will carve a path of understanding of the connection through visual and written
narrative. In this study, it is essential to remember Clark and Estes's (2008) Gap Analysis model

48
is being used to show the need for support in the areas of knowledge, motivation, and the
organization itself. The purpose of the Gap Analysis amongst these elements is to identify
whether the stakeholders, TQNB PSCs, have the knowledge and motivation to complete the
stakeholder goal within the organization, which is by 2021, at least 70% of the burnout
symptoms experienced by TQNB PSCs will be reduced by participating in educational strategies
and supports held by the organization.
Description of Conceptual Framework
Figure 1 below is a visual representation of the conceptual framework for this research.
The outward blue circle represents the organization as a whole. As shown after the name of the
organization is listed, the cultural settings and cultural models are named. First, starting with the
cultural settings, elements of this include the logo in, which their choice of colors representing
the LGBQ+T community, the names of buildings that honor past advocates and lives of people
who have lived with HIV, and the annual HIV/AIDS community walk within the city.
Braunstein et al. (2014) created a study to examine how racially and socioeconomically diverse
civic organizations bridge their cultural practices and used prayer or religious practice as the
medium. A take away from the study is that what is essential is not just "the presence of cultural
practices, but also to the content and form of practice within specific settings" (Braunstein et al.,
2014, p.721). DCCH was at the forefront of the HIV/AIDS movement since the rise of the
disease in the 1980s (Our History, 2019). In terms of cultural settings, HIV treatment and
LGBQ+T healthcare is the practice that is reflective of the foundation of DCCH, but also one
that continuously evolves as the needs of the patients evolve.
For DCCH, the cultural model reflects what this study will name as Affirming Services to
Clients and LGBTQ+, HIV and AIDS centered care. It is vital to note these aspects of cultural

49
settings and cultural models within this graph to give representation of not only what the
environment is grounded in at DCCH, but also where stakeholders have a part in holding onto
this tradition and reputation within the community. Lastly, the theoretical framework of the
Clark and Estes (2008) KMO Gap Analysis is what is going to structure this study to help answer
the research questions.
Underneath the theoretical framework is another bold circle which contains the
stakeholders who are the focus of the study (TQNB-identified), and the list of knowledge
influences that will be considered within the study to help answer the research questions. Next,
there is a list of theories which will help give perspective to the motivational influences of the
PSCs. From here, there is a black arrow that is pointing downward to the main goal of the study
within the orange box: By 2021, at least 70% of burnout symptoms experienced by Transgender,
Queer, and Non-Binary Peer Support volunteers will be reduced by participating in educational
strategies and supports held by the organization.

50
Figure 1
DCCH’s Conceptual Framework

Organization
DC Community Healthcare (DCCH)
Cultural Settings: Company logo, Names of Buildings, Annual Community Walk
Cultural Model: Affirming Services to Clients, LGBQ+T, HIV and AIDS centered care
Theoretical Framework: Clark and Estes's (2008) KMO Gap Analysis model

Goal for Stakeholder:
By 2021, at least 70% of burnout symptoms
experienced by Transgender, Queer, and Non-Binary
Peer Support volunteers will be reduced by
participating in educational strategies and supports held
by the organization.
Stakeholder (TQNB-Identified PSCs)
Knowledge 1: PSC need knowledge about the symptoms of
burnout (Factual)

Knowledge 2: PSCs need knowledge of how aspects of minority
stress around a TQNB-identity may influence burnout.
(Conceptual)

Knowledge 3: PSCs need knowledge about one’s thinking about
burnout symptoms and their experience as a PSC.
(Metacognitive)
Theories of Motivation:
Self-Efficacy
Attribution Theory

51

Summary

This evaluation study seeks to address possible burnout symptoms PSC within DCCH
who identify as TQNB. In meeting the stakeholder goal by 2021, at least 70% burnout
symptoms experience by TQNB PSC will be reduced by participating in educational strategies
and supports held by the organization. To inform this study, this chapter reviewed literature
related to experiences of burnout with PSC who identify as TQNB in a Washington, DC
community healthcare organization. This review explored the definitions and prevalence of
burnout within therapeutic programs, the challenges around competent services within healthcare
for TQNB people, the dynamics and requirements of the Peer Support modality, as well as how
Peer Support has become an alternative therapeutic treatment for people in marginalized
populations. This literature review process led to the identification of the assumed knowledge,
motivation, and organizational influences specifically related to the achievement of the
stakeholder goal and TQNB’s experiences within Peer Support programs. The knowledge
influences include the conceptual knowledge related to information about burnout, and how it
shows up in the nature of their work, and metacognitive knowledge to process how the aspects of
burnout affect the quality of service the PSC give as well as what they think about the outcomes.
The motivation influences are grounded in the theoretical perspectives of self-efficacy and
attribution theory. Finally, the organizational influences are grounded in Clark and Estes (2008)
KMO Gap Analysis framework, and the cultural settings (company logo, names of buildings,
Annual Community Walk) and cultural models (LGBQ+T, and HIV and AIDS affirming
services) historically reflect the organization’s mission in caring and treating people within
marginalized populations such as those affected by HIV and AIDS, and people who belong to the
LGBQ+T population. Chapter Three describes the validation process for these influences

52

Chapter Three: Methods

This researcher is committed to using mixed methods to obtain information to understand
further the population's possible relationship to burnout with peer support. To collect data, the
researcher used an unstructured approach to the qualitative research for the narrative portion and
structured when referring to the survey portions of the study. Maxwell (2013) states that
compared to a structured approach, which can focus more on analyzing data explaining the
differences between people, settings, time, and researchers, the unstructured approach centers the
"particular phenomena" (p.88) and processes which leads to specific outcomes. This study used
the Maslach Burnout Toolkit™ for Human Services, which combines the Maslach Burnout
Inventory™ Human Services Survey (MBI-HSS, 1981) and the Areas of Worklife Survey
(AWS, 2011). This tool measured burnout in the worklife context to survey the Peer Support
Counselors (PSCs) within the organization who meet the study’s criteria.
The goal of using the Toolkit to survey the PSC is to explore how burnout shows up
while practicing at the organization to gather information to create educational strategies and
supports, if needed. The toolkit also examined how the organization supports the well-being of
the PSCs to affirm health and wellness care. In looking at the KMO influences stated in the
study, knowledge and organizational influences are focused mainly on the experiences of the
PSCs. Self-Efficacy and Attribution Theory (the motivational influences) will support the
participants' narrative. Cultivating this information will allow the researcher to answer the
research questions inquiry about the educational strategies and supports that could assist in
reducing possible burnout, understanding how the organization holds the experience of the PSC
in the program, and what recommendations can fill the gaps of the problem of practice.

53
COVID-19’s Effect on Study Practices
Coronavirus (COVID-19) was first identified in Wuhan, China, as a new virus spread
from person to person through respiratory droplets. Through coughing, sneezing or talking,
COVID-19 is a highly communicable disease where health organizations such as the Center for
Disease Control and Prevention (CDC) recommend face coverings in public, social distancing,
frequent handwashing, and avoiding close contact with other persons (How to Protect Yourself
& Others, 2020). Since the first confirmed case of COVID-19 in the United States on January 21,
2020 (Schuchat, 2020), organizations made an effort to plan ways to provide services to patients,
yet still, adhere to the CDC guidelines for safety. For this study, all participants and the
researcher adhered to the CDC guidelines and the policies and organizational adjustments
established by the organization around social distancing to protect all participants. Throughout
this chapter, the researcher will highlight ways COVID-19 and the CDC guidelines are followed
to maintain all participants' safety.
Participating Stakeholders
The stakeholder population of focus within this study will center the PSC within the
DCCH Peer Support program who identify as Transgender, Queer, or Non-Binary (TQNB). The
Peer Support program at DCCH calls the volunteers "Peer Counselors". This study will continue
to refer to them as Peer Support Counselors (PSCs) in order to emphasize the individuals
working within the peer support field, and not counseling, by trade. This group is supported and
supervised by members of the Behavioral Health Department, but are not licensed people paid by
the center. This study wants to continue to accentuate the PSCs experiences within the program
are voluntary.

54
In terms of addressing the gender of the volunteers, it can be difficult to determine whom
to include in the TQNB identity group due to the various definitions when it comes to identity.
For this study, the researcher used terms of identity pertaining to race, ethnicity, and gender as it
is conveyed within DCCH’s Patient Registration Form, and modified for this study (see
Appendix A). Though not a main goal, through this study, the researcher would also like to
work towards furthering inclusivity in research practices as well as the well-being of the
community at large through intentional technique and inclusive language.
PSCs who participate in this study would have also completed the required nine-hour
mandatory training held by the Behavioral Health Staff of DCCH. Though on the organization’s
website says, "ongoing supervision and support" (Peer Support-General, 2019) for each
volunteer PSC, there is not a specific number of required sessions after the initial mandatory
session.
Before the study went underway, the researcher needed an agreement with DCCH's
Director of Compliance, who manages DCCH's compliance, risk management activities, and
ethics while supporting the organization's Audit and Compliance Committee of the Board of
Directors. The researcher spoke to the organization's Research Team to ensure the study does
not interfere with the work in which they are already participating. Since the researcher is not
collecting client or patient medical records, the researcher will not have to go through the IRB
process through the organization. During the duration of the study, the researcher was able to
continue to be in connection with the Director for continuity around study logistics.
Interview Sampling Criteria and Rationale (PSCs)
The goal for this study is to have the available PSCs participate in the following: the
initial Demographic Survey (3-5 minutes), the two surveys within the Maslach Burnout

55
Toolkit™ for Human Services (15-20 minutes), and participate in the interview process (1 hour).
The total length of participation by the PSC would be between one hour and twenty minutes and
two hours. This study used nonprobability sampling in order to achieve the needed sample for
this section of the study. Gaining the sample of this group used who is available and convenient
for the study (Creswell & Creswell, 2018). This is especially considering who will have access
to the available technology such as the Internet, phone and email, during the time of COVID-19
and the emphasis on social distancing (Internet, phone, email, etc.). The sampling method for
the PSCs is stratification sampling, since participants should have specific characteristics in
order to participate in the study (listed below). This ensures that individuals who participate in
the study is a sample which “reflects the true proportion in the population of individuals with
certain characteristics” (Creswell & Creswell, 2018, p. 151).
The researcher promoted the study through distributing electronic flyers to the Peer
Support Supervisory Staff, who then presented the information about the study to the PSC group.
Information about participation will be included in the flyer, particularly contact information (the
researcher’s email address) if someone is interested in participating. The PSCs from here directly
contacted the researcher to inquire about more information to participate. The researcher
collected the participants over a three week time period. When participants wanted to join the
study, the participants emailed with their interested, where the researcher explained the logistics
of the study, reviewed the detailed guide, and completed the Demographics Survey.
After the study is complete, the researcher will use the time to use journaling to comment
on the collection of data for processing (Appendix B). The researcher will also gain insight from
the dissertation committee if issues or problems arise during data collection. Overall, the
researcher estimates the data collecting experience will be over a two-month timespan.

56
For the PSC to participate in the study, the participants must have the following criteria:
Criterion 1. Any PSC involved within the study would need to have completed the initial
nine-hour mandatory Peer Support training, led by someone who is a part of the Peer Support
Supervisory Team, who are connected to the Behavioral Health program within DCCH.
Criterion 2. Any PSC who has been an individual facilitator or group leader for at least
six individual sessions and/or facilitated six group sessions.
Criterion 3. The PSC will need to identify as a person who is TQNB.
Data Collection and Instrumentation

Due to COVID-19 and the restrictions listed by the CDC and DCCH, all data collection
will be remote to promote social distancing and lessen the spread of infection between
participants and the researcher. As stated above, the researcher agreed with the Peer Support
Supervisory staff to get information out to potential participants through emailing the study flyer.
Due to the researcher's relationship to the organization, the researcher will clearly communicate
that this research is not by the organization, but an individual project of the researcher. Any
electronic flyers were distributed by the Peer Support Supervisory Team to distribute the PSC
group to instill a level of distance between the researcher and the participants. All final decisions
about publicity around research has been approved by the Research Department in the
organization.
Surveys
As described above, the researcher used two methods for data collection within this
mixed-methods study: the combined Maslach Burnout Toolkit™ for Human Services, which
includes both the AWS (2011) and MBI-HSS (1981), and individual semi-structured interviews
with the PSCs. To learn, “to what degree are the PSCs experiencing burnout?”, the study must

57
explore if there are any effects of burnout to the PSC to create new strategies, so the MBI-HSS
(1981) and AWS (2011) will give more concrete information. Asking “ how is the knowledge
and motivation of the volunteers within the Peer Support Program related to the possible impact
of burnout experienced by volunteers?” and “what is the interaction between DCCH’s culture
and context, and the knowledge and motivation of the Peer Support volunteers?” may be helpful
in narrative, so semi-structured interviews will be used. Including PSC narrative experiences will
help the researcher work towards revealing causes of burnout amongst the PSC to reach the
organizational goal of implementing new educational strategies and supports to improve
employee and volunteer well-being for the organization in 2021.
Within this section, the researcher will discuss the quantitative survey method used to
capture the experiences of burnout amongst the PSCs within the field, the Maslach Burnout
Toolkit™ for Human Services. Before the participant takes the two surveys within the Toolkit,
the participant took the demographic survey to collect information about the identity and
examine the length of participation in the Peer Support program since their duration (Appendix
A). This study will be able to utilize the Toolkit
TM
to get a sense of the participant's experience
of burnout within the work they are doing as PSCs at the organization. In understanding the
sources and reasoning behind participants' burnout, the study will be able to answer the research
questions about the degree in which the PSCs experience burnout.
Survey Instrument
Outside of the demographic survey (Appendix A), the study will be using the Maslach
Burnout Toolkit™ for Human Services, which includes two separate surveys, the AWS (2011)
and the MBI-HSS (1981). It is noted that on the author’s request, the surveys in their entirety
cannot be duplicated because it will threaten the integrity of the test. First, the AWS (2011),

58
created by Michael P. Leiter and Christina Maslach, to give context around worklife for an
individual (Mind Garden, 2019). Within this 28-item self-administered study, participants will
use the 5-point Likert scale to assess six subscales: Workload, Control, Reward, Community,
Fairness, and Values (Jameson & Bowen, 2018). The AWS (2011) is used in tandem with the
MBI-HSS survey to shed light on “employee perceptions of whether they experience work
engagement or burnout” (Leiter & Maslach, 2004, 2011 as cited by Jameson & Bowen, 2018, p.
3). In connection with the study’s conceptual framework, this section of the study intersects with
the knowledge influences centered on the volunteer’s experience of aspects of minority stress
and how burnout affects their experience in the program. With the use of the survey results, the
study will be able to collect useful information that will help understand the extend burnout
symptoms have an effect on the experience of the PSCs within the context of their work
environment to help reach the stakeholder goal of reducing symptoms of burnout amongst the
PSCs.
The second part of the Toolkit
TM
, the original Maslach Burnout Inventory (MBI), initially
emerged in 1981 from a wealth of exploratory, qualitative field studies based on interviews, case
studies, and observations (Leiter & Maslach, 2016). Created by Christina Maslach and Susan E.
Jackson, the MBI is Likert-scaled with 22 statements (Spinelli et al., 2016) assessing the three
basic dimensions of burnout: emotional exhaustion, depersonalization, and a decreased sense of
personal accomplishment (Leiter & Maslach, 2016). Spinelli et al. (2016) quotes statements from
the assessment such as "I have control over how I do my work" where the participants would
answer from 1 "respondents strongly disagree with the statement”, to 5, "respondents strongly
agree with the statement" (Spinelli et al., 2016, p. 285). This survey is more focused on the
experience of the volunteer within the workplace. Considering the person's relationship to the

59
organization, this survey will allow the researcher to get an idea of how much the culture and
setting of the organization supports the well-being of the volunteer. Understanding the scope of
the burnout symptoms from the results of the survey will also be useful information when
implementing the educational strategies and supports for the PSCs after the study ends.
Survey Procedures
These surveys, the AWS (2011) and the MBI-HSS (1981) were the first steps within the
researcher's mixed-methods approach to gathering initial data from the PSCs about their
experiences in the workplace. For recruiting, the researcher spoke with the Peer Support
Supervisory Team about permission to provide information to their PSCs about the study in
order to seek interest in participating. This information includes the purpose of the study,
information on informed consent, and any plans to help manage the safety of all participants
(Appendix C).
The Peer Support Supervisory Team distributed the contact information to the
participants electronically via flyer constructed by the researcher, as well as to inform them of
the 50-dollar gift card as a benefit to participating. If participants are interested in the study, they
were encouraged to contact the researcher through the researcher’s email and/or provided phone
number. Seeking permission for the study will also involve a detailed conversation with the
DCCH's Compliance Department and Research Department. This conversation is to make sure
the researcher's study is not interfering with the research goals of the organization that was
already in progress. Since the researcher is not collecting personal data or evaluating client
records, going through the organization's Institutional Review Board (IRB) process is not
necessary. Once the person contacts the researcher about participating through email, the
researcher will then follow-up by phone to discuss details of the study, informed consent, and

60
any risks that may be involved. The researcher will do their best to match any accessibility needs
for the participant to participate in the study to the best of their ability. Once the researcher
received this agreement from the participant to join the study, the researcher distributed the
study’s Information Sheet for Exempt Researcher (Appendix C) via email to the participant.
During the phone call screening, the researcher used Demographic survey to screen for
qualification, and answer any questions the participant may have. This demographic survey is
also to offset the demographic survey within the Toolkit
TM
since there are binary questions about
gender and not specific enough about identity in order to capture the answers to the research
questions. Once received by the participant, the researcher will use the Demographic Survey to
screen for qualification, and answer any questions the participant may have. This Demographic
Survey will last about 3-5 minutes. Once the Demographic Survey is complete, the researcher
will assign an ID number to the participant (001, 002, 003, etc.), and refer to that assigned
number throughout the study for confidentiality purposes. The ID number, once the participant
agrees to participate in the process, which will be used for both the survey and the semi-
structured interviews to keep the information connected.
The researcher used the Mind Garden Inc.’s Transform
TM
online system to send a link to
the Maslach Burnout Toolkit™ for Human Services to the participant’s email to complete. The
participant had seven days from the day the link was sent to complete both surveys. These
surveys were collected and scored through a Mind Garden, Inc.’s Transform System, which was
paid for by the researcher. The researcher labeled the participant’s surveys by their ID number.
According to the Mind Garden, Inc. website (2019), which sells the survey toolkit, the
information sheet states the surveys combined contains 50 items and will take about 15-20
minutes to complete (2018). If the researcher needed other translations of the survey for

61
participants, according to the Mind Garden website, the survey is translated in over 45 languages
(2019). If a person is not able to complete the survey’s online, the participant could request a
paper survey, along with a paper copy of the Demographics Questionnaire, which can be
arranged to have mailed to the participant including a self-addressed stamped envelope and
instructions for completion and return.
Finally, once the researcher is notified through the Mind Garden, Inc.’s Transform
TM

System that the participant has completed both surveys, the researcher sent an email with a
scheduling link for the semi-structured interview with the researcher. The time blocks for the
interviews were set for one hour and 20 minutes and was set be within a week the surveys are
completed. Once the participant has scheduled their interview time, the researcher will send a
calendar reminder to the participant to help ensure confirmation of participation. Also, for
accessibility, for those who may have a hard time taking quizzes on the computer, the researcher
will purchase the license to be able to distribute the survey on paper. This option, as well as the
use of the computer, will be available at the time of the test and interview.
Interview Protocol and Procedures
This study will use semi-structured interviews to collect narrative information from the
PSCs. The interviews allow the opportunity to use open-ended questions to collect views and
genuine experiences of the participants (Creswell & Creswell, 2018). Qualitative interviews are
the best approach post-survey information because it allows for the voice of the person behind
the survey to be heard, especially as a person whose identity is rooted in experiences of societal
oppression such as being a part of a gender minority. The interviews also allow the participants
to expand their awareness by "engag[ing] in dialogue, critically question[ing] relationships and
circumstances, and gain[ing] new perspectives" (Smith, 1997, p. 195). This experience will

62
hopefully allow the researcher to understand the knowledge and motivation of the PSC, and how
burnout may affect the PSC's overall well-being.
For language accessibility purposes, the interviewer's primary and only language is
English, as well as the root and structure of the interview questions. For those who need other
language interpretation, it is the responsibility of the researcher to retrieve an interpreter. This
person would have been paid their preferred rate per hour for their time and labor during the
process, if needed.
To keep in accordance with the CDC and DCCH guidelines, all interviews will be done
online and through a secure Zoom online account. The researcher scheduled sessions on the
Zoom platform, where the participant will be emailed an individual link to their meeting zoom
along with a password for additional security. The participant and researcher reviewed the
informed consent information first, along with the purpose of the study. The researcher will see
if the participant has any questions, along with assuring if at any time the participant wants to
remove themselves from the study or if they did not want to be seen on camera, they are allowed
to do so.
The interview questions, rooted in the three parts of the conceptual framework, in
conjunction with the two surveys, help give a more inclusive view of the experiences of the
PSCs within the program. For knowledge, these experiences are more focused on the PSCs
knowledge about the program, aspects of burnout, and information about the psychostressors
experienced and affected oneself as a TQNB person within a Peer Support space. For the
motivational influences, questions will focus on the PSCs belief in their ability to help support
clients, and how their successes and failures within their control as PSCs relate to their peer
support duties. The volunteers also spoke to what inspired their work. Finally, organizationally,

63
there is an explanation of how the culture and setting influence the purpose of the PSC in the
peer support space. Interview questions, along with interview protocol, can be found in
Appendix A.
Before the interview began, the researcher asked the participants consent to record of the
interview. If the participant had refused, the interview would end and the data will be removed
and destroyed. Any participant who consents with moving forward, the researcher started the
recording on three different devices or programs: the first through the Zoom program, the second
is the Voice Memo programming on the Apple computer system, and finally, the researcher’s
audio device. All data and transcripts from these devices are stored on a separate zip drive
purchased and owned by the researcher. The data on the zip drive is password protected, with
only the researcher having sole access. The zip drive is locked in a security box owned by the
researcher for additional security. The data (electronic and written) is be stored in a lockbox for
at least five years from the end of the date of the study, then destroyed.
After consent is received and the recording begins, the researcher again reviewed the
Information Sheet asked again for the consent on recording, explain the purpose and process of
the study and interview, and left space for any questions. The participant was reminded again
that they have the right to end their participation in the study at any time.
The researcher will ask 19 questions to the participant covering their knowledge about
burnout, their experience as a PSC who is TQNB, and the organization’s role in promoting a
culture of affirming health and wellness, as well as supporting PSCs around burnout. The
research asked clarifying questions to get a full understanding of what the participant was trying
to convey. Once the interview was complete, the researcher again asked the participant if they
have any questions about the study.

