Peer-led Support Groups Research Articles

What works for peer support groups: learning from mental health and wellbeing groups in Bath and North East Somerset

PurposeThe purpose of this paper is to explore what worked well in terms of peer involvement in a diverse network of community groups for people affected by mental health problems in Bath and North East Somerset (BANES), UK.Design/methodology/approachA participatory action inquiry approach engaged the network’s key stakeholders (group members, facilitators, and commissioners) in critical reflection on what supported successful groups.FindingsSuccessful groups have six characteristics: mutual support, a positive shared identity, opportunities for taking on roles, negotiated ground rules, skilled facilitation, and a conducive physical environment. Additionally, each group achieved a balance between the following areas of tension: needing ground rules but wanting to avoid bureaucracy, needing internal structure whilst also committing to group activities, balancing leadership with accountability, wanting peer leadership whilst acknowledging the burden of this responsibility, and lobbying for change in mental health services whilst acknowledging the need for support from them.Research limitations/implicationsThe evaluation shows a group’s success is about adaptability and group facilitation is the art of navigating a course through these competing demands above. These insights have informed plans for a practical guide for developing peer led groups and for training of peer leaders in BANES.Originality/valueThis evaluation focuses on self-efficacy. It draws on group members’ own perceptions of what worked best for them to provide transferable learning about how peer led support groups might develop more generally. It can thus inform the growth of a comparatively new kind of community-based support for people with mental health problems and for their carers.

Fighting spirit expressed by women with breast cancer in professional-and peer-led online support groups: effects on outcomes.

Objective:Does fighting spirit reduce depression in women with breast cancer (BC)?Methods:Unlike previous studies using questionnaires, we assessed fighting spirit by analyzing interaction in BC support groups. Three online groups were studied: synchronous professionally led groups (Life Beyond Cancer), asynchronous professionallyled groups (Bosom Buddies) and asynchronous peer-led bulletin board groups (Peer Bulletin Boards). The samples were predominantly Caucasian, married, highly educated, and had early stage cancer. We used a content analysis program, DTSearch, to measure fighting words expressed in the groups. Linear regression was used to examine the relation between fighting words and follow-up depression, controlling for baseline depression and total word count. We also compared samples on the number of fight words expressed.Results:We found that viewing their cancer as a fight or battle would result in lowered depression was disconfirmed in all samples. The peer groups had twice as many fight words compared to professionally led groups.Conclusion:Previous studies as well as the current one strongly support the null hypothesis. Our finding based on a behavioral measure of fighting spirit does add to previous studies results. Unfortunately the common lay perspective for cancer sufferers is that not having fighting spirit would mean a psychological incapacity. The message is that “brave and good people defeat cancer and that cowardly and undeserving people allow it to kill them”. This view can create guilt, self flagellation and stress in woman already facing a difficult disease.

Measures of Patient Activation and Social Support in a Peer-Led Support Network for Women With Cardiovascular Disease

Social support has been associated with beneficial effects on many disease states and overall health and well-being. However, there is limited research exploring the impact of peer-led support models among women living with coronary heart disease. This study describes the structure of peer-led support groups offered by WomenHeart (WH): The National Coalition for Women Living with Heart Disease, and assesses WH participants' quality of life and social, emotional, and physical health. Participants were recruited from 50 WH groups. A 70-item online survey was administered, and the main analytic sample included 157 women. Multivariate logistic regression was used to examine the association between patient activation levels (lower activation levels: 1, 2 vs higher activation levels: 3, 4) and social support scores (range: lowest 8 to highest 34), adjusting for age. High levels of social support, patient activation, physical activity, and low levels of stress, anxiety, and depression were reported. Those who were at or above the median for the social support measures (indicating high levels of social support) had greater odds of high levels of patient activation (level 3 or 4) than individuals reporting low levels of social support (OR = 2.23; 95% CI, 1.04-4.76; P = .012). Women who regularly attended a support group by a trained peer leader were highly engaged in their health care and had low levels of stress, anxiety, and depression. These findings lend credibility to the value of the peer support model and could potentially be replicated in other disease states to enhance patient care.

Two vignettes of adolescent sexual disclosure: guidance for HIV clinical practice.

