Eight Areas That Peer Support and Peer Support Specialists Are Getting More Involved In

The role of “Peer Support Specialist” emerged out of the field of mental health, where clinicians, advocates and clients recognized the important need for a new voice in clinical settings – the voice of the person who has experienced mental illness and has made progress on their recovery.  Over the past 20 years, Peer Support Specialists have moved from a small group of vocal advocates for change, to a large group providing new professional services in a range of mental health settings.  The Veterans Health Administration has embraced Peer Support Specialists as much as any large healthcare organization, hiring more than 1000, and mandating them in every VA hospital.

Tracking the development of the field, it is not hard to see the rapid inclusion of Peer

Support Specialists into new areas of clinical care.  Some of the earliest Peer Support Specialists focused on serving adults with a serious mental illness.  They then moved into substance use treatment programs, vocational programs, outpatient and inpatient mental health programs.

Expansion within mental health is still moving ahead rapidly.  Specialty areas such as treatment programs for those who have been victims of intimate partner violence and those who have used violence have been embracing peer services. This is no surprise, as clinicians recognize the challenge of building trust/rapport and fighting the impact of stigma in these groups.  These challenges are present in additional groups, such as ex-offenders, LGBTQ adults, homeless adults, unemployed adults, people who have lost someone to suicide, and people who have attempted suicide.  These groups all have special challenges when it comes to stigma and rapport --- and so the addition of a Peer Support Specialist can be a game-changer.

The most recent trend is the movement of Peer Support Specialists into medical care and social service programs.  Primary care has been one area where peers have been active as part of integrated primary care/mental health teams.  Peers have also popped up in specialty medical programs including those for adults with diabetes, cancer, chronic pain, etc.  Many of the treatments for these illnesses involve healthy lifestyle practices – things that Peer Support Specialists can model and teach, and have a different type of credibility on.  At this point, it is not clear what clinical settings would not benefit from the addition of peer support. 

If you look at the research literature on peer support, you can see that many areas have embraced the value of peer support, and are now starting to look at whether Peer Support Specialists should be added to their teams.  Consider the following new areas:

A.     Suicide Prevention.  The U.S. Surgeon General’s national suicide prevention strategy (2012) and other guidelines have included recommendations that peer support be integrated into the care of individuals at high risk for suicide.  A recent review of research articles found 84 that examined peer support as a suicide prevention intervention (Bowersox, Jagusch, Garlick, Chen, & Pfeiffer, 2021).  For example, a recently developed suicide prevention intervention is provided exclusively by Peer Support Specialists (Pfeiffer, et al., 2019).

B.     Cancer/Oncology.  Peer support has been a valued element to care for cancer patients for some time (Hoey, Leropoli, White, & Jefford 2008).  A range of formats have been used including 1-1, group, and virtual support.  Outcome data are encouraging for those interventions that involve well trained peer support providers and structured support (Hu, et al., 2019).   There has not been well studied involvement of Peer Support Specialists in cancer care, but the interest in well trained peer support providers raises the likelihood that this will be a valuable new area for their involvement.

C.    Resettlement Programs for Refugees.  Peer Support has been increasingly used for working with refugees, with research evidence suggesting that it is very effective (Block et al., 2018; de Graaff et al., 2020).  Recently, Peer Support Specialists have been used to provide peer education and support, and specialized Peer Support Specialist interventions have been designed specifically for this group (Verbillis-Kolp, Guskovict, Hassan, & Cohen, 2023).

D.    Emergency Departments.  The use of Peer Support Specialists in mental health programs is now starting to expand into psychiatric care in emergency rooms.  Initial efforts to add Peer Support Specialists to these settings have been reviewed positively (Brasier et al., 2022; Heyland, Limp, & Johnstone, 2021) and are likely to grow.  This is not surprising, given the challenging experience of receiving care in an Emergency Room, and the demands on providers that can leave patients feelings anxious and confused.