64
At the end of the interview, the researcher arranged with the participant to give their $50-
dollar gift card through www.giftcards.com, where the participant selected their merchant and
how to receive payment (by email or gift card sent by mail). Once the participant agrees on
receiving payment and merchant, the researcher will send the gift card within 24 hours of the
interview. The researcher will thank the participant, end the call, and end the recording.

Data Analysis

Through the Mind Garden’s online system, the researcher purchased individual and group
licenses of the two surveys in order to gain access to calculated quantitative data. The online
system provided the researcher with descriptive statistical analysis for the group of participants.
For the semi-structured interviews, collecting data began at initial interaction, collecting
demographic information (Appendix A), then scheduling times for surveys and interviews. After
all data is collected and the study is closed, the researcher will write analytic memos after each
interview for each participant (one per week) for three weeks by journaling. After having the
interviews transcribed, in the first phase of coding, the researcher used in vivo and emotion
coding in order to initially find a priori codes and themes throughout in relation to the study’s
conceptual framework and research questions. The second phase of analysis has been conducted
where empirical and a prior codes are aggregated into analytic/axial codes. Then finally in the
third phase of data analysis, the researcher identified pattern codes and themes that emerged in
relation to the conceptual framework and study questions in conjunction with the themes within
the quantitative data.
All five participants completed both surveys and the demographic survey as supporting
data, they were able to be interviewed by the researcher to gather information to answer the
study’s research questions. In order to analyze the quantitative data from the interviews, a

65
recording from one of the three sources (computer recording, Zoom audio recording and phone
recorder) was sent to Rev.com to have translated. This allowed the researcher to read over the
information to help discover codes and themes throughout the interviews. In order to align with
the Clark and Estes (2008) Gap Analysis KMO framework, the questions reflect the knowledge,
motivation and organizational influences used to provide information about the PSCs experience
with possible experiences of burnout.
The first step the researcher had taken in analyzing the information was first listening to
the transcriptions with the audio recordings to make sure they are accurate. This is to prevent any
missing themes or codes which could be lost in translation. During the first listen, the researcher
focused on repeated words and phrases used throughout the interview, such as “schedule”,
“COVID-19/Coronavirus”, “stressors”, “fatigue”, “microaggressions”, “helping”, and
“obligation”. The researcher used the elemental method of in-vivo coding use the language from
the participants to build a foundation for further coding, but also the affective method of emotion
coding to capture and acknowledge the human experiences of the participants as well (Saldaña,
2016). Capturing the emotional experiences of the participants within this study is deemed
important by the researcher since this study is centered on exploring the “intrapersonal and
interpersonal participant experiences and actions” (Saldaña, 2016, p. 125). This is especially
poignant since this study uses gauging the emotionality of the PSCs (experiences with burnout
and minority stress and how they feel in relation to those concepts) to make a determination of
how they interfere with the relationship and support of the organization. To reflect these initial
emotion codes, labels such as “overwhelmed”, “fatigue”, “dread”, “fear”, “frustration”, and
“thankful” which were repeated throughout the interviews were also considered as when placing
the words in categories. In the efforts of having the study center the experiences of the PSCs, it is

66
important to the researcher to use these words of the participants to describe their experience.
Also, since populations who are transgender, queer and non-binary may be less familiar to some
due to discrimination and oppression, centering their words and experiences help “prioritize and
honor the participant’s voice” (Saldana, 2016, p. 106).
Next, the researcher manually read through the printed transcriptions to help further find
emerging themes and codes, as suggested by Maxwell (2013). A process established within
analysis was keeping a log of the researcher’s interpretation each week. This is where the
researcher would read the participants’ transcripts and keep a log of any ongoing emerging
themes each week, for three weeks. According to Maxwell (2013), this process of writing
memos about one’s analysis will be able to grasp the “analytic thinking about [the] data, but also
facilitate such thinking, stimulating analytic insights” (p. 105). Any themes or codes which were
discovered over time were added to the researcher’s codebook kept in a Microsoft Excel
spreadsheet. At the end of the three weeks, any notes or observations useful were finalized onto
the codebook and any notes or information will be destroyed for confidentiality.
Finally, once the researcher has coded and separated the information from the interview
into themes, the researcher will move more into an axial coding where the goal is to
“strategically reassemble data” to help connect categories and subcategories for a more focused
understanding of the information (Saldaña, 2016, p. 244). The researcher used the same labels
from both the MBI (Emotional Exhaustion, Depersonalization, and Low Personal
Accomplishment) and the AWS (Workload, Control, Reward, Community, Fairness, and
Values), to be in alignment with the KMO influences of the study and the interview questions
which were chosen to help answer the research questions. In respects to axial coding, when
rearranging the information to answer the research questions, the contexts, consequences,

67
patterns of interaction, and causes are all considered in both the qualitative and quantitative
methods used (Bryman, 2016).
Credibility and Trustworthiness

Merriam and Tisdell (2013) mention in Qualitative Research: A Guide to Design and
Implementation, how the role of the researcher often has to navigate power dynamics, particular
when interacting with various levels of oppression such as race, sexual orientation, ableism,
religion, and gender. With this study examining TQNB PSCs providing care at a community
health center, the researcher wants to be mindful of the levels of power they hold. The Belmont
Report (1979), the document from the Department of Health, Education and Welfare stated in
their article Ethical Principles and Guidelines for the Protection of Human Subjects of Research
that particularly with whom they named a "vulnerable subjects" (p. 9). For this particular
population, this sentiment is also reflected in Meyers (2003) article when speaking to those who
experience minority stress, describing those people as experiencing "excess stress to which
individuals from stigmatized social categories are exposed as a result of their social, often a
minority, position" (p. 3). Within this study, it is important to be clear about how positionality in
society will influence the level of participation within this study, even for the researcher.
A part of this protection from a researcher's point of view is being honest about not only
what is being studied, but who is doing the studying. Making space for the researcher appraisal
of self is the research is called reflexivity (Berger, 2003). Berger names three ways the
proximity of the researcher can impact studies: have more access and sympathy due to the
researcher sharing the participants experience; the participants shaping the interaction between
the researcher and researchee, which affects the how information is fielded to participants, which
affects the findings and conclusions in the study. Probst and Berenson (2014) also define

68
reflexivity as awareness of the influence “the researcher has on what is being studied and,
simultaneously, of how the research process affects the researcher” (p. 814).
The researcher has come up with three strategies to use in order to find a balance between
the experience of the researcher and those participating in the study. Berger lists "use of a log,
repeated reviews and seeking peer consultation" (p.230). Ways the researcher can used aspects
which line up with Berger's guidelines is with a log, creating a system where the researcher
keeps it in three parts: what was said by the participants, an interpretation of what was said, and
how did the researcher feel in a month. In creating space within the study's analysis to include
the thoughts, process and perspective of the researcher mirrors, Berger's statement about
reflexivity by demonstrating "use of first-person language and provision of a detailed and
transparent report of decisions and their rationale'' (p. 222), and personal self-supervision
through diary or journal writing. Within this second strategy, the researcher will review the data
once a week over the course of three weeks. During the last week, the researcher will log in their
overall feelings of the project. The time-lapse allows taking the same material collected and
viewing it from a different perspective (Berger, 2013).
Lastly, the researcher will also utilize peer consultation to monitor thoughts and feelings
that come up during the study to get feedback. The purpose of engaging in this as a strategy is to
help discuss the process with the researcher’s chair and committee (if needed) as well as examine
and compare the tentative interpretation (Merriam & Tisdell, 2013). The strategy in processing
with this particular person is getting feedback about the information collected to help determine
what the researcher's feelings versus the experiences of the participants. It has also helped shape
the focus back on the overall goal of creating educational strategies and supports to improve

69
volunteer well-being and reduce the impact of burnout experienced by volunteers as they engage
in the work of the organization.
Validity and Reliability

To get more information about the study's validity and reliability, the Maslach Burnout
Toolkit's Manual: AWS + MBI 4
th
Edition contains an explanation about its reliability, validity
and scoring. There is also a review copy of the AWS and the MBI forms included in the
Toolkit
TM
. (Mind Garden, 2019). The researcher purchased the Toolkit
TM
and the scoring
software to help collect and analyze the data, as well as the license to distribute the study
amongst participants (Mind Garden, 2019). Within both surveys, there are statements about their
validity and reliability. For information about the overall MBI scales, the reliability is reported to
have exceeded the “recommended levels for research instruments” (Maslach et al., 2018, p.3).
The reliability estimates have differed according not only the statistical estimation methods for
calculation, but and will also differ according to the participants’ roles in an occupation. The
creators of the study recommend when publishing the results of the burnout research, the user of
the survey should also calculate and report the internal reliability estimates (Maslach et al.,
2018). The authors also press to give more weight to the Emotional Exhaustion scores since they
are the most reliable.
For the validity, convergent validity, or using other measures and observations as points
of comparison (Creswell & Creswell, 2018), was demonstrated in various ways such as
connecting scale scores and observations, reports of job conditions and personal attitudes
(Maslach et al., 2018). Maslach et al. also discusses the presence of discriminant validity, which
determines if other psychological constructs might be closing related to what the survey is trying
to study. For example, is there a way to determine if burnout, in this study, may possibly be

70
depression, anxiety, or even job satisfaction? Maslach et al. also names other studies and
research which helps determine the differences, but also highlights that the “differences between
the concepts of burnout and occupational stress help in identifying the values and potential
limitations of approaches to preventing or alleviating burnout” (p. 21, cited by Cox et al., 1993).
This continuous assessment between various factors which may contribute to the concept of
burnout allows for the survey to help draw what Creswell and Creswell describe as “meaningful
and useful inferences from scores on the instruments” (p. 153).
For the AWS survey, the test re-test correlations of the survey are seen as strong in
consistency, yet over time, leaves room for change (Leiter & Maslach, 2011). Leiter and
Maslach confirmed that the correlations between the AWS’s six scales, Workload, Control,
Reward, Community, Fairness and Values, and the responsiveness to the employees’ respective
qualities within the work setting were within the .51 and .62 correlation range. For validity,
“examining the correspondence of scores on the AWS measure with written comments provided
by participants in a hospital study” provides evidence of validity for this study (Leiter &
Maslach, 2011, p. 18).
Spinelli et al. (2016) state the MBI has been used widely, and its validity has been
exhibited through its use in various professions, including the healthcare sector. In order to
maintain confidence in the researcher’s sample, the researcher consciously made sure everyone
has an equitable opportunity to take the survey in favorable conditions that work well for them
through extensive inquiry. The researcher will also be looking for guidance from their chair, who
also happens to have extensive experience around burnout.
Ethics

As a mixed-methods researcher, the researcher is committed to using both qualitative and

71
quantitative methods to obtain information to understand the population's experience around
burnout further. To collect data, the researcher used a semi-structured approach to the qualitative
research. Maxwell (2013) stated that compared to a structured approach, which can be more
focused on comparing data explaining the differences between people, settings, time, and
researchers, the unstructured approach is centered on the particular phenomena and processes
which leads to specific outcomes. The researcher found this approach important since specific
outcomes on well-being and burnout are centered within this study.
When conducting this study, the researcher made efforts to ensure informed consent, that
participation was voluntary, and found ways to collect and store data properly. Though the
researcher’s connection to the organization and the participants are not the focus of the study,
according to Maxwell (2013) it is important to learn (p. 93, author’s emphasis) the perceptions
and purpose of the study to develop "useful and ethically appropriate relationships" (p.93)
between the two entities. To help initially bridge the gap and build initial rapport with the
participants, all participants were given written informed consent documents that discuss the
details of the study, including information about the researcher and their connection to the
organization. To help ensure those who do want to participate in the study can participate
without accessibility issues, the researcher had informed consent forms in English, but if another
language is needed, the researcher will work to have one interpreted for the participant. With
this study using a sensitive and vulnerable population due to oppression and discrimination
within the society, there have to be specific precautions to make sure those participating as being
treated fairly and by their own merit.
As a thank you for the participant's time, energy, and emotional labor, the researcher gave
a 50-dollar gift card to each PSC who commits to engaging in the process of the study. This can

72
also mean that even though the PSC does not complete the studies and the interviews, they will
still be compensated the full amount for their time, energy and emotional labor. The researcher
will be using their funds to compensate participants for the study, which admittedly creates a
power dynamic between the researcher and the participants. Since the researcher had asked for
the time and energy of the participants, especially within a population who can experience
serious discrimination and rejection, building rapport and compensating for one’s time allows a
more solid foundation for research. Finding ways to build rapport with the community as a
researcher is important as it is fair, ethical, and just to compensate the participants for their time.

73
Chapter: 4 Results and Findings

The purpose of this project is to use a mixed method approach to evaluate the degree to
which DCCH meets the organizational goal of implementing new educational strategies and
supports to improve volunteer well-being and reduce the impact of burnout experienced by
TQNB-identified volunteers by 2021. In order to gather evidence around the PSCs experience
with burnout with an emphasis on gender identity and minority stress, the following research
questions will guide the evaluation study:
Research Question (RQ) 1: To what degree are the PSCs experiencing burnout?
Research Question (RQ) 2: How is the knowledge and motivation of the volunteers
within the Peer Support Program related to the possible impact of burnout experienced by
volunteers?
Research Question (RQ) 3: What is the interaction between DCCH’s culture and context,
and the knowledge and motivation of the Peer Support volunteers?
Research Question (RQ) 4: From the perspective of the PSCs, what could the
organization do to improve support the PSCs from the symptoms of burnout?
In order to gather information which will answer the above questions, the following data
collection included the following:
● A demographic survey (Appendix A) completed by five participants in order to gather
information about gender identity, race and ethnicity, and length of involvement
within the Peer Support Program.
● Maslach Burnout Toolkit
TM
for Human Services which include both the Areas of
Worklife Survey (AWS; 2011) (28 questions) and the Maslach Burnout Inventory™

74
Human Services Survey (MBI-HSS; 1981), with (22 questions) completed by five
PSCs. All items are closed ended and multiple choice.
● In-depth unstructured interviews with five PSCs using 19 questions (Appendix E)
grounded in the KMO framework to assess the varied experiences of the PSCs.
● To analyze the data, the researcher used in vivo and emotion coding, as well as a
secondary analysis with axial coding process to analyze the information and place it
into themes based on the outcomes of the interviews. The researcher also kept
additional notes of thoughts and feelings through a weekly journal to round out the
qualitative data. For the quantitative data, the results will be calculated through the
Mind Garden Inc. Transform
TM
system, which administers the survey electronically
to participants.
The purpose of Chapter 4 is to examine the data collectively to analyze the outcomes and
other conclusions. The chapter will also include a discussion that uses the Clark and Estes
(2008) KMO framework to tie the analysis of the data to the research questions. This chapter
will also visually display data in the form of tables in order to complement the information, when
needed for clarity. In order to analyze the transcripts of the five participants, the researcher used
the process of coding and journaling above, as well as used direct quotes and vignettes from the
individual interviews used to emphasize key themes and connect to the KMO framework. The
qualitative and quantitative data collected by the researcher is used to answer the research
questions above.
Participating Stakeholders
The researcher interviewed five qualified participants for this study who completed the
demographics survey (Appendix A), the Maslach Burnout surveys and the semi-structured

75
interview (Appendix E). Both the demographic surveys and the semi-structured interviews were
constructed by the researcher. There is a demographic survey that is included with the Maslach
Burnout Toolkit
TM
, but it is not specific enough around gender or sexual orientation. For
example, the survey asked the participants whether they are male or female. This does not
reflect the studies requirement of collecting information from these identifying as trans, queer or
non-binary. The researcher instead will use the one constructed by themselves. The information
from the Maslach demographic survey has not been used in this study.
First, in terms of racial demographics, three out of the five participants identify as
African-American/Black, as opposed to the other two participants who identified as
Caucasian/White. All participants identified as Non-Hispanic/Latino. None of participants
identified as deaf, hard of hearing, or expressed having any needs pertaining to accessibility. All
participants' first language is English. The participants ranged most in when it came to age, with
one person between the age of 22-25, one between 26-30, one between 31-35, and two who were
both 36-40. The participants were surveyed about their years of participation as a PSC within
the program as a volunteer and as a participant. In response to “How many years have you served
as a Peer Counselor?”, one person responded 1-2 years, the most respondents (three) at 2-4 years,
and one person responded 4-6 years. When asked how many years did the participants
participate in the program themselves, three respondents had never participated as a participant
as opposed to two people who were in the program between 1-2 years.
In terms of the group’s sexual orientation and gender identity, they also ranged, but
mostly due to the identities each person chose for themselves in the categories. Pertaining to
sexual orientation, one person identified as “Bisexual”, two “Straight/Heterosexual”, one person
“Queer”, one person a “Bisexual Queer”, and another person “Gay and Pansexual”. For gender

76
identity, three identified as trans men, one genderqueer and/or non-binary person, and another
trans man who also identifies as “gender queer and nonbinary”. Despite the variation, they all
still qualified for the study.
Focus on Trans Identities on a Masculine Spectrum
The five participants who were surveyed and interviewed for this study all identified
somewhere along the trans masculine spectrum. Trans masculine is defined as those who are
assigned female at birth, yet the person’s gender identity and/or gender expression is perceived,
lived, and or experienced as masculine (but not as a male as related to sex) (Gillespie, 2020). It
is also important to note that most of the groups being discussed by the study’s participants are
focused mostly on groups of people who either identify on the transgender spectrum (which
includes those who also identify as trans feminine and non-binary) or groups who just identify as
trans masculine. Out of respect for the participants, this study will not make assumptions or
inquire about how they were assigned at birth in terms of the sex of the participants, and will
focus on how they are showing up in their communities, families, work, themselves and their
groups: as queer, non-binary and straight trans masculine identified people. Most of the people
within this group do not identify with the binary of being seen as a man or a woman, and are
comfortable being genderqueer or non-binary. The information collected about the participants’
gender pronouns was used to help appropriately refer to the participants when addressing them
within the interviews. Yet all pronouns within this study will use “they/them/theirs” as a gender-
neutral alternative to respect the identity of the participants.
Quantitative Surveys
After the PSCs completed the Demographic Survey and agreed to participate in the study,
the participant’s email information was placed into the Mind Garden’s Transform
TM
system in

77
order for the participant to complete the two main surveys. The PSCs experience with burnout
within the peer support program was assessed using the Maslach Burnout Toolkit
TM
for Human
Services which include both the Areas of Worklife Survey (2011) with 28 questions and the
Maslach Burnout Inventory™ Human Services Survey (1981), with 22 questions. The
information for these two surveys was processed through Mind Garden Inc.’s Transform
TM

Survey Data Hosting system, in which the researcher purchased to analyze statistical data and its
recommendations based on the average scores for the participants as a whole. The researcher
also purchased the individual and group reports which reported the results with scale and mean
scores and standard deviation, as well as recommendations from the authors to help lessen
burnout in their workplaces. This researcher is only focusing on the group report in order to
understand how collectively the PSC team is affected by burnout and the level of care by the
organization, not how that looks per individual.
It is important to note that this study will report the above findings, but will be limited in
reporting certain information from the surveys themselves due to the author’s (Leiter et al., 2018)
concern of losing integrity of the study through replication in publication. The researcher will
report the findings in respect of the information that is relevant to the study and answering the
research questions.
In the Table 5 below, the researcher has added the data results of the surveys. At the end
of each category, the researcher will use the information presented to answer the first research
question.
Table 5
Quantitative Results
MBI and AWS Categories Sample Survey Question
from MBI or AWS
Study Group Scale and
Standard Deviation Score

78
Emotional Exhaustion (MBI)

*I feel emotionally drained
from my work.

Average Scale Score
(SS): 2
Standard Deviation (SD):
1.1
Depersonalization (MBI)

*I don’t really care what
happens to some recipients.

SS: 0.9
SD: 0.9
Personal Accomplishment
(MBI)

*I have accomplished many
worthwhile things in this
job.

SS: 4.3
SD: 1.1
Workload and Community
(AWS)

**Workload: I do not have
time to do the work that
must be done.

**Community: Members
of my work group
communicate openly.

Workload:
SS: 3.6
SD: 0.2
Community:
SS: 3.5
SD: 0.5
Control (AWS)

**I have control over how
I do my work.

SS: 3.4
SD: 0.7
Reward (AWS)

**I receive recognition
from others for my work.

SS: 4
SD: 0.2

Fairness and Values (AWS)

**Fairness: Resources are
allocated fairly here.

**Values: My values and
the Organization’s values
are alike.

Fairness:
SS: 3.1
SD: 0.4

Values:
SS: 3.7
SD: 0.5
Note. The sample questions within the Table are the sample questions permitted by the authors
of the surveys to be repeated for dissertation use. These sample questions are added to the table
for reference of what information was asked during the survey process. The authors request for

79
those who use the sample questions within their study, to also add the copyright information
below, indicated by the asterisk (*):
*Copyright ©1981 Christina Maslach & Susan E. Jackson. All rights reserved in all media.
Published by Mind Garden, Inc., www.mindgarden.com
** Copyright © 2000, 2011 Michael P. Leiter & Christina Maslach. All rights reserved in all
media. Published by Mind Garden, Inc., www.mindgarden.com
Research Question 1: To what degree are the PSCs experiencing burnout?