HIV-positive adolescents are required by law to notify sexual partners, but can find it difficult to achieve this goal. This article offers practice guidance for counselling HIV-positive adolescents about sexual disclosure in clinical settings and for building confidence in managing sexual lives with HIV. We use two vignettes to illustrate key differences between perinatally and sexually infected adolescents in terms of readiness to disclose, and include a set of strategies for both groups that can be tailored to individual circumstances and contexts. The toolbox of strategies we describe include pre-counselling, focused counselling, social support groups and technical support. Pre-counselling helps to identify barriers and motivations to sexual disclosure and is followed by counselling sessions in which the focus is on role playing and sexual scripts for disclosure. Peer-led support groups are designed to boost adolescent confidence, and pre-paid cell phones, text messaging, ready-dial phone numbers and a private Facebook page provide back-up support and out-of-hours contact. Since sexual disclosure can be a risky proposition, safety plans, such as having an emergency contact person, should always be in place. These strategies are designed to empower vulnerable adolescents, foster trust between patient and provider, and reduce HIV transmission to sexual partners.

Facilitators and barriers to treatment adherence within PMTCT programs in Malawi

ABSTRACTIn Malawi, an innovative prevention of mother-to-child transmission (PMTCT) of HIV program, Option B+, has greatly expanded access to antiretroviral treatment at no cost to women and their exposed infants. However, many women continue to experience social, cultural, and structural barriers impeding their ability to consistently access medical treatment. Understanding these women's perspectives may make programs more responsive to patients’ needs. This qualitative study sought to explore factors influencing women's adherence within PMTCT programs in southern Malawi. Participants were current PMTCT patients (the first cohort following national implementation of Option B+), healthcare providers, community leaders, and patients who had dropped out of the program (“defaulters”). Qualitative interviews and focus groups were conducted to investigate barriers and facilitators to continued participation within PMTCT programs. Data were analyzed using content analysis. Barriers identified included fears of HIV disclosure to husbands, community-based HIV/AIDS stigma, and poor interactions with some health workers. Facilitators included the improved survival of PMTCT patients in recent years and the desire to remain healthy to care for one's children. This research highlights important sociocultural factors affecting adherence within HIV/AIDS treatment programs in Malawi. Recommendations to improve access to medical care for PMTCT patients include integrated services to increase attention to confidentiality and minimize stigma, shared HIV testing and counseling for couples to minimize conflict in gender-unequal relationships, and peer-led support groups to provide social support from other women with the shared experience of an HIV-positive serostatus.

Abstract 14127: Measures of Patient Activation and Social Support in a Peer-led Support Network for Women With CVD

Introduction: Social support has been recognized as having a strong impact on health and well-being and has also been shown to have beneficial effects in a wide variety of disease states. Social support from friends, family or peers can augment the care offered in traditional healthcare settings by providing advice, encouragement and education However, there is limited research on the impact of peer-led support programs among women living with cardiovascular disease (CVD). Objective: To examine the relationship between patient activation and measures of social support among women who attended a WomenHeart: The National Coalition for Women with Heart Disease peer-led support program in their local community. We hypothesized that high levels of social support would be associated with high levels of patient activation in this study population. Methods: Participants were recruited from 50 national WomenHeart Support Network groups. A 70 item, online survey was administered and the main analytic sample for this study included 157 women. Multivariable logistic regression was used to examine the association between patient activation levels (Lower activation levels: 1,2 vs higher activation levels: 3,4) and social support scores (range: lowest 8 to highest 34), adjusting for age. Results: Study participants reported high levels of social support and patient activation. Those who were at or above the median for the social support measures (indicating high levels of social support) had greater odds of high levels of patient activation (levels 3 or 4) compared to individuals reporting low levels of social support (OR 2.23 95%CI1.04, 4.76, p = 0.012). Conclusions: Results of our survey demonstrate that this group of women with coronary heart disease who regularly attended a peer-led support group and indicated a high level of social support report taking a more active role in self-management behaviors.

Emotional approach coping and the effects of online peer-led support group participation among patients with breast cancer: a longitudinal study.

