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INVOLVING PERSONS LIVING WITH DEMENTIA IN RESEARCH: PEER MODELS AND ISSUES OF CAPACITY Literature Review December 31, 2018 Prepared by LiveWell in accordance with Eugene Washington PCORI Engagement Award “Empowering Partners: Engaging Individuals with Dementia and Care Partners in PCOR/CER” PEER TO PEER MODELS OF SUPPORT GASSAWAY, J., JONES, M. L., SWEATMAN, W. M., HONG, M., ANZIANO, P., & DEVAULT, K. (2017). EFFECTS OF PEER MENTORING ON SELF-EFFICACY AND HOSPITAL READMISSION AFTER INPATIENT REHABILITATION OF INDIVIDUALS WITH SPINAL CORD INJURY: A RANDOMIZED CONTROLLED TRIAL. ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, 98(8), 1526- 1534. Objective. To investigate the effect of intensive peer mentoring on patient-reported outcomes of self-efficacy and unplanned hospital readmissions for persons with spinal cord injury/disease (SCI/D) within the first 6 months after discharge from inpatient rehabilitation. Design. Randomized controlled trial. Setting. Nonprofit inpatient rehabilitation hospital specializing in care of persons with SCI/D and brain injury. Participants. Patients (N=158) admitted to the SCI/D rehabilitation program whose discharge location was a community setting. Participants (51% with paraplegia and 49% with tetraplegia) were 73% white and 77% men, with a mean age of 38 years. Interventions. Participants in the experimental group received initial consult/introduction with a peer support program liaison and were assigned a peer mentor, who met with the participant weekly throughout the inpatient stay and made weekly contact by phone, e-mail, or in person for 90 days postdischarge. Participants also were encouraged to participate in regularly scheduled peer support activities. Nonexperimental group participants were introduced to peer support and provided services only on request. Main Outcome Measures. General Self-efficacy Scale (adapted to SCI/D), project- developed community integration self-efficacy scale, and patient-reported unplanned rehospitalizations. Results. Growth rate for self-efficacy in the first 6 months postdischarge was significantly higher for experimental group participants than nonexperimental group participants. Experimental group participants also had significantly fewer unplanned hospital days. Conclusions. This study provides evidence that individuals receiving intensive peer mentoring during and after rehabilitation for SCI/D demonstrate greater gains in self-efficacy over time and have fewer days of unplanned rehospitalization in the first 180 days postdischarge. More research is needed to examine the long-term effects of this intervention on health care utilization and the relation between improved health and patient-reported quality of life outcomes. 1 Updated December 31, 2018 DAVIDSON, L., CHINMAN, M., KLOOS, B., WEINGARTEN, R., STAYNER, D., & TEBES, J. K. (1999). PEER SUPPORT AMONG INDIVIDUALS WITH SEVERE MENTAL ILLNESS: A REVIEW OF THE EVIDENCE. CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, 6(2), 165-187. This article reviews the history and potential effectiveness of peer support among persons with severe mental illness. Following a historical overview, we describe the three primary forms of peer support that have been developed to date by and for this population, and examine the existing empirical evidence of the feasibility, effectiveness, and utilization of each of these approaches in contributing to the recovery of individuals with psychiatric disabilities. These three forms are (1) naturally occurring mutual support groups, (2) consumer-run services, and (3) the employment of consumers as providers within clinical and rehabilitative settings. Existing studies of mutual support groups suggest that they may improve symptoms, promote larger social networks, and enhance quality of life. This research is largely from uncontrolled studies, however, and will need to be evaluated further using prospective, controlled designs. Consumer-run services and the use of consumers as providers promise to broaden the access of individuals with psychiatric disabilities to peer support, but research on these more recent developments is only preliminary and largely limited to demonstrations of their feasibility. We discuss issues entailed in participating in peer support for this population, and then close with a discussion of the implications for future policy, research, and practice. DAVIDSON, L., CHINMAN, M., SELLS, D., & ROWE, M. (2006). PEER SUPPORT AMONG ADULTS WITH SERIOUS MENTAL ILLNESS: A REPORT FROM THE FIELD. SCHIZOPHRENIA BULLETIN, 32(3), 443-450. Peer support is based on the belief that people who have faced, endured, and overcome adversity can offer useful support, encouragement, hope, and perhaps mentorship to others facing similar