Peer Support Initiative Research Articles

What happens after the funding ends?: A qualitative sustainability investigation of emergency department-based peer support programs implemented as part of Indiana's opioid state targeted response initiative

Introduction: In 2017, funding disseminated through the US Substance Abuse and Mental Health Services Administration's Opioid State Targeted Response (STR) program accelerated the expansion of peer recovery support services across several states to engage emergency department patients presenting with opioid use disorder. While there is some literature on the initial implementation of these programs, little is known about their sustainability after the STR funding's end. Identifying what happened to these programs is a key component of understanding their ultimate impact and can inform future activities to develop, fund, or sustain similar efforts. Methods: We collected qualitative data from six organizations that participated in Indiana's STR-funded Recovery Coaching and Peer Support Initiative (RCPSI). The semi-structured interview guide was designed to gather data related to eight domains of sustainability (i.e., environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, program evaluation, communications, and strategic planning). The analysts followed a deductive-inductive analysis approach, using the eight domains as an a priori coding structure and developing higher-level inductive themes. Results: A total of ten individuals (roles included 4 Program Supervisors, 2 Nurse Administrators, a Psychiatric Social Worker, a Mobile Treatment Manager, a Grant Coordinator, and a Vice President of Planning) participated in six interviews. Two programs did not sustain services, primarily because they lacked a sufficient volume of eligible patients to justify services. Factors identified as supporting sustainability in the other four programs included (1) identification of alternate funding sources, (2) evolving internal support for ED-based opioid use disorder treatment, and (3) investment in internal and external relationships. Furthermore, these themes operated across multiple sustainability domains. Conclusions: The findings illustrate a dynamic interplay between program context and multiple theorized sustainability domains that impacted the viability of RCPSI programs after the end of STR funding. Results indicate a need for a better understanding of the factors influencing the sustainability of programs supported by federal funding to mitigate the opioid crisis, and such findings will likely apply to a broader range of grant-supported programs.

Peer support as pressure ulcer prevention strategy in special school learners with paraplegia.

Adults with spinal cord injuries perceived peer support as beneficial in preventing secondary health conditions, but the role of peer support among adolescent learners with paraplegia in special schools is still unknown. To explore the perspectives of current and previous learners with paraplegia on peer support to prevent pressure ulcers in a special school. A qualitative, exploratory, descriptive study design was used. The authors conducted 12 semi-structured telephonic, audio-recorded interviews and a focus group discussion with current and previous learners with paraplegia attending a special school. The interviews were transcribed verbatim and translated, and data were organised using the Nvivo-12 Pro program. Through conducting an inductive thematic analysis categories, sub-themes and themes were identified from the participants' narratives. The participants' perspectives included positive and challenging aspects of peer support reflected in four sub-themes: group-based support, individual peer mentoring, challenges with peer support and the roles of the school physiotherapist regarding peer support. Learners saw peer support as a crucial strategy in preventing and reducing pressure ulcers. Establishing a peer support system with group and individual components in special schools could be a game-changer to end pressure ulcers among learners with paraplegia and ensure better health and educational outcomes. Physiotherapists in special schools should support peer support initiatives among learners with paraplegia to ensure successful pressure ulcer prevention.

The cycle of acceptance: mental health professionals’ experience of workplace violence in a UK community mental health team

PurposeViolence and aggression against mental health professionals is a global concern with well-documented consequences. In the UK, mental health care is increasingly delivered in the community, yet little research has explored practitioner experiences of workplace violence (WPV) outside of inpatient settings. This study aimed to explore how mental health professionals in a UK community mental health team (CMHT) perceive, experience and cope with WPV.Design/methodology/approachFace-to-face semi-structured interviews were conducted with ten multidisciplinary professionals based in a CMHT in a UK city. Data was analysed using interpretative phenomenological analysis.FindingsThree interconnected themes emerged. WPV was accepted as inevitable: participants carried on working despite its impact, and feeling unheard by management they gave up on change, perpetuating the perceived inevitability of WPV. Peer support and organisational resources like debriefing, counselling and occupational health improved coping. Stigma and ideas of professional responsibility were barriers to access.Originality/valueTo mitigate against the negative consequences of WPV, CMHTs could offer peer support initiatives, improve communication and availability of organisational resources and involve staff in post-incident decision-making. Recommendations are made to shift the attitude of acceptance of WPV and encourage help-seeking.

