Highlights of a Systematic Review of Research on Peer-Delivered Services 1989-2009

1. Highlights of a Systematic Review of Research on Peer-Delivered Services 1989-2009 Boston University Center for Psychiatric Rehabilitation March 2010 Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

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

3. Objectives of the Review • Identify and review all literature related to peer delivered services • Make the results available to all interested parties. Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

4. 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 searched for evidence about how peer delivered services made a difference. Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006

5. Required for Inclusion • Services studied must be provided by individuals with lived experience of psychiatric disability • Studies had to examine the services and their effect on consumers of services • Consumers had to be significantly involved in the design/delivery of services. Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006

6. Defined types of peer services Peer services included those that: • Were added to traditional services • Were offered in mutual support groups • Were offered in a drop in centers • Were offered in residential and other services. Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

7. Studies Included: Research Designs • Of the 126 articles initially included 48 of these made it through the screening for quality and meaning. • Included were 5 different types of research Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006

8. Studies Excluded • 12 Step programs for Substance use only • Studies that were poorly designed or implemented • Reports that could not qualify as research • Studies of attitudes about peer support unless they were contrasted with views of different groups Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006

9. Outcomes examined • Quality of life measures • Recovery attitudes • How participants viewed empowerment Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006

10. Outcomes examined (continued) • Self confidence and self esteem • Hospitalization or relapse • Psychiatric symptoms • Criminal justice involvement Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006

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

12. 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 be helpful in getting and keeping services. Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006

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

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

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

16. 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 a strong research design; Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006

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

18. Sample Questions for Discussion 1. 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? Review conducted under the Innovative Knowledge Dissemination & Utilization Project for Disability & Professional Stakeholder Organizations/ NIDRR Grant # (H133A050006)

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

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

21. For more information on Research in Psychiatric Rehabilitation Check this website – “Disability Research Right to Know” and the full report on Systematic Review of Literature on Peer-Delivered Services 1989-2009 Peer 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)