Community partnered peer support after traumatic brain injury: a feasibility case study.

Peer support is recognised as a promising intervention for people with traumatic brain injury (TBI). Peer support increases belonging, mood and self-acceptance after TBI. In peer support, working alliance is associated with rehabilitation engagement and better health-related outcomes. A better understanding of the working alliance formed between those providing and receiving TBI peer support will inform design considerations for creating peer support networks, including specific considerations for matching peer support workers with peer support receivers. The objectives of this study were to characterise how working alliance is developed through brain injury peer support, and to identify barriers and facilitators of creating peer support networks. This study used a qualitative interpretive description methodology. Semi-structured interviews were conducted with peer support receivers and peer support workers who were involved in a co-designed TBI peer support program, as well as community partners who were involved in the development or implementation of the program. Responses were analysed using reflexive thematic analysis (Objective 1) and inductive content analysis (Objective 2). Nine participants participated in the interviews: three peer support receivers, two peer support workers and four community partners. Three themes describe how working alliance is developed. First, 'feeling understood' explored the importance of validating experiences after TBI. Second, 'expanding conversations beyond injury' highlighted participants' desire to connect on similar life experiences and personal topics other than TBI, such as navigating milestones and life events. Last, 'reciprocal growth' identified how learning occurs between both the peer support receiver and worker. There were four main facilitators of forming a peer support network: characteristics of peer support workers, flexibility in content of sessions, collaboration between researchers and peer support organisations, and formatting of sessions. There were three main barriers to forming a peer support network: irregularity of sessions due to scheduling conflicts, lack of an established peer support program within acute care settings, and lack of resources including space, volunteers and funding. Findings reveal how working alliances between peer support workers and peer support receivers in TBI peer support are facilitated through validation of individual TBI recovery experiences, and mutual growth in the areas of self-acceptance and hope. Successful peer support networks appear to benefit from flexibility and individualisation of format and content of sessions, as well as the creation of collaborations between acute care and community support networks.

Background: Peer support workers (PSW) and text messaging services (TxM) are supportive health services that are frequently examined in the field of mental health. Both interventions have positive outcomes, with TxM demonstrating clinical and economic effectiveness and PSW showing its utility within the recovery-oriented model. Objective: To evaluate the effectiveness of PSW and TxM in reducing psychological distress of recently discharged patients receiving psychiatric care. Methods: This is a prospective, rater-blinded, pilot-controlled observational study consisting of 181 patients discharged from acute psychiatric care. Patients were randomized into one of four conditions: daily supportive text messages only, peer support only, peer support plus daily text messages, or treatment as usual. Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM), a standardized measure of mental distress, was administered at four time points: baseline, six weeks, three months, and six months. MANCOVA was used to assess the impact of the interventions on participants’ scores on four CORE-OM subscales across the three follow-up time points. Recovery, clinical change, and reliable change in CORE-OM all-item analysis were examined across the four groups, and the prevalence of risk symptoms was measured. Results: A total of 63 patients completed assessments at each time point. The interaction between PSW and TxM was predictive of differences in scores on the CORE-OM functioning subscale with a medium effect size (F1,63 = 4.19; p = 0.045; ηp2 = 0.07). The PSW + TxM group consistently achieved higher rates of recovery and clinical and reliable improvement compared to the other study groups. Additionally, the text message group and the PSW + TxM group significantly reduced the prevalence of risk of self/other harm symptoms after six months of intervention, with 27.59% (χ2(1) = 4.42, p = 0.04) and 50% (χ2(1) = 9.03, p < 0.01) prevalence reduction, respectively. Conclusions: The combination of peer support and supportive text messaging is an impactful intervention with positive clinical outcomes for acute care patients. Adding the two interventions into routine psychiatric care for patients after discharge is highly recommended.

