selfsea by Peer Health Exchange: Teen-Powered Approaches to Health and Wellbeing

by Colin Angevine

A Case Study from the Connected Wellbeing Impact Studio

Being a teenager can be hard. Whether you are a teen today or were a teen long ago, this simple statement probably rings true. And that’s typically because adolescence is a time that is characterized by change: changes in your body, your relationships, and your sense of identity.

Since its founding in 2003, Peer Health Exchange (PHE) has known that the first place teenagers look for support through these changes is other teens. That’s why PHE trains 18-24 year-olds to be “peer health navigators,” who then lead PHE’s school-based programs that educate high schoolers on physical health, mental health, sexual health, and more. These navigators are highly effective facilitators: as slightly older “near peers” to the high school students they teach, they have a little more life experience while also maintaining the familiarity and trust that comes from being relatable and closer in age. And with their training, the navigators are able to provide reliable, research-backed information. For the last 20 years, PHE has been using this model and training near-peers to great effect, reaching a total of over 200,000 teens in high schools around the country.

But when the Covid-19 pandemic hit, this model needed to change. The result: selfsea, a web platform that provides resources and information for teens, whether or not they are participating in PHE’s school-based programs. As PHE describes it, selfsea is “a place created inclusively with and for young people as a safe space to share knowledge on identity, mental and sexual health.” PHE’s digital strategy was already well underway before the spring of 2020, but with the onset of the pandemic, PHE accelerated their digital plans and invested in making selfsea robust and widely available. As PHE now looks to the future, they are working toward having their digital resources extend beyond the teens they have been able to reach through their decades of in-person work, and they have already reached over 400,000 young people online to date.

In this case study, we look at how PHE’s digital work uses the principles and approaches of connected wellbeing to support teens and work toward more equitable health outcomes, all through an inclusive and intergenerational collaborative effort.

About the Connected Wellbeing Initiative

The Connected Wellbeing Initiative brings together researchers, designers, educators, and funders to accelerate youth and community-powered innovations for fostering wellbeing in a digitally connected world. The Initiative’s Impact Studio supports early- to mid-stage innovations that model the core principles and approaches of connected wellbeing:

Principles
  • Young people are leaders and sources of strategies, as well as beneficiaries.
  • Caring relationships and communities are tapped as essential supports for wellbeing.
  • Solutions grow from youth identities, interests, lived experience, culture, and communities.
Approaches
  • Connecting to people who get you
  • Harnessing tech for equity and inclusion
  • Diversifying and amplifying youth voice

Peer Health Exchange is one of 11 innovations in the Impact Studio that benefits from personalized advising, capacity building opportunities, and cross-sector connections to accelerate impact and build shared purpose. This case study highlights some of the innovative and meaningful ways that Peer Health Exchange supports youth wellbeing in the digital age.

Connected wellbeing in action

Youth Advisory Board member collage. Courtesy of Peer Health Exchange.

Just as PHE’s school-based programs engage near-peers as “peer health navigators,” who facilitate programming with high school students, PHE knew that they couldn’t develop selfsea without directly involving young people. In the following vignettes, we share examples of how PHE collaborates with youth participants and how that collaboration shapes their digital work.

"The power comes from the young people."

PHE convened the first meeting of their “youth design group” in June of 2020 to identify the priorities of diverse youth audiences and come up with ways to meet those priorities. PHE used frameworks like youth centered trauma informed design and the Designing for Children’s Rights Guide to ensure participants’ safety and privacy, and engaged adult experts on their staff and on their digital wellbeing advisory board to ensure the quality and reliability of the information the group encountered. This intergenerational partnership, which is still ongoing, powers everything that is on selfsea — from the structure of the site to its visual style to the vetting of every piece of content that gets published. (And for parts of 2021 and 2022, this partnership resulted in a mobile app too.)

But creating selfsea wasn’t enough: PHE had to find a way to reach their audience. Eunetra Rutledge, Director of Distribution, recalls a strategy meeting: “We have this great product. How do we share it? …Well, we’ve already got young people that have co-designed [selfsea]. We have to get young people to share it. It has to come from other young people.” And so PHE launched a youth ambassador program. Cohorts of youth, ages 14-19, work with PHE for 6-7 weeks to engage with selfsea’s resources and develop their own ways to share them with peers and educators. Youth ambassadors may distribute fliers, make announcements in front of a health class, post content on social media, or find other creative ways to raise awareness about selfsea. PHE staff support the youth ambassadors and help track their progress.

Screenshot of selfsea on mobile. Courtesy of Peer Health Exchange.

Research background: Youth leadership and voice

A growing body of evidence indicates how centering programs on youth leadership and voice is an effective way of engaging youth and spreading new programs and behaviors. Asset and action based approaches that tap the unique power that young people have in making change and mobilizing their peers are particularly well suited to the strengths of youth from marginalized communities. PHE’s ways of engaging youth reflect well-established and research-backed approaches to mobilizing youth for social change, such as youth participatory action research, youth organizing, and transformative student voice.

The youth-adult partnerships that PHE commits to — both in production and distribution — is resource intensive, but PHE is convinced that the outcomes surpass what adults on staff could achieve on their own.

PHE’s commitment to youth leadership and intergenerational partnership shows up in their organizational structure too: PHE incentivizes youth participants equitably and competitively for their work. Although youth participants don’t work nearly as many hours as full time staff, the scale of youth involvement — a total of 72 teen and early adult participants in 2023 — displays the extent of PHE’s commitment to intergenerational partnerships, which integrates into initiatives across the organization. As Eunetra puts it: “The power comes from the young people.”