Maslach Burnout Inventory™ Human Services Survey (MBI-HSS; 1981) Results

The first research question examines to which degree the PSCs experience burnout within
the peer support program using the quantitative data collected. The MBI-HSS centers on the
three scales of burnout which are based on its definition: emotional exhaustion,
depersonalization, and low personal accomplishment. Each scale is scored on a seven-point
scale: 0-Never; 1- A few times a year or less; 2-once a month or less; 3- a few times a month; 4-
once a week; 5-a few times a week; and 6-every day. The overall group report compares this
study’s five participants to a sample of the “general population of 11,000+ people in human
services professions” for comparison (Leiter et al., 2018). For the MBI-HSS, the Transform
TM

system had also calculated the standard deviation for the scores, which according to Bryman
(2016) is the “average amount of variation around the mean” (p.338). Within this study, “the
smaller the standard deviation, the higher the agreement among group members” (Leiter et al.,
2018).
MBI-HSS’s (1981) Emotional Exhaustion
Emotional Exhaustion is defined by the study’s authors as “feeling overwhelmed,
stressed, and weary; the demands of the job feel far greater than one is able to give” (Leiter et al.,

80
2018, p. 4). If the study is able to show any elevated level of emotional exhaustion for the group
and how they can be related, then it is the possible to show the impact of burnout experienced by
volunteers. For the average MBI scale scores within this section, the Transform
TM
generated
report states that in comparison to the general population, the study’s group scored a 2 (“once a
month or less”) compared to the general population’s 2.3 for emotional exhaustion. When
looking at the mean of the group’s scores within this section, the highest score was 2.6 on an
item which was questioning the level of intensity of how much the person is working. The lowest
collective mean score, 0.6, which is between “never’ and “a few times a year or less”, refers to if
the person is nearing the end of their patience. With emotional exhaustion, the study’s group
stood at 1.1, which was slighter lower than the general population at 1.2 when it came to
standard deviation. Though the sample size of the group is relatively small, compared to the
general population, both groups were similar in the level of agreement among group members.
MBI-HSS’s (1981) Depersonalization
With Depersonalization, which is defined by the study as the loss of enthusiasm or lack
of a personal response to another person’s care, the group’s standard deviation was in more
agreement at 0.9 compared to the general population’s 1.2 (Leiter et al., 2018). The general
population average scale scores higher than the study group with 1.7 to 0.9. When asked about
whether the job was making the person emotionally stifled, the score was 1.4, which was highest
in the category. The lowest was the participants scoring 0 when asked did they treat those they
were serving, not as people, but within detached relationships. The participants all agreed that
this is not the experience they share amongst each of them.

81
MBI-HSS’s (1981) Personal Accomplishment
Finally, with Personal accomplishment, the group’s standard deviation raised slightly
higher than the general population, 1.1 compared to 0.9. With the average scale scores of
personal accomplishment, the group and the general population scored the same with 4.3. The
highest score of the group was a 5 (“a few times a week”) to the item which questions the
participants’ ability to handle any issues raised by those they are working with. The lowest score
of the group, which lands at a 3, more refers to how easy an emotional connection is with the
members of the groups they lead. This section has some of the highest scores, reflecting the
importance of feeling a personal accomplishment to the work.
Areas of Worklife Survey (AWS; 2011) Results
The AWS (2011), is used to determine the relationship of the person within their
organizational context. Leiter et al. (2018) stated that in order to address burnout within an
organization, one must tackle the organizational problems which are burnout’s root causes. Once
the six key areas, workload, control, reward, community, fairness, and values, are assessed to
understand the fit between the individual and the organization to which they work, the study is
able to point out any mismatches, or “lack of fit”, between the two (Leiter et al., 2018, p. 5). The
survey has a five-point Likert scale as follows: 1-strongly disagree, 2-disagree, 3-hard to decide,
4-agree, and 5-strongly agree. The study says within the average scale scores, if someone scores
a 2 or less, then it means the participants and the organization are a mismatch, and that area
needs to be considered as a possible source of burnout.
The AWS (2011) survey collected an average scale score for each of the six areas,
comparing them to what the study deems as the general population of “22,000+ people across a
diversity of occupations” (Leiter et al., 2018, p. 8), and not just healthcare workers like the MBI-

82
HSS. Overall, the study’s group of participants scored higher than the general population in
every area, (hough it is noted that the number of surveyed participants is significantly less.
Overall, the study’s group scored closest in agreement within all areas over the general
population.
AWS’ (2011) Workload
First, for Workload, which speaks to the amount of work which has to be done in a
specific amount of time, the study’s group scored in the average scale as a 3.6, compared to the
general population’s 3 (Leiter et al., 2018). The Transform
TM
system also calculated the
standard deviations within the two groups. Leiter et al. (2018) explains that the smaller the score
is with standard deviation, the higher the agreement is among the group members who had taken
the survey. For Workload, the study’s group scored a 0.2 over the general population’s 0.8.
In terms of quantitative data, the study does provide the average scores per each AWS
item. First for Workload, the group scored the highest (4, “Agree”) when asked when tasks are
important at their job, did they have enough time to complete the items. On the other hand, the
lowest score was a 3.4 (on a reversal scale) pertaining to having to work long periods of time at
an intense. With this score, some of the questions were structured on a reversal scale (high-to-
low), which means high scores for these questions signal a mismatch between the participant and
employer. Here, a 3.4 is still average, and does not indicate a significant mismatch.
AWS’ (2011) Community
Next with Community, or the “quality of the organization’s social environment and the
positive connection between coworkers”, 0.5 was scored by the study’s group over the general
population’s 0.8 in standard deviation (Leiter et al., 2018). The group scored a 3.5 over the
general population’s 3.4 pertaining to average scale scores recorded. For the Community scores

83
amongst the study’s group, the highest within this section is a 4, where the group felt as if they
were able to get along collectively, and on a 2.8 reversal scale, the participants felt as if they
were not close to those they worked with. Though the difference in the two items still does not
show a large mismatch between the organization and the participants, it is still important to note
there is a gap between the two scores.
AWS’ (2011) Control
Control within this study is defined by the level of opportunity within a job where a
person has the ability to make decisions and solve problems (Leiter et al., 2018). It was reported
the group scored a 3.4, and the general population a 3.3 overall, with the group scoring a 0.7 over
the general population’s 0.9 when speaking about standard deviation. The lowest scores were
pertaining to whether or not they have influence in any decision-making at the organization (2.8).
The highest, 3.8, did validate having a level of autonomy within the work they are involved in.
AWS’ (2011) Reward
A reward is a “financial and social recognition for contributions on the job” (Leiter et al.,
2018). This shows the person working the job that the organization recognizes their work and
reflects the value that it adds (Leiter et al., 2018). In the area of Rewards, the study group’s scale
score was a 4, compared to the general population’s 3.2, which is the study’s biggest gap. The
study group also scored a 0.2 compared to the general population’s 0.9 in standard deviation.
When speaking about Rewards, this section is where the participants scored the highest overall
when noting they felt appreciation for their work in the organization, 4.4. This was in opposition
from their lowest score on the reversal scale (2.2) when referring to not getting recognized for
the things they contribute to the organization.

84
AWS’ (2011) Fairness
Next, with Fairness, where rules are consistent, equitable, and applied to everyone, as
well as resources are allocated in a similar manner, the study’s group scored a 3.1, while the
general population at 2.8 in average scale scores (Leiter et al., 2018). In Fairness, the perspective
around how resources are given to each participant was a score of 3.6, compared to on a reversal
scale, 3.4 when speaking to how relationships affect how far you get ahead in the organization.
On the 5-point Likert scale, the scores ranged from a 3 to a 3.6, which on average means “Hard
to Decide”. This indicates there was a level of uncertainty in whether this comes up in the
organization amongst the PSCs.
AWS’ (2011) Values
With Values (the aspect that is most important to both the individual and organization),
the group stood at a 3.7 over the general population’s 3.2 average scale score (Leiter et al.,
2018). With standard deviation, the study’s group is on top with 0.5 compared to general
population’s 0.8. Finally, within the section about Values, the lowest score is a 3.4 when
referring to whether or not career goals of the participants are in alignment with the
organization’s goals. For the highest score, a 4, the participants agreed that the organization does
reach and commit to its quality of work.
Summary
In using the quantitative information above from both surveys, the researcher is able to
confidently answer the first research question to what degree does burnout affect the PSCs in the
peer support program. For emotional exhaustion in the MBI-HSS study, for the overall group,
the group members have collectively experienced emotional exhaustion (or burnout symptoms)
at least once a month, yet this outcome does not raise flags in the participants’ ability to manage

85
emotional exhaustion. On the other hand, it does help note that there are thoughts around how
hard a person is working in their position, which may lend some feelings of being overwhelmed
(also a symptom of burnout). When it comes to considering how hard a person is working and
how it impacts burnout, Freudenberger (1986) places emphasis that those staff members who
have tendencies to work beyond their limit and has “the proclivity to allow oneself to be used up
at one’s own expense” are in danger of burning out in their position (p. 250). This information
allows the researcher to understand though a PSCs experiences burnout at least once a month, it
gives the organization an idea of how often support should be offered to the PSCs in order to
help alleviate symptoms of burnout.
Based on the scores within Depersonalization, it seems the study participants do care
about the work they do within the peer support program, and care about the well-being of the
participants. Knowing how care for the program and for the participants overall well-being is
beneficial, the organization can invest in restoring and repairing these relationships. Although
emotional exhaustion and depersonalization are low on the overall MBI scale, having a high
score within Personal Accomplishment helps lessen the presence of burnout. The report states
“higher emotional exhaustion and depersonalization contribute to burnout, while higher Personal
Accomplishment reduces burnout” (Leiter et al., 2018, p.6). Freudenberger (1986) speaks about
how a part of the experience of burnout is having a sense of dedication or commitment to a job.
For this group of participants, it can be inferred that their feelings of pride around their work
allows for burnout to remain low.
Between the highest and lowest scores within the Workload section within the AWS’s
(2011) survey, there is a relationship between the time given by the organization to complete
tasks and how much time is taken during these opportunities. The highest score in the study

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pertaining to having enough time to complete important tasks does have an overall agreement by
the group (“4”), yet, the group also states that working for long periods of time also contribute to
possible instances of burnout. With AWS’s (2011) Community scores, again, though there is a
gap between if the group gets along or feel close, there is a high probability that the overall
feeling of the group is that there is a community to help support the PSCs confidence in their
work.
For Control, even though the participants may not feel as if they have full autonomy over
making decisions within the organization per the study, they do feel as if they have the ability to
create that autonomy within the work they are committed to in leading groups. Understanding
why certain events happen gives us more information so we can either repeat, or eliminate the
behavior for improved outcomes. The PSCs who are committed to their work would want to
make the best choices for their group based on their ability and past experiences. As with having
a high Personal Accomplishment score from the MBI-HSS, the high score for Rewards within
the AWS are parallel. This is the part of the study which seems to be keeping the participants
afloat. The more the participants feel as though they are receiving praise or recognition for their
work, there is a less occurrence of burnout amongst the workers.
Fairness scores show that there is a level of uncertainty in whether this comes up in the
organization but not specific enough to glean what that means in terms of what the organization
needs to do amongst the PSCs. Finally, with values more information about whether the PSCs
career goals align with the goals of the organization, or even its mission, but the study does
understand that the PSCs are committed to the quality of work the organization does.

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Overall, the quantitative portion of this study showed that to a degree, the participants do
experience symptoms of burnout in their organization, yet to be a bit clearer on where the
burnout occurs, the narration from the semi-structured qualitative study will support the gaps in
knowledge to help address the research questions and the overall organizational goal in
addressing burnout.
Knowledge, Motivation and Organizational Findings

Table 6 below gives an example of the initial in vivo and emotion coding process,
showing in one column the categories created from the list of repeated codes and emotions used
throughout all five interviews.
Table 6
In Vivo and Emotion Coding
Categories In Vivo and Emotion Codes

Sources of Burnout

schedule
online
COVID-19/Coronavirus
time
Introvert
Zoom/”Zoomed”

Self-Identified Feelings of Burnout “Feelings of Dread”
“don’t want to be there”
mental
physical
emotional
Stress/excess stress/Stressors
Repetitive
losing interest/bored
overwhelm/overwhelmed
apathy
disinterest
depression
anxiety

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fatigued
losing enthusiasm
anxiety
Dread

Relating to Study's Definition of Burnout
overwhelmed
depleted
job
prove
oneself
committed
headaches
somatic symptoms
irritation
crying
depression
Anxiety

Perceptions of Success

verbal praise
perceived growth of participant by
PSC
connecting
impacting
helping
listening
welcoming
asking questions
connecting
supportive
leading
mutual
Empathetic

Perception of Failure

participants not returning to group
lack of participants

Experienced Minority Stress

misgendering
white people
black people
intersections/intersection/intersectionality
race

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gender
trans
trans masculine
PTSD
discrimination
tension
negative
anticipation
frustration
microaggressions
being outted
prejudice
fear
bathrooms
dead name
acceptance (lack of)
race justice

Peer Support Identity

transgender
trans
non-binary
trans feminine
Peer support specialist/counselor
peer support counselor
counselor
group
leader
male
female
Genderqueer

Perceived Participants Responses to Service
grateful
frustration
thankful
trust
Open

Co-Facilitator
helpful
Frustrating

Other
obligation
self-care

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responsibility
helping
facilitating
aware

After coding and creating themes for after reviewing all interviews and notes, below
Table 7 shows the KMO influences, aligned interview questions and categories in reflection of
the MBI and AWS surveys reflecting the foundations of burnout along with the six key areas to
help access between employees and the organization before the themes of the interviews were
created.
Table 7
MBI, AWS, and KMO Categories, Interview Questions, Themes and Codes
MBI, AWS and
KMO
Categories/Themes
Interview Questions and Codes
Theme (MBI):
Emotional
Exhaustion

Knowledge
Influences
Factual: PSC need
knowledge about
the symptoms of
burnout

Interview Questions:
Based on your knowledge and understanding, how would you define
burnout?
How does your definition of burnout differ, or relate to, the study’s
definition of burnout?
As a PSC, how have you experienced burnout in your PS work?

Codes:
Symptoms of Burnout
Freudenberger’s Definition
Transition from In-person to Online Experience
Theme (MBI):
Depersonalization

Knowledge
Influences
Conceptual: PSCs
need knowledge of
how aspects of
minority stress
Interview Questions:

As a Trans, Queer, and Non-binary person, what social stressor do
you experience in your everyday life?
How does this definition of minority stress relate to your experience
as a TQNB-identified PSC?
As a Trans, Queer, and/or Non-binary person, what are aspects of PS
can be difficult, emotionally, behaviorally, or mentally?

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around a TQNB-
identity may
influence burnout.

As a Trans, Gender Non-conforming and/or Non-binary person, what
are aspects of Peer Support can be rewarding, emotionally,
behaviorally, or mentally?

Codes:
Being Misgendered
Being Outed
Community Acceptance
Intersectionality
Low Personal
Accomplishment
(MBI)

Knowledge
Influence
Metacognitive:
PSCs need
knowledge about
one’s thinking
about burnout
symptoms and their
experience as a
PSC.
Interview Questions:
What is at least one experience you have had in an individual or group
session, in which you have experienced symptoms related to burnout?
In looking back at that moment, how aware were you of how burnout
was showing up in your work as a PSC?
Within that experience, is there something you would have done
differently, or changed to eliminate the experience of burnout (within
your control)?

Codes:
Responsibility of Outcome
Boundaries

(AWS) Community
and Workload

Motivational
Influences
Self-Efficacy: PSCs
believe they have
the ability to
support their
clients.
Interview Question:
What is at least one way, within your position as a PC, that you
support clients?

Codes:
Affirmation around Identity
Successes
Desire to Build Community
Co-Facilitator
PSC Self-Disclosure
Control (AWS)

Motivational
Influences
Attribution Theory:
PSCs believe their
successes and
failures, as it relates
to their peer support
Interview Questions:
Within your work as a PSC, can you name a time where you felt as if
you “failed” in your ability to help someone, in an individual or group
setting?
In that situation, how much control did you feel you had over the
outcome?
Within your support, can you name a time where you felt as if you
“succeeded” in your ability to help someone, in an individual or group
setting?

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duties, are within
their control.

In that situation, how much control did you feel you had over the
outcome?

Codes:
Failures
Obligation and Duty to Participants
PSCs’ Relationship to Control
(AWS): Reward

Organizational
Influences
Cultural Model
Influence -
Availability for
Affirming Health
and Wellness Care:
The organizational
climate promotes a
culture of affirming
health and wellness
care for the
volunteers.
Interview Question:
What services are offered through the organization to help support
Peer Support Counselors around self-care, and/or affirming your
health and wellness?

Codes:
Individualized Check-ins
Groups Support Sessions
Tangible and Intangible Rewards
Continuing Education
Creating Sustainable Connections with one another

Fairness and Values
(AWS)

Organizational
Influences
Cultural Setting
Influence -
Acknowledging
Wellness for PSCs:
The organizational
setting exhibits
support and care for
burnout.
Interview Questions:
What information was given to you from the organization about
burnout?
As a PSC, what resources were you given when starting the program
that pertained to mental health, wellness and self-care?
As a TQNB-identified person who is a PSC for this organization,
what are some ways you would like to see the organization support
your work in order to help prevent symptoms of burnout?

Codes:
Lack of Control around Scheduling
Formulating Groups by Identity

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Research Question 2: How is the knowledge and motivation of the volunteers within the
Peer Support Program related to the possible impact of burnout experienced by
volunteers?

Knowledge Results
Theme 1: Emotional Exhaustion and Factual Knowledge: “Overwhelmed and Depleted”.
Code: Symptoms of Burnout. The first code within the Emotional Exhaustion theme is
“symptoms of burnout”. When the participants were asked about how they define symptoms of
burnout, all spoke about the affect burnout can have on someone emotionally, physically, and
mentally. “Exhaustion” was a common word expressed throughout the interviews, as well as
apathy and disinterest, relating burnout as the feeling of being held back in the ability to
complete and perform a task at 100%. One participant is quoted describing burnout as “it’s
fatigue, it’s losing enthusiasm, which results in not fully committing to whatever you’re trying to
do or supposed to do.” Even though they were able to contribute to naming symptoms of
burnout, there was one participant who did not experience burnout within their peer support
work.
Code: Freudenberger’s (1974) Definition. Freudenberger’s (1974) definition of
burnout was used as a grounding for the study and read aloud to the participants to compare their
definitions with Freudenberger. Even though some participants could not relate to all of the
symptoms, all of the participants agreed with the definition of burnout from also stating that the
words “overwhelmed and depleted” really do resonate with their own experiences as PSC. One
participant reflected burnout as something that affects their ability to feel a level of empathy for
other people: “The burnout comes in this emotional struggle of feeling like I need to be
compassionate and I want to be compassionate, and it’s not very fair to feel like I don’t care
about what these people are saying sometimes.”

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Code: Transition from In-person to Online Experience. Over the course of the year
2020, due to COVID-19 regulations, there have been transitions of the groups from in-person to
online, per the regulations of the healthcare center. The issue is, so has the rest of the world.
People are also working from home and online all day, so energy usually expended within a
group setting, it all centered in one place. One participant describes the experience of trying to
manage the balance between work and online peer support:
Yeah, I haven't been a peer support counselor for too long. However there's days where
I'm working longer hours. Even though the majority of the sessions are now all online, it
is difficult coming back and getting all set up for the meeting, and then you've been
Zoom calls all day and then having an hour and a half Zoom at the very end of your day.
You want to make sure it's a positive, welcoming environment so sometimes I need to
take a few minutes to just reset and refocus my day, the energy that I've accumulated
throughout the day, and then start the meeting. So I need to save extra time and
sometimes that time isn't always there.
The change in treatment modality as a source of stress for the PSCs, which can add
another layer of dread to the experience for the PSC. If participants also have increased online
responsibility outside of the peer support space, then it can add to the level of emotional
exhaustion experienced by the PSC. One participant spoke about having trouble keeping a group
in conversation because “just because I think everyone else was experiencing burnout honestly”.
The study participant did not feel as though they were able to continue to effectively hold the
meeting after a 12 hour work day, so they ended the session 15 minutes early so they “could re-
focus [their] energy”. Overall, it is helpful for the PSCs to know what the symptoms of burnout

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so they are able to be aware of them when they show up emotionally, mentally or physically, and
they can be attended to before the symptoms affect their quality of work and PSC’s well-being.
Theme 2: Depersonalization and Conceptual Knowledge: “Am I going to be misgendered
today?”
Depersonalization and the conceptual knowledge of the study are connected within this
section due to the nature of how the PSC is related to based on their identity, to themselves and
within their work. Depersonalization within the study is defined as an “unfeeling and impersonal
response” toward others, where trying to stay engaged in interaction in their positions is a
hardship (Leiter et al., 2018). With the conceptual knowledge of the study, we are examining an
identity that is considered marginalized and experienced out in society, what is deemed as
minority stress (Meyer, 2003). The study would like to find out what knowledge PSCs need to
gain to recognize how aspects of minority stress around their TQNB-identity may influence
burnout, which has the ability for the person to feel disconnected within their work. These
following codes are reflective of the ongoing discrimination and oppression which can show up
in not only in the work of PSCs but in everyday life as well.
Code: Being Misgendered (and Dead-named). One of the main stressors that the PSCs
named in their everyday lives as people who identify as transgender, queer, or non-binary is
being misgendered. This stressor can extend from common spaces like the grocery store, or with
documents such as a birth certificate, to important places to one’s health such as the hospital or
doctor’s office. One person named being dead-named (being referred to as someone’s given
name at birth, which does not include the consent from the person as opposed to referring to
them with their chosen name) as being a huge source of stress for them. Participants often
wonder if they are going to be accepted in their community or general society at large.

