Factors Enhancing Recovery

A randomized clinical trial of peer support services

E. Sally Rogers, Sc.D.
Project Director

Overview

Peer and mutual support programs have a long history in the treatment of substance use disorders and more recently have been developed by and for individuals with psychiatric disabilities. Results of nonrandomized studies suggest that participation in peer support results in decreased psychiatric symptoms and hospitalizations, larger social support networks, enhanced self-esteem and social functioning, and improved well-being. However, these conclusions are based largely on uncontrolled or demonstration studies of peer support.

Purpose

The purpose of this project was to overcome these lack of data and 1) to conduct a randomized clinical trial to examine the effectiveness of a peer support intervention with individuals who have psychiatric disabilities and are undergoing a short-term civil commitment, in terms of recovery and community integration, 2) to examine, from the point of view of the recipients, if and how peer support is helpful in promoting recovery and community functioning, 3) to examine the effects of the peer support intervention on mental health service utilization, and 4) to finalize manuals for training consumers to provide peer support.

Research Method and Major Findings

A total of 150 individuals were recruited between 2006 and 2010 from two psychiatric inpatient institutions located in southwest US. Peer support services evaluated through this study were provided by a local agency that specializes in delivering consumer-run programs. Inclusion criteria for this study included individuals who were civilly committed by the state to receive inpatient/outpatient psychiatric services who were also interested and eligible to receive peer support services at the agency. We compared two groups of individuals randomly assigned to receive either individual one-to-one peer support delivered by a specialist with a lived experience of a psychiatric disability, or services-as-usual offered by the agency. Participants were followed for 6 months. Outcomes measured included the following: 1) perceived social support, 2) symptoms, 3) recovery, and 4) quality of life.

Analysis with all participants who entered the study showed one significant differences between groups; individuals who received one-to-one peer support reported higher satisfaction with their quality of life in general. We also ran additional analysis using groups based on how much peer support individual’s received. Significant differences and trends were seen in individuals who received peer support in the areas of self-esteem, emotional functioning, overall functioning, better physical condition, and substance abuse. These results provided modest evidence of the effectiveness of individual peer support in improving some elements of recovery for individuals with psychiatric disabilities.


A study evaluating the effectiveness of a structured psycho-educational recovery intervention with English speaking and Latino samples

Marsha Langer Ellison, Ph.D.
Project Director

Overview

This project will test the efficacy of an intervention designed to foster and enhance the recovery of adults with psychiatric disabilities. The purpose of this project is to conduct research on factors that enhance recovery, including model interventions that are culturally competent. A psycho-educational approach, having recovery as its specific outcome, was designed at the Center for Psychiatric Rehabilitation over a decade ago with support from the NIDRR. While this Recovery Education Program (Spaniol, Koehler & Hutchinson, 1994) and related materials have been used and disseminated widely, it has yet to undergo a rigorous test to supply evidence as to its efficacy.

This project will undertake a randomized trial of this intervention at three rehabilitation and mental health sites using instruments that capture hypothesized components of recovery. In addition, the interventional manual has been modified to include relevant cultural values and to meet the diverse needs of Latinos. The Recovery Workbook was re-titled Recuperando La Esperanza (RLE) (Restrepo-Toro, Spaniol, Koehler, & Hutchinson, 1996) and has been piloted and tested. The cultural applicability, feasibility, and effectiveness of the RLE for individuals of Latino descent will be tested at two sites in Massachusetts.


A mixed methods study designed to reduce system fragmentation and promote health access and integration for persons with serious mental illness

E. