Peer-to-peer support, especially when delivered within the confines well-defined interventions, has been shown to be quite effective. As Judith Cook states in Peer-Delivered Wellness Recovery Services: From Evidence to Widespread Implementation: “A growing body of evidence suggests that peer-provided, recovery-oriented mental health services produce outcomes as good as and, in some cases superior to, services from non-peer professionals.”
Because the peer movement has been particularly embraced by the mental health community, most peer programs involve persons who have addressed psychiatric problems in their own lives. In sharing these common lived experiences, a peer provider can often relate well to those dealing with the same issues, thereby developing a rapport that supports recovery. (Davidson, et. al, 1999 and Chinman et al., 2006). In fact, information provided by peers is often seen as more credible than what is provided by mental health professionals (Woodhouse & Vincent, 2006).
In integrated care, peers are playing increasingly significant roles in:
- Case management: A 1995 study by found that clients of peer-run case management had the same clinical and social outcomes as those assigned to nonconsumer teams and received more services. (Solomon and Draine)
- Health and wellness coaches: Peers can play an important role in medical illness self-management, especially for people with psychiatric disabilities, helping them address areas such as smoking cessation, nutrition, sleep, exercise and activity, stress management, metabolic syndrome management, health literacy, and general wellness.
- A 2010 study of the Health and Recovery Peer Program (HARP, an adaptation of Standford’s Chronic Disease Self-Management Program for mental health consumers) found, at six months, that participants reported significantly greater improvement in physical health, quality of life, medical adherence, primary care visits, and illness management when compared to the usual-care group. (Druss et al., 2010). When peer providers are part of hospital-based care, inpatients have shorter stays, decreased re-admissions, and subsequent reduction in overall treatment costs (Chinman et al., 2001). A 2011 editorial by Judith Cook also cites a growing body of evidence suggesting that “peer provided recovery oriented mental health services produced outcomes as good as, and in some cases superior to, services from non peer professionals”.
- Self-help skills trainers for people with psychiatric disabilities: Client-led organizations such as Project Return in Los Angeles help individuals reach their personal goals, such as living independently, going to school, getting a job, having friends and enjoying life in the community.
Several states are certifying consumers of services in the delivery of peer support that are billable to Medicaid. Training and certification is provided by the Mental Health Department in most of these states, but academic institutions and advocacy groups also act as the certifying agent in others. In 2004, the National Association of Peer Specialists was formed to promote growth of this movement through education and advocacy. “Pillars of Peer Support“, a report from a Summit convened in 2009 by the Carter Center, discussed certification in depth.
One promising training program, Peer Support Whole Health (PSWH) developed by the Appalachian Consulting Group in concert with the Georgia Mental Health Consumer Network, involves “a person-centered planning process that focuses on a person’s strengths, interests and natural supports and stresses creating new health life-style habits.” In this approach, a peer specialist helps clients choose and record a health goal and provides support to help the client reach it.
Meaningful Roles for Peer Providers in Integrated Healthcare, 2014, is a guide developed by the California Association of Social Rehabilitation Agencies with support of IBHP, this website’s host. The guide provides information, tips and examples of how integrated health settings can best hire, train, integrate and retain peer specialists to benefit individuals with co-occurring health and behavioral conditions.
The Supervisor’s Guide: Peer Support Whole Health and Wellness (2013) outlines the foundations of the peer health and wellness coach role, strategies for integrating the coach into the team/agency, and ways they can promote healthy lifestyles. The 2012 Whole Health Action Management (WHAM) Peer Support Training is a “training program and peer support group model developed by the CIHS to encourage increased resiliency, wellness and self-management of health and behavioral health among people with mental health and substance use disorders.” The training is also available in Spanish.
IBHP’s Peer Models and Usage in California Behavioral Health and Primary Care Settings examines the value and roles of peers in integrated care and describes the peer certification programs in the state. Another IBHP brief,Addition of Peer support Workers to Improve Patient Outcomes and Reduce Costs makes the business case for hiring peers. IBHP’s paper on Integrating Substance Abuse Treatment Staff and Reducing Stigma in Community Clinics and Health Centers also has a section on peer services (starting on page 6), including a chart delineating peer certification by state.
In September, 2014, the National Association of State Mental Health Program Directors published “Enhancing the Peer Provider Workforce: Recruitment, Supervision and Retention“, a guide designed to increase the use of peer providers within behavioral health systems.
“WHAM: Feedback from Graduates, Research and Billable Funding of a Peer Program“, a webinar featuring WHAM (Whole Health Action Management) grads and researchers speaking about implementation successes, challenges and insights, is available on the National Council website.
The SAMHSA-HRSA Center for Integrated Health Solutions website contains valuable information on billing, sample job descriptions, roles and tips.
Probably the most valuable thing a peer can offer clients is living proof that someone with a disability similar to their own can lead a productive and fulfilling life.