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The negative experience around healthcare was the number one response from
participants, more interestingly, being rejected from a healthcare setting was always a threat,
whether the discrimination was outwardly or not. Either way, to the study participants, since
transphobia is institutional, it is always felt by them in any setting. One participant even stated
that they will avoid or postpone doctor’s appointments and sit through the pain to avoid being
misgendered. The participant stated, “I’d rather just experience the physical pain than mental
pain of not being recognized for who I am in society”.
Code: Being Outed. Another everyday fear that participants experience is the fear of
being outted, or that someone will reveal that the person is transgender against their will. This
fear ranged amongst the group whether or not people were newly in the process of their medical
or social transition, to people who have been transitioning for years and have been assumed
cisgender previously. When considering a transgender person’s physical appearance, generally
the person can experience transphobia and trans prejudice, especially through objectification and
pathologizing (Singh et al., 2011). This experiencing of “othering” through inappropriate
inquiries about their identity against their consent perpetuates the idea that transgender people
are not “legitimate and valued members of society” (Singh et al., 2011, p. 21). The participant
speaks of the fear of having to mask themselves in society: “A sense of having to hide. The sense
of potentially being found out, of people thinking that you're a liar or something to that effect.
That is the deepest, emotional, social stressor that I personally feel”.
An example of this fear playing out in everyday life issues around using public restrooms
came up in conversation amongst some of the participants. One participant reflects on the stress
of having to experience the dread of being discriminated again, and how peer support assists in
supporting that individual, even if they are the leader of the group:

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…That's compounded with the bathroom, it's compounded with the dead name and
actually I'm in the process of applying for a mortgage, so my dead name actually came
up. Peer support is a good way to talk about it, but it's also a reminder that, hey, these
stressors still can come up and are still present and they will be present throughout our
entire lives. So, it's a really nice space to just be able to talk about it…”.
Code: Community Acceptance of Identity Support. A positive aspect that is shared
with most of the participants is that there is a level of community acceptance around the PSCs
identity (being along the trans spectrum). One participant recalls because the group they were
leading all shared the same experience as a part of being TQNB, the PSC did not feel as if their
identity caused any stress while being in the group. The PSCs appreciated it being a space where
there is a source of support for them as well, even though it is intended to center the group
participants who join. This experience around community acceptance and support will come up
more when speaking about the PSCs successes within the peer support space.
Code: Intersectionality. Though this study is only focusing on TQNB-identities as the
marginalized identity affected by minority stress, it still does not isolate the human experience of
having multiple identities at once which could be affected by minority stress as well. This
concept is called intersectionality, an analytic tool and theoretical framework rooted in Black
Feminism and Critical Race Theory created by Kimberlé Williams Crenshaw initially used to
center the experiences of Black women and how their race and gender increases vulnerability
within the society to which they live (Carbado et al., 2013). Intersectionality is a “complex,
cumulative way in which the effects of multiple forms of discrimination combine, overlap, or
intersect especially in the experiences of marginalized individuals or groups” (Merriam-Webster,
2020). Though the focus on this topic is usually surrounding race, the results from the

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participants will also speak how intersectionality comes up around gender presentation, and
amount of time someone is medically and/or socially transitioning as a trans or non-binary
person. This shows that intersectionality does not just fix upon one social position, but can be
inclusive of other perspectives and identities as well (Carbado et al., 2013).
First, in thinking about participants within the study who identified as Black, name that
their racial identity matters when considering minority stress because their race and their gender
identity cannot be separated. One participant responds ,“and for me, of course, I come to this
gender-based kind of exploration peer support group with lots of thoughts around my gender
identity, but I can’t divorce those feelings and thoughts from my race”. Conversation about racial
identities and societal tensions have been coming up more due to the recent 2020 Racial
Uprisings/The Great Awakening and the desecration of capitalistic societal institutions due to the
pandemic is COVID-19.
This experience of race coming up within group sessions came up for study participants
from both racial backgrounds (Black and white). One instance for a Black participant had
mentioned the experience of tokenism. Tokenism is the experience when a dominant group
portrays a single person from a minority group or identity as representation for that person’s
entire identity group (Gillespie, 2020). For this one participant, realizing that there are not a lot
of Black trans masculine PSCs within the organization, or just participating in the groups in
general, makes the PSC feel as though the subject of race falls into the background when talking
about a shared experience around being TQNB. The feeling of not having a place to confidently
have these feelings recognized has been expressed as “disconnectedness”, which can affects the
PSCs ability (particularly one of a racialized minority group in this case) to feel a part of the
group if they cannot carry their whole self to their group.

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A disconnect that also shows up amongst the interviewees is the divide between the
masculine and feminine, or the varied experience around gender expression and identity. Many
of the PSCs identified along the queer and trans masculine spectrum, and the groups they would
mainly run are for people along the trans spectrum, which include trans feminine people. If the
PSC did not share a particular identity around their transness in the group, this was also a place
where study participants would ‘step back’, and allow space for that person’s story. A participant
also stated this experience of moving back in the conversation did make them feel as if they had
less to offer within the group, with hopes that the person participating is still able to get the
support and community they need. One participant felt stifled in being able to speak about their
experiences as a genderqueer person who was also Black. In a space where people didn’t look
like them, the person felt the need to step back in order to blend in with the group. This in turn
made the person feel as if they could not bring their full self, which made them feel as if they
could not be as much as a support as they would have liked. This experience can also be
connected to feeling as if the purpose of the group has failed if the PSC does not feel they were
able to provide a safe enough space to those participating.
Finally, another aspect of identity that this brings up is how the time in transition can
affect the PSCs ability to connect with their group participants. One study participant mentioned
how difficult it was to connect with some of the group members because they had been
transitioning for over 10 years and many people in the group were just starting out their medical
and/or social transition. The participant has learned to have space for those who are newly
transitioning, but it can be difficult. This experience will be spoke more about in depth when
referring to how PSCs feel like they have failed their participant members.

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Theme 3: Low Personal Accomplishment and Metacognitive Knowledge: “It's my
responsibility to really hold space for them, to work through that, while I also have to work
through that myself.”
Next for this section, the researcher added both elements from the MBI (Low Personal
Accomplishment). This is in reflection of the study’s metacognitive influence within the study,
which states PSCs need knowledge about one’s thinking about burnout symptoms and their
experience as a PSC. Reflecting on one’s experience of low personal accomplishment will allow
the PSC to think about why there was a negative experience, and what is a way to prevent it from
happening next time. The two codes selected for this section of the study based on the
participant’s answer are Responsibility of Outcome and Boundaries.
Code: Responsibility of Outcome. The metacognitive influence of this study looks like
the participants reflecting on their personal experiences of burnout, and also considering the
effects it has on other people outside of themselves as well. This experience can show up as
conflicting feelings: wanting to be a part of the group experience, but also feeling the dread in
being there as well. When one participant was asked about how burnout was showing up in their
work, the participant spoke about their feeling of dread that would appear before they held their
group, even though they looked forward to spending time with the participants. “But feeling like
I didn’t want to be there, definitely isn’t how I wanted to feel, but I associate that with burnout”.
On other hand, when asked why they did not ask for help from the Peer Support Supervisory
Team when they were experiences symptoms of burnout (Within that experience, is there
something you would have done differently, or changed to eliminate the experience of burnout
(within your control)?), the participant responded, “…I really did want to be doing the work
because I do enjoy the work, even if, sometimes, it feels a little burdensome.” A part of being

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able to think metacognitively about information is being able to hold both the negative and
positive aspects, and using that information to make the best decision for the best outcome.
For issues around race and the tension it can bring up for people who identify as Black,
one participant said they could have asked for space explicitly if they needed to in the moment,
especially being in an environment which they deemed supportive and empathetic, but the person
still chose not to take up space and remained quiet. When another participant was asked how
they could have changed an outcome on a moment they experienced symptoms of burnout, the
participant reflected that even though they felt like they were supported in the space by the
group, they also chose to remain quiet.
Code: Boundaries. PSCs acknowledged their experience of experiencing burnout
symptoms and thinking about where it occurs within their peer support work, the next step was
to think about the best outcome if the situation comes up again. Another code that taken from
the interview answers is “Boundaries”, emphasizing the PSCs need to find distance in their
interactions with the group participants so they are able to be knowledgeable about how
symptoms of burnout show up in their work in order to make decisions about if and how they
need assistance. One participant speaks about trying to find balance between trying to provide
what the participants need, and how to also provide that space for themselves:
Definitely in the way of feeling I don't have enough mental and emotional space for
myself, then go and go into this space and try to help some else. Trying to be cognizant
and aware of my own emotional, and sometimes physical wellbeing, while really wanting
to be able to offer to hold space, and to create welcome and safe space for people who are
also experiencing those same symptoms.

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This can be related to the previous discussion about transference and countertransference,
where in clinical terms, the patient and the clinician are able to reflect on parts of who each other
is in ways that are not always direct. The PSCs are often using themselves as a resource, which
causes one of the challenges of, by one participant, “not getting too personal or emotionally
invested. Because there is or has been less available resources for transfolk to get information.
So we’re creating our own internal squishiness. That can complicate boundaries.” Being mindful
about how to institute boundaries and being knowledge about the outcomes and the effects on
the self are all helpful information in learning about the effects of burnout within peer support.
Motivational Qualitative Results
Theme 4: AWS’ Community and Workload, and Self Efficacy Theory
Within the motivational influences section of the study, the writer will be addressing
from the AWS survey Community and Workload as the Themes. The first motivational
influence used is self-efficacy, where the PSCs believe they have the ability to support their
clients. This is in connection with Community, the quality of the connection and social
environment of the organization, as well as Workload, is the manageable work that is given
within the organization (Leiter et al., 2018). The study would like to understand in which ways
does the motivation of the PSCs committing in their ability: to help connect to creating a
sustainable environment and connecting amongst each other, and does the amount of work affect
the environment and connection impact burnout. The following codes which will be examined
to help answer the research question are Successes, Affirmation around identity, Desire to Build
Community, Co-Facilitator, and PSC Self-Disclosure.
Code: Successes. The influence of self-efficacy is rooted in four factors: mastery
experience, vicarious experience, verbal persuasion, and somatic and emotional states. (Hayden,

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2009). Through the interviews with the PSCs, all of these influences show up in how they speak
about their work, and the effect they witness within the groups and individuals that they
facilitate. In mastery and vicarious experience, study participants reported that group participants
would like to give positive reports on how their life has changed or evolved since the last group,
reporting any wins of the group as well. These opportunities for verbal feedback and sharing
allow the PSCs to see the fruits of their labor and deem those parts of the program (and their hard
work) a success.
One participant says it feels very rewarding when “people come back and say, “I went
out on a limb. I did what we talked about in the group and it worked out”. Measures of success
for the PSC can be seen if the participants in the program come back, or in other words, find
themselves committed to the community. Salston and Figley (2003) name how providers enjoy
their work by seeing the client’s growth, success and resiliency through support and establishing
the importance of services. PSCs being able to witness the evolution of the population they work
with encourages their commitment and connection to the work. Participants also sounded
enthusiastic to share the times where reflecting on what helped them was used by the group
participant and created a successful outcome: “Witnessing the fruits of your labor: Oh yeah,
that's an easy one. Yeah. Most recently two of our participants were looking for
recommendations for gender-conforming surgery. They hadn't had much luck. I provided my
personal experience. The one hasn't gone yet, but I know the other one has, and they were very
happy with this particular surgeon. I'm happy that they got the service that they were looking for.
That was really great news”.
Also, when asked how does the PSC support their clients, another participant told a story
about how someone within their group spoke about their experience with suicidal ideation, and

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how the PSC recommended a book as a resource. The next session, the group participant
reported that they read the book! It was a powerful moment for the participant stating it “really
just reinforce[s] why I do what I do”.
Finally, within their positions are PSCs, some participants are aiming for a more mastery
experience in the service provision around mental health through gaining experience and using
them for other career opportunities. Being a PSC within the organization also gives people who
are interested in the field of mental health an opportunity to hone their skills as service providers;
this is in the midst of also helping the group participants to gain support from their peers, gain
different perspectives, and gain a sense of community through the connection around their
identities. PSCs being able to walk away with sustainable skills also is a benefit outside of the
organization.
Code: Affirmation around Identity. The study participants welcome the ability to hold
space for the group participants, giving an opportunity to “coach” and not “judge them. A part
of thinking about how one's identity gets affirmed within the group is also considering the study
participants’ ability to be able to celebrate growth in whatever a person is in their medical or
social transition; this is whether it’s surgery or a name change process that has completed. One
participant said because their partner is not trans, leading the group of people who share their
trans identity allows for the PSC to get support and build community also:
“I can go to this group and we can talk and people will understand my feelings of stress,
anxiety, and whatnot. This group provides that common space where I can go and talk
where I can't necessarily do that with my family or immediate friend group. It's a really
nice space to be able to just talk.

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Participants also found making a connection around their identities with another group
participant not only rewarding for the person seeking the services, but also for themselves as
well. Even as one participant, who has been transitioning over a decade, said even though they
were farther along in their experience, it is nice to “see other people come into their own.”
This also means the experience around connection can also be heightened if the PSC shares
another identity outside of their transness. For example, being Black, and even someone who is
farther along the medical or social transition scale, finding someone who has your identity can be
affirming.
Code: Desire to Build Community. Finding and committing to community as a sign of
success: It is rewarding to have someone who felt nervous and hesitate about joining the group,
feel at the end that they found a new sense of community, and look forward to coming back. For
the facilitator, “I get a lot out of the peer support aspects myself, so feel definitely some relief
and community and affirmation just being a part of it”. This experience is felt by PSCS even if
they have not also been participants within the program. One participant who has only facilitated
and not been a part of the program as a group participant, stated they still benefited from group
while finding community and people with a common group experience.
A part of the PSCs self-efficacy is feeling as if they have the ability to assist their
participants with any conflicts they are experiencing. A way to continue the connection between
group participants and the PSC is sharing contact information to choose to make themselves
“available” is offering contact information such as emails and phone numbers. This mode of
support is also a way for PSCs to feel as if they are assisting the participants. Affirmational
support, which includes expressing to someone the appropriateness of one’s emotions, actions
and behaviors as an evaluation, allows a person to feel as if they are wanted in a space (Dennis,

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2002). If one of the participants need assistance and chooses to contact the PSC, it will make the
PSC feel useful and as if they are doing their job. This continues to feed into the desire to build
community amongst each other. One participant reflects on their experience of receiving positive
feedback from a group member and the impact it had: “…positive feedback that I've gotten from
participants in peer support was that they finally go to see other people, or hear other people, or
talk to other people that were going through the same kinds of experiences that they were going
through. So, just being an example of a real person I think, I remember that, too, from my own
experience. The first time I realized that trans people were real. I felt like, Oh, this is a
possibility.” This participant’s experience reflects the themes of this section by creating a sense
of community with other people of the same experiences, as well as understanding the work
required within facilitation have successful outcomes.
Lastly, a successful experience for the group participants is seeing group participants give
that same level of support back to themselves and other community members. One sense of
success for a PSC was learning that the group participants decided to create their own
relationships outside of the group: “My understanding is that many of them made friendships and
kept those friendships outside of the group specifically. So I think that was, THAT feels like a bit
success, and something that I feel proud [of].” This touches on the somatic and emotional states
of the PSC, which according to self-efficacy theory, gives information to the participant about
whether this experience is positive or negative and should it be repeated in the future. Overall,
success continues to feed into the experience of collectively building community, seeing the
results of one’s workload, and building confidence and experience for both the participants and
the PSC alike.

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Code: Co-Facilitator. A source of stress that has been named several times is having a
co-facilitator in the group. The group members report that they do not have a choice around who
their group facilitator is within the group. At times, the group facilitator has a different gender
identity than the study participants, which can be seen as helpful if you have a diverse group of
TQNB folks and need to talk about gender across the spectrum (for example, if you are trans
masculine person paired with a trans feminine person or someone who is genderqueer). It is
reported by the PSCs that pairings are not done by themselves, but by the Peer Support
Supervisory Team.
Yet, sometimes within these pairings, clashing personalities can be an issue as well. This
also allows the PSC to lose some control over their sense of autonomy within the group, which
may challenge the notion of self-efficacy, since they have to consider another person’s actions
during facilitation as well. There was one instance where a PSC chose not to speak up about the
disconnect between another facilitator because they did not feel as if it would be helpful. The
participant weighted their options around wanting to speak up but found keeping quiet, letting
the other person “win” and pick and choose your battles seems to be consistent in how PSCs deal
with conflict in their own work. There could easily be a conversation to help quell any conflict,
but it seems as though the PSC usually choose to stay silent.
Code: PSC Self-Disclosure. Participants also find that self-disclosing information about
their own identities allowed for a deeper connection with the participants. This experience can
also lend itself as a building of community for the PSCs themselves. Participants speak about
how this gives them the opportunity in order to display their own expertise in the field and as a
trans or non-binary person to help further the understanding of whatever the topic is for that
moment.

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A part of the PSC self-disclosing information is presenting a challenging and giving
perspective by inquiring about the person’s experience or stance. Inquiry as support can be seen
through one participant who comments as someone who is farther along in the transition process
and wants to make sure the participant’s think about everything before they make steps forward:
Oh yeah. A lot of our group are relatively early in the transition process, so I ask those
bigger questions I wish I had someone asking me when I was going through the process,
particularly with name change and gender-conforming surgeries. I make sure that they're
asking those questions to themselves and also their friends and family. And just
facilitating a dialogue that maybe some of them don't want to ask, but I'll be the one to
ask that bigger question, pushing themselves to think, think about something in a
different way maybe that they wouldn't necessarily have thought of it.
Theme 5: AWS’ Control and Attribution Theory
Attribution Theory focuses on “perceived attributional causes of achievement [such as]
success and failure relative to a specific behavior and the internal factors and external situations
that influence the outcome” (Hayden, 2009, p.45). For this study, attribution theory makes a
clear connection between the understanding of the roles, duties and control of the PSCs versus
the responsibility of the organizations, more specifically the Peer Support Supervisory Team.
The measurable outcome both are using to identify success (or failure) within the group is the
satisfaction of the participants. PSCs understand that logistically they have no control over how
the group is constructed, but have to manage the discontent of the group participants when they
do not feel connected to clearly.
Code: Failures. When asked about the PSCs experience with failure and the ability to
control or not control the outcomes, they were able to reflect various experiences which

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reminded them of when they felt their performance as a PSC was not the best. First, the PSCs
mentioned when they were not able to properly address times in which there was a disconnect in
communication about time and meeting of the groups. This disconnect would lead to a sense of
the PSCs feeling unstructured if there were errors. Not feeling as if a space is provided for group
participants to utilize the PSCs were feeling as if they were losing control and not able to meet
their own expectations:
“I’m more of a…I want to see results, I like to see results, may I say that? I like to know
that I’m making an impact in that group, the group has structure. And I don’t think that I
was able to deliver that all the time or that me or other co-facilitator that we were always
able to deliver that.”
Attribution theory stated being able to attribute a cause to an outcome allows us to have
more of a choice around certain desirable and undesirable behaviors and action per the situation
(Hayden, 2009). This shows if there is a consistent, steady, and structured workflow
communication to the PSCs by the organization, it allows for the PSCs and the group participants
to thrive in their environment without distraction.
Next, it was expressed by some of the PSCs about the inability to create space for
conversations about race and/or support people who identify specifically as Black and are
experiencing the current climate of anti-blackness and white supremacy. One participant, who
identified as white, spoke about feeling as if they should have made a different decision when
bringing up a topic about race during one of the group sessions. The participant stated they
usually like to check in with group members about comfort level first before breaching the topic.
During this particular session, the PSC was not aware that the group was uncomfortable until
they had gotten feedback from a group member: “I felt like I had the group under control, but it

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wasn’t until a group member made a comment at the end…it actually wasn’t even me who
realized it. It was another group member who felt disenfranchised, I guess”.
Another failure in connection around identity is one PSC feeling as if they failed in
facilitating is feeling at a loss when the person who they are speaking to has not gotten to the
point of accepting their own self around their gender identity. Though the PSCs understand that
everyone is in their own place around living as an out trans person or feeling acceptable for
themselves, but sessions where people have not reached that point seem to be difficult for
participants to handle, and essentially can feel as if they failed. The difference in transition
experience can cause a rift in the rapport building with another individual participant. The
participant stated that the individual participant wanted to be more led into a thought process
around their own transition that was past the personal and professional boundaries of the PSC.
Here, the PSC felt the lack of pressure around the person’s identity development felt like a
failure: “I think because they felt like they weren't getting what they wanted so I recognized that
it was probably for the best because I just didn’t feel comfortable trying to explain to this person
who they were but it still felt like a failure that I couldn’t reach them in some way to help them
find other resources or to figure something out”.
Overall, one participant felt though there were instances where someone was not fulfilled
within a session, the participant expressed that every positive experience counts and as long as
there is a lesson they group attendees were able to walk away with, the experience was not a
failure.
Code: Obligation and Duty to Participants. When the participant felt like success was
creating enough coherent structure so the group participants were able to use that connection to
build relationships off with each other, the participant felt like they had a bit of responsibility for

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that outcome due to their level of perceived control: “I feel like I had control because... To me, I
had control over what that space felt like and what happened when we were in the room and how
the conversation flowed and whether people felt like they were being welcomed or being heard.”
This experience of trying to manage what is or is not successful within their practice is
based around their experience of not wanting to fail, even if it is at the cost of their own self-
care:”… but I do think having some focus on how burnout manifest because we tend to feel this
kind of responsibility and obligation to help others, which I think is true, probably, for people in
other helping professions too... For me, I got so burnt out because I felt so much like this was
something I really needed to do. It was really important, and if I wasn't doing it, then it might not
happen. So I stuck on. I keep around, and I keep doing it, and I didn't let myself, at that point,
take a step back and deal with other stuff because I felt like it was just so important to do.
Having that as a key piece of what is talked about, in training, around self-care and burnout is I
think is useful.”
The participants know they only have control in the space, but have no responsibility to
the duties constructing the space itself: “What’s in my control is what happens during the session
itself...I am fostering a safe, comfortable place for people to come in what I feel like I have
control and what I feel like I provide when those folks come back.” At times, outside
responsibilities of the PSC can also get in the way of fulfilling their obligations to the group.
The things within my control would have been, changing my obligations that were
outside of this one particular work, because I had other volunteering and other life work
and relationship kinds of obligations. To manage the burnout I was feeling with peer
support, I would have needed to make other adjustments or sacrifices in other areas. And
I could have, and I have in the past, because doing this work is really important to me,

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but at that particular time, it just wasn't really possible for me to step back from some
other obligations that I had.
Most study participants understand that they do not have a much control over the
outcomes of the group participants, and the only control they do have is within their group space,
but still can feel responsible for not being emotionally or mentally prepared to be available for
group participants.
Code: PSCs’ Relationship to Control. When asked about the level of control the PSCs
feel they have around other peoples’ options, many felt as though they did not. Although the
person stated they needed to rest and had not had a break, there was an instance of impending
dread (a feeling brought up during defining what burnout means to the study participants):
“And so I was increasingly aware every time get to be the day for group , and I would
just have this sense like 'I just don’t want to do this'. 'I just have the mental space to do
this. And I felt obligated to continue to lead an ongoing group like that because there
didn't seem to be enough. There just didn't seem to be enough. There were too many
people. There were so many people who wanted to be in a group, and they're weren't
enough people to lead the groups. I felt really responsible to offer space.... So I was
aware of the burnout for a good few months before I finally said, "I'm going to have to do
something different."
Sometimes self-consciousness or limit setting around the level of experience is set by the
PSC based on the fact that they do not have a degree. One PSC stated that they did not feel as if
they had control over the situation with the peer because they were a volunteer as opposed to a
licensed professional. This added to their feeling of helplessness to manage issues that come up
in group.

