University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Theses, Dissertations, and Student Research: Department of Psychology Psychology, Department of 10-2013 Peer Support for Consumers with Psychosis Elizabeth Ann Cook University of Nebraska-Lincoln, [email protected] Follow this and additional works at: https://digitalcommons.unl.edu/psychdiss Part of the Clinical Psychology Commons Cook, Elizabeth Ann, "Peer Support for Consumers with Psychosis" (2013). Theses, Dissertations, and Student Research: Department of Psychology. 62. https://digitalcommons.unl.edu/psychdiss/62 This Article is brought to you for free and open access by the Psychology, Department of at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Theses, Dissertations, and Student Research: Department of Psychology by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. PEER SUPPORT FOR CONSUMERS WITH PSYCHOSIS by Elizabeth A. Cook A DISSERTATION Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy Major: Psychology Under the Supervision of Professor William D. Spaulding Lincoln, Nebraska October, 2013 PEER SUPPORT FOR CONSUMERS WITH PSYCHOSIS Elizabeth Ann Cook, Ph.D. University of Nebraska, 2014 Adviser: William D. Spaulding The purposes of this project were: 1) to collaboratively adapt an existing cognitive-behavioral intervention for consumers with serious mental illness (SMI) so that it could be provided by peers, and 2) to evaluate the feasibility of the resulting group intervention and perform a preliminary analysis of its effectiveness. Focus groups consisting of 7 consumers with SMI and 9 peer providers assisted in the determination of group content and structure. Results from the focus groups suggested significant overlap between topics covered and educational strategies utilized in traditional psychosocial interventions and preferences for the peer-based group. However, participants expressed a preference for support strategies and nuances in language that differentiated the group from more traditional interventions. Consumers and peer providers also offered helpful suggestions about how to keep individuals engaged in the group, how to address complicated decisions such as when to breach confidentiality, and how to select peer providers to lead the group. After assembling a treatment manual based on group feedback, we conducted a feasibility study with 17 consumers and 3 peer providers during which we monitored fidelity, repeatedly assessed functional outcomes, and collected data related to treatment engagement, personal reactions to the treatment, and adverse events. Results from the feasibility study demonstrated that peer providers did not attain acceptable fidelity ratings, but this was more likely an artifact of the fidelity measure than a reflection of provider ability. With respect to outcomes, the study demonstrated that consumers experienced an improvement in some domains of psychiatric symptoms and social functioning, but did not experience a change in stigma beliefs. Contrary to our expectation, there was no observed relationship between stigma beliefs and treatment engagement. Finally, consumers and peer providers provided positive ratings of the intervention, and few adverse events were reported during the study period. This study is significant in that it represents a key step toward the integration of the mental health professional and consumer communities for the betterment of those affected by SMI. iv DEDICATION To my parents, who instilled in me the value of education and supported me throughout all of my academic pursuits. v ACKNOWLEDGEMENTS It is difficult to put into words how thankful I am for the many individuals who contributed to this project, and who facilitated my growth as a researcher, scholar, and clinician along the way. First and foremost, I acknowledge and thank the participants of this research. Their contributions represent much more than simply data points; their feedback has forever changed the way I think about research, about the language that I use with my clients, and about the experience of recovery. I also greatly benefited from the perspectives of the Serious Mental Illness Research Group at the University of Nebraska-Lincoln. In particular, I acknowledge J. Rock Johnson, who encouraged me, connected me to resources, and enhanced the project through her insight and creativity. I also recognize Jesse Hochheiser, who assisted with fidelity monitoring associated with this project. The project would not have been possible without the collaboration and support of the Mental Health Association of Nebraska. Thank you to Kasey Moyer, whose excellent work inspired this whole project. Thank you to the staff at Keya House and at the Region V building for being so accommodating to me and the participants of this research. Thank you to Lesa Hoffman, who clarified the formerly nebulous world of multilevel modeling, and who provided statistical consultation on this project. Last, but far from least, I express my most sincere gratitude to Will Spaulding. Without his example, his wisdom, and his belief in my potential, I would not be where I am today. It has been an honor and a privilege to be the student of someone who has inspired so many. vi GRANT INFORMATION This project was funded in part by a grant from the RAC/Warden Committee of the Department of Psychology at the University of Nebraska-Lincoln. It was also partially funded by a grant from the Behavioral Health Education Center of Nebraska, in affiliation with the University of Nebraska Medical Center. vii TABLE OF CONTENTS CHAPTER 1: INTRODUCTION ........................................................................................1 CHAPTER 2: COGNITIVE BEHAVIORAL THERAPY FOR PSYCHOSIS (CBTp) ....3 Review of the Empirical Literature ..................................................................................3 Challenges with the Delivery of CBTp ............................................................................6 CHAPTER 3: PEER PROVIDED SERVICES .................................................................14 Definition and Rationale ................................................................................................14 History and Theoretical Foundations ............................................................................15 Review of the Empirical Literature ................................................................................19 Challenges with Peer Provided Services ........................................................................22 CHAPTER 4: THE PRESENT STUDY ............................................................................24 Study 1 ............................................................................................................................24 Study 2 ............................................................................................................................26 CHAPTER 5: METHOD ...................................................................................................28 Study 1 ............................................................................................................................28 Study 2 ............................................................................................................................35 CHAPTER 6: RESULTS ...................................................................................................48 Study 1 ...........................................................................................................................48 Study 2 ...........................................................................................................................58 CHAPTER 7: DISCUSSION ...........................................................................................169 Results Summary ..........................................................................................................169 Limitations ....................................................................................................................175 Conclusions ....................................................................................................................177 REFERENCES ................................................................................................................179 FOOTNOTES ..................................................................................................................194 APPENDIX ......................................................................................................................195 viii LIST OF MULTIMEDIA OBJECTS Table 5.1 Demographic Characteristics of Consumers and Peer Providers (Study 1) ...................................................................................30 Table 5.2 Demographic Characteristics of Consumers and Peer Providers (Study 2) ...................................................................................36 Figure 6.1 Participants’ Votes for Topics ...................................................................49 Figure 6.2 Participants’ Votes for Educational Strategies ..........................................52 Figure 6.3 Participants’ Votes for Support Strategies .................................................53 Table 6.1 Means (Standard Deviations) of Outcome Variables by Time Point .............................................................................................60