BackgroundPrevious research on the effects of online peer support on psychological well-being of patients with cancer showed mixed findings. There is a need for longitudinal studies explaining if and when online peer-led support groups are beneficial. How patients cope with emotions that come along with the cancer diagnosis might influence effectiveness of online participation. Emotional approach coping is a construct encompassing the intentional use of emotional processing and emotional expression in efforts to manage adverse circumstances.ObjectiveIn this longitudinal study, we hypothesize that mixed findings in previous research are partly caused by individual differences in coping with emotions, which may moderate the effects of online support group participation on patients’ well-being.MethodsA total of 133 Dutch patients with breast cancer filled out a baseline (T0) and a follow-up (T1, 6 months later) questionnaire assessing intensity of online participation within the online support community, emotional approach coping (ie, actively processing and expressing emotions), and psychological well-being (depression, emotional well-being, and breast cancer–related concerns). There were 109 patients who visited an online support community at both points in time. Repeated measures ANOVAs assessed change in well-being over time.ResultsResults showed 3-way interactions of time, online intensity of participation, and emotional approach coping on emotional well-being (F 1,89=4.232, P=.04, η2 ρ=.045) and depression (F 1,88=8.167, P=.005, η2 ρ=.085). Online support group participation increased emotional well-being over time for patients who scored low on emotional approach coping at T0, provided that they were highly active online. Patients who were highly active online with a high score on emotional approach coping reported no change in sense of well-being, but showed the highest score on well-being overall. Participating less frequently online was only beneficial for patients who scored high on emotional approach coping, showing an increase in well-being over time. Patients participating less frequently and with a low score on emotional approach coping reported no significant change in well-being over time.ConclusionsThis study extends previous findings on the effects of online peer support in two ways: by testing changes in well-being as a function of intensity of online support group participation and by examining the role of individual differences in emotional coping styles. Findings showed no negative effects of intense support group participation. Participating frequently online was especially helpful for patients who approach their emotions less actively; their emotional well-being increased over time. In contrast, frequent online users who actively approach their emotions experienced no change in well-being, reporting highest levels of well-being overall. For patients who participate less intensively within the support community, coping style seems to outweigh effects of online participation; over time, patients who actively approached emotions experienced an increase in psychological well-being, whereas patients with a low score on emotional approach coping reported no change in depression and emotional well-being.

Cell phone based peer counselling can support exclusive breastfeeding: a randomized controlled trial in Kenya (119.5)

Objective: To test whether exposure to community‐based continuous cell phone based peer support (CPS) or monthly peer‐led support groups (PSG) increases adoption and duration of exclusive breastfeeding (EBF), as compared to current standard of facility‐based support (Control).Methods: We randomized low‐income women attending antenatal care at a large hospital to receive one of three support strategies from late pregnancy (32‐26 weeks) to 3 months postpartum: CPS, PSG or Control. We compared EBF estimated by maternal 24 h recall of infant foods at 3 months age by intervention group.Results: Participant flow was adequate for power (753 women enrolled, 81% of eligible; 504 infants completed, including twins, 66.6%). Both interventions were associated with a higher proportion of EBF CPS: 90.9%, PSG: 82.8%, Control: 78.2%, p=0.007). Pairwise comparisons of 24 h EBF indicated a significant association of CPS with an 12.7% higher prevalence than Control (90.9 versus 78.2, a 16.2% greater EBF response rate than Control; Chi‐square = 9.8201, p=0.0017) and an 8.1% higher prevalence than PSG (90.9 versus 82.8, a 9.8% greater EBF response rate than PSG; Chi‐square = 4.5768, p=0.0324). Differences could not be attributed to baseline indicators, dropout rates or biases, prevalence and timing of breastfeeding initiation, or EBF prevalence one week after birth. They may be attributed to the frequency of advice.Conclusions: Cell phone based counselling approaches can be at least as effective in supporting EBF as peer support group and facility‐based approaches.Supported by Bill & Melinda Gates Foundation to FHI 360, through the Alive & Thrive Small Grants Program managed by UC Davis; Global Alliance for Improved Nutrition; Canada Research Chair program award.

The Value of Peer-Led Support Groups Among Caregivers of Persons With Parkinson's Disease

Many persons with Parkinson's disease are cared for by family members. The strain of caregiving can negatively affect the health of the caregiver and affect long-term care decisions, making caregiver support a priority. This study highlights the importance of peer-led support groups for family caregivers of persons with Parkinson's disease.