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With the participant who had made the recommendation around surgery, they did feel as
if they had some control over the outcome. Though it felt like a small contribution, the facilitator
felt like their recommendation along with the co-facilitators, went a long way. In terms of
attribution theory: some PSCs took pride and claimed some control over outcome, which signals
to them that they should repeat that behavior or duty because there are positive outcomes.

Summary: Answering Research Question 2
After analyzing both knowledge and motivational influences, the researcher has enough
information to confidently answer the second research question about how is the knowledge and
motivation of the volunteers within the Peer Support Program related to the possible impact of
burnout experienced by volunteers? Based on the information above within the knowledge
influence, the portion of emotional exhaustion and factual information, the participants feel as if
they can identify the symptoms of burnout when they happen, and know when it creeps into their
work so they can make a decision about next steps (whether moving forward with the task or
abandoning it). This relates to Freudenberger’s (1986) statement that workers need to also be
aware of when burnout comes about, and encourage communication with their organization
when it’s experienced. For example, if there is a concern about the job being repetitive,
communicating with one’s organization about how to vary their duties could be helpful
(Freudenberger, 1974). Having knowledge about one’s own personal experience in PSC work
can decrease the possible impact of burnout experienced by PSCs.
Also considering TQNB people, the knowledge of the PSCs within the program about
their experiences are related to the possible impact of burnout through the experience of minority
stress within, and outside, of the peer support program. Being misgendered is a subtle form of
stigma that those one the transgender spectrum experience which shapes how a person thinks,

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feels and sees themselves compared to others in society (McLemore, 2015). Being misgendered
and outed are reflective of Meyer’s (2003) four mentioned processes of minority stress: stress
conditions, expectation of events and vigilance, internalized negative attitudes, and concealing
one’s identity. Misgendering as an aspect minority stress also appears when speaking about
issues with bathrooms, and even healthcare. If being misgendered is one of the main sources of
stress in identity, being around people who understand the stress of being misgendered can
eliminate that stressor amongst TQNB people. This means affirmation around one’s identity can
come from others. This is confirmed in theories such as identity control theory where it “suggests
that people simply want others to see them as members of the groups they belong to”
(McLemore, 2015, p. 52). Testa et al. (2014) discuss how trans people interact with other trans
people, particularly in early development, lessen their experiences of anxiety and suicidality and
increase a sense of comfort. Hendricks and Testa (2012) also mention how being trans in a
homophobic and transphobic society exposes that group to victimization and discrimination,
their identity is dismissed. The knowledge about how prevalent discrimination and oppression is
for those who meet the intersections of gender, gender expression, and race will be cruicial when
informing facilitators to help manage conversations and experiences in group related to such
issues.
The motivational influences of volunteers can be related to the possibility of burnout if
being the PSCs are not being supported around and affired around their identity. The Peer
Support program should consider ways it can be a success in building community and connection
with the group participants, and also finding ways to prevent the feeling of failure. In connection
with Gagne et al.’s (2018) four roles of PSCs: using lived experience as connection, coaching
and mentoring, offering resources in the community (even if they themselves are the resource),

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and helping those participating move to recovery. With the weight of these roles can contribute
to possible burnout if support, particularly from the organization, does not exist. Overall, the
knowledge and motivation of the volunteers within the Peer Support Program also experience the
impact of burnout based on workload, the level of control they have within their work
environment, and if the PSCs have the confidence of completing peer support tasks and building
community within the group.
Research Question 3: What is the interaction between DCCH’s culture and context, and
the knowledge and motivation of the Peer Support volunteers?

Outside of what was shared with the quantitative data, the interaction between the
organization’s culture and context, and the knowledge and motivation of the PSCs lies in the
PSCs feeling as if they are being heard around any difficulties they may be experiencing to fulfill
their duties. One participant spoke about not experiencing stress or burnout as a PSC and much
of it is due to the cultural settings and models of the organization:
I haven’t really experienced that stress as a peer support counselor. Fortunately, it was
just the community within DCCH, the community that I experience at DCCH is very
accepting, very open, and we’re all very similar in that we are of the same sexual and
gender minority group, so we kind of commiserate as opposed to augmenting the
stressors.
Even though this person is content on the level of support from the organization, being
able to understand the level of trust and commitment this person has is due to finding a similar
peer group to receive support from, as well as investing in the culture and climate which is
fostering this experience. One way PSCs would like to feel supported is by having more
frequent check-ins with the Peer Support Supervisory Team. Freudenberger (1986) suggests
supervision to help combat burnout amongst their employees, which may give suggestions to

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help improve communication within the organization and help earn to set boundaries when one is
feeling overwhelmed and burdened. Participants state quarterly check-ins were happening during
the year, but with COVID-19 appearing and the organization switching to online services, it has
thrown the schedule and frequency off. This wanting to connect with group leaders as a way to
maintain stability as a PSC as connected to the failure concept with the motivational influence of
Attribution Theory. PSC considered returning participants or those who affirm the usefulness of
the group as successful. The act of showing up confirms commitment to the process. For the
PSCs, this is also asked by them to the organization. If the organization is able to find ways to
consistently show up and support, the PSCs will continue to commit to their work as well.
Research Question 4:
From the perspective of the PSCs, what could the organization do to improve support from
PSCs from the symptoms of burnout?

Organizational Qualitative Results
Theme 6: AWS’ Reward and Organizational Cultural Model Influence
Code: Groups Support Sessions and Individualized Check-ins. Most were unaware
of support services that were specifically for PSCs centered around burnout. Participants report
having information given to them (documents and supplemental information) about self-care but
nothing speaking about how symptoms of burnout play a part in their work nor speaking about
burnout as its own concept. One participant did make an observation that information around
burnout was usually given to the patients, and the materials were open to the PSCs as they are
affiliated with the organization, but there was nothing specifically geared towards PSCs. One
participant stated that they did not know if there was a connection between self-care and burnout,
which was not made clear by the organization in training. Some participants could clearly name
what was available to clients at the center and were aware that if they wanted to use those

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services, they could. Yet overall, there are no particular supports that cater specifically to the
PSCs’ wellness, self-care and mental health.
Participants did recall if they experienced any difficulties within the program and needed
someone to speak to, that someone on the Peer Support Supervisory Team would be able to
provide individualized support. Due to COVID-19 and the switch from in-person to online
sessions, resources around support groups have shifted and are not available as often as desired
by the PSCs. The PSCs expressed desire around doing more regular check-ins, possibly quarterly
meetings with the whole group. This was a service that was offered more frequently, but again
with the shift around access, there has been a decrease in the number of sessions offered.
Code: Tangible and Intangible Rewards. One participant named the desire for tangible
awards such has pizza parties and t-shirts. Rewards, whether tangible or intangible, are all
representations of recognition and affirmation from the organization. One participant expressed
the desire to feel appreciated by the organization for the work they and other PSCs do within the
program. These rewards are a reflection to the PSCs on how the organizations affirms their
health and well-being, which helps increase the feeling of personal accomplishment (see Low
Personal Accomplishment and Value above), which eventually prevents symptoms of burnout:
“…we are volunteering and we’re just doing this out of the kindness of our heart, so it’s
important to us to feel supported.”
Code: Continuing Education: PSCs stated there is information given out when they first
started with the program about self-care, but it was not particular to burnout specifically. Many
of the participants suggested additional resources such as information on burnout, as well as
specialized sessions about various types supported by the organization. There were also
suggestions asking for educational sessions with guest speakers about peer support work. One

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participant suggested a specific topic around wellness and mental health for “caregivers”. Mead
et al. (2001) comments that peer support training not only assists in educating people in
developing tolerance when feeling uncomfortable in the work with other people, but also helps
people understand what can trigger their emotions and how to normalize it. Additional
educational resources were a frequent ask amongst this group.
Code: Creating Sustainable Connections with One Another
The study participants requested for space to meet with other peer support facilitators in
order to hear and reflect on their own experiences within their work. One participant commented
that listening to the experience of others can improve the quality of the work they are doing by
hearing how other facilitators are emerging with their groups. This also includes sharing any
issues that may arise and share the positive outcomes as well.
“That's really helpful to hear how other facilitators are engaging with their groups and
what issues as well as positive outcomes they've had within their groups.” These support groups
for the Peer Support Counselor are beneficial in reflecting how they can continue to improve
their experiences in order to help be aware and attentive to symptoms of burnout.
Theme 7: AWS’ Fairness and Values, and Organizational Cultural Setting Influence
In terms of how the participant would like for the organization to recognize when support
and care for burnout is affecting their peer support work, a couple of suggestions were made in
this area. First, the PSCs named that they felt there were not enough PSCs per participants
needing services, which was overloading the PSCs who were actively facilitating groups and
individual sessions. The participants also commented on the lack of resources, and not enough
training by the organization around some of these issues, which can also be attributed to the
change in service modality by the recent pandemic (face-to-face, to online treatment only). The

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following codes, lack of control around scheduling and formulating groups by identity, will give
a good summary of what was expressed by the PSCs around their experiences of how the
organization’s setting could improve their support for burnout.
Code: Lack of Control around Scheduling. For PSCs, being overwhelmed was not just
about the weight of the task at hand, but also the repetitive nature of the work as well. One
example of this experience is around scheduling. One expressed concern which was challenging
the idea around fairness, was the scheduling concerns by the PSCs. These are also experiences
that were brought up in the motivational section of the study when speaking about control and
the failure in creating sustainable structures for the participants. When asked about ways the
organization can grant support for the facilitators, one participant mentioned the scheduling
concerns which does not allow for a break in facilitating, which can be overwhelming if someone
also has other responsibilities outside of the organization. Since the PSCs also have competing
responsibility outside of the peer support program, not being able to manage the frequency of the
groups adds stress. An aspect that was mentioned several times in the interviews was a
preference in how groups were run on a certain schedule. The participants seemed to prefer
having groups on a more time-limited rotation (about 10 weeks) compared to the ongoing groups
with no ending.
Another instance where participants are overwhelmed is having to manage duties that are
outside of their control such as communicating with the group participants outside of the group
session. Study participants report that group logistics such as sending emails, scheduling group
times and coordinating the groups gathering are not the PSCs responsibility and they rely on the
Peer Support Supervisory Team to do it. The lack of access to the group with the inability to
contact them causes frustration on both ends. For the PSCs, the lack of access does not allow the

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PSC to know who and how many people are supposed to show up at group, which can change
the group dynamics. The participant spoke about how when the group was able to meet in-
person, there was one incident where only one person had shown up. This was information the
study participant was not given beforehand. Being able to know who will be in attendance
allows for the PSC to feel more prepared.
One of the participants speaks to how the lack of control causes disconnect for
themselves in the group:
But I think just that disconnect between how much bandwidth I had or just how much
responsibility that I had in maybe…It really never felt like my group, you know what I
mean? If that makes sense? It was my group but as far as communicating and
understanding there’s the HIPAA and there’s so many things that prevent the peer
support specialist from getting to involved with the clients.
The participant also mentions that the lack of credentials for people in peer support is less
than those who are certified mental health counselors, so they do operate under different rules
and institutions. This participant mentioned having more control over their group in terms of
logistics this would have been helpful in preventing burnout of the PSC.
Code: Formulating Groups by Identity. This was mentioned before when speaking
about Community and Workload, but it was also mentioned in this section of the study when
asked about what are some ways the PSCs would like to see the organization support their work
in order to help prevent symptoms of burnout. Though many participants mentioned identity at
times being a barrier for connection within groups, a suggestion by a participant had mentioned
the intersection around experience with where they are on their journey of transitioning, and how
length of time can get in the way of service. “The kinds of concerns and stressors that are related

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to my identity as a trans person “, one participant said, “are sometimes they are not always
different than the things of the people who are more new and just kinda starting their transition
will feel.”
Summary

Overall, this study shows the importance of how the knowledge and motivational factors
commits the PSCs to the work, yet the success of the program and the deterring burnout is also
the responsibility of the organization. The key to addressing symptoms of burnout experienced
by TQNB-identified PSCs is building a substantial connection of support through education,
community, and a commitment to wellness for both all involved within the program. In using
the quantitative results to answer question one (to what degree to which the PSCs experience
burnout?), the two surveys within Maslach’s Burnout Toolkit
TM
reveal that PSCs within the
organization are pretty content with their roles and generally feel as if they are able to show up
for their duties, but also have some concerns about workload and a consistent level of connection
amongst each other. There was a concern about the level of connection with the organization, to
which the researcher then uses the qualitative data to understand what can be done by both
parties (the organization and PSCs) to support each other in the work. Within the qualitative
review, the general consensus is a desire for more support from the organization in terms of
supervision, control over groups and an increase in reward, yet also investing in the PSCs
perspective on their personal accomplishment and educating the group about burnout in order for
them to be more conscious around their own care.
The researcher for this study found the results from the quantitative and the qualitative
data to be accurate and through the themes and codes gleaned from both projects, complement
each other well to help come up with recommendations for the organization to address the

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symptoms of burnout. The researcher felt the information from methodology answered all four
research questions, but also had revealed more opportunities for future research, specifically with
such a marginalized group (being majority Black, and identifying as trans masculine and or non
binary). Overall, as said earlier within this document, the researcher feels in order to improve the
interaction between DCCH’s culture and context, and the PSCs knowledge and motivation
influences, the organization can find alignment based in Freudenberger’s (1986) suggestion of
creating supervisory support groups within the organization, speaking with the PSCs about how
to prevent burnout through setting boundaries, and learning to say no when one feels
overwhelmed, all touching on various themes seen in the study (Community, Workload, Control,
Attribution Theory and Self-Efficacy Theory). This solidified Pine’s (2002) belief around the
root of burnout which is grounded in the need for people to feel their life has meaning and how
they express that meaning is significant as well as important. The researcher believes without
this space provided by the organization, according to the participant’s response, it has a direct
effect on the PSCs experiences of burnout. Based on the data collected above, the researcher
suggested five recommendations as well as suggested programming to assist in structural shifts
of the organization which will be expanded on in Chapter 5: Considering educational resources
for the PSCs provided by the organization; considering shared identities when constructing
groups; consider scheduling as a method of maintaining wellness; considering consistent
supportive check in structures for PSCs; and considering the effects of world issues and how
they affect service practice.

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Chapter Five: Discussion

Overall, based on the study above, what are the recommendations in the areas of
knowledge, motivation, and organizational resources may be appropriate for solving the problem
of practice? The researcher gleaned at least five different recommendations from the data from
the study which should be considered in order to address the problem of practice, which is how
burnout affect the quality of support given by PSC who identify as TQNB. These
recommendations are a following: Considering educational resources for the PSCs provided by
the organization, consider shared identities when constructing groups, consider scheduling as a
method of maintaining wellness, considering consistent supportive check-in structures for PSC,
and considering the effects of world issues and how they affect service practice. These
recommendations will be paired below with the knowledge, motivational, and organizational
context-specific recommendations centered on what the organization can do in order to decrease
the symptoms of burnout experienced by the PSCs.
With the data that has been gathered and considering the above recommendations, the
information will be used to create a program for the organization that helps continue to foster a
relationship between the organization and the PSCs. This program will include a biannual
assessment and evaluation with the PSCs and the Peer Support Supervisory Team,
implementation of the Maslach Burnout Toolkit™ for Human Services, which combines the
Maslach Burnout Inventory™ Human Services Survey (MBI-HSS, 1981) and the Areas of
Worklife Survey (AWS, 2011), a Rating Scale for Post-Program Implementation, and a yearly
gathering with organizational leaders and PSC to review their experiences and interpret their
experiences around wellness, being TQNB and burnout. Using Clark and Estes (2008) Gap
Analysis Framework and the Kirkpatrick New World (2016) model of evaluation, this study will

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create a program to help increase the commitment of wellness with the organization to the PSCs
and will reflect Levels 1, 2, 3 and 4.
Recommendations for Practice to Address KMO Influences
Introduction
Table 8 lists the assumed knowledge influences: the knowledge about the symptoms of
burnout, the knowledge of minority stress around an TQNB-identity may influence burnout, and
knowledge about one’s thinking about burnout symptoms and their experience as a PSC. Also,
within Table 8, it lists the probability of the knowledge influences being validated in order to
achieve the stakeholder’s goal of reducing burnout symptoms amongst the PSCs. Within this
study, it is anticipated that each influence will have a high probability of being validated and
have high priority for achieving the stakeholder’s goal. Lastly, Table 8 lists recommendations
for the knowledge influences grounded in theoretical principles.
Table 8
Summary of Knowledge Influences and Recommendations
Assumed Knowledge Influence

Principle and Citation Context-Specific
Recommendation
Peer Support Counselors (PSCs)
need knowledge about the
symptoms of burnout. (D/F)
Providing scaffolding and
assisted performance in a
person’s ZPD (zones of
proximal development),
promotes developmentally
appropriate instruction (Scott
& Palincsar, 2006).

Social interaction,
cooperative learning, and
cognitive apprenticeships
(such as reciprocal
teaching) facilitate
construction of new
The PSCs will use social
interaction, cooperative
learning, and
cognitive apprenticeship to
help facilitate construction of
new knowledge (Scott &
Palincsar, 2006) about the
connection between burnout
and how it affects their well-
being.

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knowledge (Scott &
Palincsar, 2006).

PSCs need knowledge of how
psychosocial stressors around an
TQNB-identity may influence
burnout.
(D/C)

Learning tasks that are
similar to those that are
common to the individual’s
familiar cultural settings will
promote learning and
transfer (Gallimore &
Goldenberg, 2001).

Social interaction,
cooperative learning, and
cognitive apprenticeships
(such as reciprocal
teaching) facilitate
construction of new
knowledge (Scott &
Palincsar, 2006).

The PSCs will receive will
use social interaction,
cooperative learning, and
cognitive apprenticeship to
help facilitate construction of
how psychosocial stressors
around an TQNB-identity
may influence burnout.
PSCs need knowledge about
one’s thinking about burnout
symptoms and their experience as
a PSC. (M)
Learning and motivation are
enhanced when learners set
goals, monitor their
performance
and evaluate their progress
towards achieving their
goals.
(Ambrose et al., 2010;
Meyer, 2011)

Social interaction,
cooperative learning, and
cognitive apprenticeships
(such as reciprocal teaching)
facilitate construction of new
knowledge (Scott &
Palincsar, 2006).

The PSCs will have the
opportunity to practice to
reflect on knowledge about
their thinking of burnout
symptoms and their
experience as a PSC by
providing scaffolding and
through assisted performance.

