Peer Support: Results from Systematic Review of Peer Programs and Training

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Peer Support Results from Systematic Review of
Peer Programs and Training

• Cheryl Gagne, Sc.D.
• Center for Psychiatric Rehabilitation
• Boston University

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Peer Support Agenda

• Findings of systematic review
• Peer support training programs

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Innovative Knowledge Translation Grantfunded by
NIDRR
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Goals

• What are the goals of this knowledge translation
  project?
• Develop a prototype for Knowledge Translation
  focused on reviewing, grading and synthesizing
  research information for disability and
  professional organizations

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What has occurred.

• Develop/adapt rating scales for Quality (e.g.,
  Rigor and Meaning)
• Select knowledge to translate
• Develop a information products and a website
  for the resulting information
• Conduct Systematic Reviews

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Topical Areas Reviewed

• Supported Housing
• Supported Education
• Peer Support
• Disability-Right-to-Know site developed to house
  these reviews

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Principles of Peer Support That Transcend
Disability Groups

• First, a definition of peer support
• social emotional support, coupled with
  instrumental support that is mutually offered or
  provided by persons having a mental health
  condition to others sharing a similar
  conditionto bring about a desired social or
  personal change (Gartner Reissman, 1982)

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Types of of Peer Support

• Self-help groups
• Drop-in Centers
• Advocacy and Education Programs
• Internet online support groups
• Peer delivered services
• Peer run or operated services
• Peer employees
• These different types of peer support make a
  systematic review very challenging

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Processes or Effective Ingredients of Peer
Support (Solomon, 2004 Campbell, et al., 2005)

• Social support (buffer against stress, promote a
  sense of belonging)
• Experiential knowledge (special experiences only
  available through a peer)
• Credible role models (can model positive life
  changes/experiences)

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Essential Ingredients

• Promoting choice and empowerment (peer support is
  a voluntary, non-hierarchical, allowing choice
  and promoting efficacy and competence)
• Tangible or instrumental assistance (can provide
  help with resources, or to make life changes)
• Non-judgmental acceptance (peer accepts you for
  where you are in your journey/life)

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Critical Ingredients-FACIT (Fidelity Assessment
Common Ingredient Tool) (Johnsen, et al., 2005)

• Developed for SAMHSA study to measure peer
  operated services
• Examined program structure, environment, belief
  systems, peer support, education and advocacy
  elements
• There were significant differences in all of
  these components when traditional and peer
  operated programs were rated and compared
• FACIT can be used to measure extent to which a
  program is, or is becoming, peer driven

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Process Belief Systems(Holter, et al., 2004)

• Empowerment-emphasize personal growth
• Recovery Beliefs -recovery is possible
• Recovery Practices-taking control of ones life,
  focusing on strengths
• Group Empowerment- where appropriate, exercise
  collective voices
• Advocacy- develop advocacy skills for change

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Learnings from Peer Support Systematic Review

• All literature in peer support has been
  identified for the past 20 years
• Majority of research is correlational, pre-post,
  descriptive of models
• Some randomized trials do exist comparing peer
  support to traditional services
• Results of some trials comparing peers to
  traditional services are equivocal
• We have found no studies on rural peer support in
  particular

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Results of Research-Tentative Findings

• Peer support promotes empowerment and overall
  recovery or well being
• May decrease the need for acute mental health
  services and mental health hospitalizations
• May increase social support, functioning and
  activities
• May decrease substance abuse
• May have a beneficial impact on perceived quality
  of life
• (Findings from most of these studies are
  tentative because of limits to the methods)

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Consumer Operated Study

• SAMHSA funded large study of consumer run
  services (n1,827)
• Three models of peer delivered services were
  studied drop in centers one-on-one peer
  support advocacy and education interventions
• Results suggest effects on overall well being and
  empowerment
• Use of the consumer run services was limited

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Peer Support Training Programs Review

• Review process
• Common themes in peer training
• Content
• Structure/Format
• Credentialing issues
• Recruitment/retention issues
• Employment issues
• Research

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Review Process

• Searched using search engines and government data
  bases
• Gathered academic journal articles, newsletters,
  and training program descriptions
• Gathered training curriculum from 33 training
  programs
• Conducted interviews with 17 peer
  trainers/directors of peer training programs

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Peer Support Training Programs Summary

• Peer training is happening all over the world
• Training programs vary greatly in structure and
  content
• Operated by peer organizations, mental health
  programs, governmental organizations, and NGOs
• Multiple ways of funding-both public and private

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Training Content

• Review of training curriculum yielded
  approximately 65 different content areas ranging
  from the role of advocacy to the use of
  language.
• Key informants report that selecting the most
  critical content is one of the greatest
  challenges of peer support training program design

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Training Content

• Core content-Advanced content-Specialized content
• Some consensus about core content across training
  programs
• Strong consensus that training programs need to
  prepare peers for real roles in real settings
• Most training programs emphasize the development
  of skills, not just knowledge

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Training Content Core Knowledge and Competencies

• Strong consensus
• Role of peer support vs. professional support
• Establishing a positive relationship
• Listening and other interpersonal skills
• Using your lived experience to assist another
  person
• Knowing and sharing your wellness resources

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Training Content Core Knowledge and Competencies

• Core content controversies
• Importance of training about mental illness and
  other illnesses
• Importance of training about medication and other
  medical issues
• Emphasis on self-care of peer support person

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Advanced Content

• Advanced content included knowledge and skills
  beyond the basic peer training
• Spirituality
• Health and wellness
• Trauma recovery
• WRAP (Wellness Recovery Action Plan)
• Financial empowerment

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Specialty Content

• Training to develop peers specific expertise to
  work in a range of settings and roles
• Addiction
• Youth and young adults
• Employment
• Housing
• Assertive community treatment

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Training Program Structure

• Length of training ranged from 20 to 107 hours
• Intensity of training varied
• Training groups ranged in size from 10-40 peers
• Training groups had between 1-15 different
  trainers

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Training Program Structure (continued)

• Most trainings included out of class assignments
• All trainings included experiential components,
  but differed in percentage of experiential
  didactic components
• More mature peer training programs tend to have
  more experiential components, such as role
  playing, practice, and out-of-class activities

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Training Program Recruitment and Selection

• Recruit within and outside established programs
• Selection process includes orientation,
  application, references, interview, and personal
  statements
• Most training programs required basic education
  (high school, GED etc.)
• The ideal candidate was described as someone who
  was already working as a peer provider

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Credentialing Issues

• Credentialing is controversial in mental health
• Credentialing is the goal in about one half of
  the training programs
• Credential is granted after the successful
  completion of the training program and a passing
  grade on written and oral examinations
• Programs reported passing rates of 50-80
• Currently no national standard examination

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Training Program Outcomes

• Very few programs report outcomes
• Outcomes measured
• Knowledge and skill acquisition
• Employment of peer support worker

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Research Findings on Peer Training Programs

• Almost no research examining the efficacy of peer
  training programs have been conducted
• Research needs to be done to learn about
• Effective training interventions
• Peers success and satisfaction with employment
• Peers career paths
• Peers preferences for supervision, continuing
  education and personal/professional development