Post on 16-Dec-2015
Anthony O. Ahmed, PhD
Assistant Professor
Dept. of Psychiatry and Health Behavior
Medical College of Georgia
Georgia Regents University
The Peer-Provider Collaboration as a Platform for Research and Service
Delivery
Disclosures
• Educational grant from U.S. Department of Health Resources and Service Administration (HRSA) Bureau of Health Professions (BHPr)
2012 Award for Creativity in Psychiatric Education from the American College of Psychiatrists
OutlinePeers and peer-led interventions: clinical
research update
The GMHCN-Project GREAT collaborative study of recovery in certified peer specialists
Peer-led interventions, services, and research in the state of Georgia: whither are we bound?
Peer Specialists as Cornerstones of Recovery
Traditional interventions in the mental health field have won some battles…lost the warLittle has been gained in promoting wellness, personal
growth, quality of life, personhood…There is some increasing recognition of the importance of
recovery among traditional providers but psychiatry and psychology are still lagging behind
The consequence is high rates of treatment disengagement
Peer-led interventions are necessary to sustain the gains of the recovery movement Need to give voices to individuals receiving servicesNeed to maintain adjunctive interventions to traditional careNeed to maintain alternative services to traditional carePeer-led programs outnumber traditional mental health
organizations
Peer-Led Interventions
Consumer-Operated ServicesIntentional, voluntary,
reciprocal or non-reciprocal relationship with
peers in community and/orservice settings
Mutual Support/Self-HelpIntentional, voluntary,
reciprocal or non-reciprocal relationship with
peers in community and/orservice settings
Peer SupportIntentional, voluntary,
non-reciprocal relationship with peers in service settings
Classification of Peer-Led Interventions
Peer-Provider Research: An OpportunityTraditional psychiatry research has been good
for discovery and treatment innovation but suffers important limitationsSocial distance and stigma
Peer-led recovery-based research has potential to provide an important perspectiveDecrease social distanceIncrease involvementServe activist objectives
How then may peers collaborate in research?
Peer-Led Interventions: Feasibility
Feasibility studies demonstrated that it is possible to train peers to provide mental health services
Four seminal studies conducted in the 1990s
Peer-Led Interventions: The Evidence
Courtesy Davidson et al., 2006
Peer-Led Interventions: The Evidence
• Peers are able to deliver services that are at least as effective as services delivered by traditional providers
• In some cases slightly better outcomes
Peer Staff Versus Non-Peer Staff
Since year 2000, there has been an increased focus on comparing peers to non-peers—are peers really better at case management?
Comparison trials have consistently shown that peers do better at engaging “difficult-to-treat” clients, reduce hospitalization rates, duration of hospitalization, and decreasing substance useExample: Rowe et al. (2007)--Peer support significantly
reduced alcohol, drug use, and criminal justice involvement in individuals with dual diagnosis over traditional treatment
Future Research Into Peer-led Interventions
New third generation research interest is to—Identify the ways peer-led
interventions are different and outperform tradition treatment
Identify the interventions that only peers are uniquely qualified to provide
Distill the active ingredients of peer-led interventions
What are the experiences of peers providing interventions? In what ways does the Peer Specialist role influence peers’ lives?
