Peer Programs Research Articles

Improving Outcomes in Rehabilitation

This article addresses the issue of measurement in a geriatric rehabilitation program (GRP). The Sisters of Charity of Ottawa Health Service Geriatric Rehabilitation Program was found to have a long length of stay relative to peer programs. Therefore, a number of processes were adopted, over 15 months, to improve outcomes. The results of these interventions produced a net improvement in patient outcome including a threefold increase in rate of patient improvement and a corresponding increase in cost efficiency.

Peer support: a theoretical perspective.

This article offers one theoretical perspective of peer support and attempts to define the elements that, when reinforced through education and training, provide a new cultural context for healing and recovery. Persons labeled with psychiatric disability have become victims of social and cultural ostracism and consequently have developed a sense of self that reinforces the "patient" identity. Enabling members of peer support to understand the nature and impact of these cultural forces leads individuals and peer communities toward a capacity for personal, relational, and social change. It is our hope that consumers from all different types of programs (e.g. drop-in, social clubs, advocacy, support, outreach, respite), traditional providers, and policy makers will find this article helpful in stimulating dialogue about the role of peer programs in the development of a recovery based system.

Social Distance Between Inmates, Peer Counselors, and Program Staff in a Woman's Prison

Establishing and maintaining highly structured groups is an essential aspect of correctional management and operations. Policies and procedures stipulating appropriate roles and responsibilities can result in limiting interactions and creating social distance between different groups. This exploratory study examines whether social distance varies between three different prison groups: female inmates, peer counselors, and program staff. The major findings reveal that female inmates were least likely to have interactions within and outside their own group. Peer counselors and program staff were significantly more likely to interact amongst themselves and other groups. A primary implication of this research is whether one can move beyond group status, and the associated traits, to perceive members as individuals with specific needs. Subsequently, these perceptions might ultimately affect treatment and rehabilitation as well as the general administration of corrections.

The EARLY ALLIANCE prevention trial: an integrated set of interventions to promote competence and reduce risk for conduct disorder, substance abuse, and school failure.

Describes the EARLY ALLIANCE interventions, an integrated set of four programs designed to promote competence and reduce risk for early-onset conduct disorder, substance abuse, and school failure. These interventions are evaluated as part of a prevention trial that begins at school entry and targets child functioning and socializing practices across multiple contexts (school, peer group, family) and multiple domains (affective, social, and achievement coping-competence). The paper presents the conceptual foundation of the four interventions, including a synopsis of the risk and protective factors associated with conduct disorder and related outcomes, and of the coping-competence model driving EARLY ALLIANCE. The developmental rationale, intended impact, and procedures are described for each intervention: a universally administered classroom program and indicated, peer, reading-mentoring, and family programs. Interventions are currently being tested in a prevention trial, which is briefly summarized.

Peer helping/involvement: an efficacious way to meet the challenge of reducing alcohol, tobacco, and other drug use among youth?

Peer-led drug prevention programs for middle school youth are reviewed as to whether or not they are a vital resource in an overall effort to minimize the use of alcohol, tobacco, and other drugs (ATOD). The paper focuses on the following: a) results of a 120-study meta-analysis of school-based drug prevention programs and positive program features; b) considerations for falsely concluding that peer programs are ineffective; c) features of two model or stellar programs that compared interactive (peer leadership) to teacher/researcher-led (non-interactive) programs that followed National Peer Helpers Association (NPHA) Programmatic Standards; and d) suggestions for designing and implementing high-quality, peer-led programs. The authors conclude that interactive peer interventions for middle school students are statistically superior to non-interactive didactic, lecture programs led by teachers/researchers. Programs implemented according to NPHA Programmatic Standards may eliminate Type II (false negative) and III ("implementation failure" or ineffectively designed and implemented program) errors. Opportunities for prudent application of well-designed peer programs appropriately implemented and evaluated must remain a salient priority.