E.     Parents.  The use of parent peer support groups for parents facing challenging situations, has been around for some time, and has been shown to be very helpful (Shilling et al., 2013). Some of these individual and group peer support resources were developed for parents with children with specific disabilities or receiving care in intensive care units (Hall, Ryan, Beatty, & Grubbs, 2015; Nieuwboer, Fukkink, & Hermanns, 2013).  Others were more broadly used for parents who simply need more support.  The use of Peer Support Specialists in this area has not been studied at this point but is likely to develop.

F.     Viral Infections:  HIV, COVID, etc.  Peer support has been used in a number of clinical programs for HIV+ populations, including both simple and more focused peer support by specially trained peers (Van Tam et al., 2012). A recent review found compelling evidence of a positive impact both on treatment compliance and health outcomes (Berg, Page, & Øgård-Repål, 2021).  COVID created situations naturally addressed by peer support interventions.  Some of these interventions used peer support to address the social isolation and mental health needs of the general population while others used peer support interventions to address the needs of people suffering lasting effects of COVID (Fortuna, et al., 2020; Hope et al., 2021). Similar work has been done with hepatitis (Stagg et al., 2019). Watch for the expansion of these programs to obtain the same benefits for groups of patients with other viruses or other infectious diseases.

G.    Groups of People Who Are at Special Risk – Rural Adults.  Rural adults tend to use medical care and mental healthcare less often, and when they do, it is less likely to be of high quality and to be evidence-based.  This has led to recommendations for improving healthcare for rural populations, including the strategy of using peer support as a means of enhancing treatment entry and participation.  Peer support interventions have been used with rural populations (Lauckner, H. M., & Hutchinson, S. L., 2016). Peer Support Specialists are working in rural areas (Cronise, Teixeira, Rogers, & Harrington, 2016).  Look for new Peer Support Specialist roles and interventions that are adapted to address to specific needs of access and support in rural populations.

H.    Sensory Problems – blindness, hearing impairment, etc.  Peer support has been found to be correlated with resilience among people with vision and hearing deficits (Lasanen, Määttä, & Uusiautti, 2019; Noviatun, Hermawan, & Supratiwi, 2022; Habibah, & Sucipto, 2020). It is difficult to find any evaluations of peer support specialist interventions with adults with sensory problems, but the relevance of peer support to the mental health needs of these populations has led some to call for specialty Peer Support Specialists trained to work with sensory impaired individuals (Gournaris, 2016).

REFERENCES

Berg, R. C., Page, S., & Øgård-Repål, A. (2021). The effectiveness of peer-support for people living with HIV: A systematic review and meta-analysis. PLoS One, 16(6), e0252623.

 Block, A. M., Aizenman, L., Saad, A., Harrison, S., Sloan, A., Vecchio, S., & Wilson, V. (2018). Peer support groups: Evaluating a culturally grounded, strengths-based approach for work with refugees. Advances in Social Work, 18(3), 930-948.

Bowersox, N. W., Jagusch, J., Garlick, J., Chen, J. I., & Pfeiffer, P. N. (2021). Peer‐based interventions targeting suicide prevention: A scoping review. American journal of community psychology, 68(1-2), 232-248.

Brasier, C., Roennfeldt, H., Hamilton, B., Martel, A., Hill, N., Stratford, A., ... & Brophy, L. (2022). Peer support work for people experiencing mental distress attending the emergency department: Exploring the potential. Emergency Medicine Australasia, 34(1), 78-84.

Cronise, R., Teixeira, C., Rogers, E. S., & Harrington, S. (2016). The peer support workforce: Results of a national survey. Psychiatric Rehabilitation Journal, 39(3), 211.

de Graaff, A. M., Cuijpers, P., McDaid, D., Park, A., Woodward, A., Bryant, R. A., ... & Sijbrandij, M. (2020). Peer-provided Problem Management Plus (PM+) for adult Syrian refugees: a pilot randomised controlled trial on effectiveness and cost-effectiveness. Epidemiology and Psychiatric Sciences, 29, e162.