Emergence of Yalom's Therapeutic Factors in a Peer-Led, Asynchronous, Online Support Group for Family Caregivers

Support groups fill a critical void in the health care system, harnessing the power of shared experiences to provide support to group members. Likewise, family caregivers fill a void in the health care system, providing billions in unpaid care to the chronically ill. Caregiver support groups offer an opportunity for alleviating the psychological burden of caregiving. The power of any group, including a support group, to foster psychological well-being lies in its ability to cultivate Yalom's therapeutic factors. Gaps in the literature remain regarding the ability of non-prototypical groups to promote therapeutic mechanisms of change. The purpose of this study was to determine if and when Yalom's therapeutic group factors emerged in a peer-led support group delivered in an asynchronous, online format. Qualitative content analysis utilizing deductive category application was employed. Participants’ responses were coded and frequency counts were conducted. Results revealed that 9 of 11 therapeutic factors emerged over the course of the group, with Group Cohesiveness, Catharsis, Imparting of Information, and Universality occurring most often. Several factors, including Interpersonal Learning, Corrective Recapitulation of the Primary Family Group, Imitative Behavior, and Development of Socializing Techniques were absent or virtually absent, likely due to the peer-led format of the group. Progression of therapeutic factors over the course of the group is presented. Findings demonstrate the presence of a variety of Yalom's therapeutic factors in an asynchronous, peer-led online support group.

The Sistah Powah Structured Writing Intervention: A Feasibility Study for Aging, Low-Income, HIV-Positive Black Women

The purpose of this study was to test the feasibility and assess outcomes of health care adherence based on whether participants engage in particular risky behaviors relevant to general health or living with human immunodeficiency virus (HIV) infection and the frequency of these adherent behaviors. Health adherent behaviors include both self-advocacy and decreased stigma as underlying key components. A randomized control trial comparing peer-led attention control support and intervention groups. Community-based women's drop-in center in an urban, black neighborhood of Boston, Massachusetts. Aging, low-income, black women living with HIV infection. Peer-led, small-group, structured writing using film clips from Women's Voices Women's Lives as a writing prompt. Demographic and outcome data that included adherence, self-advocacy, and stigma; collected at baseline, 6 weeks, and 6 months. Repeated-measures analysis of variance scores were examined between groups and waves. Paired-sample t-tests were used to examine mean differences across time. Sample included 110 women (intervention, n = 56; comparison, n = 54). Retention was 85.5%. Repeated-measures analysis indicated intervention group condom use (n = 69, F = 8.02, df = 1, p < .01) and safe sex (n = 71, F = 13.02, df = 1, p < .01) was higher than that of comparison group. A time effect was also found in the Silencing the Self Scale (n = 91, Pillai's trace = 7.21, df = 2, p < .01). This study demonstrates the feasibility of a tailored, peer-led, and culturally relevant interventions and tentative efficacy in populations affected by health disparities. Key limitations include no comparison intervention format with women who can't write and the need to test generalizability.

Lessons Learned from Two Peer-Led Mutual Support Groups

This case report and analysis describe the formation of two peer-led mutual support groups conducted within the context of a Veterans Administration Medical Center. Based on our assessment of the success of one of these groups and the failure of the other, we offer several recommendations and suggestions to help promote this modality. More specifically, we hypothesize that such groups are more likely to be successful (1) if participants are transferred en masse from another group, (2) that, at least initially, housing the group in the same context as formal clinician-led groups or overlapping clinician-led and peer-led groups may help smooth the transition from authority-led treatment to a mutual peer support format, and finally, (3) that prior experiences in interpersonal process groups may promote the skills and cohesion to promote successful transition to mutual support.

Investigating support needs for people living with heart disease

To identify the issues that required ongoing support for people who have completed a cardiac rehabilitation programme. Surviving a serious cardiac event is a stressful and traumatic experience, often resulting in major changes in a person's lifestyle, work, finances and family dynamics. Individuals who have experienced a cardiac event and completed a cardiac rehabilitation programme may require ongoing support. The issues requiring support are unclear. A qualitative, descriptive study. Nine participants, who were at least four weeks postcompletion of a cardiac rehabilitation programme, were interviewed. Data were collected using semi-structured interviews and analysed using thematic analysis. The participants in this project clearly articulated that informational, psychological and social supports were imperative in enabling recovery from a serious cardiac event. Even though participation in a cardiac rehabilitation programme is seen as being very valuable, there is a need for ongoing support to absorb shock, maintain lifestyle changes and navigate a new way of life. This study highlights the gap in ongoing support for people postparticipation in cardiac rehabilitation programmes and the need for different levels of support during their recovery. Agencies such as Heart Foundation are well placed to facilitate connections between people living with heart disease and available support programmes and services. Initiatives that link individuals to community-run, peer-led support groups, walking and exercise programmes would be especially valuable. Individuals who have experienced an acute cardiac event need ongoing support across the recovery continuum. Consideration needs to be given to care models that address this need including exploring the potential of peer support.

