Peer-based Programs Research Articles

Peer-based behavioural strategies to improve chronic disease self-management and clinical outcomes: evidence, logistics, evaluation considerations and needs for future research

The diagnosis of a chronic disease such as diabetes generally evokes strong emotions and often brings with it the need to make changes in lifestyle behaviours, such as diet, exercise, medication management and monitoring clinical and metabolic parameters. The diagnosis thus affects not only the person diagnosed but also the family members. Chronic illnesses are largely self-managed with approximately 99% of the care becoming the responsibility of patients and their families or others involved in the daily management of their illnesses. While the responsibility for outcomes, such as metabolic control and chronic complications, are shared with the health care team, the daily decisions and behaviours adopted by patients clearly have a strong influence on their future health and well-being. While diabetes self-management education is essential, it is generally not sufficient for patients to sustain behaviours and cope with a lifetime of diabetes. Peers have been proposed as one method for assisting patients to deal with the behavioural and affective components of diabetes and to provide ongoing self-management support. This paper first describes effective behavioural strategies in diabetes, based on multiple studies and/or meta-analyses, and then provides examples of their use by peers or in peer-based programmes in diabetes. A comprehensive search using the MEDLINE and Cinahl databases was conducted. Key search terms included peer mentors, peer leaders, peer educators, lay health workers and community health workers. Studies that clearly identified behavioural strategies used by peers were included.

A Framework for Defining the Role of Peer-Based Approaches in Mental Health Promotion

Peer-based approaches have become a popular health promotion strategy among marginalised young and other hard to reach populations who may not access mainstream support services. However, very few evaluation studies have been conducted to justify the continued and safe use of such programmes. There is also a confusing array of terminology and approaches evident in the field. As a result, practitioners have limited evidence describing the outcomes delivered by peer-based approaches, and few tools to assess when and where a peer-based approach is appropriate. This paper presents a framework for understanding and positioning the role of peer-based approaches in mental health promotion. A case study is included to illustrate application of the framework. Using the framework as a starting point, practitioners may be able to formulate more accurate, realistic and consistent outcomes for peer-based programmes. Consequently, more robust evaluation strategies may be developed, resulting in additional empirical dat...

Key Challenges and Prospects in Peer-Based Delinquency Prevention Programs: Comment on van Lier, Vitaro, and Eisner

This article provides a brief commentary on Pol van Lier, Frank Vitaro, and Manuel Eisner’s excellent article in this issue. In Saving Children from a Life of Crime: Early Risk Factors and Effective Interventions (Farrington and Welsh 2007), we found that there is convincing evidence of the effectiveness of a number of early individual, family, and school interventions to tackle risk factors to prevent delinquency and later offending, but little is known about peer-based programs. Future experiments are needed to test the effectiveness of these programs, as well as to investigate the causal effects of peer influence.