Police peer supporters in a domestic abuse-specific peer support initiative: Motivations, experiences and challenges

Police peer support programmes traditionally focus on mental health issues and experiences of trauma in work. Increased awareness of domestic abuse (DA), its impacts in the workplace, and calls to adopt trauma-informed approaches in the emergency and public services in the UK have culminated in a southern English police force instituting a novel peer support programme for personnel who are experiencing DA. This qualitative study interviewed 16 self-selected DA peer supporters to explore their motivations and experiences in providing support for their colleagues and the application of trauma-informed practice. Findings support previous research on the ongoing prevalence of stigma around help-seeking in the police generally, and this is perhaps even more pronounced for DA. However, the presence of this form of peer support has symbolic value to challenge prevailing culture and foster increased confidence to make disclosures. Findings also indicate value in adopting DA-specific peer support from an organizational justice perspective because this may enable a greater sense of staff well-being. The approaches employed in the DA peer support programme exhibited implicit trauma-informed practice, which could be made more explicit and aligned to wider initiatives of creating a more trauma-informed police service.

Stress and Coping Mechanisms in South Korean High School Students: Academic Pressure, Social Expectations, and Mental Health Support

This paper examines the stress and coping mechanisms among high school students in South Korea, with a focus on academic pressure, social expectations, and mental health support systems. The highly competitive education system, coupled with significant expectations from teachers, parents, and society, creates an environment of intense stress for students. Additionally, the influence of social media and peer pressure exacerbates these stress levels. The paper explores both adaptive and maladaptive coping strategies employed by students to manage their stress. Adaptive strategies such as effective time management, seeking social support, engaging in physical activities, and practicing mindfulness are highlighted as beneficial, whereas maladaptive strategies like avoidance, substance abuse, and social withdrawal are identified as harmful. The effectiveness of various mental health support systems within schools, including counseling services, mental health education programs, peer support initiatives, and wellness activities, is assessed. The paper concludes by emphasizing the need for a comprehensive, multi-faceted approach to support students’ mental health and academic success, involving educators, parents, policymakers, and mental health professionals.

Barriers and Facilitators to the Implementation of a Peer Support Intervention in Universities

ABSTRACT A growing number of postsecondary institutions offer peer support interventions to promote mental health among their students. However, little is known about the key factors that influence the implementation of this type of intervention. This study explored barriers and facilitators to implementing an online peer support program based on Acceptance and Commitment Therapy aimed at reducing stress and anxiety among students of three universities in Montreal, Canada. Peer supporters were asked to complete a survey containing open-ended questions at the end of each semester. Interviews were also conducted with the program coordinator, three psychologists who acted as supervisors, and 14 peer supporters. The data were analysed with an inductive and a deductive approach using the Consolidated Framework for Implementation Research (CFIR). Perceived barriers to the implementation of the intervention included technical problems with the videoconferencing platform, psychosocial and comorbidity issues among peers, recruitment difficulties, and communication concerns between stakeholders. Key perceived facilitators were the theoretical and empirical foundations of the intervention, the support offered by directors, and the process used to recruit, select, and supervise peer supporters. Based on the results of this study, practical recommendations are provided for researchers and practitioners interested in implementing online peer support initiatives in postsecondary institutions.

State Level Policies on First Responder Mental Health in the U.S.: A Scoping Review.

