Peer Support Services Reaching People with Schizophrenia: Considerations for Research and Practice

Description

Many mental health providers are seeking guidance in designing and improving peer support programs for people with mental illnesses. However, the evidence base in this area is limited by lack of consensus on the core components of peer support. This research provides a comprehensive, nuanced view of peer support reaching people with schizophrenia. Results of a realist review of 355 sources and interviews with experts in the field are presented. Realist review is an approach to evidence synthesis that asks, ‘What works, for whom, and in what circumstances?’ Results include a typology of key functions of peer support (e.g., being there, linkage to clinical care and community resources, systems advocacy, ongoing support), documented benefits (e.g., decreased acute care utilization, increased recovery), and implementation recommendations (e.g., critical mass of peer workers, supportive infrastructure, an organizational recovery orientation). The book is intended for program planners, managers, and researchers. Preface Acknowledgments Contents Abbreviations Chapter 1: Schizophrenia as a Public Health Problem 1.1 Complex Etiology of Schizophrenia 1.2 Public Health Burden of Serious Mental Illness 1.3 Public Health Burden of Schizophrenia 1.4 Substance Use Among People with Schizophrenia 1.4.1 Nicotine and Tobacco Use 1.4.2 Alcohol Use 1.4.3 Cannabis Use 1.5 Suicide Risk 1.6 Housing and Schizophrenia 1.7 Employment and Schizophrenia 1.8 Social Isolation and Loneliness 1.9 Stigma 1.10 Disparities in Schizophrenia Diagnosis 1.11 Summary References Chapter 2: Current Approaches to Schizophrenia Treatment 2.1 Goals of Treatment: Remission and Recovery 2.2 Pharmacological Treatment 2.3 Psychosocial Treatment 2.4 Treatment Engagement 2.5 Racial and Ethnic Disparities in Schizophrenia Treatment 2.6 Summary References Chapter 3: Theoretical Foundations of Peer Support 3.1 Social Relationships and Social Support 3.2 The Value of Experiential Knowledge and Expertise 3.3 Social Cognitive Theory and Observational Learning 3.4 Social Comparison Theory 3.5 Stigma and Modified Labeling Theory 3.6 Key Functions of Peer Support 3.6.1 “Being there” 3.6.2 Assistance in Self-Management 3.6.3 Social and Emotional Support 3.6.4 Linkage to Clinical Care and Community Resources 3.6.5 Ongoing Support 3.7 A Socioecological Model of Peer Support Reaching People with Schizophrenia 3.8 Summary and Implications References Chapter 4: Origins of Peer Support and the Modern Recovery Movement in the United States 4.1 Moral Treatment 4.2 Institutionalization and Associated Human Rights Abuses 4.3 Deinstitutionalization 4.4 Organized Civil Rights and the Growth of the Recovery Movement 4.5 Organizing of Families of People with Mental Illnesses 4.6 Ideological Differences and Debates 4.7 Recovery in the Mainstream 4.8 Growth of Formal Peer Support Services 4.9 Summary References Chapter 5: Peer Support and Mental Health: A Review of the Evidence 5.1 Review of Systematic Reviews and Meta-Analyses 5.2 The Distinctive Contributions of Peer Support 5.3 Current Evidence Regarding Peer Support in the Treatment of Schizophrenia 5.4 Potential for Peer Support to Promote Recovery Among People with Schizophrenia 5.5 Research Gaps and Implications 5.6 Summary References Chapter 6: Realist Perspective and Methodology 6.1 Realist Perspective Framing This Research 6.2 Research Activity 1: Realist Review of the Literature 6.2.1 Overview of Realist Review Methodology 6.2.2 Research Aim 6.2.3 Stage 1: Clarification of the Scope of Review 6.2.3.1 Review of Systematic Reviews and Meta-Analyses 6.2.3.2 Refining the Research Question 6.2.4 Stage 2: Searching for Evidence 6.2.5 Stage 3: Data Extraction 6.2.6 Stage 4: Data Synthesis and Drawing