BackgroundPeer support is increasingly acknowledged as an integral part of mental health services around the world. However, most research on peer support comes from high-income countries, with little attention to similarities and differences between different settings and how these affect implementation. Mental health workers have an important role to play in integrating formal peer support into statutory services, and their attitudes toward peer support can represent either a barrier to or facilitator of successful implementation. Thus, this study investigates mental health workers’ attitudes toward peer support across a range of high- (Germany, Israel), middle- (India), and low-income country (Tanzania, Uganda) settings.MethodsSix focus groups were conducted in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be’er Sheva (Israel), and Ahmedabad, Gujarat (India) with a total of 35 participants. Transcripts were analyzed using thematic content analysis.ResultsParticipants across the study sites demonstrated overall positive attitudes towards peer support in mental health care, although some concerns were raised on potentially harmful effects of peer support such as negative role modelling and giving inadequate advice to service users. Notably, mental health workers from low- and middle-income countries described peer support workers as bridge-builders and emphasized the mutual benefits of peer support. Mental health workers’ views on peer support workers’ roles and role boundaries differed between sites. In some settings, mental health workers strongly agreed on the need for role clarity, whereas in others, mental health workers expressed mixed views, with some preferring blurred role boundaries. Regarding collaboration, mental health workers described peer support workers as supporters and utilizers, equal partners or emphasized a need for trust and commitment.ConclusionsMental health workers’ attitudes toward peer support workers were positive overall, but they also varied depending on local context, resources and previous experiences with peer support. This affected their conceptions of peer support workers’ roles, role clarity, and collaboration. This study demonstrated that reconciling the need for local adaptations and safeguarding the core values of peer support is necessary and possible, especially when the implementation of recovery-oriented interventions such as peer support is accelerating worldwide.

BackgroundPeer support for mental health is recommended across international policy guidance and provision. Our systematic umbrella review summarises evidence on the effectiveness, implementation, and experiences of paid peer support approaches for mental health.MethodsWe searched MEDLINE, EMBASE, PsycINFO, The Campbell Collaboration, and The Cochrane Database of Systematic Reviews (2012–2022) for reviews of paid peer support interventions for mental health. The AMSTAR2 assessed quality. Results were synthesised narratively, with implementation reported using the CFIR (Consolidated Framework for Implementation Research). The protocol was registered with PROSPERO (registration number: CRD42022362099).ResultsWe included 35 reviews (426 primary studies, n = 95–40,927 participants): systematic reviews with (n = 13) or without (n = 13) meta-analysis, or with qualitative synthesis (n = 3), scoping reviews (n = 6). Most reviews were low or critically low (97%) quality, one review was high quality. Effectiveness was investigated in 23 reviews. Results were mixed; there was some evidence from meta-analyses that peer support may improve depression symptoms (particularly perinatal depression), self-efficacy, and recovery. Factors promoting successful implementation, investigated in 9 reviews, included adequate training and supervision, a recovery-oriented workplace, strong leadership, and a supportive and trusting workplace culture with effective collaboration. Barriers included lack of time, resources and funding, and lack of recognised peer support worker (PSW) certification. Experiences of peer support were explored in 11 reviews, with 3 overarching themes: (i) what the PSW role can bring, including recovery and improved wellbeing for service users and PSWs; (ii) confusion over the PSW role, including role ambiguity and unclear boundaries; and (iii) organisational challenges and impact, including low pay, negative non-peer staff attitudes, and lack of support and training.ConclusionsPeer support may be effective at improving some clinical outcomes, self-efficacy, and recovery. Certain populations, e.g. perinatal populations, may especially benefit from peer support. Potential strategies to successfully implement PSWs include co-production, clearly defined PSW roles, a receptive hierarchical structure and staff, appropriate PSW and staff training with clinical and/or peer supervision alongside safeguarding. Services could benefit from clear, coproduced, setting specific implementation guidelines for PSW. PSW roles tend to be poorly defined and associations between PSW intervention content and impacts need further investigation. Future research should reflect the priorities of providers/service users involved in peer support.

ObjectiveThe introduction of peer support in mental health teams creates opportunities and challenges for both peer and non-peer staff. However, the majority of research on mental health workers’ (MHWs) experiences...

Shared Decision Making and Peer Support: New Directions for Research and Practice.