A growing body of evidence demonstrates potential adverse mental health outcomes associated with exposure to occupational trauma among first responders. In response, policymakers nationwide are eager to work on these issues as evidenced by the number of states covering or considering laws for mental health conditions for first responders. Yet, little information exists to facilitate understanding of the impact of mental health-related policies in the United States on this important population. This study aims to identify and synthesize relevant state-level policies and related research on first responder mental health in the United States. Using a scoping review framework, authors searched the empirical and policy literature. State level policies were identified and grouped into two categories: (1) Workers' Compensation-related policies and (2) non-Workers' Compensation (WC) related policies. While benefits levels and other specifics vary greatly by state, 28 states cover certain first responder mental health claims under WC statutes. In addition, at the time of this study, 28 states have policies governing first responder mental health outside of WC. Policies include requiring mental health assessments, provisions for counseling and critical incident management, requiring education and training, providing funding to localities for program development, bolstering peer support initiatives and confidentiality measures, and establishing statewide offices of responder wellness, among others. Authors found a dearth of outcomes research on the impact of state level policies on first responder mental health. Consequently, more research is needed to learn about the direct impact of legislation and establish best practice guidelines for implementing state policy on first responder mental health. By conducting systematic evaluations, researchers can lay the foundation for an evidence-based approach to develop more integrated systems that effectively deliver and finance mental health care for first responders who experience work-related trauma. Such evaluations are crucial for building an understanding of the impact of policies and facilitating improvements in the support provided to first responders in managing mental health challenges arising from their work.

Student peer support initiatives in higher education: A collection of South African case studies by X. Cupido, N. Frade, T. Govender, E. Samkange & S. Pather (Eds.) (2022). Stellenbosch, SA: African Sun Media

Student peer support initiatives in higher education: A collection of South African case studies by X. Cupido, N. Frade, T. Govender, E. Samkange & S. Pather (Eds.) (2022). Stellenbosch, SA: African Sun Media

Implementation and effectiveness of a physician-focused peer support program.

The practice of medicine faces a mounting burnout crisis. Physician burnout leads to worse mental health outcomes, provider turnover, and decreased quality of care. Peer support, a viable strategy to combat burnout, has been shown to be well received by physicians. This study evaluates the Peer Outreach Support Team (POST) program, a physician-focused peer support initiative established in a 2-hospital system, using descriptive statistical methodologies. We evaluate the POST program using the Practical Robust Implementation and Sustainability Model (PRISM) framework to describe important contextual factors including characteristics of the intervention, recipients, implementation and sustainability infrastructure, and external environment, and to assess RE-AIM outcomes including reach, effectiveness, adoption, implementation, and maintenance. This program successfully trained 59 peer supporters across 11 departments in a 2-hospital system over a 3-year period. Trained supporters unanimously felt the training was useful and aided in general departmental culture shift (100% of respondents). After 3 years, 48.5% of physician survey respondents across 5 active departments had had a peer support interaction, with 306 successful interactions recorded. The rate of interactions increased over the 3-year study period, and the program was adopted by 11 departments, representing approximately 60% of all physicians in the 2-hospital system. Important implementation barriers and facilitators were identified. Physician recipients of peer support reported improved well-being, decreased negative emotions and stigma, and perceived positive cultural changes within their departments. We found that POST, a physician-focused peer support program, had widespread reach and a positive effect on perceived physician well-being and departmental culture. This analysis outlines a viable approach to support physicians and suggests future studies considering direct effectiveness measures and programmatic adaptations. Our findings can inform and guide other healthcare systems striving to establish peer support initiatives to improve physician well-being.

Staff Perspectives: Defining the Types, Challenges and Lessons Learnt of University Peer Support for Student Mental Health and Wellbeing

In university settings, peer support brings people together based on their student identity. Peer support has been advocated as an innovative intervention to aid student mental health and wellbeing as part of a whole university approach, especially post-pandemic when student support is critical. While the literature describes three types of university peer support for student mental health and wellbeing, peer-led support groups, peer mentoring, and peer learning, the sector lacks agreed definitions for these interventions. Formal reporting on peer support initiatives is rare, suggesting further types of peer support practice may exist. This qualitative study, comprising semi-structured interviews with 16 university staff members at 14 different institutions, aimed to generate comprehensive definitions of the types of peer support used in the sector through template analysis. The study also sought to understand the current practice, experiences, and challenges around implementing peer support interventions for undergraduate and postgraduate students’ mental health and wellbeing from the perspective of the staff who support and coordinate these programmes. Five types of peer support were identified and defined. In addition, the challenges of engagement, resource and capacity, and evaluation were highlighted. Finally, lessons learnt provided potential ways to address the challenges outlined and provided sector guidance for further developing peer support as part of a whole university approach to student mental health and wellbeing.

Time to VENT: a weekly, voluntary peer support initiative to improve colleague wellbeing and promote reflective practice

Background: Anaesthesia trainees are particularly susceptible to burnout and depression.1 2 The Association of Anaesthetists of Great Britain and Ireland suggest that wellbeing interventions warrant further research, leading to campaigns such as ‘#CoffeeAndAGas’. A pre-intervention survey showed, within our department, that being on call causes stress that negatively impacts trainees’ wellbeing beyond shifts and there is not always someone who understands their job role to talk to. Trainees do not want to speak to consultants or supervisors about these wellbeing issues but are more willing to speak to colleagues of a similar grade. Therefore, weekly VENT sessions were designed and implemented in our department. Methods: Weekly, voluntary, 30-min VENT sessions were organised for all junior anaesthetists. Ground rules were displayed at the beginning of every session. Core principles included: voluntary engagement, mutual respect, no consultant presence, complete confidentiality, and non-judgmental discussion. The aims were to promote wellbeing through offloading, developing reflective practice, and stimulating culture change. Sessions were structured the same way to promote a comfortable, empathetic, and open environment. The sessions included Vocalising how you really feel, Empathising with colleagues (sharing similar feelings, experiences, and advice), learning a New wellbeing theory or mindfulness technique each session, and finally, Talking about cases and experiences. Anonymous surveys were sent to attendees after four sessions to assess impact and gain feedback. Results: Voluntary attendance was sustained at 95% of all available trainees. Ten (90%) responded to the post session survey. All respondents believed the sessions were helpful for wellbeing and were valuable for learning, with most (80%) seeing value in learning wellbeing theory. All felt the sessions will promote ‘cultural change’ and have a positive impact on overall wellbeing. All respondents believed VENT should be offered by other hospitals and should continue in our hospital. Free text feedback included comments expressing relief and reassurance gained from speaking to more senior trainees, relieving stress, and improving confidence. Trainees also found it helpful to talk through scenarios which aided their own reflection and processing of difficult situations. Conclusion: Junior anaesthetists feel more comfortable speaking to their peers about wellbeing issues than to consultants. The ability to talk to colleagues about things that have happened whilst working is beneficial. Promoting an open environment with a familiar structure exceeded expectations of colleague engagement with most colleagues attending regularly. VENT allows learning from each other’s experiences, and revisiting of personal experiences allows improved reflective practice. VENT is also beneficial in teaching colleagues how to look after their own wellbeing. Overall, regular VENT sessions have had a positive impact on personal wellbeing of our trainees and should become embedded into practice, and be adopted by other hospitals. 1.Looseley A, Wainwright E, Cook TM, et al. Anaesthesia 2019; 74: 1231–92.Nyssen AS, Hansez I, Baele P, Lamy M, De Keyser V. Br J Anaesth 2003; 90: 333–7

Evaluation of a technology-enhanced, integrated community health and wellness program for seniors (HWePS): protocol of a non-randomized comparison trial

BackgroundHealthy aging for all in the community is a shared public health agenda for countries with aging populations, but there is a lack of empirical evidence on community-wide preventive models that promote the health of older people residing in socially-disadvantaged communities. The Health and Wellness Program for Seniors (HWePS) is a technology-enhanced, multi-level, integrated health equity intervention model. This study evaluates the effect of the HWePS on the health and well-being of older adults residing in urban, low-income communities. Methods/designHWePS is a prospective, non-randomized comparison trial conducted in an intervention and a control neighborhood (dong) in Seoul, South Korea, over 12 months. Older people who reside in the small areas and meet the inclusion/exclusion criteria are eligible to participate. The multi-level, multi-faceted HWePS intervention is a preventive community care model for older residents guided by the expanded chronic care model, the comprehensive health literacy intervention model, and the Systems for Person-centered Elder Care model along with health equity frameworks. HWePS consists of four components: a health literacy intervention based on individual and community needs assessments, personalized (self-)care management featuring nurse coaching and peer support, a healthy-living and healthy-aging community initiative, and information and communication technology (ICT) systems. The primary outcomes are self-reported health and health-related quality of life. Outcome assessors and data analysts are blinded to group assignment. Process evaluation will be also conducted.DiscussionAs a multi-level health equity project, HWePS has adopted a novel study design that simultaneously targets individual- and community-level factors known to contribute to health inequality in later life in the community. The study will provide insights into the effectiveness and implementation process of an integrated, multi-level, preventive community care model, which in turn can help improve the health outcomes of older residents and reduce disparities in underserved urban communities.Trial registrationISRCTN29103760. Registered 2 September 2021, https://www.isrctn.com/ISRCTN29103760