Peer Counseling, Family Education Could Ease Vets' Transition

Back to table of contents Previous article Next article Government NewsFull AccessPeer Counseling, Family Education Could Ease Vets' TransitionAaron LevinAaron LevinSearch for more papers by this authorPublished Online:1 Jun 2007https://doi.org/10.1176/pn.42.11.0004aThe heavy reliance on National Guard and Reserve troops, with many units drawn from small towns, has increased the need for mental health services far from the usual sites of the Department of Veterans Affairs, Ralph Ibson of Mental Health America told senators in Washington, D.C., in April.The stress of combat is only worsened by repeated tours of duty, he said at a hearing of the Senate Committee on Veterans Affairs.“Half of all Army National Guard soldiers and 45 percent of Army and Marine reservists report mental health issues on their return from war,” he said. “The VA can do more and should do more for them.”The VA health system has great strengths, he added. However, “it is a facility-based system that does not necessarily provide good access to care for veterans in rural America or in other areas remote from health care facilities.”Readjustment counseling could benefit most returning veterans, he said, but that help was usually limited to the 200 readjustment counseling centers (also called vet centers) and is not available at the VA's medical centers and clinics. There was no barrier preventing these larger sites from also providing such services, however, Ibson said.Women make up 15 percent of the forces in Iraq and Afghanistan and even their “noncombat” roles—like driving trucks, flying helicopters, or serving as military police—frequently exposed them to traumatic episodes that would meet any definition of warfare.“The jury is still out on care of women veterans and the perceptions of the VA as a welcoming, caring place for them,” said Ibson.Ibson offered several suggestions for helping veterans and their families cope with the return of service members.The VA should develop peer-based outreach programs by training veterans of Iraq and Afghanistan to work at the VA or in the community to provide support for vets and make VA facilities welcoming environments. Families should also be offered services, at least for a specified period after a service member's return home. Help for small-town or rural veterans might be offered at local community mental health centers, where they exist.Finally, the window of eligibility during which veterans may sign up with the VA without proving a service connection for any complaints should be extended from two to five years.Earlier in the hearing, the senators heard from families of a soldier and a Marine who had returned from Iraq and later died.The parents of Spc. Joshua Omvig of Grundy Center, Iowa, an Army Reserve military policeman, told how their son was “unable to live with the physical, mental, and psychological effects” of his time in Iraq and committed suicide a year after he returned home from an 11-month tour in Iraq.To avoid tragedies like their son's, other troops need peer counseling before they come home, family education and outreach, increased training on recognizing symptoms that could lead to suicide, and substance abuse treatment, said Randall Omvig. While troops are still in uniform, their transition back into civilian life might be eased by having them spend days doing service-connected work while spending evenings and nights with their families.“It helps them process their experience,” said Omvig. “It would help them live the American dream that they fought for.”Justin Bailey, a Marine veteran of the invasion of Iraq, died on January 27 in the West Los Angeles Veterans Affairs Hospital of an apparent overdose of prescription drugs, his father, Tony Bailey, told the senators. Despite a history of overusing drugs prescribed for pain from a war injury and for PTSD, Justin was given two-to four-week supplies of benzodiazepines, antidepressants, and methadone. Tony Bailey blamed “apathy and complacency” in the VA for his son's death.“Nobody cared until I was on ABC News,” said Bailey, who served 20 years in the armed forces. Families of veterans needed to advocate for patients in the VA, he said. “Always ask questions. Don't assume the VA will help without someone to push.”Speaking on behalf of the VA, Ira Katz, M.D., Ph.D., deputy chief patient care services officer for mental health, said the VA was already hiring more suicide prevention coordinators and was working to integrate its approach to substance abuse and mental health care.“We want accountability,” said Katz. “But we must go beyond narrow silos.”The effects of the “invisible wounds” suffered by veterans of the current conflicts will be felt for many years, said Sen. Daniel Akaka (D-Hawaii), the committee's chair, but he expected that the VA would adapt to meet the mental health needs of those and all veterans.Written testimony from the Senate hearing is posted at<http://veterans.senate.gov/index.cfm?FuseAction=Hearings.CurrentHearings&rID=996>.▪ ISSUES NewArchived

A Peer-Based Assistance Program for Officers With the New York City Police Department: Report of the Effects of Sept. 11, 2001

A Peer-Based Assistance Program for Officers With the New York City Police Department: Report of the Effects of Sept. 11, 2001

Developing locally relevant outreach programs for same sex attracted youth in regional areas

This paper reports on the process evaluation of the Same Sky project,1 which was aimed at developing regional community support programs for same sex attracted youth (SSAY) and their families in four regional sites in Western Australia. A multi-faceted approach modelled on successful urban outreach programs was used to build professional capacity and develop peer-based support programs in the community. A triangulated mixed methods evaluation design was implemented to capture various outputs and outcomes of the intervention strategies. Data were collected via interviews and questionnaires and by assessing community readiness through community participation and involvement in the programs and through demand for printed resources. There was increased community awareness of same sex attraction issues and professional capacity to help SSAY regionally following training and distribution of printed resources. Improved alliances between regional and metropolitan service providers were also evident. Not all of the planned peer support interventions could be implemented. Drop-in centres and peer support groups proved particularly problematic to establish. Basing the project officer in one of the rural sites was notable in improving project progress. Some aspects of the urban outreach models for SSAY were transportable to rural areas, others were not. Some specific problems identified were a lack of community readiness, a distrust of 'outsiders' to the community, significant differences between the needs of SSAY across regional demonstration sites, and difficulties in engaging locally based volunteers and agencies to develop and run rural outreach services.

Effectiveness and benefit-cost of peer-based workplace substance abuse prevention coupled with random testing

Few studies have evaluated the impact of workplace substance abuse prevention programs on occupational injury, despite this being a justification for these programs. This paper estimates the effectiveness and benefit-cost ratio of a peer-based substance abuse prevention program at a U.S. transportation company, implemented in phases from 1988 to 1990. The program focuses on changing workplace attitudes toward on-the-job substance use in addition to training workers to recognize and intervene with coworkers who have a problem. The program was strengthened by federally mandated random drug and alcohol testing (implemented, respectively, in 1990 and 1994). With time-series analysis, we analyzed the association of monthly injury rates and costs with phased program implementation, controlling for industry injury trend. The combination of the peer-based program and testing was associated with an approximate one-third reduction in injury rate, avoiding an estimated $48 million in employer costs in 1999. That year, the peer-based program cost the company $35 and testing cost another $35 per employee. The program avoided an estimated $1850 in employer injury costs per employee in 1999, corresponding to a benefit-cost ratio of 26:1. The findings suggest that peer-based programs buttressed by random testing can be cost-effective in the workplace.

Peer Standing and Substance Use in Early-Adolescent Grade-Level Networks: A Short-Term Longitudinal Study

Two competing hypotheses were tested concerning the associations between current alcohol and cigarette use and measures of individual, group and network peer standing in an ethnically-diverse sample of 156 male and female adolescents sampled at two time points in the seventh grade. Findings lent greater support to the person hypothesis, with early regular substance users enjoying elevated standing amongst their peers and maintaining this standing regardless of their maintenance of or desistance from current use later in the school year. In the fall semester, users (n=20, 13%) had greater social impact, were described by their peers as more popular, and were more central to the peer network than abstainers (i.e., those who did not report current use).Conversely, in the spring semester, there were no differences between users (n=22, 13%) and abstainers in peer ratings of popularity or social impact. Notably, the spring semester users group retained fewer than half of the users from the fall semester. Further, students who had reported current use in the fall, as a group, retained their positions of elevated peer standing in the spring, compared to all other students, and continued to be rated by their peers as more popular and as having greater social impact. We discuss the findings in terms of the benefit of employing simultaneous systemic and individual measures of peer standing or group prominence, which in the case of peer-based prevention programs, can help clarify the truly influential from the "pretenders" in the case of diffusion of risk-related behaviors.

Trends in HIV-1 in young adults in south India from 2000 to 2004: a prevalence study

Major increases in HIV-1 prevalence in India have been predicted. Incident infections need to be tracked to understand the epidemic's course, especially in some southern states of India where the epidemic is more advanced. To estimate incidence, we investigated the prevalence of HIV-1 in young people attending antenatal and sexually transmitted infection (STI) clinics in India. We analysed unlinked, anonymous HIV-1 prevalence data from 294 050 women attending 216 antenatal clinics and 58 790 men attending 132 STI clinics in 2000-04. Southern and northern states were analysed separately. The age-standardised HIV-1 prevalence in women aged 15-24 years in southern states fell from 1.7% to 1.1% in 2000-04 (relative reduction 35%; p(trend)<0.0001, yearly reduction 11%), but did not fall significantly in women aged 25-34 years. Reductions in women aged 15-24 years were seen in key demographic groups and were similar in sites tested continuously or in all sites. Prevalence in the north was about a fifth of that in the south, with no significant decreases (or increases) in 2000-04. Prevalence fell in men aged 20-29 years attending STI clinics in the south (p(trend)<0.0001), including those with ulcerative STIs (p(trend)=0.0008), but reductions were more modest in their northern counterparts. A reduction of more than a third in HIV-1 prevalence in 2000-04 in young women in south India seems realistic, and is not easily attributable to bias or to mortality. This fall is probably due to rising condom use by men and female sex workers in south India, and thus reduced transmission to wives. Expansion of peer-based condom and education programmes for sex workers remains a top priority to control HIV-1 in India.

A Peer-Based Assistance Program for Officers With the New York City Police Department: Report of the Effects of Sept. 11, 2001

Few data on stress symptoms related to the World Trade Center disaster in law enforcement personnel have been reported. Most New York City Police Department (NYPD) officers had significant exposure to the events of Sept. 11, 2001. Approximately 5,000 officers responded within the first 2 days, and more than 25,000 officers worked at ground zero, the morgues, or the Staten Island landfill. Because the police are the first line of defense against terrorist attacks, it is imperative that they maintain optimal health and functioning. Concern for the long-term effects from traumatic exposure is warranted. In partnership with Project Liberty, peer officers and clinicians from the Police Organization Providing Peer Assistance performed outreach, support work, and screening for stress symptoms related to the disaster in the NYPD from December 2002 until December 2003. Psychological issues in law enforcement personnel, a description of the outreach program, and data from these screenings are presented.

A Confidential Peer-Based Assistance Program for Police Officers

A Confidential Peer-Based Assistance Program for Police Officers

Caught in the Crossfire: the effects of a peer-based intervention program for violently injured youth

Caught in the Crossfire: the effects of a peer-based intervention program for violently injured youth

Caught in the Crossfire: the effects of a peer-based intervention program for violently injured youth

Purpose To assess the effect of a hospital-based peer intervention program serving youth who have been hospitalized for violent injuries on participant involvement in the criminal justice system and violent reinjury and death after hospital discharge. Methods A total of 112 violently injured youth (ages 12–20 years; 80% male; predominantly African-American [60%] and Latino [26%]) hospitalized in Oakland, California participated in a retrospective case–control study. Clients were matched by age and injury severity. Treatment and control youth were followed for 6 months after their individual dates of injury. The outcome variables of rate of entry/reentry into the criminal justice system, rate of rehospitalization for violent injuries and rate of violence-related deaths were compared for treatment and control groups using an odds ratio analysis. Results Intervention youth were 70% less likely to be arrested for any offense (odds ratio [OR] = 0.257) and 60% less likely to have any criminal involvement (OR = 0.356) when compared with controls. No statistically significant differences were found for rates of reinjury or death. Conclusion A peer-based program that intervenes immediately after, or very soon after, youth are violently injured can directly reduce at-risk youth involvement in the criminal justice system.

Peer-Enhanced Weight Management Treatment for Overweight Adolescents: Some Preliminary Findings

The purpose of this study was to evaluate the utility of adding a peer-based intervention (peer-based skills training [PBST]) to a traditional cognitive–behavioral weight management intervention for overweight adolescents. Sixteen adolescents between the ages of 13 and 16 years and between 30 and 80$percnt; overweight participated in a 16-week group-based weight management program with the addition of peer-based skills training. Adolescents and parents separately attended 60-min group sessions addressing diet, physical activity, and behavior modification techniques. In addition, adolescents attended a 90-min PBST session each week. Group activities included both mental and physical challenges that fostered development of trust, social skills, and self-confidence. Measures of height and weight, as well as questionnaires assessing self-concept, physical self-worth, and social functioning, were obtained prior to treatment, immediately following the 16-week intervention, and 6 months after completion of active treatment. Paired t tests revealed significant improvements over time in measures of physical self-worth, physical appearance and romantic appeal. Adolescents lost an average of 14.73 pounds from the start to end of treatment, and this was maintained at 6-month follow-up. These preliminary findings provide some support for the application of a novel peer-based program as an adjunctive treatment for adolescent weight management intervention.

Mentoring with Elementary-Age Students

The use and benefits of mentors have been investigated and documented for a variety of professions and populations, including numerous peer-based mentoring programs for elementary-age students. These peer-based programs, although reporting positive academic and social outcomes, have typically utilized controlled experimental procedures in manipulated settings, calling into question whether the benefits of mentoring can be generalized and maintained in real life situations. This article examines the use of mentoring in a natural setting between elementary-age students with and without disabilities as a way to improve the longevity and generalization of the benefits associated with peer-mentoring programs. Benefits of mentoring are reviewed, and recommendations are made regarding the organization and implementation of mentoring programs for social and academic purposes under natural conditions.

MAPs: Labor‐Based Peer Assistance in the Workplace

An offshoot of management‐based Employee Assistance Programs, Member Assistance Programs (MAPs) are peer‐based programs designed to help union members suffering from substance abuse and other personal problems. Although a relatively recent phenomenon, MAPs are rooted in traditional union principles of voluntarism and mutual aid. This article examines the emergence and growing popularity of MAPs, differences in MAP structure and orientation across unions, and the potential significance of MAPs to unions and industrial relations.

Better Disciplined Schools: Is Mediation the Answer?

Peer-based mediation programs have great potential for eliminating conflict and improving school climate. Here's how one program works.

The consequences of child abuse for the formation of relationships with peers

The peer interaction of 26 physically abused children was observed and compared to the peer interaction of normal children (n = 26), neglected children (n = 4) and children referred to a child guidance clinic (n = 21). The children were either enrolled in a day-care intervention program and observed in well-established peer groups or not enrolled in peer-based intervention and observed in newly formed peer groups. The hypothesis that abused children who were enrolled in day-care intervention programs would be more competent in peer interaction than abused children who were observed in newly formed groups and not enrolled in peer-based intervention programs was supported. The peer interaction of abused children in well-established groups was similar to that of normal children and more skillful than that of abused and clinic children in newly formed groups. Normal children engaged in similar peer interaction in newly formed and well-established groups. The results are discussed in terms of the social support network provided by the day-care intervention and missing in the family environment of abused children.