The Peer-Provider Collaboration as a
Platform for Research and Service Delivery
Anthony O. Ahmed, PhD
Assistant Professor
Dept. of Psychiatry and Health Behavior
Medical College of Georgia
Georgia Regents University
Disclosures
• Educational grant from U.S. Department of
Health Resources and Service Administration
(HRSA) Bureau of Health Professions (BHPr)
2012 Award for Creativity in Psychiatric Education
from the American College of Psychiatrists
Outline
 Peers and peer-led interventions: clinical research update
 The GMHCN-Project GREAT collaborative study of recovery in
certified peer specialists
 Peer-led interventions, services, and research in the state of
Georgia: whither are we bound?
Peer Specialists as Cornerstones of Recovery
 Traditional interventions in the mental health field have won some
battles…lost the war
 Little has been gained in promoting wellness, personal growth, quality of life,
personhood…
 There is some increasing recognition of the importance of recovery among
traditional providers but psychiatry and psychology are still lagging behind
 The consequence is high rates of treatment disengagement
 Peer-led interventions are necessary to sustain the gains of the
recovery movement
 Need to give voices to individuals receiving services
 Need to maintain adjunctive interventions to traditional care
 Need to maintain alternative services to traditional care
 Peer-led programs outnumber traditional mental health organizations
Classification of Peer-Led Interventions
Peer-Led Interventions
Consumer-Operated Services
Intentional, voluntary,
reciprocal or non-reciprocal
relationship with
peers in community and/or
service settings
Mutual Support/Self-Help
Intentional, voluntary,
reciprocal or non-reciprocal
relationship with
peers in community and/or
service settings
Peer Support
Intentional, voluntary,
non-reciprocal relationship
with peers in service settings
Peer-Provider Research: An Opportunity
 Traditional psychiatry research has been good for discovery
and treatment innovation but suffers important limitations
 Social distance and stigma
 Peer-led recovery-based research has potential to provide an
important perspective
 Decrease social distance
 Increase involvement
 Serve activist objectives
 How then may peers collaborate in research?
Peer-Led Interventions: Feasibility
 Feasibility studies
demonstrated that it is
possible to train peers to
provide mental health
services
 Four seminal studies
conducted in the 1990s
Peer-Led Interventions: The Evidence
Courtesy Davidson et al., 2006
Peer-Led Interventions: The Evidence
• Peers are able to deliver
services that are at least as
effective as services
delivered by traditional
providers
• In some cases slightly better
outcomes
Peer Staff Versus Non-Peer Staff
 Since year 2000, there has been an increased focus on comparing peers
to non-peers—are peers really better at case management?
 Comparison trials have consistently shown that peers do better at
engaging “difficult-to-treat” clients, reduce hospitalization rates,
duration of hospitalization, and decreasing substance use
 Example: Rowe et al. (2007)--Peer support significantly reduced alcohol, drug
use, and criminal justice involvement in individuals with dual diagnosis over
traditional treatment
Future Research Into Peer-led Interventions
 New third generation research
interest is to—
 Identify the ways peer-led
interventions are different and
outperform tradition treatment
 Identify the interventions that only
peers are uniquely qualified to
provide
 Distill the active ingredients of
peer-led interventions
 What are the experiences of peers
providing interventions? In what
ways does the Peer Specialist role
influence peers’ lives?
Third Generation Studies
 NIMH-funded studies by Larry Davidson’s team:
 Tondora et al. (2010): 290 adults with SMI randomly assigned to a) usual care
plus IMR; b) usual care plus IMR plus a peer-facilitated person-centered
planning process (PCP); and c) usual care plus IMR and PCP with the addition of
the peer-run community connector program.