Meeting the Challenges of Perinatal Bereavement Support Through Collaboration and Innovation

Poster Presentation Purpose for the Program To better meet the needs of the patient and families who experience perinatal loss and those of the staff providing care. Proposed Change To improve and expand the perinatal bereavement program in response to staff, patients, and community feedback. Implementation, Outcomes, and Evaluation The perinatal bereavement committee was expanded to include staff from labor and delivery, neonatal intensive care unit, mother–baby unit, genetic counseling, pastoral care, and nursing leadership. The committee identified opportunities for improvement in staff education, and the need to increase and improve processes for the respectful and individualized care of patients and infants. The existing process for burial was cost prohibitive for many families and confusing to implement. In response to these concerns, contact was made with the hospital's Foundation to identify financial resources to make this service accessible to all families who experience perinatal loss. We partnered with community resources, such as The Alexis Foundation, Linnemann Funeral Home, the HEARTS peer led support group and volunteers, to provide improved quality of care and tools. Tools include handmade blankets and hats, memory boxes individualized for gestational age, PresHand carriers for the respectful transport and handling of these infants, and brochures to assist patients and families in their journey through the grief process. Nursing management provided encouragement and financial support for the development and implementation of education for all nursing staff. Implications for Nursing Practice Collaboration within the healthcare system and the community affects the care we give our patients. Education and quality tools empower nurses to give individualized and respectful care to patients and infants. As a Magnet hospital, St. Elizabeth Healthcare continually focuses on the importance of collaboration and innovation to improve patient care and the enhancement of professional growth and development of nurses.

What makes a successful peer-led aphasia support group?

Background: People with aphasia frequently report reduced social networks as well as a desire for increased social interaction. Individuals with aphasia and speech-language pathologists have identified peer support as an important component of adjusting to post-stroke changes and learning to live successfully with aphasia. Peer-led aphasia support groups can provide greater, long-term access to peer support and social communication opportunities for people with aphasia and their families. However, more research is needed to facilitate their development and sustainability in local communities. Aims: The primary aim of this study was to identify the core components of a successful peer-led aphasia support group from the perspective of people with aphasia and their family members. A second aim of the study was to explore the information and support needs of peer leaders in starting and running a group. Methods & Procedures: The qualitative research approach of focused ethnography was used to understand and interpret the functioning of peer-led aphasia support groups in the community. Twenty-six people, who were attending a peer-led aphasia support group, participated in the study. Participants comprised 19 people with aphasia (mean age 64.8 ± 12.9) and seven family members (mean age 58.3 ± 9.0), including three peer leaders. Data were collected from the following sources: participant observation; focus group discussion; individual interview; and written artefacts. Thematic analysis of the focus group and interview transcripts was conducted, while field notes and written artefacts were used in triangulation of the identified themes. Outcomes & Results: The findings indicate that a number of themes are important for the successful functioning of a peer-led aphasia support group, including friendship, informality, a supportive communication environment, providing support and practical considerations for the timing and location of meetings. Factors that facilitated peer leaders to start and run groups included informational support, practical support, attracting new members, time and organisation, and particular personal qualities. Conclusions: The findings confirm the positive and empowering nature of peer-led aphasia support groups that provide opportunities for developing genuine friendships and authentic communicative interactions in a supportive environment. Results of the study provide useful guidelines to assist people with aphasia in developing and sustaining peer-led aphasia support groups in the community.