BackgroundPeer support workers provide support for people experiencing mental health conditions based on their own lived experience of mental health problems. Assessing fidelity to core ingredients of peer support is vital for successful implementation and intervention delivery. Modifications to its implementation are needed when scaling up to different socio-economic settings, raising further uncertainty about fidelity. As part of a large multi-centre study on peer support called Using Peer Support In Developing Empowering Mental Health Services (UPSIDES), we developed and evaluated the psychometric properties of the UPSIDES Fidelity Scale.MethodsWe constructed the fidelity scale based on an initial item pool developed through international expert consultation and iterative feedback. Scale refinement involved site-level expert consultation and translation, resulting in a service user-rated 28-item version and a peer support worker-rated 21-item version assessing receipt, engagement, enactment, competence, communication and peer support-specific components. Both versions are available in six languages: English, German, Luganda, Kiswahili, Hebrew and Gujarati. The scale was then evaluated at six study sites across five countries, with peer support workers and their clients completing their respective ratings four and eight months after initial peer support worker contact. Psychometric evaluation included analysis of internal consistency, construct validity and criterion validity.ResultsFor the 315 participants, item statistics showed a skewed distribution of fidelity values but no restriction of range. Internal consistency was adequate (range α = 0.675 to 0.969) for total scores and all subscales in both versions. Confirmatory factor analysis indicated acceptable fit of the proposed factor structure for the service user version (χ2/df = 2.746; RMSEA = 0.084) and moderate fit for the peer support worker version (χ2/df = 3.087; RMSEA = 0.093). Both versions showed significant correlations with external criteria: number of peer support sessions; perceived recovery orientation of the intervention; and severity of illness.ConclusionsThe scale demonstrates good reliability, construct and criterion validity, making it a pragmatic and psychometrically acceptable measure for assessing fidelity to a manualised peer support worker intervention. Recommendations for use, along with research and practical implications, are addressed. As validated, multi-lingual tool that adapts to diverse settings this scale is uniquely positioned for global application.Trial registrationISRCTN, ISRCTN26008944. Registered on 30 October 2019.

PPE for your mind: a peer support initiative for health care workers.

In the last 20 years, research on the inclusion of peer support within mental healthsettings has burgeoned, paralleling the broad adoption of service user inclusion withinpolicy as a moral imperative and universally beneficial. Despite the seemingly progressiveimpetus behind inclusion, increasingly peer support workers talk of exhaustion workingwithin mental health systems, the slow rate of change to oppressive values and practices,and ongoing experiences of workplace exclusion. Such experiences suggest differences inthe way in which inclusion is produced across different stakeholder groups and contexts.In this article, we adopt Bacchi’s ‘what’s the problem represented to be?’ approach toidentify how mental health research, often understood as an a-political activity, producesversions of inclusion. We argue current research predominantly produces inclusion as‘assimilation’ and ‘integration’. We use critical inclusion, mental health, and survivorscholarship to evaluate the effects these productions have for peer support and peersupport workers, finding that both problematise peer support workers and those seekingsupport. We consider possibilities for more liberatory productions of inclusion, buildingon the notion of inclusion as ‘co-optation’. Our analysis points to the need forresearchers to engage with an uncomfortable reflexivity to enable more emancipatorypossibilities regarding inclusion and peer support.

Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.

Gray M., Davies K., Butcher L. Finding the right connections: Peer support within a community‐based mental health serviceThis article reports on a qualitative study that examined the organisational enablers and barriers to implementing peer support work in an Australian, rural, community‐based mental health service. Interviews with 19 peer and non‐peer staff were conducted to identify attitudes towards peer support and whether there were organisational values, practices and strategies that might support the implementation of peer support. The findings revealed that peer support workers were valued for their ability to build trusting connections with clients and to accept client choice in a non‐judgemental way. However, peer support workers tended to ‘fill service gaps’ within intensive, administrative case‐management environments. These findings highlight the importance of an organisational‐wide approach to integrating peer support, where the responsibilities for adopting new ways of working fall to all staff, not just the peer support workers themselves.Key Practitioner Message: • Practitioners placed high value on the peer support workers on their teams due to their unique personalised engagement with clients; • The roles of peer support workers were poorly understood by team members; • Organisational integration of peer support principles could improve the way all staff engage with clients to reflect a recovery orientation.