Fortuna, K. L., Myers, A. L., Walsh, D., Walker, R., Mois, G., & Brooks, J. M. (2020). Strategies to increase peer support specialists’ capacity to use digital technology in the era of COVID-19: Pre-post study. JMIR mental health, 7(7), e20429.

Gournaris, M. J. (2016). Certified peer support specialists: Advancing peer support services in deaf mental health care. JADARA, 50(1), 1.

Habibah, U., & Sucipto, A. (2020). Building peer social support as a mental disorder solution for the blind. Journal of Advanced Guidance and Counseling, 1(1), 68-81.

Hall, S. L., Ryan, D. J., Beatty, J., & Grubbs, L. (2015). Recommendations for peer-to-peer support for NICU parents. Journal of Perinatology, 35(1), S9-S13.

Heyland, M., Limp, M., & Johnstone, P. (2021). Utilization of Peer Support Specialists as a Model of Emergency Psychiatric Care. Journal of Psychosocial Nursing and Mental Health Services, 59(5), 33-37.

Hoey, L. M., Ieropoli, S. C., White, V. M., & Jefford, M. (2008). Systematic review of peer-support programs for people with cancer. Patient education and counseling, 70(3), 315-337.

Hope, A. A., Johnson, A., McPeake, J., Felt, H., Sevin, C. M., Mikkelsen, M. E., ... & Williams, C. (2021). Establishing a peer support program for survivors of COVID-19: a report from the critical and acute illness recovery organization. American Journal of Critical Care, 30(2), 150-154.

Hu, J., Wang, X., Guo, S., Chen, F., Wu, Y. Y., Ji, F. J., & Fang, X. (2019). Peer support interventions for breast cancer patients: a systematic review. Breast cancer research and treatment, 174, 325-341.

Lasanen, M., Määttä, K., & Uusiautti, S. (2019). ‘I am not alone’–an ethnographic research on the peer support among northern-Finnish children with hearing loss. Early child development and care, 189(7), 1203-1218.

Lauckner, H. M., & Hutchinson, S. L. (2016). Peer support for people with chronic conditions in rural areas: a scoping review. Rural and remote health, 16(1), 1-14.

Nieuwboer, C. C., Fukkink, R. G., & Hermanns, J. M. (2013). Peer and professional parenting support on the Internet: a systematic review. Cyberpsychology, behavior, and social networking, 16(7), 518-528.

Noviatun, A., Hermawan, H., & Supratiwi, M. (2022). The Relationship between Peer Social Support with The Resilience of Blind Adolescents in Surakarta. Journal of ICSAR, 6(1), 78-82.

Office of the Surgeon General and National Action Alliance for Suicide Prevention, 2012).

Pfeiffer, P. N., King, C., Ilgen, M., Ganoczy, D., Clive, R., Garlick, J., ... & Valenstein, M. (2019). Development and pilot study of a suicide prevention intervention delivered by peer support specialists. Psychological services, 16(3), 360.

Shilling, V., Morris, C., Thompson‐Coon, J., Ukoumunne, O., Rogers, M., & Logan, S. (2013). Peer support for parents of children with chronic disabling conditions: a systematic review of quantitative and qualitative studies. Developmental medicine & child neurology, 55(7), 602-609.

Stagg, H. R., Surey, J., Francis, M., MacLellan, J., Foster, G. R., Charlett, A., & Abubakar, I. (2019). Improving engagement with healthcare in hepatitis C: a randomised controlled trial of a peer support intervention. BMC medicine, 17, 1-9.

Van Tam, V., Larsson, M., Pharris, A., Diedrichs, B., Nguyen, H. P., Nguyen, C. T. K., ... & Thorson, A. (2012). Peer support and improved quality of life among persons living with HIV on antiretroviral treatment: a randomised controlled trial from north-eastern Vietnam. Health and quality of life outcomes, 10, 1-13.

Verbillis-Kolp, S., Guskovict, K., Hassan, M., & Cohen, S. (2023). A Refugee and Immigrant Peer Support Program in the United States

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