situations. While this belief is well accepted for many conditions, such as addiction, trauma, or cancer, stigma and stereotypes about mental illness have impeded attempts on the part of people in recovery to offer such supports within the mental health system. Beginning in the early 1990s with programs that deployed people with mental illness to provide conventional services such as case management, opportunities for the provision and receipt of peer support within the mental health system have proliferated rapidly across the country as part of the emerging recovery movement. This article defines peer support as a form of mental health are and reviews data from 4 randomized controlled trials, which demonstrated few differences between the outcomes of conventional care when provided by peers versus non-peers. We then consider what, if any, unique contributions can be made by virtue of a person’s history of serious mental illness and recovery and review beginning 2 Updated December 31, 2018 efforts to identify and evaluate these potential valued-added components of care. We conclude by suggesting that peer support is still early in its development as a form of mental health service provision and encourage further exploration and evaluation of this promising, if yet unproven, practice. REPPER, J., & CARTER, T. (2011). A REVIEW OF THE LITERATURE ON PEER SUPPORT IN MENTAL HEALTH SERVICES. JOURNAL OF MENTAL HEALTH, 20(4), 392-411. Background. Although mutual support and self-help groups based on shared experience play a large part in recovery, the employment of peer support workers (PSWs) in mental health services is a recent development. However, peer support has been implemented outside the UK and is showing great promise in facilitating recovery. Aims. This article aims to review the literature on PSWs employed in mental health services to provide a description of the development, impact and challenges presented by the employment of PSWs and to inform implementation in the UK. Method. An inclusive search of published and grey literature was undertaken to identify all studies of intentional peer support in mental health services. Articles were summarised and findings analysed. Results. The literature demonstrates that PSWs can lead to a reduction in admissions among those with whom they work. Additionally, associated improvements have been reported on numerous issues that can impact on the lives of people with mental health problems. Conclusion. PSWs have the potential to drive through recovery-focused changes in services. However, many challenges are involved in the development of peer support. Careful training, supervision and management of all involved are required. WALKER, G., & BRYANT, W. (2013). PEER SUPPORT IN ADULT MENTAL HEALTH SERVICES: A METASYNTHESIS OF QUALITATIVE FINDINGS. PSYCHIATRIC REHABILITATION JOURNAL, 36(1), 28. Objectives: Peer support involves people in recovery from psychiatric disability offering support to others in the same situation. It is based on the belief that people who have endured and overcome a psychiatric disability can offer useful support, encouragement, and hope to their peers. Although several quantitative reviews on the effectiveness of peer support have been conducted, qualitative studies were excluded. This study aimed to synthesize findings from these studies. Method: A qualitative metasynthesis was conducted, involving examination, critical comparison, and synthesis of 27 published studies. The experiences of peer support workers, their nonpeer colleagues, and the recipients of peer support services were investigated. Results: Peer support workers experiences included nonpeer staff discrimination and prejudice, low pay and hours, and difficulty managing the transition from “patient” to peer support worker. Positive experiences included collegial relationships with nonpeer staff, and other peers; and 3 Updated December 31, 2018 increased wellness secondary to working. Recipients of peer support services experienced increased social networks and wellness. Conclusions and Implications for Practice: The findings highlight training, supervision, pay, nonpeer staff/peer staff relationships, as important factors for statutory mental health peer support programs. BELLAMY, C., SCHMUTTE, T., & DAVIDSON, L. (2017). AN UPDATE ON THE GROWING EVIDENCE BASE FOR PEER SUPPORT. MENTAL HEALTH AND SOCIAL INCLUSION, 21(3), 161-167. Purpose. As peer support services have become increasingly used in mental health settings as a recovery-oriented practice, so has the body of published research on this approach to care. The purpose of this paper is to provide an update on the current evidence base for peer support for adults with mental illness in two domains: mental health and recovery, and physical health and wellness. Design/methodology/approach.