The Health Sciences Scholarship Strategy: a pilot peer-support initiative for academics

This presentation will report on a pilot initiative being undertaken within a team of university academics, with the aim of promoting peer support, space to develop and improve scholarly activity in all its forms. Scholarship and scholarly teaching are at the core of each university academic’s role (Ling, 2020; Boyer, 1990): ensuring currency, best-practice and skill development in a rapidly changing educational landscape (Matos et al., 2022). Communities of Practice (CoP) and peer support are known to encourage academics to participate in scholarly activities and professional development (Wenger, McDermott, & Snyder, 2002), arising from Vygotsky’s theory that learning is enhanced when occurring in a group (Vygotsky, 1978). The project design contains many features of a CoP, such as a shared domain and set of practices; places for discussion and group activities (Jakovljevic, Buckley, & Bushney, 2013). With the support of online technologies, this innovative project aims to provide a framework for supporting Health Science (HS) academics in the development of scholarly teaching practices and their capacity to immerse in scholarship from a discipline community perspective. The project also aims to demonstrate strategies for promoting team member research capabilities, development, and outcomes. Designed to sit within the wider institution research and scholarship centres, strategic plans, policies and procedures, the HS Scholarship Strategy is a local, co-creative initiative being formed through on-going and evolving team member participation and feedback. The HS Scholarship Strategy contains two main components – a community group called the HS Scholarly Teaching Think Tank, and the Research Incubator Group. These groups provide an informal space for team members to ideate, plan, progress and support research and scholarly teaching activities. With team members located around Australia, various technologies are being employed to deliver these components synchronously and asynchronously. In addition, four other sub-initiatives are included in the strategy: peer-support workshops; scholarly forums; a scholarly literature club; and an active teaching development project. The main outcomes of interest are participation and engagement in scholarly development activities. The strategy components, including their aims and specific outcomes being measured, will be further described. Given the challenges of teaching and learning during the COVID-19 pandemic, knowledge sharing has been made easier using technology, within this project of enhancing scholarly capabilities. Overall, this pilot strategy been designed with the support of the literature on peer support and its potential in developing faculty scholarship, academic culture and the construction of professional identity (Van Schyndel, et al., 2019; Clarke, Hyde, & Drennan, 2013 In alignment with these theoretical bases, this presentation will share early findings and areas for further professional development. There is potential for broader implementation in other teams across the university. This may be of interest to academic and other university teams looking for contextualised, team-based strategies for improving scholarship activities and scholarly teaching outcomes.

Re-orientating health and nursing care: a qualitative study on indigenous conceptualisations of wellbeing

BackgroundHealth systems often fail to address the wellbeing needs of older Indigenous populations; this is attributed to a lack of knowledge of Indigenous health systems arising from a privileging of dominant western biomedical epistemologies. In Aotearoa/New Zealand, there is a dearth of nursing knowledge relating to Māori, which negatively impacts on the provision of holistic nursing care. This research explores insights and perspectives of older Māori adult’s (pakeke) perceptions of wellbeing so nurses can provide culturally responsive care and support the wellbeing of Indigenous New Zealanders.MethodsAn Indigenous kaupapa Māori methodology underpinned and directed this research project. Audio-recorded interviews were conducted face to face in participants’ homes, marae (meeting house) and workplaces. Pakeke over the age of 55 participated in in-depth interviews. A total of 10 pakeke were interviewed and narratives were thematically analysed in accordance with meanings derived from Māori worldviews.ResultsWellbeing was attributed to the holistic interconnection and balancing of whānau (wider family), whanaungatanga (social connectedness), hinengaro (mental and emotional wellbeing), taha tinana (physical wellbeing) and wairua (spirituality).ConclusionThe findings offer unique insights into how wellbeing is constructed for pakeke; the results are unique but consistent with international accounts of older Indigenous peoples. Pakeke wellbeing can be supported by acknowledging existing cultural and spiritual beliefs and peer-support initiatives. Nursing models of care should prioritise Indigenous ways of knowing; this research offers nursing-focused recommendations to improve care.