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The PSCs need knowledge about the symptoms of burnout
After collecting the data, the researcher sees that the PSCs will need knowledge of which
aspects of peer support that contribute to burnout. The theory used to explore this gap is from
Sociocultural Theory. Scott and Palincsar (2006) suggested providing scaffolding and assistant
performance in a person’s zone of proximal development (ZPD) in order to promote
developmentally appropriate instruction and social interaction, cooperative learning, and
cognitive apprenticeships (such as reciprocal teaching) facilitate construction of new knowledge.
Based on these principles, the recommendation is PSCs will use social interaction, cooperative
learning, and cognitive apprenticeship to help facilitate construction of new knowledge (Scott &
Palincsar, 2006) about the connection between burnout and how it affects their well-being.
Sociocultural Theory tries to make space for the processes where there is learning and
development, can evolve to higher social mental functions (Shabani et al., 2010). This theory
considers how cultural and social aspects also impact “the roles of tools in learning” (Rueda,
2011, p. 26). The stress within the environment at work, along with the constant shifting of
social, economic, and ethical dynamics in an institution, causes an increasing strain with people
and their relationship to work (Leiter & Maslach, 2005). Freudenberger (1986) warns
individuals and organizations not to ignore signs and deny the physical and emotional symptoms
of burnout, coupled with ongoing pressure and stress, which may eventually be "self-destructive"
(p. 250). Freudenberger (1986) states, "If the signs of stress exist, the staff person has a
responsibility to take care of him/herself and program administrators have a responsibility to call
it to [their] attention as well as to offer assistance in overcoming burnout" (p. 250). In using the
PSC’s zone of proximal development, which exposes the actual and potential levels of
development, the recommendation supports using social interaction, cooperative learning and

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cognitive apprenticeship to build new knowledge (Scott & Palincsar, 2006). With the outcomes
of the data from the study, this will allow the connection between burnout and how it affects
their well-being in order to build supports within the organization to help the PSCs gain the
knowledge needed to perform their duties.
PSCs need knowledge of how minority stress around an TQNB-identity may influence
burnout
There is a high probability that as TQNB-identified people, the volunteers need
knowledge of how minority stress influences the effectiveness of PSCs. For this knowledge
influence, the researcher will be using Sociocultural Theory to address the gap. Gallimore and
Goldenberg (2001) state learning tasks that are similar to those that are common to the
individual’s familiar cultural settings will promote learning and transfer and Social interaction,
cooperative learning, and cognitive apprenticeships (such as reciprocal teaching) facilitate
construction of new knowledge (Scott & Palincsar, 2006).
It follows, then, that the recommendation is that the PSCs will use social interaction,
cooperative learning, and cognitive apprenticeship to help facilitate construction of new
knowledge (Scott & Palincsar, 2006) about how minority stress around an TQNB-identity may
influence burnout. This is gleaned from the date from the PSCs, considering educational
resources for the PSCs provided by the organization creates educational opportunities for the
PSC to learn about burnout, to process how burnout shows up in their work, and how to take
preventative measures to give quality care. The educational resources do not just have to focus
on burnout, but also would be beneficial to also assist in discussions around how to handle topics
of race (if you are a part of a marginalized community, or not). This is important in the work
because it will be able to equip all people, no matter how your identify, to feel like they can

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bring their full selves to the group. Also aspects of intersectionality that can also be discussed
are different stages of transitioning and the difference in experiences with those on various parts
of the gender spectrum. Minority stress is the “excess stress to which individuals from
stigmatized social categories are exposed as a result of their social, often a minority, position”
(Meyer, 2003, p.3). Meyer (2003) explains there are three relevant processes of minority stress
for LGB people: chronic and acute stressful events and conditions, the expectations in the
environments as well as the level of vigilance needed in the space, and finally how any negative
attitudes become internalized. If PSCs may not have the ability to be mindful about their
experiences of burnout in Peer Support settings, it would be difficult to be knowledgeable about
their experience as PSCs with marginalized identities. By speaking about their experiences
within the study, the data collected can be used to help educate other TQNB-identified PSCs
learn how to recognize and get assistance around burnout. Gallimore and Goldenberg (2001)
says learning tasks that are similar to those that are common to the individual’s familiar cultural
settings will promote learning and transfer. Again, using the experiences of PSC to teach other
gives an accurate depiction to other TQNB-identified PSC on how to deal with specific issues
around burnout and identity within a peer support space. Learning how the PSCs’ presence
within peer support spaces affects the relationship between the two (i.e., transference and
countertransference), would also help the PSCs be aware about the quality of work they are
providing to the community.
PSCs need knowledge about one’s thinking about burnout symptoms and their experience
as a PSC
There is a high probability that the PSCs will need knowledge of which aspects of peer
support that contribute to burnout. The PSCs need knowledge about one's thinking about burnout

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symptoms and the effects of peer support. According to Ambrose et al. (2012) and Meyer (2011),
in order to enhance the learners ability to set goals, monitor their performance and evaluate the
process in their work, they have to set goals. Taking their goals and processing them with others
with increase social interaction, cooperative learning and cognitive apprenticeships allow for an
increase in constructing new knowledge (Scott & Palincsar, 2006). Mayer (2011) states
implementation should provide guidance, modeling, coaching, and other scaffolding during
performance in order for learning to occur. The recommendation follows that stakeholders will
be given models and guidance around their process of thought on burnout symptoms and how it
affects their ability to perform their duties during Peer Support sessions. The volunteers will
have the opportunity to practice to reflect on knowledge about their thinking of burnout
symptoms and effects of peer support through education during sessions with their Supervisors.
Again, the Sociocultural Theory is used within this influence in order to have the practice
influence the theory and vice versa (Jackson & Burch, 2017). Experiences over time allow for a
building of experience and language through action and learning. Jackson & Burch (2017) argue
that parts of Sociocultural Theory can be recognized as “innate mental functions [that] are
mediated through social and cultural systems: symbols, especially language; concepts, which are
developed through language; and activities conducted in language” (p. 718). When thinking
about burnout symptoms within peer support, Freudenberger (1986) emphasizes it is both the
staff person and the organization who have to take responsibility to recognize and address, when
burnout is present. Elwood et al. (2011) state for therapeutic professions, advocacy for
prevention and treatment resources, and increasing awareness for the group to help alleviate
symptoms of trauma within their work. To continue to encourage the practice of reflecting on

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one’s knowledge about their thinking of burnout symptoms and their experience, this study
would recommend providing scaffolding and their assisted performance for the PSCs.
Motivation Recommendations
Table 9 exhibits the assumed motivational influences used in this study, self- efficacy and
attribution theory. Supported by motivational theory and information from the literature review,
Table 9 also lists their probability of the influences being validated based on the ones which
appear more frequent. Both motivational influences have not only a high probability of being
validated, but also have a high priority for achieving stakeholder’s goals. Table 9 listed below
displays the recommendations for the motivational influences, which are also connected to
theoretically based principles.
Table 9
Summary of Motivation Influences and Recommendations
Assumed Motivation
Influence*

Principle and Citation Context-Specific
Recommendation
Self-Efficacy: PSCs need to
believe they have the ability
to support their clients.
Feedback and modeling
increases self-efficacy
(Pajares & Valiante,
2006).

High self-efficacy can
positively influence
motivation (Pajares &
Valiante, 2006).
Feedback and modeling with the
Peer Support Supervisory Staff
will allow PSCs to reflect on
their ability to support their
clients.

Make it clear that individuals are
capable of learning what is being
taught or are capable of
performing a task (Pajares &
Valiante, 2006).

Point out how learning and
training will be useful in people’s
lives (Pintrich, 2003).

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Attribution: PSCs need to
believe their successes and
failures, as it relates to their
peer support duties, are
within their control.
Learning and motivation
are enhanced when
individuals attribute
success or failures to
effort rather than ability
(Anderman & Anderman,
2009).
Pertaining to the subject of
burnout, it is recommended that
PSCs will receive accurate
feedback about the efficiency of
their knowledge and skills, and
plan for any educational supports
to address information gaps.

Self-Efficacy: PSCs believe they have the ability to support their clients
There is a high probability that PSCs believe they have the ability to support their clients.
Self-efficacy, which is the “belief in one’s own ability to successfully accomplish something”
(Hayden, 2009, p. 7) informs the recommendation for this influence. This theory explains that
people will only attempt tasks they believe they will be successful in, and will not attempt tasks
in which they think they will fail (Hayden, 2009). Feedback and modeling increases self-efficacy
(Pajares & Valiante, 2006). In addition, Pajares and Valiante (2006) states that having a high
self-efficacy can motivate influence in a positive way. In order to help hone and process the
experience for the PSCs, Pajares and Valiante (2006) also states that feedback and modeling
increases self-efficacy. For the stakeholders in this study, having an understanding around their
ability to support their clients may allow the PSC the ability to understand when symptoms of
burnout arise.
Within the recommendation of considering shared identities when constructing groups,
one proposal is having an option to pair specific identities of groups as a way for preventing
burnout amongst the PSCs. What is not specifically covered within any of the themes from Leiter
et al.’s (2018) study is considering how being from marginalized gender, sexuality, and racial
identities also play a part in contributing to burnout. Within the qualitative study, there is no
distinction between the experiences of those who also have a marginalized racial identity in

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additional to their queer gender and sexual identity. For them, those experiences, being Black
and transgender for example, all go hand in hand and still need to be considered as well.
Concepts such as intersectionality would give a clearer lens on the impact of varied marginalized
identities within the Peer Support field, eventually gaining information in order for the
organization to be a better support to their peer support counselors overall. Considering more
groups based on the intersections of other marginalized identities will give people the
opportunity not to have to choose one experience or identity over the other.
Steyn and de Klerk (2015) reported from their study that those who had higher burnout
scores believe having the ability to support their clients, meant putting those clients before the
service worker’s needs. For those who had low burnout, those service workers were able to
figure out ways to accommodate the needs of themselves and their clients at the same time.
Being able to differentiate one’s ability to know if they do, or do not, have the capacity to
support their clients will help PSCs manage the existence of burnout symptoms. It is
recommended that PSCs participate in bi-yearly evaluations with their supervisor on burnout in
order to review their ability to support clients and plan for any educational supports to address
information gaps. PSCs can use the time to review the evaluation on their performance to
determine any gaps that need to be filled in terms of motivation, as well as examining what
educational information needs to be given for additional support.
Attribution: PSCs believe successes and failures are within their control
There is a high probability that PSCs believe their successes and failures, as it relates to
their peer support duties, are within their control. This influence will be using Attribution Theory
as it’s foundation, meaning how successes and failures can be attributed to specific behaviors, as
well as how outcomes are influenced by “internal factors and external situations” (Hayden, 2009,

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p.45). Anderman and Anderman (2009) states rather than solely look at ability, learning and
motivation are enhanced when one can attribute success or failures to effort rather than ability
Pertaining to the subject of burnout, it is recommended that PSCs will receive accurate feedback
about the efficiency of their knowledge and skills, and plan for any educational supports to
address information gaps. This will allow time and space for PSCs to receive feedback on their
performance, and make them aware of any symptoms of burnout that may appear.
Having the confidence in believing one’s ability to assess for successes and failures and
understand what is in their control can play into one’s motivation. From the perspective of
Attribution Theory, the three aspects of cause, locus of control, stability and controllability, all
play a part in PSCs knowledge of control as it related to their peer support duties (Hayden,
2009). Hayden (2009) reports it is important to give attribution of causation to an outcome, for
example, to help avoid negative behaviors, for the sake of explanation, and this may help manage
psychologically difficult events. Hayden found that attributions are helpful in understanding the
outcomes of events in order to repeat positive behaviors, and eliminate negative ones . With
locus of control, PSCs may believe they can control their internal and external events that may
affect their well-being. For stability, PSCs need to consider the skills and abilities they currently
own are able to sustain them through deeper work. Finally, PSCs also need to understand what
can or cannot be controlled, externally or internally. Based on this research, the recommendation
follows to provide accurate feedback, along with any communication skills and knowledge that
allow PSCs to attribute successes and failures to effort, and continue to get the needed support
they deserve, and education if they choose.

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Organization Recommendations
Table 10 exhibits two assumed organizational influences used in this study, one cultural
model and the others a cultural setting. The cultural model is the availability for affirming health
and wellness care with the organizational climate promoting a culture of affirming health and
wellness care of the PSCs. The cultural setting speaks to acknowledging wellness for PSCS by
exhibiting support and care for burnout. The priorities listed within this section are not listed as
high according to the writer because the main focus of the study is the effect of burnout toward
PSCs. The organization’s role is still important, but more supportive to the stakeholder’s goal of
reducing burnout symptoms by participating in educational strategies and supports held by the
organization. The framework used to help guide the discussion for organizational influences will
be Clark and Estes (2008), which will examine the PSC experience within the organization
through the perspective of KMO (knowledge, motivation, and organizational). In addition to
Clarks and Estes (2008) Gap Analysis, this chart is based on the theoretical perspective of
Denning (2005), Lewis (2011), and Mezirow (1997; 2000). The two organizational
recommendations for the organization are the organization will name at least one way they
actively create and manage working relationships with its PSCs (through intentional scheduling
and supportive check-ins from the Peer Support Supervisory Team), and the organization will
appoint a consistent supervision time to meet and create supportive environments with PSCs to
reflect their experience with burnout to inform care (through supporting PSCs in adjusting to the
new modalities of service treatment post-COVID-19). Table 10 reviews the aforementioned
influences, gaps and their level of priority, supportive principles and citations for the context-
specific recommendation.

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Table 10
Summary of Organization Influences and Recommendations
Assumed Organization
Influence*

Principle and Citation

Context-Specific
Recommendation
Cultural Model Influence 1-
Availability for Affirming
Health and Wellness Care:
The organizational climate
needs to promote a culture of
affirming health and
wellness care for the
volunteers.

Effective leaders know how
to create and manage good
working relationships with
stakeholders (Denning,
2005; Lewis, 2011).

The organization will
name at least one
way they actively
create and manage
working relationships
with its PSCs.
Cultural Setting Influence 2 -
Acknowledging Wellness for
PSCs: The organizational
setting needs to exhibit
support and care for burnout.

Organizational effectiveness
increases when leaders are
knowledgeable about and
are consistently learning
about themselves and their
business (e.g., learning).

Participants engaging in
reflective work need to have
complete and accurate
information about the topic
for discussion, be free from
bias, and meet in an
environment of acceptance,
empathy, and trust
(Mezirow, 1997, 2000).

The organization will
appoint a consistent
supervision time to
meet and create
supportive
environments with
PSCs to reflect their
experience with
burnout to inform
care.
The organizational climate promotes a culture of affirming health and wellness care for the
PSCs volunteer
There is a high probability that the organizational climate promotes a culture of affirming
health and wellness care of the PSCs. The theoretical perspective being used to create the
recommendations for the solution is Clark and Estes (2008) Gap Analysis, where the aim is the
take research and create a solid foundation to help improve performance and organizational

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effectiveness. The principle that will be used for this influence is from Denning (2005) and
Lewis (2011), which states effective leaders know how to create and manage good working
relationships with stakeholders. For the PSCs who are the stakeholders, this principle will
encourage building sustainable relationships with the PSCs as a way to promote a culture of
affirming health and wellness. The recommendation for this influence would be for the
organization to name at least one way they actively create and manage working relationships
with its PSCs.
Clark and Estes (2008) stated for organizations, the “work process” creates a culture
which will dictate “how we work together to get our job done” (p.107). Where present in one’s
consciousness or unconsciousness, work culture show up in the understanding of “who we are,
what we value, and how we do what we do as an organization” (p. 107). Jones et al. (2019)
discussed how the relationship between organizational and supervisory support usually leads to
satisfaction, commitment and performance, particularly when there is support for career
development. From the study of Jones et al. (2019), their findings report being more committed
to each other’s success, the more favorable outcome: “Our findings showed that peer specialists
reporting greater depth and breadth of participation in roles/responsibilities in areas of
organizational leadership and representation were more likely to be based in organization types
that offered more positive climate and support” (p. 13). According to both Denning (2005) and
Lewis (2011), in order for organizations to have effective leaders, they must know how to sustain
good working relationship with the stakeholders in the organization. This is a reflection of the
recommendation of considering the effects of world issues and how they affect service practice.
Currently with how the pandemic of COVID-19 is affecting the way people are interacting with
the health system currently, in parallel to the Racial Uprisings/Great Awakening, and the current

137
conservative administration which is adamant about limiting the rights and freedoms of those
who are a part of the LGBQ+T community, these world issues cannot be avoided. Depending on
the intersection of identity in which the person falls, any of these world events may be more dire
than another. One participant reflected on the current new of today and how it affects them being
a person who is transgender:
I think the passing of Ruth Bader Ginsburg and that whole thing with the Supreme
Court,... these are just national stressors. They're external. They're things that we can't
even if we aren't particularly worried about politics or anything like that... As trans folk,
these are realities that have the potential to really significantly impact our lives. So, it will
be unavoidable to have to talk about, and manage, and deal with these kinds of stressors
in a peer support setting.
Being able to make space for PSCs to be more support around how these issues come up,
whether educationally, or being supportive emotionally, the organization has a responsibility to
make sure the participants are affirmed and cared for as volunteers experiencing the varied levels
of minority stress in their work. One PSC commented that being able to feel cared for and seen
allows for the organization to prioritize that their “humanity is a little more recognized”. Based
on the research, since establishing a connection is important in creating a culture of affirming
health and wellness for the peer support works, it is recommended that the organization will
name at least one way they actively create and manage.
The organizational setting exhibits support and care for burnout
Based on the collected data from the study, there is a high probability that the
organizational setting exhibits support and care for burnout. The theoretical perspective also used
within this influence to create the recommendations for the solution is Clark and Estes (2008)

138
Gap Analysis. The main principle which will be cited is Mezirwo (1997, 2000), which states
reflective work within the organizational space which is bias-free allows for acceptance,
empathy, and trust. For the PSCs, the organizations increasing effectiveness and engaging in
reflective work works to exhibit support and care for burnout within the setting. The
organization will appoint a consistent supervision time to meet and create supportive
environments with PSCs to reflect their experience with burnout to inform care.
Clark and Estes (2008) explains that in order to address the performance gaps within an
organization, one must also address the organizational barriers as well. A barrier within this
study is possibly the gap between the organization and the care and support for PSCs around
burnout. According to Stehman, Clark, Purpura, and Kellogg (2020), getting organizations to
seek an improvement in the wellbeing of their workers should be the goal in the attempt to create
cultures of wellness. Within the Stehman et al.’s (2020) study of physicians, burnout, and how
to promote wellness, the study concluded that in order for the organization to create a culture of
wellness, they must look at the physicians’ whole environment including “ the physicians
themselves, the organizations they practice in, and the societal issues they face” (p.562).
Mezirow (1997; 2000) states how those who participate in reflective work need to be informed
about the matter at hand in order to feel there is environment of acceptance, empathy and trust.
In order for the organization to help create the environment PSCs can thrive in,
particularly around addressing burnout, the recommendation is for consistent supervision with
the Supervisory Team and the stakeholder to reflect on the experience of burnout. Who
recommendations which will assist is considering scheduling as a method of maintaining
wellness and considering consistent supportive check-ins structures for PSC. This information
from the surveys and from the qualitative portion of the study connects with the study

139
participants’ expressed concern around the scheduling and communication to group participants,
the stress of having ongoing groups as opposed to time-limited, which they all feel a shift would
make difference in their experiences of symptoms of burnout. One suggestion made by Elwood
et al. (2011) is the organization limiting work time, decreasing caseload and increasing
opportunities for self-care to help eliminate burnout. Next, since the Peer Support Supervisory
Team is responsible for their schedule and communicating with the group members, this removes
a level of control from the PSCs. This means, within the PSC groups, there is more time spent
hashing out issues as opposed to processing information or focusing on the group topic at hand.
The group participants can feel frustrated and take their complaints to group sessions for the
PSCs to manage. This, to one of the study participants, felt as if they had to “take on the
frustration because of bad communication…”. Feeling frustrated being a part of the definition of
burnout, showing a direct connection to how the interaction between DCCH’s organizational
culture and context interacts with the knowledge and motivation of the Peer Support counselors.
Due to this interaction between the organization and the PSCs around disconnect in
communication around logistics, there might be a larger conversation at hand on how to organize
a better communication flow. It might even be beneficial to discuss what are some duties the
PSC may hold for groups to run smoother, or even hire an assistant to help manage individual
groups. This may take the pressure off the Peer Support Supervisory Team in terms of managing
multiple groups and individual PSCs, and it gives a direct line of communication specifically for
that group. It would be beneficial for the organization to find ways to involve PSC in
scheduling, or just extending communication around statuses of the groups, in order to help
prevent burnout.

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There was also a recommendation around rotating PSC facilitators in order to give a bit
more space in between group facilitations. For example, if the group meets every other week for
10 weeks, after the 10-week cycle is over, that PSCs would get a break and allow other PSCs to
take over for that group. This will allow the initial PSC to recharge and prevent symptoms of
burnout such as feeling overwhelmed and depleted, and also expand the number of PSCs who are
getting experience with groups and individual sessions. Increasing time limited groups,
organizing a rotating schedule and the option to recommit per season of session would give the
opportunity for PSCs to rest. The PSCs would also have the work feel more manageable so they
are able to commit more to the program as a whole.
It was also recommended to consider consistent supportive check-in structures for PSCs.
It was also frequently requested to have consistent supportive check-ins or groups with the PSC
by the organization to discuss their experiences within individual sessions and groups, and the
effects of burnout they may have on the facilitator. This type of supervision could improve their
quality of work, which means better service. These check-ins and groups can also include
tangible and intangible rewards, which makes the PSCs feel appreciated and see in the work they
are doing. This also emphasizes the mission of the organization to invest in the affirmation and
wellness of the PSCs. These rewards were all considered a representation of the appreciation the
PSCs would like to feel from the organization, possibly as ways to affirm their health and
wellness. This gives the organization to learn more about the stakeholder’s experience, their
environment and how to give additional support when needed.

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Integrated Implementation and Evaluation Plan

Implementation and Evaluation Framework
The implementation and evaluation framework which will be used within this study is the
New World Kirkpatrick Model (2009), created by Dr. Donald Kirkpatrick (Kirkpatrick &
Kirkpatrick (2016). This model uses the four levels, results, behavior, learning, and reaction, to
help build and modernize business to maximize their effectiveness. This model flips the levels
in reverse, starting with Level 4 (results), and working its way to Level 1 (reaction). This model
will assist in the researcher in designing a plan to help create successful next steps for the
organization’s goal of gaining knowledge to create educational strategies and supports to help
reduce the impact of burnout experienced by the PSCs.
Organizational Purpose, Need and Expectations
The study’s organization, DCCH, expresses the mission of the organization is to provide
the community affirming wellness services, specifically centering the needs of LGBQ+T people
and those living with HIV and AIDS. Through equality and inclusive practices, DCCH
encourages everyone to live healthy lives as well as love and connect with each other openly.
From this mission, the study is centering the role burnout plays in impacting the well-being of
TQNB PSCs in community health organizations as the need to be addressed. From this need and
the mission of the organization, the researcher created an organizational performance goal, which
aims in 2021 for DCCH to implement new educational strategies and supports to improve
volunteer well-being and reduce the impact of burnout experienced by volunteers as they engage
in the work of the organization.
Examining PSCs as the primary stakeholder group in the study will help the researcher,
who created the goal, to understand the PSCs knowledge and motivational influences around

142
participating in the peer support program and the effects on their mental well-being. If this
utilizing this information can benefit TQNB-identified people who work within Peer Support
Programs community settings and organizations, formulating a level of connectedness amongst
the population will double as protection against minority stress and victimization (Shilo et al.,
2015; Scheeh & Antebi-Gruszka, 2019). The information will enlighten and further the
implementation of new educational strategies and supports to improve volunteer well-being and
reduce the impact of burnout experienced by volunteers as they engage in the work of the
organization. This implementation of the educational strategies and supports in the overall
assisting in achieving the organization’s mission and overall goal by informing peer support
workers to help reduce the impact of burnout. The expectation for desired results and outcomes
is to increase the interactions between the organization and the stakeholders through supervision
and trainings, as well as implementing an assessment to help gather information about the
experiences of burnout to increase awareness and educate as a way of prevention.
Level 4: Results and Leading Indicators
Kirkpatrick and Kirkpatrick (2016) state Level 4 (Results) targets the outcomes which are
the direct results of the training, support and accountability package offered to the organization.
To help establish a connection between the critical behavior’s performance and the potential for
a high result from the organization, leading indicators are used (Kirkpatrick & Kirkpatrick,
2016). Leading indicators “provide personalized targets that all contribute to the organizational
results” as well as “short-term observations and measurements that suggest that critical behaviors
are on track to create a positive impact on the desired results” (Kirkpatrick & Kirkpatrick, 2016,
p. 61).