Quality of life, coping strategies and support needs of women seeking Traditional Chinese Medicine for infertility and viable pregnancy in Australia: a mixed methods approach

BackgroundInfertility affects about 15% of couples in Western-societies with most progressing to fertility clinics for treatment. Despite being common, infertility is often experienced as a lonely road for affected couples. In this paper we expand on our previously published findings of women’s experiences with infertility or difficulty of viable pregnancy who had sought Traditional Chinese Medicine (TCM) therapy in Australia, and focus on women’s quality of life, coping strategies, and support needs.MethodsWe applied mixed methods using the Tuebingen Quality of Life and the COPE questionnaires and in-depth interviews with 25 women with primary or secondary infertility, recurrent miscarriages or unexplained stillbirth, and who had consulted a TCM practitioner. We used a thematic approach to analyse the interviews, and descriptive statistics to evaluate questionnaire responses.ResultsWomen reported through both questionnaires and interviews compromised quality of life due to the high level of distress, guilt, grief, and frustration caused by infertility. However, our women represented a highly motivated sample, actively seeking alternative support. While the TCM approach to infertility management increased women’s sense of personal agency and control through education and continuity of care, the need for greater understanding and support on a societal level remains.ConclusionsIn infertility, ongoing emotional and instrumental support is pivotal to the wellbeing and quality of life of the affected. Traditional Chinese Medicine addresses some support needs in infertility not routinely available in the Western model of care. More peer-led and professional-led support groups are greatly needed for women experiencing infertility to help break isolation and raise awareness of integrative approaches to fertility management.

Effect of a Group Adherence Intervention for Mexican-American Older Adults With Type 2 Diabetes

I evaluated the effect of a culturally tailored, peer-led support group intervention on improvement in adherence behaviors of Mexican-American older adults with type 2 diabetes mellitus and obtained feedback on the cultural relevance of the manual that structured the intervention. The one-group pretest-posttest design used five self-report questionnaires and blood testing to measure change among 4 men and 12 women, ages 60-85. Empowerment, self-efficacy, and attitude were highly significant at 2-, 4-, and 6-mo posttests. Glycosylated hemoglobin test results were significant at p < .05 between pretest and 2-mo posttest with a stabilizing effect on the 6-mo posttest. Mexican-American older adults' adherence may improve with a culturally sensitive, structured peer-led program with indirect consultation from an occupational therapist.

Building a Network of Grief Support on College Campuses: A National Grassroots Initiative

About one in four college students report grieving the death of a family member or close friend within the past year. Although grief may be difficult at any time, there are several factors unique to the college age and environment that can make it particularly difficult. These factors include geographic distance from home and usual support systems, academic demands, college's “carefree” social life, lack of grief support from peers, and many college campuses' limited resources for grief support. Thus, grieving college students are at greater risk than their peers of a host of academic, social, and developmental issues. In spite of this “silent epidemic,” few targeted, supportive interventions existed on college campuses until 2006, when National Students of AMF was created by grieving college students to support their fellow grieving students. National Students of AMF primarily achieves its mission by creating Campus Chapters, which are university-recognized student organizations. They include a targeted, peer-led Support Group for grieving students to connect with others who “get it” and a Service Group that encourages students to channel their grief towards championing causes that have impacted them. Abundant anecdotal evidence suggests that students, especially males, who shy away from support groups and professional counseling, have found participation in service activities in honor of deceased loved ones to be a preferable therapeutic outlet. Campus Chapters also leverage the “student voice” to promote the other, often underutilized supportive grief resources on campus. Today, there are 43 university-recognized Campus Chapters. In this article, we discuss findings and outline several vital steps that university counselors and administrators can take to facilitate the continued growth of supportive outlets, like National Students of AMF, for grieving college students.

A Culturally Sensitive Diabetes Peer Support for Older Mexican‐Americans

The purpose of this study was to determine if a peer-led diabetes support group intervention could improve adherence to recommendations for self-management in 42 Mexican-American elders with type 2 diabetes. This mixed-method pilot study occurred at a community-based diabetes education centre in Texas. The 10-week intervention programme was compared to usual care on five self-reported questionnaires and blood tests during four collection periods. Participants displayed statistically significant improvements in blood sugar, self-efficacy, transformational change and personal resources. Qualitative themes were derived from 30 focus group meetings, which were as follows: do not trust the system, choice + control = power and the social cost of diabetes. The results suggested a consultation role for occupational therapists in training peer leaders to learn to lead and manage community-based diabetes self-management programmes. Limitations were the sample size of the convenience sample, and the lack of qualitative analysis of the control group discussions. Future research should involve a study of expanded community-based social networks using experimental design.

Recovery Is Up to You, a peer-run course

Recovery Is Up to You, a peer-run course