BackgroundSpecialized early intervention services (EIS) for psychosis have been shown to have superior outcomes compared to routine care. However, these gains are often lost when care is transferred to community mental health care teams. Research has shown that young adults experience anxiety, worry and stigma around the transition process from EIS, which can impact ongoing engagement with treatment. Transition to a new care team has been shown to be a time for disengagement. Despite this area’s acknowledged importance, there is a paucity of literature on how to maintain engagement during the transition process from an EIS to community services. We conducted a qualitative study with EIS for psychosis patients in various phases of transition which informed the development of a peer support program focused on the transition time period.MethodsFocus groups were conducted to identify strengths and weaknesses of the transition process from a Canadian EIS program. Thematic analysis was conducted on the transcripts from the focus groups. Following themes from the focus groups, a research study was developed to create and evaluate a peer support worker (PSW) program for individuals in transition from the EIS. Peer support workers were recruited from individuals who had successfully transitioned from the same five year EIS for psychosis program. Individuals underwent training as peer support workers that was tailored to the needs of individuals with a psychotic disorder. Peer support workers met with clients in both clinical and community settings with support and feedback provided by clinicians in the EIS.ResultsStrengths identified included preparation time, helping individuals feel stable prior to transition and inclusion in decision making. Weaknesses included communication, more individualized preparation for transition and a desire for more opportunities to build independence and responsibility. A major theme was lack of peer support during the process, with a voiced desire to maintain connection to EIS by being a peer mentor in those who had already transitioned out. We recruited 7 individuals interested in becoming PSW and with a PSACC Certified Peer Support Mentor, designed a curriculum for training based on his peer support training experience with feedback from clinicians to customize it to the experience of living with psychosis and transition. The features of this curriculum will be discussed. 5 of 7 individuals completed training. 4 expressed an interest in being hired. 1 was not able to complete the hiring process but did an exit interview and impediments to hiring included costs associated with hiring practices that needed to be paid up front then reimbursed, limited internet access to a secure connection that allowed HR software to function and transportation issues. 3 individuals were hired as PSW (2 F,1M) and supported participants transitioning from our clinic who were interested. PSW would meet in the clinic with individuals prior to transition then support them in the community for several months after transition. 1 PSW relapsed during the course of the study. Only 1 PSW has continued with our program. Patients in transition participating in the program underwent semi-structured interviews that indicated satisfaction with the program.DiscussionAt project launch, we examined the literature and could only find one paper related to the concept of PSW and transition in psychosis. Having lived the process of developing the program, we gained an understanding of the difficulties of enacting what we have found to be a highly successful adjunct to our program. PSW programs involving individuals with psychosis are expensive to launch and attrition is high but these costs need to be weighed against improved transition outcomes.

Background: Mental health providers play an integral role in youth mental health services, providing assessment, diagnosis and treatment of mental health concerns, and supporting recovery. Evidence shows mental health providers are challenged due to health system limitations and increased demands for services, resulting in long wait times and negatively impacting quality of care. To increase mental health service accessibility and mitigate disengagement of youth from care, some organizations have incorporated peer support as an adjunct to the provision of traditional mental health services. Peer support involves an individual with lived experience (a peer support worker) supporting youth with navigating their recovery journey. The addition of peer support work to youth serving organizations has the potential empower youth to take a more active role in their mental health journey. Objectives and methods: In partnership with ACCESS Open Minds, an Integrated Youth Service (IYS) organization in Canada, 21 staff (including mental health clinicians, nurses, and social workers) participated in qualitative interviews exploring their experiences working alongside Peer Support Workers in an IYS setting. Questions were asked to understand how mental health providers were able to incorporate peer support into their practice and processes, what barriers and facilitators exist to integrating peer support into an IYS setting, and what role mental health providers felt that peer support workers could best play within IYS. All interviews were transcribed verbatim and thematic analysis was used to code and theme the interviews. Results: Systems navigation, the generation of hope and providing a broader life perspective were identified as key components of youth peer support work. There were some barriers identified, such as lack of clarity about how to access the service, and a limited number of peer support service hours. Lack of understanding as to how peer support services fit into the IYS was an additional barrier. Facilitators of youth engagement with peer support services included youth feeling increased respect from providers and within the IYS setting, transparency, and increased youth empowerment. Conclusions and learning opportunities: Mental health providers working within Integrated Youth Services require education and guidance on how to incorporate peer support into mental health care for youth. This includes ensuring peer support services are available when needed by youth (e.g. after school), and information is provided that clearly distinguishes peer support work from mental healthcare. Findings from this study can inform best practices regarding integration of peer support into youth mental health services.