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The Table 11 below exhibits the outcomes, metrics and methods of this study which state
the short-term observations and measurements that indicate that the stakeholder is achieving the
desired results.
Table 11

Outcomes, Metrics, and Methods for External and Internal Outcomes

Outcome Metric(s) Method(s)

External Outcome:
The PSCs will gain an
increased level of
knowledge about
symptoms of burnout.
40% increase in results between
initial score and second attempt
from biannual assessments on
burnout and well-being for PSCs

Add at least one additional lesson
which emphasizes burnout
symptoms within initial trainings
and on boarding of new PSCs
Record kept of participation
of PSCs in biannual
assessments with the Peer
Support Supervisor

Department-specific
curriculum will be created to
increase knowledge on
symptoms of burnout for
PSCs

Internal Outcome:
PSCs will gain the
ability to recognize
their own burnout
symptoms, if they
were to exist.
Number of recognized symptoms Record kept of participation
of PSCs in biannual
assessments, which includes
a section for narrative around
personal experiences of
burnout, if they were to exist.
Internal Outcome:
PSCs will increase the
promotion for health
and wellness for the
PSCs, including
focusing on symptoms
of burnout.
Increased communication
between PSCs and administration
to assess biannually for symptoms
of burnout.
Department-specific
curriculum will check in with
the PSCs about opportunities
for fostering a relationship
with one another.

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Internal Outcome:
The PSCs will
increase awareness of
how minority stress
around TQNB-identity
may influence
burnout.
40% increase in results from
biannual assessment between
initial score and second attempt
about burnout, with an added
emphasis in the intersection of
gender and/or sexual orientation
Department-specific
curriculum will emphasize
the role of minority stress in
burnout for TQNB identified
PSCs

Level 3: Behavior
Critical behaviors
Level 3 focuses on the behaviors within the organization. Kirkpatrick and Kirkpatrick
(2016) describes this level as “the degree to which participants apply what they have learned
during training when they are back on the job” (p. 14). The specific actions that are performed
on the job consistently are called critical behaviors. In the chart below, the researcher listed key
behaviors that the stakeholder of focus will have to demonstrate to achieve the outcomes. The
two critical behaviors which will be noted by the researchers is the stakeholder participation in
supervisions, with biannual assessment and evaluations included, with the Peer Support
Supervisory Team support, and the administrators will hold a meeting yearly with the PSC
around their experience within the organization.
Below, Table 12, will give more context around the critical behaviors, metrics, methods
and timing.
Table 12

Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s) Method(s) Timing
1. Stakeholder
participation in
supervisions, with
biannual
2. Number of
additional
supports
used per
1. Peer Support
Supervisory
Team will track
each PSCs use
1. At least
twice a
year

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assessment and
evaluations
included, with the
Peer Support
Supervisory Team
support
every six
months
of supports
within the Peer
Support
Program during
biannual
assessment and
evaluations
2. Administrators
will meet with the
PSC around their
experience within
the organization
for assisted
learning and
reflective practice
2. A rubric that
documents
participants
in meetings
2. An
administrator
within the
organization
will facilitate a
meeting yearly
with PSC in the
organization
2. Once a
year

Required drivers
Level 3 also includes required drivers, defined as “processes and systems that reinforce,
monitor, encourage, and reward performance of critical behaviors on the job” (Kirkpatrick &
Kirkpatrick, 2016, p.14). In order to help create a successful initiative, there needs to be an active
execution and monitoring of the required drivers to assist with accountability (Kirkpatrick &
Kirkpatrick, 2016). In order to drive the achievement of the stakeholder outcomes, this section
will focus on both the motivation and organizational influences. For the motivational influences,
this section will examine self-efficacy, where the PSCs need to believe they have the ability to
support their clients and attribution, where PSCs need to believe their successes and failures, as it
relates to their peer support duties, are within their control. For the organizational influences,
these include availability for affirming health and wellness care and acknowledging wellness for
PSCs around symptoms of burnout.
Within Table 13 below, the researcher lists the various methods, as well as the timing of
each influences as well as defining which critical behaviors supported.

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Table 13
Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical Behaviors Supported
1, 2, 3 Etc.
Reinforcing
Peer Support Counselors
(PSCs) need knowledge about
the symptoms of burnout.
Ongoing 1, 2
PSCs need knowledge of how
minority stress around an
TQNB-identity may influence
burnout.

Ongoing 1, 2
PSCs need knowledge about
one’s thinking about burnout
symptoms and their
experience as a PSC.
Ongoing 1, 2
Encouraging
Self-Efficacy: PSCs need to
believe they have the ability
to support their clients.
Ongoing 1, 2
Attribution: PSCs need to
believe their successes and
failures, as it relates to their
peer support duties, are within
their control.
Ongoing 1, 2
Rewarding
Peer Support Appreciation
(food, group recognition,
awards)
Four times a year 1, 2
Company recognition
(appreciation on the listserv,
spotlight features, offered
spots to blog about
experience)
At least three times a year 1, 2
Monitoring

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Cultural Model Influence 1-
Availability for Affirming
Health and Wellness Care:
The organizational climate
promotes a culture of
affirming health and wellness
care for the volunteers.

Twice a year 1, 2
Cultural Setting Influence 2 -
Acknowledging Wellness for
PSCs: The organizational
setting exhibits support and
care for burnout.

Once a year 1, 2

Based on the influences listed above, in order to hold the researcher accountable, the
researcher will encourage more of an organizational commitment, particularly from higher
management, to the PSCs around their well-being and mental health. The influences above have
the common theme of centering the voices and experiences of the PSCs, and increasing the
commitment between the stakeholders and the organization as a whole. In order to ensure the
drivers above are implemented on a continuous basis, the researcher would suggest establishing a
policy around building biannual assessments and evaluations with the Peer Support Supervisory
Staff to build a relationship with the PSCs for space around processing thoughts, feelings and
emotions for clarity or education. This level of accountability can be done through action
learning, touch bases/meetings and observation, per Kirkpatrick and Kirkpatrick (2016).
Supports suggested above include coaching through supervision, creating communities of
practice as a way to building relationships between the stakeholders and the organization, and
being recognized through rewards (Kirkpatrick & Kirkpatrick, 2016).

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Organizational support
Within this study in terms of organizational influences, there is a cultural model influence
which aims to promote a culture of affirming health and wellness care for the volunteers. For the
cultural setting influence, the organizational setting exhibits support and care for burnout through
acknowledging wellness for the PSCs. With the critical behaviors listed above, it is important to
understand how the organizational supports are going to support the stakeholder’s critical
behaviors. The first critical behavior is the stakeholder participation in supervisions, with
biannual assessment and evaluations included, with the Peer Support Supervisory Team. The
second critical behavior is administrators will hold a meeting yearly with the PSC around their
experience within the organization. Both will need the support and commitment from the
organization in order to support these critical behaviors. Freudenberger (1986) states in
situations where stress exists, it is up to both the staff person and the organization to care for one
another: “if the signs of care of him/herself and program administrators have a responsibility to
call it to his/her attention as well as to offer assistance in overcoming burnout”. (p. 250). Ley et
al. (2010) states support from organization should include components of supervision and
evaluation which should be embedded within an ongoing process of learning and development
(p.24). With finding a way to integrate the needs of the organization and the stakeholders, this
study would implement Level 3 interventions such as observations, action planning, and
coaching. This allows the opportunity to continue and consistent support from the organization
for the stakeholders and their critical behavior.

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Level 2: Learning
Learning goals
Following completion of the recommended solutions will allow the stakeholders in the
organization to be able to:
1. Stakeholders will participate in supervisions with the Peer Support Supervisory
Team, which includes the assessment and evaluation, twice a year with 100% accuracy.
(E)
2. Stakeholders will complete the assessment and evaluation questions used to
process and identify the existence of burnout and well-being with the Peer Support
Supervisory Team at least twice a year (every six months). (R)
3. Higher level administration will hold open discussion groups at least once a year
in order to process the experiences of PSCs and their relationship to burnout and wellness
in the organization. (R)
4. Higher level administration will partner with PSCs to action plan in order to apply
the information they learned to the organizational culture, at least once a year. (C)

Program
After creating the stakeholder learning goals, the researcher will create a program which
will help the organization support the achievement of said goals, which will be based on the
previously discussed KMO needs analysis and recommendations. According to Kirkpatrick and
Kirkpatrick (2016), when constructing a program, planning, execution, and demonstration of
value are the three phases used to maximize the effectiveness of the initiative and its value. With
planning, the study must first identify the Level 4 result of the organization. For this study, the
recommendations, listed in Tables I and II, all reflect the organization's needs to build a stronger

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relationship between the organization and the stakeholders, as well as the goal of learning more
about symptoms of burnout with PSCs, and how to increase a level of well-being. For that
planning stage, the program will be implementation of an additional assessment and evaluation
of the PSCs to encourage thought around wellness, burnout and their experiences within the
organization. This will be added to each PSCs biannual supervision meeting with the Peer
Support Supervisory Team in order to monitor the concerns above. Within the evaluative tools,
there is a copy of the assessment and evaluation proposed.
Next, the execution phase of program development, which “includes not only the training
program or event but also activities to prepare for the program and all subsequent support and
accountability activities” (Kirkpatrick & Kirkpatrick, 2016, p.29). To prepare the organization
for the added shift in supervision, the researcher will propose an educational training program to
help target symptoms of burnout and increase commitment to PSCs overall well-being in the
organization. After training the Peer Support Supervisory Team, the assessment will be added as
a policy in the program. This also includes training the organization’s higher level
administrators on setting up a yearly meeting to help construct a relationship with the PSCs and
process their needs. This allows building a relationship so the needs of the PSC are centered and
heard by the administration.
Finally, with demonstration of value, it allows you to gather data from the
implementations and tell the story from the information (Kirkpatrick & Kirkpatrick, 2016). In
examining the learning goals of this study, using the assessment and evaluation will be able to
create space for relationship building with the organization and the stakeholders, and gather
information about any concerns about the symptoms of burnout (per the goals above). In order
to examine whether the program was successful, is examining the data at least after one year (so

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the organization is able to compare and contrast the results). The program should be
implemented into the organization and used until the needs of the organization change, or if there
is a shift in the experiences of the PSCs. Once the assessment and evaluation are created,
stakeholders should be evaluated at least every six months. The check-ins do not have to be
more than an hour. For the organization's gatherings, they do not have to be over three hours,
but the flexibility around the needs in the space can allow for an expansion, if possible. The
program delivery method lies in the Peer Supervisory Staff initiating the evaluation during
biannual check in.
Evaluation of the components of learning
Below is the Table 14, which introduces the study to the methods and activities in which
the researcher will use to evaluate the learning goals. This information was taken from the
learning goals created for the stakeholder and the need for the organization to create a closer
relationship with the PSCs. Each method and activity are related to knowledge, declarative,
procedural, attitude, confidence and commitment, as well as labeling how much time is required
for each.
Table 14
Evaluation of the Components of Learning for the Program
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”
Knowledge about symptoms of burnout will be
evaluated through biannual assessment and
evaluation
Twice a year
Knowledge of how TQNB identity affects PSCs
within the Peer Support program
Twice a year
Procedural Skills “I can do it right now.”

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Observation of ability to meet the duties of the
Peer Support program
Twice a year
Observation of ability to communicate to
administration and Peer Support Supervisory
Team for support
As needed
Attitude “I believe this is worthwhile.”
Evaluating expressed levels of value and
commitment to the work as PSCs
As needed
Requesting feedback from PSCs throughout the
year
As needed
Stakeholders will participate in supervisions with
the Peer Support Supervisory Team, which
includes the assessment and evaluation

Twice a year
Stakeholders will complete the assessment and
evaluation questions used to process and identify
the existence of burnout and well-being with the
Peer Support Supervisory Team

At least twice a year (every six months).
Confidence “I think I can do it on the job.”
Higher level administration will hold open
discussion groups in order to process the
experiences of PSCs and their relationship to
burnout and wellness in the organization.

At least once a year
Higher level administration will partner with
PSCs to create an action plan in order to apply
the information they learned to the
organizational culture
At least once a year
Commitment “I will do it on the job.”
Participation in biannual supervisions for
accountability
At least twice as year
Understanding one’s own experience witty
symptoms of burnout allows one to examine the
awareness of how it comes up in their work
At least twice a year (but supervision can
be used as needed)

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Level 1: Reaction
Level I, which focuses on reactions, where to the degree “in which participants find the
training favorable, engaging, and relevant to their jobs” (Kirkpatrick & Kirkpatrick, 2016, p. 39).
Within the methods or tools used, this table below displays using formative evaluation methods,
how engagement, relevance and customer satisfaction. This table will also give approximates to
timing, giving an idea of when these reactions will occur during a learning event.

Table 15
Components to Measure Reactions to the Program
Method(s) or Tool(s) Timing
Engagement
Seeing assessment and evaluation in
supervisions used in replacement of therapy
Ongoing
Anxiety and resistance from PSC Ongoing
Anxiety and resistance from organization Ongoing
Relevance
Organization being resistant to change Ongoing
PSCs being resistant to change or intaking
more information pertaining to their position
Ongoing
Customer Satisfaction
Possibly anxiety from the PSC due to
discussing triggering and uncomfortable
experiences
Ongoing
Organizational resistance around
relationship building with PSCs
Ongoing

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Evaluation Tools
Immediately following the program implementation.
Appendix A lists out the additional questions to supplement the biannual evaluation and
assessment of the PSCs, but there are also two surveys attached which were used in the original
study, the Maslach Burnout Toolkit™ for Human Services. The evaluation tool consists of items
within the category of Level I. For engagement, discussion questions processing their experience
may bring up some uncomfortable feelings, from both the PSCs and administration. The
experience of resistance with the process also can come up within Relevance and Customer
Satisfaction. With Level 2, making interpersonal connections and commitment to relationship
building and processing one’s experience exudes declarative, knowledge, procedural skills,
attitude, confidence and commitment. Please see Appendix A for more information.
Delayed for a period after the program implementation

Appendix B is the Rating Scale Post-Program Implementation, which is the evaluation
tool will be given to participants three months after their initial training to evaluate how much
information was internalized and applied to the PSCs peer support duties. This can also be used
to evaluate the degrees of evaluation and participation amongst the PSCs three months after each
biannual assessment. This consistently will allow the team to collect more data over time for
more accurate information on the interactions with PSCs by the organization, as well as how the
organization can support around possible symptoms of burnout.
Data Analysis and Reporting

Kirkpatrick and Kirkpatrick (2016) stated that data analysis and reporting “is an ongoing
process that occurs throughout the program implementation, and not a discrete activity that occurs
at the end of the process” (p. 119). Examining this process illuminates the influences that shift the

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programming to allow for maximum outcomes and values (Kirkpatrick & Kirkpatrick, 2016). In
terms of reporting the findings to the organization, the information will be distributed in a briefing
with both administration, and PSCs (including the Peer Support Supervisory Staff). This gives the
opportunity to not only facilitate the relationship-building between administration and PSCs, but
also allows open dialogue and process about possible symptoms of burnout or a need to address
issues around well-being within the culture. Appendix F will not only show the overall results of
the data collected within the Rating Scale for Post-Program Implementation, but also leave room
for those reviewing the information an opportunity to give feedback on the results (Appendix G).
There will also be a link available to the PSCs in case they would like to also leave anonymous
feedback for future reporting as well. This link will remain live throughout the period of the
program and used to supplement the data from surveys and biannual assessments and evaluations.
Limitations and Delimitations

There are concerns about anticipated limitations or things the researcher cannot control,
such as the relationship the researcher has with the organization, any technological errors, the
working or interpretation of the surveys, and the global pandemic. First, for the researcher,
DCCH has personal ties that help color the study's perspective, but which also brings up the
ethical topic of a dual relationship that is both physical and emotional. The researcher has
connected to the organization through service and has used the organization's services to support
a personal growth process.
Identifying as a Black Queer Nonbinary person, the researcher was a part of a volunteer
support group for Queer Black women, which met at least once a month over ten years ago from
the date of the study. The researcher had always been a participant and never a group leader.
The group was dismantled once the partnership with DCCH was over. The researcher will

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maintain relational ethics and were aware of their role and impact as a researcher in this study.
The researcher continued to be mindful in their ownership of power. This includes treating the
participants as "whole people", and not just data (Tracy, 2013, p. 245 as cited by Merriam &
Tisdale, 2016). This also reflects Hammersley and Atkinson's (2007) concept of reflexivity,
where the researcher unavoidably influences and influences a part of the community in which
they are studying (Maxwell, 2013).
Next, the weight of COVID-19 has hit the organization, as with most healthcare
institutions in the United States, hard and has affected the PSCs' level of commitment. Per the
researcher’s observation and analysis of the quantitative data, signing on more participants to
participate was difficult due to the organization's mandated social distancing, which led to a
change in treatment modality (from face-to-face to technology-based) and no opportunities to
gather as a group or in person. With the increase in need for services due to the effects of social
isolation and physical and environmental trauma, this may have diminished the chance for
consistent access to the group and a larger sample size. This is also coupled with the researcher
relying on the Peer Support Supervisory Team to contact the PSCs by email about the study to
remove the researcher's level of power. During this time of COVID-19 where there is an
increase in technological use for communication in all participants' lives, additional emails may
also contribute to fatigue of the sample population. Even though the data set is small, the
researcher has found value in the survey items being supplements to the interviews to give more
insight into how burnout appears in their workplace, especially examining a niche group of
majority Black and a trans masculine group nonbinary queer people.
Since all communication through DCCH is online, the study did run the risk of
navigating issues with technology and building rapport and trust with the participants, even if

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they and the researcher do not meet in person. The researcher continued to check in with
participants around access and make accommodations where needed to adjust the study. For
example, if the person is more comfortable with their camera off during the interview online, the
researcher made adjustments to that request, such as ensure there is enough audio to capture and
translate. The researcher’s first and foremost goal is the researcher and participants' safety and
making sure the previously discussed protocols are enforced.
Future Research Recommendations

First, looking into how changes in service provision from in person to online shifts the
peer support experience of the service providers and the participants would be useful to see the
degree in which peer support is helpful. The changes in service were immediate; without proper
training or skill-building to help steadily acclimate to the new system is the organization's
responsibility to prepare the PSCs. Being in a healthcare organization amongst a global
pandemic can cause other stressors, especially during a shutdown. Future research
recommendations should look deeper into how service is given when all systems, from macro to
micro/direct services practice, is under duress during a global pandemic. Studying this during
this unique and central time is going to be important to learn how to care for organizations and
its consumers/patients during this time and prepare for the future of service provision when it
comes to online treatment in peer support.
Next, exploring people of all genders and sexual orientations would also help discover
how identity and minority stress play a part in the healthcare system for peer support. This is
especially since those who are a part of the LGBQ+T community experience are more likely to
receive adverse treatment when they are seeking services. This can lead to exploration around
identity.

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If identity is a factor in how symptoms of burnout show up albeit race, gender, sexual
orientation, etc., is there a difference in how these symptoms show up? If so, this is also a
difference in service provision and treatment and supervision for the PSCs. The study does show
that being of a marginalized identity, whether Black, or trans or nonbinary, does make a
difference in how subjects are approached, depending on your proximity to them. How can this
information be used to help organizations be accountable for their well-being within their
positions, particularly if the PSCs share the same experiences in and outside the group? The
relationship of identity and how it is centered and utilized in relationships between the
organization and the service provider. Understanding min to the degree in which minority stress
affects service provision would be a great next step to future studies to help improve healthcare
organizations' health and well-being.
It would also be benefit researching time limited versus ongoing groups and their effects
on the degree of burnout experienced. Many PSCs commented causing burnout symptoms to
increase. Future work can explore why that is the case and how the modality of treatment plays a
part in the quality of care on who is providing the service. In relation to length of time, also,
looking at the length of time someone was a PSC would benefit the researcher and have direct
conversations with the actual group participants to see how some of these themes show up in
their lives. There could also be a study that center on the Supervisory Team's needs to function
collectively and effectively as well. If care can be given to one set of stakeholders due to stress
within the organizational system, the researcher would also like to examine the people who are
supervisors the direct service practice stakeholders (the PSCs) are also having an experience of
burnout as well.