Insights from the youth design team

From their earliest meetings, selfsea’s youth design team made a few points clear about the priorities they were bringing to the design process.

First, the youth design team “didn’t want any gatekeepers.” As Eunetra recalls, “Young people from New York were engaging with young people from California [in the youth design team]. And they were having a conversation about what they learned in health class, for example. Two totally different curriculums – ‘We didn’t get to learn about that.’ ‘Well, how do you know that? We didn’t know that.’ [The teens] realiz[ed] that adults are sometimes gatekeeping the information.” The youth design team have been clear that this kind of gatekeeping would only erode trust in selfsea.

“We believe in a world where every young person has full access and every opportunity to a healthy, happy life. To make this a reality, we commit to a pro-liberation approach while working alongside the young people we serve to dismantle unequal power structures that hurt us all, but especially those with marginalized identities.”

Phone and desktop mockup of selfsea.org. Courtesy of Peer Health Exchange.

Research on the social determinants of health affirm this focus on marginalized identities and inequitable health outcomes. Rey Canseco, Director of Business Development, reflects on the materials that selfsea publishes, saying “What is so special and unique is the identity-affirming part. Other young people that share similar identities to me — there is a resource for that. And I take it on a personal level like, wow, that wasn’t a thing when I was younger. But I love seeing videos and storytelling from young people from different marginalized communities talk about issues that are affecting them.”

And third, the youth design team insisted that selfsea foster a sense of connection and community. Eunetra describes the youth design team’s goal to “get rid of that stigma of: if you ask for help, especially in regards to mental health or sexual health, there’s something wrong with you.” As a result, selfsea’s digital resources — much like the peer health navigators in person — reflect a relatable, approachable tone that welcomes the questions of its audience and makes the vulnerabilities that can come along with being a teenager feel okay.

Research background: Equity through co-design

Equity-oriented research and design efforts like PHE are increasingly involving the intended beneficiaries of technologies and programs in the design process. These commitments are particularly important when serving youth and other marginalized groups whose backgrounds differ from the perspectives of designers or program providers. Addressing power dynamics and differences in background between adults and youth is essential for solutions to effectively serve youth needs and achieve equity goals. Research has documented many cases where limited stakeholder input meant new technologies intended to broaden access resulted in more benefits to already privileged groups. Youth-adult co-design and participatory action research have resulted in solutions that reflect the genuine needs and culture of diverse groups of young people.

“We had to go where the young people are”

In addition to selfsea, PHE has a strong social media presence. In fact, PHE focused its efforts on TikTok before even starting to develop selfsea. The youth design team made this a clear priority: Eunetra recalls, “We learned early from listening to our young people and youth design group that we had to go where the young people were.” As a result, today PHE has over 10 million views on TikTok related to its health education content.

Posts on these platforms respond to topics teens seek out, for example:

  • Guides to understanding gender dysphoria, sexuality, or imposter syndrome
  • Testimonials from peers on topics like coping with family conflict or what to pack for the first day of school
  • Playful reinterpretations of popular memes that broach topics like depression, birth control, or relationship breakups

Screenshot collage of TikTok videos from Peer Health Exchange’s TikTok channel. Courtesy of Peer Health Exchange.

Comments on some posts make their impact obvious to anyone following. One of PHE’s TikTok posts on National Coming Out Day has the caption “Come out on your own terms!” The accompanying video is a six second clip that mashes together a song, a Progress Pride Flag slowly appearing in the background, and a person from a vintage video superimposed on top. The first comment under the video reads: “I used this TikTok to come out to two of my best friends – thank you!”

PHE’s social media presence, like their other digital and school-based programs, are the result of a youth-adult partnership. In some cases, teens who follow PHE might send a direct message with a question or a request for a new video explaining a topic, and PHE staff follow up by posting an explainer video produced by adult experts. In other cases, youth digital storytellers submit their own editorial or testimonial videos describing their firsthand experience of a subject (which PHE experts then vet before publishing). Other times still, PHE staff is just riffing, playing with memes, and engaging with the ever-changing discourse on social media platforms. Across these different approaches, PHE’s strategy is consistent: to go where the young people are, using digital platforms to provide relevant, relatable information about their health and wellbeing.

Research background: Meeting youth where they are

Too often, health-oriented programs and technologies designed by educators and researchers are not accessed or taken up by young people. Research has documented numerous disconnects. Products are rarely tailored to youth language and culture, and they are difficult to discover, particularly for young people who are underserved by traditional health systems. PHE addresses this challenge by meeting youth where they are. Almost 1 in 5 teens in America report using TikTok everyday, making it the second most widely used social media platform since 2022. This story highlights PHE’s intentional effort towards acknowledging and leveraging TikTok as the platform of choice for youth today for offering resources and opportunities that matter to youth.

Conclusion

Community Partnerships Team Retreat in Palm Springs, CA. Photo by Rey Canseco.

Youth digital culture changes at a rapid pace — and so does selfsea. And yet one thing that has been consistent since its founding: Peer Health Exchange’s commitment to working by, with, and for young people. And so as selfsea evolves and reaches an even wider audience, we can expect its commitment to youth-powered approaches to wellbeing to continue.

This case study was produced in partnership with Peer Health Exchange and the Connected Learning Lab at UC Irvine, with the support of Brian Cross, research consultant; Mimi Ito, Connected Learning Lab Director at UC Irvine; and Krithika Jagannath, postdoctoral scholar at UC Berkeley’s Institute of Human Development. We also thank the communications and web team at the Connected Learning Alliance for their work on layout and design.