 Peer-facilitated care planning increased the sense that treatment was responsive and inclusive of
outcomes that mattered to peers
 The peer-run community connector program increased hope, belongingness, treatment
engagement, and decreased psychotic symptoms
 Sledge et al. (2011): 74 participants who had been hospitalized at least twice in
the last 18 months randomly assigned to usual care versus usual care plus peer
recovery mentor
 The inclusion of peer mentorship decreased the number of hospitalizations (Cohen’s d = 0.41)
and the duration of hospitalization (Cohen’ d = 0.44)
 There was also a significant decrease in substance use and depression with peer mentorship
The GMHCN-Project GREAT Collaborative Study of Recovery
among CPSs
 Objectives:
 Study the professional
experiences of CPSs trained
through the GMHCN
 Identify the correlates of
recovery among CPSs that
may inform experiential
aspects of recovery
Method
 Mailed out packets to GMHCN CPSs that included survey questions and
psychometric measures
 20% completion rate for mail-outs (N = 84)
 Sample survey domains:
 Income and sources of Income
 Employment and work status
 Housing and neighborhood
 Peer professional status and responsibilities
 Quality of CPS professional experience
 Challenges of the CPS role
 Psychometric measures:
 Maryland Assessment of Recovery for SMI (MARS); Connors-Davidson Resilience Scale
(CD-RISC); Brief-COPE; Social Functioning Scale (SFS); Social Support Questionnaire
(SSQ); Internalized Stigma of Mental Illness (ISMI); Brief Symptom Inventory (BSI); the
NEO Five Factors Inventory (NEO-FFI-3)
Results: Demographic Characteristics
Vocational and Financial Status of CPSs
 Approximately 85% of CPSs have at least
some college education/post-high school
and over 40% have a bachelors degree
 Most CPSs earn between $10,000 to
$20,000 per year
 The unemployment rate of CPSs is high at
38.30%
 49.40% reported that they were “Mostly
Dissatisfied” or “Very Dissatisfied” with
their financial status and 37.50% for their
employment situation
 There was an association between income
satisfaction and employment satisfaction (r
= .54, p < .0001)
CPS Professional Role
 Only a minority of peer specialists are
working for pay in that role
 Peer specialists reported working
18.47 hours a week on average
(range = 0-85 hrs)
 The majority of peer specialists feel
included as part of the treatment team
 The majority of respondents are at
least “Mostly Satisfied” with their role
as a CPS
Peer Specialist Employment Benefits
 72.4%% of peer specialist
received no employment
benefit
 The benefits for CPS positions
are low compared to other
professions of similar levels of
education
Housing and Living Situation
 Most respondents own their
own apartment
 Most peer specialists reported
being at least “Mostly Satisfied”
with their housing
 Most respondents were at least
“Mostly Satisfied” with their
neighborhoods
What are some things you do to help peers?
 Peer Mentoring and Support (60%)
 Goal setting, leading recovery groups; sharing recovery stories; providing support
services; hospital visits, etc.
 Teaching or Leading Treatment Groups (51.11%)
 E.g., skill-based groups and wellness activities such as WRAP, IMR, social skills,
etc.
 Case Management (29%)
 Housing assistance; employment; transportation; entitlements; legal support;
community resources etc.
 Advocacy (11.11%)
 Consultation Services to Treatment Teams (6.7%)
What do you find rewarding about being a CPS?
 The Helping Role: Assisting others to embark on the recovery
journey, empowering peers, instilling hope, etc. (71.18%)
 The Power of the Narrative: Sharing recovery stories and
positive experiences (15.25%)
 Personal Growth: Better insight, knowledge through
education/training, growing with peers, etc. (12.00%)
 The Reciprocity: Developing friendships and partnerships
with other peers and other providers (20%)
What are the most difficult
challenges of the CPS role?
 Limited Compensation/Resources (25.45%)
 Conflicts and Misunderstandings with Traditional
Providers (25.45%)
 Paperwork (21.81%)
 Peer Difficulties (21.82%)
 Maintaining Personal Wellness (10.91%)
 Limited Peer Specialist Positions (7.27%)
Current Problems in Place of Employment
 Limited compensation and benefits (32%)
 Stressful work environments/millieu (22.03%)
 Untenable productivity standards; difficult co-workers; problematic shifts; too
much paperwork
 Underemployment (15.25%)
 Issues of appreciation and respect (13.56%)
 Limited workplace resources for optimal service delivery (8.47%)
 Inadequate supervision; office space; equipment issues
 Poorly defined roles and responsibilities (4%)
What steps did you take to deal with relapse?
 Recruiting Positive Coping Skills
 WRAP; 12 steps; recovery tools; support network; peer support
 Modifying Work Schedule
 Taking time off; fewer work hours; reducing work load;
 Psychiatric Services
 Medication reevaluation; hospitalization; psychotherapy; counseling;
Support and Accommodations Provided by Employer
 Employer Provided Time Off
 Day off, extended time off, paid sick leave, unpaid leave etc.
 Employer Provided a Lighter Work Load
 Fewer cases, additional help, etc.
 Employer Adjusted Roles
 New job, flexible schedule
 Clinical Support
 EAP, Onsite Intervention, Hospital Transport
 None
 Employer unaware, employer viewed relapse as inconvenience,
What opportunities, tools, and supports could improve your
experience as a peer specialist?