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Conclusion

Within this study, the researcher used, in conjunction with Clark and Estes (2008) Gap
Analysis KMO framework, the New World Kirkpatrick Model to plan, implement and evaluate
the researcher’s recommendations for the organization. This plan using all four Levels, reaction,
learning, behavior, and results, allows the study to optimize achieving the stakeholder goal and
the organizational goal. The expectations that the researcher has for this framework is to use the
data collected from the PSCs, and create a fluid plan for the PSCs and administration to build
strong working relationships with one another to help detect symptoms of burnout and commit to
overall well-being within Peer Support work. This is to help gather data to help create
educational support within the organization to inform PSC and allow a shift in structure for care,
when needed. Based on the data collected, the values of the intervention (surveys, annual
administrative meetings and biannual assessment and evaluations) are seen as a return on
expectations. Overall, the hope is that this program will bridge the connection between the PSC
and the organization, creating relationships and care that can be sustainable with consistency and
commitment as well as help alleviate symptoms of burnout.
Based on the information above, there are recommendations in the three areas of
knowledge, motivation and organizational resources which may be appropriate for solving the
problem of practice: emphasis on education as burnout prevention and as supporting for
community and relationship building. For knowledge, the researcher recommends based on the
study’s information collected above that helping PSCs be aware of the experience of burnout
through education around symptoms. Freudenberger (1986) says if a staff member is in a
situation where there is ongoing stress and pressure, the person could adapt to the environment
and ignore their own signs of distress. This, as Freudenberger reports, “may be self-destructive”

160
(p. 250). Mead et al. (2001) discusses how training for those within the peer support field can
help build some tolerance around any discomfort by helping to examine any emotional triggers
and discuss relationship dynamics. One way PSCs can become more conscious and informed
about their experiences of burnout is utilizing the support of the organization through education.
Education can not only keep people informed, but also help process their own inner conflicts
which can help diagnose burnout.
This ties in with the motivational influences, where the researcher would also suggest
creating ways to allow PSCs to build community with one another in order to express care and
connection to also alleviate burnout. With motivational influences, motivation of the volunteers
relate to the possible impact of burnout if the following is not monitored within the Peer Support
Program: have workloads assigned to them controlled (or at least manageable); community
support is important for validation within their PSC role; and their level of control in making
decisions to produce successful outcomes. This experience is validated by the work of
Freudenberger (1986) who says the feeling of burnout can come with the experience of “being
overloaded”, which can cause a loss in motivation in doing the work that was so important to
them (p. 247).
Finally, an organizational resource which would be appropriate for solving the problem
of practice (addressing the threat of burnout to the well-being TQNB-identified PSCs) is
providing educational opportunities to learn about the experiences of burnout, as well as
techniques and ways to acknowledge how the organization can be a better support emotionally
overall. Fairness and Values as an area of worklife within the study is connected to this study
through the examination of the cultural setting influence. Within this category, examining the
organization’s setting and how it exhibits support and care for burnout will allow the researcher

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to understand how it acknowledges wellness for the PSCs. Both AWS’s (2011) concepts are
connected to this cultural setting because being able to offer support that is equitable and is
valued by both the individual and the organization allows buy-in to care that benefits everyone.
This acknowledgement and reciprocation are similar to the idea of a culture of wellness, which
refers to the relationships developed in the organization which reflect collaboration,
communication and coordination for sufficient patient care (Olson et al., 2019). The idea is that
if there is a desire to have efficiency within the workplace, it is up to the organization to build an
environment where “the clinical and administrative workload should be supported by sufficient
resources to maintain quality, productivity and work-life balance” (p. 2). In order to address the
Fairness and Values within the organization’s cultural settings, the researcher would suggest
leaning in on supporting community and relationship building between the organization and the
PSCs to build a stronger alliance together to help build resilience against burnout within the
workplace.
A goal for the organization to help address burnout in its organization is creating a
culture of wellness. This is defined as “a work environment with a set of normative values,
attitudes and behaviors that promote self-care, personal and professional growth, and compassion
for colleagues, patient and self”, according to Stehman et al. (2020). In looking at the high levels
of Personal Accomplishment, which lowers both emotional exhaustion and depersonalization,
within an organizational context, finding ways to support feelings of Personal Accomplishment
(such as competence and effectiveness) would be beneficial in lowering the presence of burnout
in PSCs. This is particularly true in healthcare settings in a post COVID-19 world, when people
are not only forced to be isolated from each other, but also hold the responsibility of working
from home, caring for children, maintaining a household, and also follow strict health protocols

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in order to keep themselves and other people safe. According to Wu et al. (2020), if staff feel
unsupported during this time, “COVID-19-related trauma may cause symptoms of distress and
burnout and decrease their ability to function effectively” (p. 822). If these symptoms are left
unattended to, they could evolve into chronic health and mental health disorders such as
posttraumatic stress disorder (Wu et al., 2020). The more the organization can support the PSCs
skills and abilities to increase their professional confidence, this also improves the nature of the
relationships between the PSC and the group participants as well (Hecimovich & Volet, 2011).
The researcher is confident that creating educational opportunities for the PSCs to feel more
supported around their experiences with burnout will address the problem of practice within the
study.
In conclusion, Mead et al. (2001) expresses that peer support is a model that is inclusive
and allows for people being who they are and having opportunities to grow, which means a shift
in the larger system. Frost and Meyer (2012) comment that having a level of community
connectedness, where an individual builds a mutually, rewarding influential relationships to a
larger collective and shares an emotional connection, allows for improving community-level
health and well-being especially for LGBQ+T folks. This study shows that working with the
organization in order to help implement any recommendations will allow the PSCs, the
organization, and lastly the group participants to feel held, seen and committed to a community
system that is willing to affirm their health and wellness, as committed in the mission of the
organization. To center the voices of the study participants within this study, lastly, the
researcher will end this chapter will a quote that connects the experience of depersonalization
around their identity as a trans person and someone who is Black, and how boosting their sense

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of personal accomplishment makes for a supportive program, and lessens the experience of
burnout:
I think it relates a lot to what has been a growing kind of sense of fear right? I think trans
folk and minority folk have held the sense of fear for a long time, for about all kinds of
reasons. But in the current political climate that we find ourselves in, there's this growing
and everyday sense of, my rights might be taken away, what rights I do have. Or, the
kinds of prejudices that exist might increase. That kind of fear, that trans folk just have to
live with, now especially, makes it even more challenging in some ways to be a peer
support worker because, what I am experiencing, they're the same things that the people
who are coming into that space are experiencing. It's my responsibility to really hold
space for them, to work through that, while I also have to work through that myself.

164
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community-in-2019
Washington, DC Population. (July 11, 2019). Retrieved July 28, 2019, from
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Webb, A., Matsuno, E., Budge, S., Krishnan, M., & Balsam, K. (n.d.). Non-Binary Gender
Identities: Fact sheet. Retrieved from https://www.apadivisions.org/division-
44/resources/advocacy/non-binary-facts.pdf
Willms, D. G. (1997). You start your research on your being. In Smith, S. E., Willms, D.G. &
Johnson, N. A. (Eds.), Nurtured by knowledge: Learning to do participatory action-
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180
communication strategies to promote institutional resilience. Annals of Internal Medicine.
Retrieved from https://doi.org/10.7326/M20-1236

181
Appendix A
Demographic Survey Items

Participant ID Number:______________
Date: ______________

Race: I identify as ______ (Check All that Apply).
o African American/Black (including Africa, Caribbean)
o Caucasian/White (including Middle Eastern)
o American Indian or Alaska Native (including all original peoples of the Americas)
o Asian (please specify)
o Asian Indian
o Chinese
o Filipino
o Japanese
o Korean
o Vietnamese
o Other Asian
o Native Hawaiian/Pacific Islander (please specify)
o Native Hawaiian
o Samoan
o Guamanian or Chamorro
o Other Pacific Islander
o Prefer Not to Respond
Ethnicity: I identify as _________ (Check All that Apply).

182
o Non-Hispanic/Non-Latino
o Hispanic/Latino (please specify)
o Mexican, Mexican American, Chicano/a
o Puerto Rican
o Cuban
o Another Hispanic Latino/a; Spanish Origin
o Language:
o English
o Spanish
o Prefer not to respond
o __________________
Are you Deaf or Hard of Hearing?:
o Yes
o No
o Prefer not to Respond
Age Range:
o 18-21
o 22 -25
o 26-30
o 31-35
o 36-40
o 41-50
o 51+

183
o Prefer not to respond
How many years have you served as a Peer Counselor?
o 1-2 years
o 2-4 years
o 4-6 years
o 6-10 years
o 10+ years
o Prefer not to Respond
How many years have you participated Peer Support Participant (if applicable)?:
o I have never participated within the Peer Support Program as a Peer Support Participant.
o 1-2 years
o 3-4 years
o 5-6 years
o 7-10 years
o 11+ years
o Prefer not to Respond
Sexual Orientation (Check All that Apply):
o Lesbian
o Gay
o Bisexual
o Straight/Heterosexual
o Queer
o Prefer not to Respond

184
o __________
Gender Identity: I identify as ______.
o Cisgender Man
o Cisgender Woman
o Trans Man
o Trans Woman
o Genderqueer and/or Non-Binary
o __________________________
o Prefer not To Respond
Gender Pronouns: Which gender pronouns do you use (Check all that apply)?:
o He/him/his
o She/her/hers
o They/them/theirs
o Prefer Not To Respond
o ____________

185
Appendix B - Handwritten Notes and Observation

Dates of Observation: __________

Notable Quotes from Participant:

Researcher’s Interpretation:

In one week, the researcher’s interpretation of the data is:

In two weeks, the researcher’s interpretation of the data is:

In three week, the researcher’s overall interpretation of the data is:

186
Appendix C: Flyer

187
Appendix D:
INFORMATION SHEET FOR EXEMPT RESEARCH

STUDY TITLE: "The Dedicated and the Committed": An Examination of Burnout within
Peer Support for Transgender, Queer, and Non-Binary Volunteers

PRINCIPAL INVESTIGATOR: Shanéa Thomas, LICSW, M.Ed.

FACULTY ADVISOR: Bryant Adibe, Ph.D.

You are invited to participate in a research study. Your participation is voluntary. This document
explains information about this study. You should ask questions about anything that is unclear to
you.

PURPOSE

The purpose of this study is to explore the role burnout plays in impacting the well-being of peer
support counselors who identify as Transgender, Queer, and Non-Binary (TQNB) in community
health organizations. While using two surveys (the Maslach Burnout Toolkit™ for Human
Services, which includes two separate surveys, the Areas of Worklife Survey and the Maslach
Burnout Inventory™ Human Services Survey), and a semi-structured interview, this study would
like to gather information to help address if peer support work can manifest burnout symptoms.
We hope to learn how to burnout affects peer support in order to help gather information to
create educational strategies and supports to improve the peer support worker’s overall well-
being. You are invited as a possible participant because you identify as a Peer Support
Counselor who identifies as Transgender, Queer or Non-Binary (TQNB). This research is being
funded by the researcher, Shanéa Thomas, LICSW, M.Ed.

PARTICIPANT INVOLVEMENT

If you decide to take part, you will be asked to:
● Enroll in the study after the Peer Support Supervisory Team receives the detailed study
information, which will include the Principle Investigator’s (PI) (Shanéa Thomas,
LICSW, M.Ed.) email and phone number for participation, and the Information Sheet
about the study. The Peer Support Supervisory Team will distribute the contact
information to the participants, as well as to inform them of the 50-dollar gift card as a
benefit to participating.
● Once the participant decides they would like to participate, the participant will use the
email address or phone number to get in contact with the PI with interest in participating.
Once the PI received this notification through email or phone, the PI will distribute the
Information Sheet via email to the participant. Once received by the participant, the PI
will use the Demographic Survey to screen for qualification, and answer any questions
the participant may have. This Demographic Survey will last about 3-5 minutes.

188
● Once the Demographic Survey is complete, the researcher will assign an ID number to
the participant, who be referred as that assigned number throughout the study for
confidentiality purposes.
● The researcher will send a link to the Maslach Burnout Toolkit™ for Human Services to
the participant’s email to complete. The participant will have a seven (7) days from the
day the link was sent to complete both surveys. These surveys will be collected and
scored through a Mind Garden, Inc.’s Transform System (paid by the researcher). The
participant will use their assigned ID number to sign in and complete both surveys.
● Once the researcher sees through the Mind Garden, Inc.’s Transform System that the
participant has complete both surveys, the researcher will send an email with a
scheduling link for the semi-structured interview with the researcher. The time blocks
for the interviews are for one hour and 20 minutes and will be within a week (7 days) the
surveys are completed.
● Once the participant has scheduled their interview time, the researcher will send a
calendar reminder to the participant to help ensure confirmation of participation. The
researcher will also make one courtesy phone contact (phone or text) within 48 hours of
the scheduled interview to confirm.
● As a standard of care, due to COVID-19 and physical restrictions around distance, all
interviews will be held remotely and through the Zoom online platform.
● On the day of the scheduled interview, the researcher will email the online Zoom
meeting link at least 4 (four) hours in advance. This meeting will also be password
protected to ensure the safety of the interview from outside interruptions.
● Before the interview begins, the researcher will ask the participant to consent to
recording of the interview. If the participant refuses, the interview will end and the
data will be removed and destroyed. If the participant consents with moving forward,
the researcher will start the recording on three different devices: the first will be covered
through the Zoom program, the second is the Voice Memo programming on the Apple
computer system, and finally, the researcher’s audio device. All data and transcripts
from these devices will be stored on a separate zip drive owned and purchased by the
researcher. If the participant refuses to be recorded, the interview will continue and
information will be collected through written methods on paper. The data on the zip
drive will also be password protected, with only the researcher having sole access. The
zip drive will be locked in a security box owned by the researcher for additional security.
Your data (electronic and written) will be stored on a zipdrive and lockbox for at least
five (5) years from the end of the date of the study, then destroyed.
● After consent is received and the recording begins, the researcher will review the
Information Sheet, explain the purpose and process of the study and interview, and leave
space for any questions. The participant will be reminded that they have the right to end
their participation in the study at any time.
● The researcher will ask 19 questions to the participant covering their knowledge about
burnout, their experience as a Peer Support Counselor who is TQNB, and the
organization’s role in promoting a culture of affirming health and wellness, as well as
supporting PSCs around burnout. The research may ask clarifying questions in order to
get a full understanding of what the participant is trying to convey.
● Once the interview is complete, the researcher will again ask the participant if they have
any questions about the study. The researcher will then arrange with the participant

189
around giving their $50-dollar giftcard through giftcards.com, where the participant can
select their merchant and how to receive payment (by email or giftcard sent by mail).
● Once the participant agrees on receiving payment and merchant, the researcher will send
the giftcard within 24 hours of the interview.
● The researcher will thank the participant, end the call, and end the recording.
● Total length of subject participation: One hour and 20 minutes-2 hours

PAYMENT/COMPENSATION FOR PARTICIPATION

Participants who choose to participate in the study will receive a 50-dollar giftcard from a
merchant of their choice on the www.giftcards.com website. After participants choose to
complete the surveys and interview, the researcher will then arrange with the participant around
giving their $50-dollar giftcard through www.giftcards.com, where the participant can select
their merchant and how to receive payment (by email or giftcard sent by mail). Once the
participant agrees on receiving payment and merchant, the researcher will send the giftcard
within 24 hours of the interview.

Compensation cannot be withheld until the participant completes the entire study. Payment
should be provided within 24 hours of the last interaction between the researcher and the
participant of the study. You do not have to answer all of the questions in order to receive the
card. If the participant does not complete the entire study for any reason, the researcher will
compensate the participant.

CONFIDENTIALITY
The members of the research team, and the University of Southern California Institutional
Review Board (IRB) may access the data. The IRB reviews and monitors research studies to
protect the rights and welfare of research subjects.

The participant’s personal information will not be connected to their responses, as identities will
be concealed by giving each participant an ID number when they agree to participate in the
study. Your information that is collected as part of this research will not be used or distributed
for future research studies, even if all your identifiers are removed. For any reason, if there is a
breach in confidentiality, the participants will be notified as soon as possible, and that set of data
will be destroyed.

Your data will be recorded on three different devices: through the Zoom program, the Voice
Memo programming on the researcher’s Apple computer system, and finally, the researcher’s
audio device. If the participant refuses to be recorded, the interview will continue and
information will be collected through written methods on paper. All data and transcripts
(electronic and written) from these devices will be stored on a separate zip drive owned and
purchased by the researcher. The data on the zip drive will also be password protected, with only
the researcher having sole access. The zip drive will be locked in a security box owned by the
researcher for additional security. Your data will be stored on this zipdrive for at least five (5)
years from the end of the date of the study, then destroyed. The only person who will have access
to the data and password will be the researcher of the study.

190

The researcher will be using Zoom to help transcribe the interviews, but also using the
audio/video recordings to supplement any missing information to the transcription as well.
The participate does have the right to review any audio/video recordings or transcripts by
request. The participant will not have the right to edit the audio/video recordings or transcripts.
The participant can request at any time to delete or destroy audio, video or written information.

191
Appendix E: Semi-Structured Interview Questions and Notes Page

Participant ID: ___________________
Date:______________________

KMO Influence (from the Conceptual
Framework)
Interview Questions
Knowledge Influences
Peer Support Counselors (PSCs) need
knowledge about the symptoms of burnout.
Factual

Assessment: PSCs will identify at least one
aspect of burnout experienced as PSCs.

1. Based on your own knowledge and
understanding, how would you define
burnout?
2. Freudenberger (1974) who founded the
concept of burnout, describes burnout as “a
consequence of feeling overwhelmed and
depleted while being committed to a job
while needing to “prove oneself” (p.247).
One can also feel physical symptoms such as
headaches and somatic symptoms,
behavioral symptoms, such as irritation and
crying, and mental symptoms such as
depression and anxiety. How does your
definition of burnout differ, or relate to,
the study’s definition of burnout?

3. As a Peer Support Counselor, how have
you experienced burnout in your Peer
Support work?
PSCs need knowledge of how aspects of
minority stress around an TQNB-identity
may influence burnout. (Conceptual)

Assessment: PSCs will be able to name at
least one related aspect of minority stress
in relation to burnout.

4. This next section will examine your
experiences as a TQNB-identified Peer
Support Counselor and how aspects of
minority stress around your identity may
influence burnout. As a Trans, Gender
Non-Conforming, and Non-Binary person,
what social stressors do you experience in
your everyday life?
5. Meyer (2003) describes minority stress as
“the excess stress to which individuals from
stigmatized social categories are exposed as
a result of their social, often a minority,
position” (p. 3). In this study, we are

192
focusing on sexual and gender prejudice as
the stigmatize social category. How does
this definition of minority stress relate to
your experience as a TQNB-identified
PSC?
6. As a Trans, Gender Non-conforming
and/or Non-binary person, what are
aspects of Peer Support can be difficult,
emotionally, behaviorally, or mentally?

7. As a Trans, Gender Non-conforming
and/or Non-binary person, what are
aspects of Peer Support can be rewarding,
emotionally, behaviorally, or mentally?
PSCs need knowledge about one’s
thinking about burnout symptoms and their
experience as a PSC. (Metacognitive)

Assessment: PSCs will be able to name
and reflect at least one experience of
burnout.
8. What is at least one experience you have
had in an individual or group session, in
which you have experienced symptoms
related to burnout?
9. In looking back at that moment, how
aware were you of how burnout was
showing up in your work as a PSC?
10. Within that experience, is there something
you would have done differently, or
changed to eliminate the experience of
burnout (within your control)?
Motivation Influences
Self-Efficacy: PSCs believe they have the
ability to support their clients.

Assessment: PSCs will identify at least one
way they believe they support clients.

11. What is at least one way, within your
position as a PC, that you support clients?
Attribution: PSCs believe their successes
and failures, as it relates to their peer
support duties, are within their control.

12. Within your work as a PSC, can you name
a time where you felt as if you “failed” in
your ability to help someone, in an
individual or group setting?

193
Assessment: PSCs will identify at least one
way they felt they have failed, and one
way they have succeeded within their peer
support duties. The PSCs will also describe
in each of those scenarios, how much
control did they have in the outcome.
13. In that situation, how much control did
you feel you had over the outcome?
14. Within your support, can you name a time
where you felt as if you “succeeded” in
your ability to help someone, in an
individual or group setting?

15. In that situation, how much control did
you feel you had over the outcome?
Organization Influences
Cultural Model Influence - Availability
for Affirming Health and Wellness
Care: The organizational climate promotes
a culture of affirming health and wellness
care for the volunteers.

Assessment: In semi-structured interview
questions, stakeholders will identify at
least one way the organizational climate
promotes a culture of affirming health and
wellness care for the PSCs.

16. What services are offered through the
organization to help support Peer Support
Counselors around self-care, and/or
affirming your health and wellness?
Cultural Setting Influence -
Acknowledging Wellness for PSCs: The
organizational setting exhibits support and
care for burnout.

Assessment: In semi-structured interview
questions, stakeholders will identify at
least one way the organization supports the
PSCs around burnout.

17. What information was given to you from
the organization about burnout?
18. As a PSC, what resources were you given
when starting the program that pertained
to mental health, wellness and self-care?
19. As a TQNB-identified person who is a
PSC for this organization, what are some
ways you would like to see the
organization support your work in order
to help prevent symptoms of burnout?

194
Appendix F: Rating Scale for Post-Program Implementation

This evaluation tool will be given to participants three months after their initial training to
evaluate how much information was internalized and applied to your peer support duties. Please
be honest, thoughtful and clear about your experience with the information shared.

Evaluative Question Rating (Scale of 1-
10)
Additional Notes
1. On a scale
of 1-10, how
well do you
feel since the
training that
you have an
increased level
of knowledge
about
symptoms of
burnout?

2. On a scale
of 1-10, how
well do you
feel the
organization
has promoted
health and
wellness for
PSCs,
specifically?

3. On a scale
of 1-10, how
well do you
feel since the
training that
you have an
increase
awareness of
how minority
stress around
TQNB-identity

195
may influence
burnout?
4. On a scale
of 1-10, how
comfortable do
you feel
participating in
biannual
assessments
and
evaluations
with the Peer
Support
Supervisory
Staff?

5. On a scale
of 1-10, how
comfortable do
you feel
attending a
meeting with
administration
to share your
experiences
around peer
support?

196
6. On a scale
of 1-10, how
openly
appreciated do
you feel by
administration
(whether it’s
awards,
listserv
appreciation,
food, etc.)?

There is also an ongoing link that can be accessed at commentsforPSCforDCCH.com for a
chance to give ongoing feedback about these questions and any other comments or concerns.
These answers are anonymous and will be shared by the Peer Support Supervisory Staff,
administration and the PSC peers.

197

Appendix G: Data Analysis and Reporting
(Rating Scale for Post-Program Implementation)

Evaluative Question Rating
(Scale of 1-10)
Tallied Answers
Additional Notes and Comments
1. On a scale
of 1-10, how
well do you
feel since the
training that
you have an
increased level
of knowledge
about
symptoms of
burnout?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

2. On a scale
of 1-10, how
well do you
feel the
organization
has promoted
health and
wellness for
PSCs,
specifically?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

3. On a scale
of 1-10, how
well do you
feel since the
training that
you have an
increase
awareness of
how minority
stress around
TQNB-identity
may influence
burnout?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

198
4. On a scale
of 1-10, how
comfortable do
you feel
participating in
biannual
assessments
and
evaluations
with the Peer
Support
Supervisory
Staff?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

5. On a scale
of 1-10, how
comfortable do
you feel
attending a
meeting with
administration
to share your
experiences
around peer
support?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

6. On a scale
of 1-10, how
openly
appreciated do
you feel by
administration
(whether it’s
awards,
listserv
appreciation,
food, etc.)?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Abstract (if available)

Abstract This dissertation addressed the role burnout plays in impacting the well-being of Peer Support Counselors (PSC) in community health organizations, specifically those identifying as Transgender, Queer, and Non-Binary (TQNB). Within the TQNB population, they experience factors of minority stress such as discrimination, rejection, and internalized transphobia in society (Meyers, 2003

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Asset Metadata

Creator Thomas, Shanéa Patrice (author)

Core Title The dedicated and the committed: an examination of burnout within peer support for transgender, queer, and non-binary volunteers

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 02/22/2021

Defense Date 12/01/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Burnout,community health,healthcare,intersectionality,minority stress theory,non-binary,OAI-PMH Harvest,peer support,queer,transgender

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Adibe, Bryant (committee chair), Bremond, Diandra (committee member), Hirabayashi, Kimberly (committee member)

Creator Email spthomas@usc.edu,spthomas516@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-422669

Unique identifier UC11668427

Identifier etd-ThomasShan-9280.pdf (filename),usctheses-c89-422669 (legacy record id)

Legacy Identifier etd-ThomasShan-9280.pdf

Dmrecord 422669

Document Type Dissertation

Rights Thomas, Shanéa Patrice

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA