Peer Intervention Research Articles

Training Peers to Ease Hospital Discharge: A Community-Clinical Partnership in Complex HIV Care.

Since many people now live with human immunodeficiency virus (HIV) as a complex, chronic health condition that may require frequent medical and psychosocial services, a potential new role for HIV-positive peers involves support during an inpatient admission that extends past discharge to improve the transition home from hospital. We sought to begin outlining scope of peer support in complex HIV care, by detailing a training curriculum alongside experiences and recommendations by Peer Volunteers. A community-clinical partnership designed a personalized peer intervention for people living with HIV who were acutely hospitalized and struggling with antiretroviral adherence and substance use. Five Peer Volunteers delivered the program, which involved being matched with a participant for a pre-discharge in-person meeting followed by frequent phone contact in the 7 weeks following discharge. A 4-day peer training focused on active listening, structuring a call, use of self, boundaries, and facilitating program closure. The curriculum was informed by theories of change, motivational interviewing, and simulation. Peer Volunteers participated in pre-match and post-match interviews with peer researchers (also living with HIV). Thematic analysis was employed by four independent coders to understand how prepared peers were and areas for program improvement. Peers verified participant feelings and affirmed their experiences, followed-up on participant goals to track progress, disclosed their own relevant experiences to build rapport, and facilitated closure to enable program success. Peers struggled maintaining an emotional connection over the phone and were concerned when participants were nonresponsive. This article discusses how the training was piloted and adapted for practice.

Effectiveness of Peer Support Interventions for Adolescents and Young Adults Living with HIV Globally

Background: Adolescents and young adults living with HIV (AYALHIV, ages 10-24) have poorer outcomes in care compared to other age groups. The global Treat All strategy aims to extend antiretroviral therapy (ART) to all individuals living with HIV. Efforts to improve outcomes in the AYALHIV population are essential to successfully achieving viral suppression and improving the long-term health outcomes of young people, and ultimately to ending the HIV pandemic. Peer support interventions are increasingly implemented by care programs, and are broadly favored by AYALHIV. This systematic review will evaluate the current evidence for quantitative effects of peer support interventions on AYALHIV treatment outcomes. 
 Methods: We searched MEDLINE, Embase, Global Health, CINAHL Complete, Cochrane, and Scopus databases for papers published between 1994 and October 2019, in all languages and regions. Studies of the effect of peer support interventions for AYALHIV on measures of adherence or retention in care were included. Solely qualitative studies and those without a comparator or control were excluded. Three researchers screened the papers independently, and those meeting criteria were included. Abstracted variables included study characteristics, participant population, peer intervention characteristics, and outcomes. 
 Results: The current evidence base for the effect of peer interventions for AYALHIV is very limited. Included studies were of small sample size, and primarily consisted of observational cohort studies with imperfect comparators. In initial analyses we find that studies of peer interventions have had mixed findings regarding the effect of such interventions on adherence to ART. By contrast, studies have consistently reported a favorable effect of peer interventions on increased retention in care among AYALHIV. 
 Conclusion/Implications: Rigorous studies of interventions to improve outcomes among AYALHIV are urgently needed. Further analyses in this review will examine differences according to study population, design, or intervention characteristics, which may underlie variable effects identified.

Effect of peer intervention by popular opinion leaders among young students who have sex with men

Objective The proposal of this study is to determine the feasibility of using online social software to guide popular opinion leaders (POLs) among young students MSM (men who have sex with men, MSM) carrying out comprehensive AIDS prevention in young students MSM. Methods From November to December 2019 in Tianjin, 22 POLs who had previously experienced AIDS prevention education and training foucus on life skills were recruited. Though snowball sampling method, 100 POLs’ partners (friends, sexual partners, classmates, etc) were invited into the study. From January to March 2020, regular posters will be sent through the WeChat platfonn to guide POL to intervene their partners/sexual partners. The questionnaire surveys were conducted before and after the intervention. Results After the intervention, both the proportion of young students MSM had sex and with multiple sex partners decreased (χ 2 = 12.12, 5.94, P <0.05). The comprehensive ability of AIDS prevention has improved significantly, the National Eight Items correct rate has risen from 90.0% to 99.0% (χ 2 = 5.82, 7.56, P <0.05), and the Youth Eight Items correct rate has increased from 86.0% to 98.0% ( P <0.01). Knowledge score increased from (11.08±1.89) to (11.84±1.27); Attitude score increased from (54.29±4.01) to (56.06±3.75), the behavior score increased from (52.12±4.78) to (55.08±4.25), skill score increased from (51.96±4.75) to (54.67±5.04), The comprehensive prevention ability score (percent) increased from (87.30 ±6.95) to (91.86±5.42) ( t = −4.21, −3.51, −5.32, −5.16, −6.45, P <0.01). Conclusion Using Wechat platform to guide POL carrying out comprehensive AIDS prevention is effective for improving the comprehensive AIDS prevention ability of young students MSM. 【摘要】 目的 利用微信平台指导青年学生男男性行为人群 (men who have sex with men, MSM)中大众意见领袖 (popular opinion leader, POL)开展预防艾滋病综合能力的同伴干预及其效果评价, 为开展艾滋病预防教育提供参考依据。 方法 2019年11一12月, 以天津为中心, 招募参与过前期以生活技能为核心的艾滋病预防教育培训的POL 22名, 并通过滚雪球 法, 将POL招募的100名同伴或性伴纳人研究。2020年1一3月, 通过微信平台定期发送海报, 指导POL对招募的同伴/性 伴的艾滋病预防能力进行干预, 并分别在干预前后进行问卷调查。 结果 干预后, 青年学生MSM发生性行为、多性伴的比 例下降 (χ 2 值分别为 12.12,5.94, P 值均<0.05) ；POL同伴的预防艾滋病综合能力明显提升, “国八条”知晓率由90.0%提高 至 99.0%, “青八条”知晓率由86.0%提高至98.0% (χ 2 值分别为 5.82,7.56, P 值均<0.05)。 知识 得分由 (11.08± 1.89)分提 高至 (11.84±1.27)分, 态度得分由(54.29±4.01)分提高至(56.06±3.75)分, 行为得分由(52.12±4.78)分提高至(55.08±4.25)分, 技能得分由 (51.96±4.75)分提高至 (54.67±5.04)分, 预防艾滋病综合能力得分 (百分制) 由 (87.30±6.95)分上升至 (91.86±5.42)分 ( t 值分别为-4.21, -3.51, -5.32, -5.16, -6.55, P 值均<0.01)。 结论 通过微信平台指导POL开展预防艾 滋病教育干预, 对提高同伴的预防艾滋病综合能力有效。

Expert Opinions on Web-Based Peer Education Interventions for Youth Sexual Health Promotion: Qualitative Study.

BackgroundParticipatory education, in the form of peer education, may be an effective way to promote youth sexual health. With the advent of the internet, web-based interventions have potential as an attractive new tool for sexual health promotion by peers.ObjectiveThe aim of this study was to evaluate professional experts’ opinions on the perspectives for web-based participatory interventions to promote sexual health by peers and among young people.MethodsSemistructured interviews were carried out with 20 experts (stakeholders in direct contact with young people, researchers, and institutional actors) specializing in sexual health, health promotion, peer education, youth, internet, and social media. After coding with N’Vivo, data were subjected to qualitative thematic analysis.ResultsThe majority of experts (18/20, 90%) found this kind of intervention to be attractive, but highlighted the necessary conditions, risks, and limitations attached to developing an acceptable peer intervention on the internet for sexual health promotion among young people. Five main themes were identified: (1) an internet intervention; (2) sexual health; (3) internet skills, and uses and the need for moderation; (4) multifaceted peers; and (5) minority peers. In the absence of youth interest for institutional messages, the experts highlighted the attractive participatory features of web-based interventions and the need for geolocalized resources. However, they also warned of the limitations associated with the possibility of integrating peers into education: peers should not be mere messengers, and should remain peers so as not to be outsiders to the target group. Experts highlighted concrete proposals to design an online participatory peer intervention, including the process of peer implication, online features in the intervention, and key points for conception and evaluation.ConclusionsThe experts agreed that web-based participatory interventions for youth sexual health promotion must be tailored to needs, uses, and preferences. This type of action requires youth involvement framed in an inclusive and holistic sexual health approach. Peer education can be implemented via the internet, but the design of the intervention also requires not being overly institutional in nature. Involving young people in their own education in an interactive, safe online space has the potential to develop their empowerment and to foster long-term positive behaviors, especially in the area of sexual health.

The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy.

We conducted a novel pilot randomized controlled trial of the Treatment Ambassador Program (TAP), an 8-session, peer-based, behavioral intervention for people with HIV (PWH) in South Africa not on antiretroviral therapy (ART). PWH (43 intervention, 41 controls) completed baseline, 3- and 6-month assessments. TAP was highly feasible (90% completion), with peer counselors demonstrating good intervention fidelity. Post-intervention interviews showed high acceptability of TAP and counselors, who supported autonomy, assisted with clinical navigation, and provided psychosocial support. Intention-to-treat analyses indicated increased ART initiation by 3months in the intervention vs. control arm (12.2% [5/41] vs. 2.3% [1/43], Fisher exact p-value = 0.105; Cohen's h = 0.41). Among those previously on ART (off for > 6months), 33.3% initiated ART by 3months in the intervention vs. 14.3% in the control arm (Cohen's h = 0.45). Results suggest that TAP was highly acceptable and feasible among PWH not on ART.

Using a STEM activity to improve social communication interactions in autism spectrum disorder

Social communication deficits associated with Autism Spectrum Disorder are often exacerbated during adolescence. Group based approaches are effective intervention techniques for facilitating improved social communication skills in people with ASD; however, science, technology, engineering, and math activities, while highly preferred areas of interest, are overlooked as a therapeutic tool. This study determines the effectiveness of peer collaborations using a STEM activity on social communication for adolescents with ASD. Using solarbotics kits, peer dyads worked together over the course of a 12-week period to construct a functioning robot. Measures of social communication were collected prior to the initiation of the intervention, during the intervention, and after the intervention. Results indicated that the collaborative peer intervention using a STEM focused approach facilitated non-verbal and pragmatic improvements.

A brief telephone-delivered peer intervention to encourage enrollment in medication for opioid use disorder in individuals surviving an opioid overdose: Results from a randomized pilot trial

BackgroundMedication for opioid use disorder (MOUD) can decrease the risk of opioid overdose (OOD) in individuals with opioid use disorder. Peer recovery support services (PRSS) are increasingly used to promote MOUD engagement but evidence of their efficacy is limited. This study’s objective was to evaluate a single 20-minute telephone-delivered PRSS intervention for increasing MOUD enrollment and decreasing recurring OODs. MethodThis single-site, randomized controlled pilot trial enrolled adults, primarily recruited from a syringe service program, with an opioid-positive urine drug screen (UDS) reporting having been treated for an OOD within the past 6 months. Participants (N = 80) were randomized to PRSS (n = 40) or Control (n = 40) condition with all participants receiving personally-tailored OOD education and naloxone. Outcome measures obtained at 3 (n = 66), 6 (n = 58), and 12 (n = 44) months post-randomization included verified MOUD enrollment (primary), self-reported OOD, and opioid use assessed by self-report and UDS. ResultsThrough 12-month follow-up, 32.5 % of PRSS, compared to 17.5 % of Control participants enrolled in MOUD (X2 = 2.4, p = 0.12; odds ratio = 2.27 (0.79–6.49)). PRSS participants were significantly less likely to have experienced an OOD through 12-month follow-up (12.5 % of PRSS participants, 32.5 % of Control, p = 0.03). No significant treatment effect was found for opioid use through 12-month follow-up as measured by either opioid-positive UDSs or self-reported past month opioid use days. Based on self-report, PRSS had good acceptability for both the interventionists and participants. ConclusionsThe results suggest that further development and testing of this PRSS telephone intervention to encourage MOUD enrollment and reduce OOD may be warranted.

Preliminary Outcomes of an Older Peer and Clinician co-Facilitated Pain Rehabilitation Intervention among Adults Aged 50Years and Older with Comorbid Chronic Pain and Mental Health Conditions.

The present study aimed to examine the acceptability, feasibility, and preliminary effectiveness of an older peer and clinician co-facilitated Behavioral Activation for Pain Rehabilitation (BA-PR) intervention among adults aged 50years and older with comorbid chronic pain and mental health conditions. This was a mixed-methods research design with eight participants aged 55 to 62years old with mental health conditions including schizophrenia spectrum disorder, bipolar disorder, major depressive disorder, personality disorder, and adjustment disorder. The quantitative data were assessed from observational methods, a pain rating scale and related measures. We used semi-structured interviews for qualitative feedback on experiences with the BA-PR intervention after participation. Overall, the participants had positive experiences following receipt of the BA-PR intervention. The recruitment and adherence rates for participants were 72.7% and 100%, respectively. Approximately 75% of the participants remained enrolled in the study. Findings from a paired t-test showed the BA-PR intervention was linked to significantly reduced prescription opioid misuse risk, t (7) = 2.42, p < 0.05. There were also non-significant reductions in pain intensity and depression severity, in addition to improvements in active and passive pain coping strategies and behavioral activation.The BA-PR intervention is the first pain rehabilitation intervention specifically designed for middle-aged and older adults with comorbid chronic pain and mental health conditions. Our findings indicate promise for the BA-PR intervention to potentially reduce prescription opioid misuse risk, pain, and depressive symptoms. However, a quasi-experimental study is needed before rigorous effectiveness testing.

Improving the understanding of written peer feedback through face-to-face peer dialogue: students’ perspective

ABSTRACT Feedback plays a vital role in the process of mastering writing in many academic disciplines. Although peer feedback has been proven helpful to develop students’ academic writing competency, the role of additional face-to-face peer dialogue in this context remains indistinct. Face-to-face peer dialogue on written peer feedback is expected to improve students’ understanding; however, it is unclear under which conditions it might do so. The purpose of this exploratory study is to explore students’ beliefs about peer feedback and to investigate both the instructiveness of face-to-face peer dialogue and the conditions for achieving improved understanding. Second-year university students (N = 84) participated in a mixed-method study that included questionnaires and focus groups. The intervention comprised face-to-face dialogue in small groups about the participants’ written peer feedback on a draft report. Quantitative data showed students perceived peer feedback as meaningful, useful and a very important skill to possess. They felt confident about feedback quality, both provided and received. Overall, students perceived written feedback and face-to-face dialogue to be instructive, although no significant difference between the two forms was established. Qualitative findings revealed that face-to-face dialogue stimulates peers to elaborate on their written feedback, helps them deliver constructive comments and feel responsible for the feedback process. Important conditions appeared to be the quality of the written feedback, the non-anonymous character of the dialogue, and the opportunity to revise the report. It can be concluded that face-to-face peer dialogue is a useful variation within peer feedback, which enhances further elaboration and students’ engagement with feedback. This study provides insight in important conditions to design and implement face-to-face dialogue peer interventions in higher education in the context of academic writing.

Buddy Care, a Peer-to-Peer Intervention: A Pilot Quality Improvement Project to Decrease Occupational Stress Among an Overseas Military Population.

Occupational stress can have a direct influence on worker safety and health. Navy medical professionals are known to neglect self-care, putting them at risk for deteriorations in psychological health that can lead to adverse patient outcomes. To support medical professionals, a peer-to-peer intervention called Buddy Care, embedded in Navy Medicine's Caregiver Occupational Stress Control (CgOSC) program, was evaluated. Strategies to prevent and better manage occupational stress are vital to improve the health care providers' abilities to cope with day-to-day stressors, which is crucial to maintaining mission readiness. The overarching aim of this quality improvement pilot project was to implement and evaluate Buddy Care and to provide context as an evidenced-based peer intervention and leadership tool at a military hospital in Guam. This project is the first to implement and evaluate Buddy Care intervention for an active duty U.S. Navy population stationed overseas. A convenience sample of 40 Navy active duty assigned to three inpatient units were offered Buddy Care intervention, which was introduced by conducting a Unit Assessment. A pre-test and 3- and 6-month post-test intervention design used a self-administered, 79-item CgOSC Staff Wellness Questionnaire which included five validated measures to assess the independent variable: (1) Response to Stressful Experience Scale, (2) Perception of Safety, (3) Horizontal Cohesion, (4) Perceived Stress Scale, and (5) Burnout Measure, short version. This project was determined as exempt by the Department of Navy Human Research Protection Program and did not require further review by the Institutional Review Board. Of the 40 questionnaires collected, 39 were partially completed. Paired sample t-tests were conducted between designated time-points to maximize the sample size and retain the repeated measures nature of the outcome variables. The small sample size allowed for statistical comparisons; however no statistically significant differences were found across the time-points. There was a large effect size for Perceptions of Safety and a medium effect size for Burnout Measure from baseline to 3 months, with both lowered at the 6 months. Although the sample size was too small to achieve statistical significance, the effect size analysis suggested that significance might be obtained with a larger sample. The small number of participants and missing data significantly limited the ability to identify reliable changes across time-points. Despite the lack of statistically significant findings, there was an unintended positive result. The Unit Assessment piqued the interest of other departments, and during the project period, 11 departments requested a Unit Assessment. Although there were no requests for Buddy Care intervention from the targeted sample, it was occurring an average of 40 times per month throughout the command. Replication of this project in a similar setting is encouraged so that Buddy Care can be further evaluated. Understanding the effectiveness of well-mental health programs that promote early intervention and prevention efforts may contribute to a psychologically tougher medically ready force. Shortly after project completion, a CgOSC Instruction was approved by the Navy Surgeon General, highlighting the importance of CgOSC and Buddy Care on the operational readiness of Navy Medicine.

The impact of China-to-US immigration on structural and cultural determinants of HIV-related stigma: implications for HIV care of Chinese immigrants

ABSTRACT Objectives: Asian Americans have poor HIV-related outcomes, yet culturally salient barriers to care remain unclear, limiting development of targeted interventions for this group. We applied the ‘what matters most’ theory of stigma to identify structural and cultural factors that shape the nature of stigma before and after immigration from China to the US. Design: Semi-structured interviews were conducted with 16 immigrants to New York from China, recruited from an HIV clinic and community centers. Deductive followed by focal inductive qualitative analyses examined how Chinese cultural values (lian, guanxi, renqing) and structural factors influenced stigma before and after immigration. Results: In China, HIV stigma was felt through the loss of lian (moral status) and limited guanxi (social network) opportunities. A social structure characterized by limited HIV knowledge, discriminatory treatment from healthcare systems, and human rights violations impinged on the ability of people living with HIV to fulfill culturally valued goals. Upon moving to the US, positions of structural vulnerability shifted to enable maintenance of lian and formation of new guanxi, thus ameliorating aspects of stigma. Conclusions: HIV prevention and stigma reduction interventions among Chinese immigrants may be most effective by both addressing structural constraints and facilitating achievement of cultural values through clinical, peer, and group interventions.

Peer engagement in toddlers with autism: Community implementation of dyadic and individual Joint Attention, Symbolic Play, Engagement, and Regulation intervention.