Conclusions 6.2.7 Stage 5: Dissemination, Implementation, and Evaluation 6.3 Research Activity 2: Expert Interviews 6.3.1 Sampling and Recruitment 6.3.2 Interview Topics 6.3.3 Data Collection and Analysis References Chapter 7: Diversity in Programmatic Features, Peer Support Strategies, Potential Mechanisms, and Outcomes 7.1 Preliminary Findings from Exploratory Scoping of the Literature 7.2 Overview of Findings from Realist Review 7.2.1 Description of Published and Grey Literature Sources Reviewed 7.2.2 Contexts, Peer Support Strategies, Potential Mechanisms, and Outcomes 7.2.2.1 Contextual and Programmatic Features 7.2.2.2 Peer Support Strategies 7.2.2.3 Potential Mechanisms 7.2.2.4 Outcomes 7.3 Peer Interventions Focused on Improving Physical Health among People with SMI 7.3.1 Contextual and Programmatic Features 7.3.1.1 Peer Support Strategies 7.3.1.2 Potential Mechanisms 7.3.1.3 Outcomes Measured 7.3.1.4 Significant Findings 7.3.1.5 Summary 7.4 Peer Interventions Focused on Improving Mental Health 7.4.1 Standalone Peer Support Services 7.4.1.1 Contextual and Programmatic Features 7.4.1.2 Peer Support Strategies 7.4.1.3 Potential Mechanisms 7.4.1.4 Hypothesized Outcomes 7.4.1.5 Significant Findings 7.4.1.6 Summary 7.4.2 Peer Support Services in Conjunction with Clinical Services 7.4.2.1 Contextual and Programmatic Features 7.4.2.2 Peer Support Strategies 7.4.2.3 Potential Mechanisms 7.4.2.4 Outcomes Measured 7.4.2.5 Significant Findings 7.4.2.6 Summary 7.4.3 Clinical, Paraclinical, or Case Management Services Delivered by Peers 7.4.3.1 Contextual and Programmatic Features 7.4.3.2 Peer Support Strategies 7.4.3.3 Potential Mechanisms 7.4.3.4 Hypothesized Outcomes 7.4.3.5 Significant Findings 7.4.3.6 Summary 7.5 Peer Intervention Focused on Improving Both Mental and Physical Health 7.6 Refinement of Results Based on Expert Interview Feedback References Chapter 8: Implementation Considerations and Key Challenges 8.1 Facilitators and Barriers to Successful Implementation of Peer Programs 8.1.1 Organizational Culture, Recovery Orientation, and Readiness to Change 8.1.2 Paternalism and Peer Support: Concerns About Maintaining Recovery 8.1.3 “Critical Mass” of Peer Supporters 8.1.4 Role Confusion and Conflict 8.2 Key Issues and Challenges in the Field 8.2.1 “Friendly Fire”: Perspectives on Professionalization of the Peer Support Role 8.2.2 Boundaries: “It’s Very Fuzzy, But It’s Certainly Something That We Address” 8.2.3 “Both/And”: Issues Relating to Matching Peers with Those They Support 8.2.4 “Everybody’s Really Nice, But…”: Tokenism and Peer Support 8.2.5 “It Costs Money and Time to Actually Do Something Different”: Investing in Peers 8.3 Looking Forward: Opportunities for Growth in the Field References Chapter 9: Summary, Implications, and Future Directions 9.1 Summary of Key Results 9.1.1 Suggested Core Components of Peer Support for People with Schizophrenia 9.1.2 Patterns of Strategies, Mechanisms, and Outcomes 9.1.2.1 Programs Focused on Improving Physical Health 9.1.2.2 Mental Health-Focused Standalone Peer Support Programs 9.1.2.3 Mental Health-Focused Peer Support Delivered in Conjunction with Clinical Care 9.1.2.4 Mental Health-Focused Clinical, Paraclinical, or Case Management Services Delivered by Peers 9.1.3 Potential Areas for Expansion 9.1.4 Factors Influencing the Implementation of Peer Support Programs 9.1.4.1 Recovery Transformation and the Role of Peer Support 9.1.4.2 Key Challenges in the Field 9.1.4.3 Professionalization 9.1.4.4 Negotiating Boundaries 9.1.4.5 Matching 9.2 Study Strengths 9.3 Study Limitations 9.4 Implications for Research and Practice 9.4.1 Evaluating Effectiveness of the Core Components of Peer Support 9.4.2 Intervention Dose and Ongoing Support 9.4.3 Critical Examination of the Concept of Self-Determination 9.4.4 Variety and Multiple Models References Index