Support, care and peer support for gay and bi men engaging in chemsex.

The objective of this research was to explore how gay men use drugs in their sex lives, colloquially called "chemsex". This paper reports on a sub-theme within the research about support, care and peer support. Longitudinal interviews were conducted with 20 gay and bi men between April 2017 and July 2019. Participants were recruited via geolocated dating apps (n= 17) and snowball sampling (n= 3). The main findings of this research are that medicalised forms of support for gay and bi men engaging in chemsex are often tardy in their responses to need, and whilst helpful for cessation of drug use, fail to address the holistic needs of the participants. A wide variety of peer support was practiced amongst the sample which often echoed previous forms of peer support practiced in the LGBT+ community. It was offered by both people who engaged in chemsex and those who did not and was highly beneficial to people who experienced problems with chemsex. However, peer support was also limited by factors such as shame and the instability of those offering support. In conclusion, we suggest that medicalised forms of chemsex support could benefit from more rigorous and rapid forms of assessment for problematic chemsex, and also provide infrastructure and training to peer support initiatives. We also suggest that medical services could learn from patients and their peers about what support needs remain unaddressed by professional services, and engage in collaborative approaches to practice development.

‘It's like a much deeper understanding and you kind of believe them more …’: The value of peer support for young people affected by sexual violence

AbstractResearch demonstrates that relationships are key when working to support young people affected by sexual violence. Within these relationships, young people show a preference for non‐judgemental, flexible, consistent and informal support. Peer support – defined here as support provided by those with similar experiences – is however an uncharted area for assisting young people affected by sexual violence. This paper draws on interviews with 25 respondents with knowledge and experience of setting up, supervising and/or participating in peer support initiatives for young people impacted by different forms of sexual violence in Europe and North America. The article highlights how one form of peer support, peer or ‘survivor’ mentoring, can provide emotional and social support; create space for ‘normality’; and give choices to young people. It outlines three unique dimensions to the support provided by peers more generally: relatability, credibility and translatability. The discussion reflects on what this might mean for traditional support provided by professionals. It also draws attention to the significance of recognising both the variety of experience and identity of young survivors of sexual trauma and the impact this may have on promoting relatability within relationships.

Development of the Mental Health Peer Support Questionnaire in colleges and vocational schools in Singapore

BackgroundA nation-wide mental health peer support initiative was established in college and vocational schools in Singapore. The purpose of this cross-sectional study was to develop and validate a 20-item self-report instrument, the Mental Health Peer Support Questionnaire (MHPSQ), to assess young adults’ perceived knowledge and skills in mental health peer support.MethodsWe administered the questionnaire to 102 students who were trained as peer supporters, and 306 students who were not trained as peer supporters (denoted as non-peer supporters), in five college and vocational schools. Exploratory factor analysis and descriptive statistics were conducted. Cronbach’s α was used to assess reliability, and independent sample t-tests to assess criterion validity.ResultsExploratory factor analysis indicated a three-factor structure with adequate internal reliability (discerning stigma [α = .76], personal mastery [α = .77], skills in handling challenging interpersonal situations [α = .74]; overall scale [α = .74]). Consistent with establishing criterion validity, peer supporters rated themselves as significantly more knowledgeable and skilled than non-peer supporters on all items except two: (1) letting peer support recipients make their own mental health decisions, and (2) young adults’ self-awareness of feeling overwhelmed. Peer supporters who had served the role for a longer period of time had significantly higher perceived awareness of stigma affecting mental health help-seeking. Peer supporters who had reached out to more peer support recipients reported significantly higher perceived skills in handling challenging interpersonal situations, particularly in encouraging professional help-seeking and identifying warning signs of suicide.ConclusionsThe MHPSQ may be a useful tool for obtaining a baseline assessment of young adults’ perceived knowledge and skills in mental health peer support, prior to them being trained as peer supporters. This could facilitate tailoring of training programs based on young adults’ initial understanding of mental health peer support. Subsequent to young adults’ training and application of skills, the MHPSQ could also be applied to evaluate the effectiveness of peer programs and mental health training.