Effectiveness of Alliances and Partnerships for Health Promotion

SUMMARY This paper assesses the impact of alliances or partnerships for health promotion in northern and southern nations, as described in published papers and through contemporary accounts of best practice. The balance of evidence from published literature and case study accounts is clear. Alliance or partnership initiatives to promote health across sectors, across professional and lay boundaries and between public, private and nongovernment agencies, do work. They work in tackling the broader determinants of health and well-being in populations in a sustainable manner, as well as in promoting individual health-related behaviour change. The greater the level of local community involvement in setting agendas for action and in the practice of health promotion, the larger the impact. Volunteer activities, peer programmes and civic activities ensure the maximum benefit from community approaches. In addition, durable structures which facilitate planning and decisionmaking, such as local committees and councils, are key factors in successful alliances or partnerships for health promotion. Such mechanisms also support the sharing of power, responsibility and authority for change, the maintenance of order and of programmatic relevance, and allow local people one means of reflection and for dissent. At a national, regional, district, village and local community or neighbourhood level, this review found that the existence and implementation of policies for health promotion activities were also crucial to sustainability. The evidence from the review suggests the need for new ‘social’ indicators to measure the effects of health promotion. Indicators for success which focus only upon benefits for individuals cannot capture adequately the extent of the impact of the many and varied collective, collaborative health promotion initiatives, alliances or partnerships currently underway around the world. These have been shown to affect families, communities, institutions and aspects of the organisation of social and civic life. This paper posits the notion of social capital as one important new framework for organising our thinking about the broader determinants of health and how to influence them through communitybased approaches to reduce inequalities in health and well-being.

A meta-analysis of smoking prevention programs after adjustment for errors in the unit of analysis.

This article presents the results of a meta-analysis designed to test the prevailing view that we largely understand why adolescents start to smoke and how to delay it. This view has developed even though none of the major reviews of the last 12 years has adjusted for the important methodological problems that all of those reviews identified as common in the published literature. School-based smoking prevention programs based on peer or social-type programs, published between 1974 and 1991, were included in this meta-analysis. Treatment characteristics were used to predict an effect size after adjustment for study design and population characteristics, and in particular, after a post hoc correction for errors in the original unit of analysis. The results suggest that the average effect for peer or social-type programs is likely to be quite limited in magnitude, and that the reduction in smoking may be only 0.10 standard deviation units, or perhaps 5%. Even under optimal conditions, the reduction in smoking may be only 0.50 to 0.75 standard deviation units, or perhaps 20%-30%.

Using peer helpers for tuberculosis prevention.

The authors report on a novel and effective peer helper program initiated by the University of Iowa Student Health Service (SHS) in fall 1992 to help prevent the development of active tuberculosis among foreign nationals attending the university. Before instituting the peer program, compliance with tuberculosis-prevention efforts for those students eligible for treatment was less than 5%. Since the peer program was initiated, compliance has risen to 50%.

Prenatal peer counseling: an answer to the persistent difficulties with prenatal care for low-income women.

Our intention in this article is to provide the reader with the theoretical framework of prenatal peer counseling. A second article describing a prenatal peer program that is functional in the province of Quebec will be presented subsequently with its outcomes and recommendations. However, before planning the implementation of such a program or even assessing its effectiveness, one must understand how peer counseling can be used as an assistive strategy and why it is perceived to be a community approach worth considering with pregnant women from poor socioeconomic backgrounds. This approach addresses most problems encountered when prenatal programs fail to meet the specific needs of these women. Principles of the therapeutic community and its derivatives are put forward to lay the theoretical foundation of prenatal peer counseling. The studies reviewed show that psychosocial variables associated with pregnancy outcome and poverty such as anxiety, social support, and self-esteem can be positively influenced through a prenatal peer counseling program. We strongly recommend that nurses working with low-income families consider prenatal peer counseling as an empowering strategy for mothers within a given community.

From personal health into community action: another step forward in peer health education.

Health education as a field is turning from its individualist roots in which behavior change is viewed as an isolated phenomenon that occurs within an individual to a new contextual framework in which behavior change occurs within a complex ecology of individuals interacting with and influenced by other people, cultural norms, access to healthcare, affiliation with community--the entire environment of a person's life. This article focuses on the "how to's" of translating this shift in the field of health education into a practical and replicable action step forward in peer health education. The author first examines four assumptions implicit in many current peer health education training and program delivery models. She then describes a training curriculum that helps reshape the philosophy and activity of peer health education programs from an individualist paradigm grounded in information to a community-oriented model grounded in service. This training model, entitled From Personal Health Into Community Action, is intentionally designed to facilitate students' understanding of the connections between their personal health and the health of the community.