To evaluate the impact of a community-based peer support program for individuals and their family members following traumatic brain injury (TBI). Community-based sample of family members and individuals with traumatic brain injury. Twenty individuals who had participated in the peer support program (11 individuals with TBI and 9 family members). Quantitative and qualitative approaches were used: a retrospective structured interview assessing self-reported impacts of peer support on empowerment, quality of life, mood, skills and knowledge, and social supports; an in-depth qualitative interview with a subgroup of family members focused on the specific benefits/limitations of the peer support program. Participants in the peer support program reported positive impacts of peer support on increasing their knowledge of TBI, enhancing their overall quality of life, improving their general outlook, and enhancing their ability to cope with depression post TBI. The peer support program was reported to have had a minimal impact on enhancing social support from families, friends, and the community, with varying impacts noted on levels of happiness, coping with anger and anxiety, communication with professionals, and control over one's life. Qualitative analysis suggests the merits of this type of community-based support and areas of improvement for the peer support program itself. Preliminary data suggest that peer support is a promising approach to enhancing coping for both individuals and their family members after TBI.

BackgroundInitial training is essential for the mental health peer support worker (PSW) role. Training needs to incorporate recent advances in digital peer support and the increase of peer support work roles internationally. There is a lack of evidence on training topics that are important for initial peer support work training and on which training topics can be provided on the internet.ObjectiveThe objective of this study is to establish consensus levels about the content of initial training for mental health PSWs and the extent to which each identified topic can be delivered over the internet.MethodsA systematized review was conducted to identify a preliminary list of training topics from existing training manuals. Three rounds of Delphi consultation were then conducted to establish the importance and web-based deliverability of each topic. In round 1, participants were asked to rate the training topics for importance, and the topic list was refined. In rounds 2 and 3, participants were asked to rate each topic for importance and the extent to which they could be delivered over the internet.ResultsThe systematized review identified 32 training manuals from 14 countries: Argentina, Australia, Brazil, Canada, Chile, Germany, Ireland, the Netherlands, Norway, Scotland, Sweden, Uganda, the United Kingdom, and the United States. These were synthesized to develop a preliminary list of 18 topics. The Delphi consultation involved 110 participants (49 PSWs, 36 managers, and 25 researchers) from 21 countries (14 high-income, 5 middle-income, and 2 low-income countries). After the Delphi consultation (round 1: n=110; round 2: n=89; and round 3: n=82), 20 training topics (18 universal and 2 context-specific) were identified. There was a strong consensus about the importance of five topics: lived experience as an asset, ethics, PSW well-being, and PSW role focus on recovery and communication, with a moderate consensus for all other topics apart from the knowledge of mental health. There was no clear pattern of differences among PSW, manager, and researcher ratings of importance or between responses from participants in countries with different resource levels. All training topics were identified with a strong consensus as being deliverable through blended web-based and face-to-face training (rating 1) or fully deliverable on the internet with moderation (rating 2), with none identified as only deliverable through face-to-face teaching (rating 0) or deliverable fully on the web as a stand-alone course without moderation (rating 3).ConclusionsThe 20 training topics identified can be recommended for inclusion in the curriculum of initial training programs for PSWs. Further research on web-based delivery of initial training is needed to understand the role of web-based moderation and whether web-based training better prepares recipients to deliver web-based peer support.