Third Generation Studies NIMH-funded studies by Larry Davidson’s team:
Tondora et al. (2010): 290 adults with SMI randomly assigned to a) usual care plus IMR; b) usual care plus IMR plus a peer-facilitated person-centered planning process (PCP); and c) usual care plus IMR and PCP with the addition of the peer-run community connector program. Peer-facilitated care planning increased the sense that treatment was
responsive and inclusive of outcomes that mattered to peers The peer-run community connector program increased hope,
belongingness, treatment engagement, and decreased psychotic symptoms
Sledge et al. (2011): 74 participants who had been hospitalized at least twice in the last 18 months randomly assigned to usual care versus usual care plus peer recovery mentor The inclusion of peer mentorship decreased the number of hospitalizations
(Cohen’s d = 0.41) and the duration of hospitalization (Cohen’ d = 0.44) There was also a significant decrease in substance use and depression
with peer mentorship
The GMHCN-Project GREAT Collaborative Study of Recovery among CPSs
Objectives:Study the professional
experiences of CPSs trained through the GMHCN
Identify the correlates of recovery among CPSs that may inform experiential aspects of recovery
MethodMailed out packets to GMHCN CPSs that included
survey questions and psychometric measures20% completion rate for mail-outs (N = 84)Sample survey domains:
Income and sources of IncomeEmployment and work statusHousing and neighborhoodPeer professional status and responsibilities Quality of CPS professional experienceChallenges of the CPS role
Psychometric measures: Maryland Assessment of Recovery for SMI (MARS); Connors-
Davidson Resilience Scale (CD-RISC); Brief-COPE; Social Functioning Scale (SFS); Social Support Questionnaire (SSQ); Internalized Stigma of Mental Illness (ISMI); Brief Symptom Inventory (BSI); the NEO Five Factors Inventory (NEO-FFI-3)
Results: Demographic Characteristics
Vocational and Financial Status of CPSs
Approximately 85% of CPSs have at least some college education/post-high school and over 40% have a bachelors degree
Most CPSs earn between $10,000 to $20,000 per year
The unemployment rate of CPSs is high at 38.30%
49.40% reported that they were “Mostly Dissatisfied” or “Very Dissatisfied” with their financial status and 37.50% for their employment situation
There was an association between income satisfaction and employment satisfaction (r = .54, p < .0001)
CPS Professional Role Only a minority of peer
specialists are working for pay in that role
Peer specialists reported working 18.47 hours a week on average (range = 0-85 hrs)
The majority of peer specialists feel included as part of the treatment team
The majority of respondents are at least “Mostly Satisfied” with their role as a CPS
Peer Specialist Employment Benefits
72.4%% of peer specialist received no employment benefit
The benefits for CPS positions are low compared to other professions of similar levels of education
Housing and Living Situation
Most respondents own their own apartment
Most peer specialists reported being at least “Mostly Satisfied” with their housing
Most respondents were at least “Mostly Satisfied” with their neighborhoods
What are some things you do to help peers?
Peer Mentoring and Support (60%)Goal setting, leading recovery groups; sharing recovery
stories; providing support services; hospital visits, etc.
Teaching or Leading Treatment Groups (51.11%)E.g., skill-based groups and wellness activities such as
WRAP, IMR, social skills, etc.
Case Management (29%)Housing assistance; employment; transportation;
entitlements; legal support; community resources etc.
Advocacy (11.11%)
Consultation Services to Treatment Teams (6.7%)
What do you find rewarding about being a CPS?
The Helping Role: Assisting others to embark on the recovery journey, empowering peers, instilling hope, etc. (71.18%)
The Power of the Narrative: Sharing recovery stories and positive experiences (15.25%)
Personal Growth: Better insight, knowledge through education/training, growing with peers, etc. (12.00%)
The Reciprocity: Developing friendships and partnerships with other peers and other providers (20%)
What are the most difficult challenges of the CPS role?
Limited Compensation/Resources (25.45%)
Conflicts and Misunderstandings with Traditional Providers (25.45%)
Paperwork (21.81%)
Peer Difficulties (21.82%)
Maintaining Personal Wellness (10.91%)
Limited Peer Specialist Positions (7.27%)
Current Problems in Place of Employment
Limited compensation and benefits (32%)
Stressful work environments/millieu (22.03%)Untenable productivity standards; difficult co-workers;
problematic shifts; too much paperwork
Underemployment (15.25%)
Issues of appreciation and respect (13.56%)
Limited workplace resources for optimal service delivery (8.47%)Inadequate supervision; office space; equipment issues
Poorly defined roles and responsibilities (4%)
What steps did you take to deal with relapse?
Recruiting Positive Coping SkillsWRAP; 12 steps; recovery tools; support
network; peer support
Modifying Work ScheduleTaking time off; fewer work hours; reducing
work load;
Psychiatric ServicesMedication reevaluation; hospitalization;
psychotherapy; counseling;
Support and Accommodations Provided by Employer
Employer Provided Time OffDay off, extended time off, paid sick leave, unpaid leave etc.
Employer Provided a Lighter Work LoadFewer cases, additional help, etc.
Employer Adjusted RolesNew job, flexible schedule
Clinical SupportEAP, Onsite Intervention, Hospital Transport
NoneEmployer unaware, employer viewed relapse as
inconvenience,
What opportunities, tools, and supports could improve your experience as a peer specialist?