Conduct Disorder: Long-Term Outcomes and Intervention Effectiveness

To review the literature on conduct disorder in two areas: long-term outcome and the effects of interventions. The sources of the articles for review were computer searches, but the articles were selected for this review to illustrate key findings in the long-term outcome area and to review critically four intervention strategies to prevent or treat conduct disorder, namely, parent- and family-targeted programs, social-cognitive programs, peer and school-based programs, and community programs. Conduct problems in childhood predict the same increased rates of psychiatric disorder overall in men and women but the patterns are different: for externalizing disorders, the prediction is stronger in men and for internalizing disorders, the prediction is stronger in women. In the intervention domain, the literature provides limited evidence of the effectiveness of either primary or secondary prevention. Prospective studies of community samples of children provide the best opportunity to understand more thoroughly the adult outcomes of conduct disorder. Because of the heavy burden of suffering of conduct disorder, and the limited effectiveness of clinical interventions, there is a compelling argument in favor of an increased emphasis on primary prevention efforts.

Sex education: the effect of a peer programme on pupils (aged 13-14 years) and their peer leaders

In 1992 and 1993, 66 selected, trained peer leaders (aged 16-17 years) worked with 38 secondary school classes in the Southwest of England. Questionnaires elicited the views of the class teachers (N = 12), peer leaders (N = 54) and pupils (N = 884; 98 per cent). The majority of the pupils (aged 13-14 years), including those with low self-esteem or special needs, participated in discussion (90 per cent) and role plays (83 per cent), and talked about the programme (with friends: 66 per cent; parents: 24 per cent). Responses indicate that the programme positively affected the pupils' knowledge, skills, and beliefs relating to social norms; peer leaders gained knowledge, skills and self-confidence. Peer education in school could be extended, benefiting both peer leaders and the recipients.

Examination of Tutor and Tutee Interactions and Attitudes

For many years peer tutoring programs have been implemented to improve students' academic skills. Same-age, cross-age and reverse-role peer programs have been developed for students in regular and special education classes. Social benefits have been studied but research investigating the effects of peer tutoring on social/emotional aspects has not been as widespread as that looking at academic gains. Even less research has focused on the student interactions that occur during peer tutoring sessions. The purpose of the current investigation was to examine tutor and tutee verbal interactions. An added dimension was to look at the effects of peer tutoring on the perceptions of students when the tutor was either accepted or not accepted socially. The results indicated that students who were initialiy disliked were liked more at the end of the tutoring program when they served as tutors. Tutors who were initially liked continued to be liked at the end. In addition, tutors initiated more of the verbal interacti...

Planning for the Future of Peer Education

In 1970, the University of Massachusetts began a pioneering program using student peer educators in the fields of alcohol and other drug use and sexuality. Peer educators continue to have an impact on the campus through their creative and innovative health-promotion interventions. These student educators are valued as agents of change because they can communicate effectively with their contemporaries in ways that professional staff members cannot. The current restructuring of the UMass, Amherst, peer program that collapsed three individual topic-based programs into one integrated 2-semester course is an appropriate response to critical personnel problems and economic realities. The long-range goals for peer education respond to an agenda that supports and encourages the value of peer education on campus and accepts the need for flexibility in providing for program continuity and vitality.

India: Anti-AIDS policies

AIDS will not be notifiable disease in India in the interests of maintaining confidentiality for people with HIV/AIDS. This decision was made at the 1st meeting last month of the National AIDS Committee constituted under the chairmanship of the Minister of Health and Family Welfare last October to provide policy direction and oversee the work of the National AIDS Control Organization (NACO). The committee also decided that providing needles or syringes to injecting drug users would give wrong signals about government policy on drug abuse. Here drug abuse is a criminal offense punishable by imprisonment. Intravenous drug use (and needle sharing) is widespread in some northeastern states of India particularly Manipur where 54% of injecting drug users have been found to be HIV positive. Most of them are now in jail. In the many other parts of the country where drugs are rarely injected the 1st priority is to prevent a shift towards drug injection. Media campaigns against injection might arouse curiosity rather than deter from injection--as happened in 1991 in Nepal where after such a campaign there was a rapid switch from oral to injecting drug use. Only low-key peer programs are likely to be effective in such situations. The committee also raised concern about how hospitals have refused to treat AIDS patients and called on physicians to educate themselves first. Such a refusal had in early February led the Government to instruct the All India Institute of Medical Sciences not to refuse any AIDS/HIV patient even if surgery were needed--this instruction followed an inquiry into how in 1991 the institute had to call in a private practitioner to deliver an HIV-positive woman of her baby because its own doctors has refused to do so. (full text)