Although young children may participate in education and intervention programs that take place in classrooms or groups, there is little information about how toddlers with special needs, and specifically toddlers with autism, are engaging with their peers. This study takes place in a public center-based early intervention program for toddlers with autism. Classrooms of toddlers were randomly assigned to an individual social communication intervention or the same intervention adapted to include a peer. Children in both groups made gains in social communication and play skills. Children who had the peer intervention were more engaged with peers when an adult was present, but not when the children were unsupported. This article adds information about early skills that may be important for children to master so that they have more success when trying to interact with their peers. These skills include understanding language (referred to as "receptive language" at 12 months or more) and play skills including building and stacking (referred to as "combination play"-for example, building with blocks or completing a puzzle) and extending familiar actions to themselves, others, and figures (referred to as "presymbolic play"-for example, putting a bottle to the doll or to themselves). Understanding which skills to target can help practitioners focus their instruction to build children's skills toward connecting with peers through play.

Effectiveness of Peer and Parent-led Intervention to Improve the Perception of In-School Adolescents towards HIV Prevention

Effectiveness of Peer and Parent-led Intervention to Improve the Perception of In-School Adolescents towards HIV Prevention

Māori Becoming Peer Educators in Later Life: Impacts on Identity, Well-being, and Social Connectedness.

The aim of this study was to examine ways that older Māori (New Zealand's Indigenous people) enhanced their ability to be peer educators and how this role impacted on their sense of purpose and well-being in later life. Kaupapa Māori and community-based participatory research principles guided the peer intervention involving 26 Māori kaumātua (older people 55 years and older) as peer educators (tuakana) for 121 other kaumātua (teina) facing transitions in later life. Each pair held up to 3 conversations; independent coders rated tuakana communication skills. We used mixed methods in a pre- and post-test, clustered staggered design. Participants completed baseline and post-intervention assessments of health and well-being consistent with Māori worldviews. 5 focus groups involving 22 teina and 1 with 5 tuakana were held. Tuakana communication skills were rated as high by teina and independent coders. Qualitative analysis supported the importance of Māori communication processes for the role. Further, three measures increased significantly from the baseline to the final period for tuakana accounting for about 15% of the variance in these variables: sense of purpose (p = .07), self-rated health (p = .05), and health-related quality of life (p = .04). The qualitative analysis supported the benefits of the peer educator role for older Māori including enhanced sense of identity, well-being, and social connectedness. The results demonstrated that kaumātua had strong communication in the peer educator role and that the intervention has positive impacts for them. The study contributes to peer intervention research that may help to improve experiences ofIndigenous and other older people.

A Peer-Delivered Intervention for High School Students With Impairing ADHD Symptoms

This study evaluates a peer-delivered intervention for high school students with impairing attention deficit hyperactivity disorder (ADHD) symptoms targeting organization, time management, and planning (OTP) and motivation (Students Taking Responsibility and Initiative through Peer Enhanced Support; STRIPES). A mixed methods open trial (Study 1; N = 18) and parallel group randomized controlled trial (Study 2; N = 72) were conducted to examine acceptability, target mechanisms, student outcomes, population fit, and feasibility. Study 1 established acceptability for STRIPES delivered after school but identified forgetfulness and competing social activities as population-specific implementation barriers. In Study 2, three schools employed unique implementation strategies and results varied. An elective pullout model engaging 12th grade peer interventionists under teacher supervision demonstrated good fidelity, attendance, and population fit and significant between-group differences in book bag organization (d = 1.11), academic motivation (d = 0.85 to 2.05), and class attendance (d = 1.47) over time compared to control. When implementation strategy demonstrates population fit, STRIPES shows promise for preventing declining school engagement across ninth grade.

T224. TESTING THE EFFECTIVENESS OF A BRIEF, PEER SUPPORT INTERVENTION TO FACILITATE TRANSITION FROM PSYCHIATRIC HOSPITALIZATION FOR A SCHIZOPHRENIA SPECTRUM POPULATION