Professional Development/Continuing Education:Literature to assist in facilitating groupsTraining in working with peers with dual diagnosisTraining in working with peers during acute episodesTraining specific to running peer groupsOperating as a peer specialist on an ACT teamSocializing and professional networkingDealing and resolving ethical dilemmas
Vocational Resources:More job opportunities for peersCreate opportunities for vocational training
What opportunities, tools, and supports could improve your experience as a peer specialist?
Financial Compensation and Resources: Pay advancementProvide support for activities and supplies Increase range of benefitsTransportationHousing
Increase Awareness:Educate traditional providers about peers
provider competenciesEducate traditional providers about peer-led
interventionsEducate peer providers about the value of peer
specialists
In What Roles or Activities Would You like to see CPSs in the Future?
Administrative and Supervisoryadvisors to regional offices and hospital administrators,
program directors, decision-making teams, etc.Education and Training
Staff training, family psychoeducation, anti-stigma etc. Hospital/Clinical Roles
Nursing, counseling, case management, treatment planning, crises intervention, physical health training, etc
Judicial SystemIn police departments; more involvement in the court
system
In What Roles or Activities Would You like to see CPSs in the Future?
Academic SettingsSchools alongside guidance counselors and other
staffUniversity psychology clinics and counseling
centers Proliferation of Peer-Led Interventions
Increase the number of peer centersDevelop more peer-led interventionsProvide services in social security and DHRProvide services in private practice clinics
Other ActivitiesSpiritual counselingLife coachingPolitical activism
The Peer Specialist Position Confers Clinical Benefits
Psychiatric diagnosis does not impact CPS status
Low past year hospitalization rate among CPSs
Over 40% of CPSs reported relapse while functioning as CPS but almost all took effective steps to manage relapse
Summary of the Correlates of Recovery in Peers Specialists
Measured recovery with the Maryland Assessment of Recovery in Severe Mental Illness (MARS)Factor analysis distills recovery into—Hope/holistic,
Empowerment, Self-Direction, and Strengths
Recovery predicted: Positive coping Resilience—control, commitment, action-orientation, faith, and
tolerance Community living—social engagement, communication,
recreation, independence Frequency and satisfaction with social support Internalized Stigma—positive association with stigma resistance
and inverse association with alienation, stereotype endorsement, withdrawal
Recovery attitudes as a Cognitive Antidote..
Recovery does not depend on personality organization
Recovery Attitudes Promote Community Functioning
.52*-.25*
Recovery (MARS)
Symptoms Community Functioning (SFS)-.23* (-.10)
Recovery Attitudes are Protective From Stress
.49*-.92*
Recovery (MARS)
Stressors
Index
Symptoms
-.82* (-.13)
What do Peer Specialists in Recovery Do to Cope?Religion
Use of Emotional Support
Active Coping
Positive Reframing
Use of Instrumental Support
Planning
Venting
Humor
Acceptance
Strategies for Proliferating Peer Services
Involve people in recovery and non-peer stakeholders in the process of creating peer positions
A clear job description and role clarification
Identifying and valuing the unique contributions that peers can make to the programs and settings where they will work
Providing CPS jobs that reflect the diversity of strengths and educational background of peers
Provide compensation commensurate with background and experience
Sponsored education and training for peers to enhance the quality of their services
Senior administrator take on the role of peer staff “champion” who can address issues and problems (Davidson et al., 2012)
Providing training and education for non-peer staff that covers relevant disability and discrimination legislation and its implications (Davidson et al., 2012)
Providing supervision for peer staff that concentrates on job skills, performance, and support
Disseminate success stories of the impact of peer-led interventions
AcknowledgementsThe Georgia Mental Health Consumer
NetworkMs. Sherry Jenkins-TuckerMr. Charles Willis
All Certified Peer Specialists of the Georgia Mental Health Consumer Network“Thank you for being missionaries of hope”
Mr. Mark Baker~ Center for Recovery Transformation
AcknowledgementsCurrent Peer
SpecialistsLinda JohnsonVanessa DuntonStacy CamilleBarry Jones
Past Peer SpecialistsSherry EvansJulie Roberts
Project GREATProject GREAT
AcknowledgementsAcknowledgements
Project GREAT Project GREAT Emeritus Peer SpecialistsEmeritus Peer Specialists
Certified Peer Specialists