Understanding and Using Professional Peer-Assistance Programs

The idea of using concerned caring peers to intervene on behalf of another peer who is suffering from the disease of chemical dependency is a rather new concept in our society. However, the idea has produced great success and today we find that most professional societies sponsor a peer-assistance program. Peer programs are easy to access and provide an array of services. Some of the services extend to the entire professional population. Such things as continuing education credit and monitoring of recovering pharmacists for an employer can benefit all members of the profession. Because peer programs work very closely with State Boards of Pharmacy, advocacy can be provided for the recovering pharmacist. A person who feels the need to report a suspected impairment can feel comfortable that the peer committee and the professional licensing board will handle the problem in a fair and confidential manner. Colleagues, coworkers, spouses, or any concerned person should feel good about using the services of a peer-assistance committee. Use of these services can make the difference in saving the professional career or possibly the life of a peer or loved one.

Issues in employee drug testing. Council on Scientific Affairs

This report on employee drug and alcohol screening, adopted by the American Medical Association's House of Delegates at the 1987 annual meeting, reflects the views of the scientific literature as of February 1987 and is not intended to serve as a standard of medical care. It addresses constitutional, statutory, and common law issues involving privacy, discrimination, and public safety in employer-employee relations and in peer programs for impaired physicians. The Council recommends that the AMA reaffirm its commitment to education on the scientific issues of drug testing; monitor legal issues, especially those involving employment discrimination; and support drug and alcohol screening limited to (1) employees whose jobs affect the health and safety of others, (2) employees who are reasonably suspected of impaired job performance related to substance abuse, and (3) employees in comprehensive treatment and rehabilitation programs.

Meta-Analysis of 143 Adolescent Drug Prevention Programs: Quantitative Outcome Results of Program Participants Compared to a Control or Comparison Group

Presented is a meta-analysis of the outcome results for 143 adolescent drug prevention programs to identify the most effective program modalities for reducing teenage drug use. Glass' et al. (1981) meta-analysis techniques provided a systematic approach for the accumulation, quantification and integration of the numerous research findings. Five major modalities were identified and their effect sizes computed for five distinctly different outcomes: Knowledge, Attitudes, Use, Skills and Behavior measures. The magnitude of the effect size was found dependent on the outcome measure employed and the rigor of the experimental design. These factors were controlled for through use of a standard regression analysis. Peer Programs were found to show a definite superiority for the magnitude of the effect size obtained on all outcome measures. On the ultimate criteria of drug use, Peer Programs were significantly different than the combined results of all the remaining programs (p < .0005). Peer Programs maintained high effect size for alcohol, soft drugs and hard drugs, as well as for cigarette use. Recommendations are made concerning the effectiveness of the underlying theoretical assumption for the different program modalities. Future programming implications are discussed as Peer Programs were identified as effective for the average school-based adolescent population, but the Alternatives programs were shown to be highly successful for the “at risk” adolescents such as drug abusers, juvenile delinquents or students having school problems.

Transfer of Training in Behavior Modification Programs: An Evaluative Review

A selective review of behavior modification programs, which emphasized procedures for programming transfer of training and response maintenance, was undertaken. The principle focus was to evaluate the effectiveness of generalization techniques utilized with exceptional children and to enumerate several points for maintaining performance in the classroom. The role of self-management skills was also discussed, but it was conlcuded that logistical constraints and motivational impediments present in most special education classrooms prevent the emergence of widespread self-regulatory programming at this time. The most influential factors in programming transfer of training and response maintenance were found to be varying stimulus conditions, parent training, and peer programming.