Transcript Highlights of the Systematic Review of Peer

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 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 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 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?
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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)443450.
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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 1989-2008
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)
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