 Professional Development/Continuing Education:
 Literature to assist in facilitating groups
 Training in working with peers with dual diagnosis
 Training in working with peers during acute episodes
 Training specific to running peer groups
 Operating as a peer specialist on an ACT team
 Socializing and professional networking
 Dealing and resolving ethical dilemmas
 Vocational Resources:
 More job opportunities for peers
 Create opportunities for vocational training
What opportunities, tools, and supports could improve your
experience as a peer specialist?
 Financial Compensation and Resources:
 Pay advancement
 Provide support for activities and supplies
 Increase range of benefits
 Transportation
 Housing
 Increase Awareness:
 Educate traditional providers about peers provider competencies
 Educate traditional providers about peer-led interventions
 Educate peer providers about the value of peer specialists
In What Roles or Activities Would
You like to see CPSs in the Future?
 Administrative and Supervisory
 advisors to regional offices and hospital administrators, program
directors, decision-making teams, etc.
 Education and Training
 Staff training, family psychoeducation, anti-stigma etc.
 Hospital/Clinical Roles
 Nursing, counseling, case management, treatment planning, crises
intervention, physical health training, etc
 Judicial System
 In police departments; more involvement in the court system
In What Roles or Activities Would
You like to see CPSs in the Future?
 Academic Settings
 Schools alongside guidance counselors and other staff
 University psychology clinics and counseling centers
 Proliferation of Peer-Led Interventions
 Increase the number of peer centers
 Develop more peer-led interventions
 Provide services in social security and DHR
 Provide services in private practice clinics
 Other Activities
 Spiritual counseling
 Life coaching
 Political activism
The Peer Specialist Position Confers Clinical Benefits
 Psychiatric diagnosis does not
impact CPS status
 Low past year hospitalization rate
among CPSs
 Over 40% of CPSs reported
relapse while functioning as CPS
but almost all took effective steps
to manage relapse
Summary of the Correlates of Recovery
in Peers Specialists
 Measured recovery with the Maryland Assessment of Recovery in
Severe Mental Illness (MARS)
 Factor analysis distills recovery into—Hope/holistic, Empowerment, Self-
Direction, and Strengths
 Recovery predicted:
 Positive coping
 Resilience—control, commitment, action-orientation, faith, and tolerance
 Community living—social engagement, communication, recreation, independence
 Frequency and satisfaction with social support
 Internalized Stigma—positive association with stigma resistance and inverse association
with alienation, stereotype endorsement, withdrawal
 Recovery attitudes as a Cognitive Antidote..
 Recovery does not depend on personality organization
Recovery Attitudes Promote Community Functioning
Recovery (MARS)
.52*
-.25*
Symptoms
-.23* (-.10)
Community
Functioning (SFS)
Recovery Attitudes are Protective From Stress
Recovery (MARS)
.49*
-.92*
Stressors
Index
Symptoms
-.82* (-.13)
What do Peer Specialists in Recovery
Do to Cope?
 Religion
 Planning
 Use of Emotional Support
 Venting
 Active Coping
 Humor
 Positive Reframing
 Acceptance
 Use of Instrumental Support
Strategies for Proliferating Peer Services
 Involve people in recovery and non-peer
 Sponsored education and training for
 A clear job description and role
 Senior administrator take on the role of
stakeholders in the process of creating
peer positions
clarification
 Identifying and valuing the unique
contributions that peers can make to the
programs and settings where they will
work
peers to enhance the quality of their
services
peer staff “champion” who can address
issues and problems (Davidson et al.,
2012)
 Providing training and education for non-
peer staff that covers relevant disability
and discrimination legislation and its
implications (Davidson et al., 2012)
 Providing CPS jobs that reflect the
diversity of strengths and educational
background of peers
 Provide compensation commensurate
with background and experience
 Providing supervision for peer staff that
concentrates on job skills, performance,
and support
 Disseminate success stories of the impact
of peer-led interventions
Acknowledgements
 The Georgia Mental Health Consumer Network
 Ms. Sherry Jenkins-Tucker
 Mr. Charles Willis
 All Certified Peer Specialists of the Georgia Mental Health
Consumer Network
 “Thank you for being missionaries of hope”
 Mr. Mark Baker~ Center for Recovery Transformation
Acknowledgements
 Current Peer Specialists
 Linda Johnson
 Vanessa Dunton
 Stacy Camille
 Barry Jones
 Past Peer Specialists
 Sherry Evans
 Julie Roberts
Acknowledgements
Project GREAT
Project GREAT
Emeritus Peer Specialists
Certified Peer Specialists