How is Social Care Provided in Adult Prisons in England and Wales?

AbstractThere is variation in provision of social care in prisons. Our research aimed to understand variation across adult prisons in England and Wales, including: (1) what social care is provided? (2) who delivers social care? (3) what peer support initiatives are used? (4) what social care indicators are relevant? and (5) are there differences between prison type and social care provision? We analysed Her Majesty’s Inspectorate of Prisons (HMIP) reports (published 2017–2020) from 102 prisons. From these reports we extracted and analysed data on social care provision. Elements of social care are not consistently delivered; need assessments (81.4 per cent) and referrals (75.5 per cent) were most frequently reported. Different providers (health care/social care/prison) deliver social care. Forty-one prisons (40.2 per cent) included peer support (formal to informal). We found no notable differences between prison categories and social care delivery, although, within category D prisons, a significantly larger proportion of those with a disability reported receiving support they needed. Inspection reports highlighted that prison social care should mirror community social care, but we could not fully evaluate this due to reporting issues. Social care provision varies; effectiveness of different models is not yet known. We provide recommendations to improve social care reporting within HMIP reports.

Identifying unique barriers to implementing rural emergency department-based peer services for opioid use disorder through qualitative comparison with urban sites

BackgroundIn an effort to address the current opioid epidemic, a number of hospitals across the United States have implemented emergency department-based interventions for engaging patients presenting with opioid use disorder. The current study seeks to address gaps in knowledge regarding implementation of a sub-type of such interventions, emergency department-based peer support services, in rural areas by comparing implementation of rural and urban programs that participated in Indiana’s Recovery Coach and Peer Support Initiative (RCPSI).MethodsWe conducted a secondary analysis of qualitative semi-structured implementation interviews collected as part of an evaluation of 10 programs (4 rural and 6 urban) participating in the RCPSI. We conducted interviews with representatives from each program at 3 time points over the course of the first year of implementation. Our deductive coding process was guided by the Consolidated Framework for Implementation Research (CFIR) and an external context taxonomy.ResultsWe identified key differences for rural programs corresponding to each of the 5 primary constructs in the coding scheme. (1) Intervention characteristics: rural sites questioned intervention fit with their context, required more adaptations, and encountered unexpected costs. (2) External context: rural sites were not appropriately staffed to meet patient needs, encountered logistical and legal barriers regarding patient privacy, and had limited patient transportation options. (3) Inner setting: rural sites lacked strong mechanisms for internal communication and difficulties integrating with pre-existing culture and climate. (4) Characteristics of individuals: some rural providers resisted working with peers due to pre-existing attitudes and beliefs. (5) Implementation process: rural sites spent more time identifying external partners and abandoned more components of their initial implementation plans.ConclusionsFindings demonstrate how rural programs faced greater challenges implementing emergency department-based peer services over time. These challenges required flexible adaptations to originally intended plans. Rural programs likely require flexibility to adapt interventions that were developed in urban settings to ensure success considering local contextual constraints that were identified by our analysis.

An online peer support program to improve mental health among university students: A randomized controlled trial

Despite recent calls for more peer support initiatives aimed at promoting mental health in postsecondary institutions, those initiatives remain scarce. In this study, a multisite randomized controlled trial was designed to assess the effect of an online peer support intervention based on acceptance and commitment therapy using mental health and school indicators. Undergraduate students were recruited in three Canadian universities and randomly assigned to an intervention (n = 54) or a wait-list control group (n = 53). Compared to control participants, those who took part in the program self-reported reduced psychological inflexibility, stress, anxiety and depression, and increased psychological flexibility and well-being. The intervention had no effect on academic satisfaction and engagement. These results were found both in completer and intent-to-treat samples. The findings provide evidence that peer support may be a beneficial adjunct to mental health interventions offered to college and university students.