BackgroundThe period immediately following discharge is highly stressful for many individuals with schizophrenia spectrum illnesses as they transition from protracted inpatient stays to community settings with minimal support. In this period the risk of hospital re-admission is at its highest, many do not engage with community supports and clinical resources, and the risk of suicide is greatest. The evidence base for brief, effective interventions to support such transitions is to date underdeveloped.MethodsThis randomized controlled trial examined the effectiveness of a Peer Support intervention that combines components of Cognitive Adaptation Training (CAT) and the Welcome Basket Program. CAT is an evidence-based intervention that provides environmental supports to help people with schizophrenia compensate for the cognitive impacts of the illness. The Welcome Basket Program is a peer intervention approach that helps bridge discharge through the provision of a small individualized ‘basket’ of staple supplies and comfort items along with the facilitation of engagement with community resources. The intervention involves peer supports engaging patients in the days preceding discharge to assess goals and needs followed by weekly visits post-discharge for 1 month providing Welcome Basket and CAT supports. The study also collected pilot data examining the outcomes of an abbreviated, two contact version of the intervention. Inpatients with a schizophrenia spectrum diagnosis were randomized with a 2:2:1 ratio to treatment as usual, the full intervention, and the abbreviated intervention. Along with feasibility assessments, outcome metrics included re-hospitalization, symptomatology, quality of life, and community functioning. Assessments at baseline, 1-month post-discharge, and 6 months post-discharge facilitated the examination of relative effectiveness and sustainment of gains.ResultsThe trial was successfully implemented with data collected from 106 participants at baseline, 82 at post-intervention, and 74 at 6-month follow up. Overall, the interventions and the study design appeared feasibility with attrition primarily due to the high acuity nature of a population recruited largely through an early psychosis inpatient unit (mean age 34.6 years). Preliminary analysis suggests limited effects on community functioning though completed analyses of other metrics are pending and may provide insight into the possible mechanisms of action of this intervention should it prove to be effective.DiscussionThis study was designed to assess the development and dissemination of a cost-effective method for mitigating relapse risk and promoting community involvement and engagement in care. The effort to better support successful care transitions through approaches such as this is a priority area for service systems globally and contributes to the literature on peer support. While widely implemented, models of peer support have seldom been examined for effectiveness in clinical trials.

PIN84 KNOWLEDGE, BELIEFS, AND ACTIVATION REGARDING VACCINE-PREVENTABLE DISEASES: RESULTS FROM THE VACCINE EDUCATION THROUGH PHARMACISTS AND SENIOR CENTERS (VEPSC) STUDY

The Vaccine Education through Pharmacists and Senior Centers (VEPSC) study sought to compare the effect of pharmacist-led didactic training (PHARM) to peer-to-peer small group education (PEER) for improving knowledge, beliefs, and activation regarding 3 common vaccine-preventable diseases (pneumonia, zoster, influenza). This analysis reports changes in knowledge, beliefs, and activation at three timepoints – baseline (BL), immediate post-program (PT) and 1-month post-program (M1), along with program costs. VEPSC was conducted through Delaware Valley senior centers from October 2017-September 2018. Participant knowledge, beliefs, and activation were assessed at BL, PT, and M1. At each timepoint knowledge was assessed via a 22-item instrument; between-group changes in knowledge were compared via Wilcoxon Rank-Sum tests. Between-group differences in beliefs and activation were calculated using Fisher’s Exact or Chi-Square tests. Per-participant program delivery costs were calculated for each arm and included monetary value of staff and peer leader time, mileage, and supplies. 287 participants were included (140 PEER; 147 PHARM). Most were female (n=231, 80.5%) and black (n=183, 63.8%). From BL to PT and BL to M1, total knowledge scores increased within both PEER and PHARM (p<0.0001). Mean knowledge improvement was greater for PEER (4.9 vs. 3.5 for BL to PT, p=0.0081; 4.3 vs. 3.4 for BL to M1; p=0.1094). Within-group beliefs in vaccination importance improved significantly from BL to PT (PEER p<0.0001, PHARM p=0.0011) and from BL to M1 (PEER p<0.0001, PHARM p=0.0028). While activation scores were higher among PHARM for zoster (BL p=0.0163, PT p=0.0028, M1 p=0.433), at M1 significantly more PEER participants had received influenza (p=0.0141) and pneumonia (p=0.0457) vaccines. Total cost of PEER was $14,887.45 ($106.34/participant) vs. $7,392.94 ($50.29/participant) for PHARM. Results indicate that community-based peer interventions are powerful tools to improve vaccine knowledge. Though PEER was more costly, it yielded greater gains in knowledge and activation vs. PHARM.

