Do Peer Support Services Work? How and Why Allen Daniels And - PDF document

Allen Daniels / Peter Ashenden 10/13/2014 Do Peer Support Services Work? How and Why Allen Daniels And Peter Ashenden Do Peer Support Services Work? How and Why • Introductions and Overview – A view from the field - Peter • A review of the evidence – Allen • Final thoughts and discussion - Peter iNAPS Conference Atlanta 1

Allen Daniels / Peter Ashenden 10/13/2014 Do Peer Support Services Work? 1. A review of the Scientific Literature • An evidence Review of Peer Support Services 2. A Quick Lesson on Scientific Methods – for those that may have been disinterested or asleep in science class… Or, What does a 50% chance of rain really mean? 3. A Strong Evidence Base for Why Peer Support Services Do Work 4. Challenges for the Peer Support Services Field in the Evolving Landscape of Integrated Health Care A B S T R A C T Background - In mental health services, the past several decades has seen a slow but steady trend towards employment of past or present consumers of the service to work alongside mental health professionals in providing services. However the effects of this employment on clients (service recipients) and services has remained unclear. We conducted a systematic review of randomised trials assessing the effects of employing consumers of mental health services as providers of mental health services to clients. The consumer- provider’s role can encompass peer support, coaching, advocacy, case management or outreach, crisis worker or assertive community treatment worker, or providing social support programmes. Authors’ conclusions Involving consumer-providers in mental health teams results in psychosocial, mental health symptom and service use outcomes for clients that were no better or worse than those achieved by professionals employed in similar roles, particularly for case management services. There is low quality evidence that involving consumer-providers in mental health teams results in a small reduction in clients’ use of crisis or emergency services. The overall quality of the evidence is moderate to low. There is no evidence of harm associated with involving consumer-providers in mental health teams. iNAPS Conference Atlanta 2

Allen Daniels / Peter Ashenden 10/13/2014 Results: The level of evidence for each type of peer support service was moderate. Many studies had methodological shortcomings, and outcome measures varied. The effectiveness varied by service type. Across the range of methodological rigor, a majority of studies of two service types— peers added and peers delivering curricula—showed some improvement favoring peers. Compared with professional staff, peers were better able to reduce inpatient use and improve a range of recovery outcomes, although one study found a negative impact. Effectiveness of peers in existing clinical roles was mixed. Conclusions: Peer support services have demonstrated many notable outcomes. However, studies that better differentiate the contributions of the peer role and are conducted with greater specificity, consistency, and rigor would strengthen the evidence. iNAPS Conference Atlanta 3

Allen Daniels / Peter Ashenden 10/13/2014 Findings - Although scarce in the literature, the few experimental trials show that at the very least, PSWs do not make any difference to mental health outcomes of people using services. When a broader range of studies are taken into account, the benefits of PSW become more apparent. What PSWs appear to be able to do more successfully than professionally qualified staff is promote hope and belief in the possibility of recovery; empowerment and increased self-esteem, self-efficacy and self-management of difficulties and social inclusion, engagement and increased social networks. It is just these outcomes that people with lived experience have associated with their own recovery; indeed these have been proposed as the central tenets of recovery: hope, control/agency and opportunity. In addition, employment as a PSW brings benefits for the PSWs themselves in every reported evaluation. iNAPS Conference Atlanta 4

Allen Daniels / Peter Ashenden 10/13/2014 Part 2 A Quick Lesson on Scientific Methods – for those that may have been disinterested or asleep in science class – Or, tools to evaluate the research on peer support services And, What does a 50% chance of rain really mean? What is a Randomized Controlled Trial? A Randomized Controlled Trial is the gold standard in scientific research, and is study in which people are allocated at random to receive one of several interventions Trial Participants Experimental Group Control Group can be: Receives New/Test Conventional Practice; No Intervention Intervention; or, Placebo Result = Does the new intervention out perform treatment as usual, no intervention, or placebo iNAPS Conference Atlanta 5

Allen Daniels / Peter Ashenden 10/13/2014 More Science - Do Parachutes Really Work? Source: BMJ VOLUME 327 20–27 DECEMBER 2003 Franz Reichelt AUSTRIAN-FRENCH TAILOR AND INVENTOR DIED (1912) AFTER HE TRIED USING ONE OF HIS SELF-MADE PARACHUTING DEVICES TO JUMP OFF the EIFFEL TOWER in PARIS iNAPS Conference Atlanta 6

Allen Daniels / Peter Ashenden 10/13/2014 Parachute use to prevent death and major trauma Parachute use to prevent death and major trauma Parachute use to prevent death and major trauma Parachute use to prevent death and major trauma related to related to related to related to gravitational challenge: systematic review of randomized gravitational challenge: systematic review gravitational challenge: systematic review gravitational challenge: systematic review of randomized of randomized of randomized controlled controlled trials trials Gordon C S Smith, Jill P Pell, BMJ controlled controlled trials trials BMJ 2003;327:1459 2003;327:1459– –61 61 BMJ BMJ 2003;327:1459 2003;327:1459 – – 61 61 Abstract Objectives To determine whether parachutes are effective in preventing major trauma related to gravitational challenge. Design Systematic review of randomized controlled trials. Data sources: Medline,Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists. Study selection: Studies showing the effects of using a parachute during free fall. Main outcome measure Death or major trauma, defined as an injury severity score > 15. Results We were unable to identify any randomized controlled trials of parachute intervention. Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomized controlled trials. Advocates of evidence based medicine have criticized the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organized and participated in a double blind, randomized, placebo controlled, crossover trial of the parachute. How Science Really Works So, What Does a 50% Chance Of Rain really Mean? iNAPS Conference Atlanta 7

Allen Daniels / Peter Ashenden 10/13/2014 Part 3 - How Peer Support Services Work: What Peer Specialists do to Foster Recovery Fricks and Powell in Daniels et al, 2012 Stage 1 - Being overwhelmed by the disabling power of the illness The Peer Specialist Role – Decreasing the emotional distress by reducing the impact of symptoms: • The role of the Peer Specialist is to help understand the illness and opportunities for improvement • Knowledge is Power – and the disabling power of the illness is overcome through improved health literacy iNAPS Conference Atlanta 8