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Highlights of a Systematic Review of Literature on Peer-Delivered Services

1989-2009

Boston University Center for Psychiatric Rehabilitation

June 2010

Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

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Purpose of This Presentation To describe a recent review about

Mental Health Peer Delivered Services;

To provide accurate information to those who develop, evaluate or advocate for peer delivered services.

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Objectives of the Review

Identify and review all literature related to peer delivered services

Make the results available to all interested parties.

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Need for This Review

Dramatic growth in peer delivered services in recent years;

Survey in 2006 showed about 7500 mental health mutual support groups and peer operated services – more than number of traditional programs;

The review went in search of evidence about how peer delivered services made a difference.

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Required for Inclusion Services studied must be provided by

individuals with lived experience of psychiatric disability

Studies had to examine the services or their effect on consumers of services

Consumers had to be significantly involved in the design/delivery of services.

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Defined types of peer servicesPeer services included those that: Were added to traditional services

Were offered in mutual support groups

Were offered in a drop in centers

Were residential and other services.

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Studies Included: Research Designs

126 articles initially included; 48 of these made it through the screening for quality and meaning.

Included were 5 different types of research

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Studies Excluded 12 Step programs for Substance use only

Studies that were poorly designed or implemented

Reports that were not really research

Studies of attitudes about peer support unless they were contrasted with views of different groups

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Outcomes examined

Quality of life measures

Recovery attitudes

How participants viewed empowerment

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Outcomes examined (continued) Self confidence and self esteem

Hospitalization or relapse

Psychiatric symptoms

Criminal justice involvement

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Process Before the Review Each study was scored for good

research principles and to see if the research questions were of general interest

12 Experts in the field reviewed the list of studies to ensure that no important study had been missed.

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Research Conclusions 1

Several authors concluded that peer services had similar outcomes to those of professionals;

Several studies suggested that adding peer delivered services to regular services did not change outcomes but…

There was some evidence that peers provided special skills & experiences that may increase the chances that individuals get into and remain in services .

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Research Conclusions 2 Some evidence that peer services provided in

a group can improve outcomes if members attend regularly and for long enough time;

Some of the peer group services such as Vet to Vet suggested that those who used the program regularly had better outcomes e.g. felt empowered and functioned better.

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Research Conclusions 3 The kinds of peer services were quite different

from each other so it was very hard to make any conclusions, however…

There is some evidence that those who stay with the group program long enough do benefit: e.g. no substance abuse, feeling of empowerment, quality of life, social support, satisfaction, reduced criminal justice involvement, psychiatric stability and other outcomes.

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Research Conclusions 4 The COSP study – across several models

suggests that the peer intervention was associated with many positive changes in well being but these studies are not completed.

Two studies of peer run residential services show modest evidence of effectiveness.

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Challenges in the Existing Research In many studies the services provided

were not defined;

In some studies it was not possible to tell which services individuals used;

Many of the studies did not have strong research design;

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Challenges in the Existing Research (continued) The variety of peer delivered supports

make it difficult to have strong research design;

Very few studies were well controlled (scientific) on the effects of peer support. (Davidson et al)

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Sample Questions for Discussion1. Is it important for Peer Delivered

services to have a strong research base? Why or why not?

2. What are some of the barriers to having good research on Peer Delivered services?

3. What suggestions do you have to increase and improve the research base for these services?

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Sample Questions for Discussion

4. If there was good research for Peer Delivered services, what would help to make the research design strong?

5. If there was good research for Peer Delivered services, how could consumer organizations use the results?

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Reference

Davidson L., Chinman, M., Sells, M. & Rowe, M. 2006. Peer Support Among Adults with Serious Mental Illness: A report from the Field. Schizophrenia Bulletin. 32(3)443-450.

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For more information on Research in Psychiatric RehabilitationCheck this website – “Disability Research Right toKnow” and the full report on Systematic Review ofLiterature on Peer-Delivered Services 1989-2008Peer Delivered Services go to:

http://drrk.bu.edu/

Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)