Understanding Our Peers with Pablo: Exploring the Merit of an Autism Spectrum Disorder De-stigmatisation Programme Targeting Peers in Irish Early Education Mainstream Settings.

The political drive for inclusion means there are increasing numbers of children with autism spectrum disorder (ASD) being educated alongside their neurotypical peers. Pervasive victimisation has prompted the development of peer interventions targeting stigma. This study evaluated the 'Understanding Our Peers with Pablo' programme for effects on knowledge, attitudes and behavioural intentions of infant schoolchildren (N = 222) towards autistic peers. Classes were randomly assigned to an intervention or waitlist control condition. Change over time in knowledge of autism and attitudes and behavioural intentions towards familiar and unfamiliar peers was analysed using mixed analyses of variance. The intervention condition showed gains in knowledge and increased positive attitudes towards unfamiliar autistic peers (maintained over three-months). There were significant improvements in attitudes towards familiar autistic peers, and time-limited decreases in behavioural intentions across both conditions. Overall, results support the use of this programme in early-years education.

Whole‐school antibullying interventions: A systematic review of 20 years of publications

AbstractA systematic literature review on whole‐school antibullying interventions was conducted. Twelve databases were consulted, considering as inclusion criteria: scientific article, published between 1998 and June 2018, in English or Portuguese, describing empirical studies on whole‐school antibullying interventions. Seventeen studies were analyzed, indicating that the interventions had the reduction of bullying prevalence as main goal, and secondary goals as improvements in reporting bullying occurrences, bullying identification, and attitudes toward bullying. Six interventions had experimental designs, five were quasiexperimental, and six were preexperimental. Data collection in 14 studies involved exclusively students, in two studies measurements also encompassed teachers, and one study applied questionnaires to parents only. Intervention effects on bullying prevalence were inconsistent, with eight studies finding significant decreases in bullying involvement, while seven studies did not show significant effects on bullying prevalence or found negative results, such as an increase of its prevalence. However, the interventions had significant positive effects on increasing the reporting of bullying occurrences, attitudes toward bullying, and perceived peer and teacher intervention. Thus, whole‐school antibullying interventions, incorporating multiple strategies and targeting multiple individuals, should be encouraged to address the complexity of bullying.

Experiences and Insights from the Early US COVID-19 Epicenter: A Rapid Assessment Procedure Informed Clinical Ethnography Case Series

Objective The Coronavirus disease (COVID-19) outbreak has evolved into a pandemic crisis, with King County in Washington State emerging as the early US epicenter. A literature review revealed few reports providing front-line clinical and research teams guidance related to multilevel, rapidly evolving COVID-19 directives. Method The Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) method was used to develop a clinical case series and conduct participant observation during an ongoing comparative effectiveness trial of peer-integrated, patient-centered interventions after traumatic injury. Participants were patients enrolled in the intervention arm of the ongoing trial, as well as front-line clinicians, patient peer interventionists, and clinical research team members implementing the trial. All participants were exposed to the Washington State COVID-19 outbreak. Results Primary and secondary COVID-19 prevention strategies were feasibly integrated into ongoing care coordination and behavioral interventions for at-risk patients. Beyond the compilation of case studies, as an iterative method, RAPICE data collection naturalistically evolved to include observations of intervention team activity occurring within the larger pandemic epicenter context. A daily clinical research team huddle that flexibly accommodated virtual participation was also feasibly implemented. Conclusions Primary and secondary COVID-19 prevention strategies can be feasibly integrated into ongoing clinical interventions during the pandemic. Routine, proactive clinical and research team communication that transparently addresses ethical tensions and health-sustaining activities may promote well-being for providers grappling with rapidly evolving pandemic directives. Proactive assessments of individual provider vulnerabilities for severe COVID-19 related respiratory illness may also be a crucial element of the health care system pandemic responses.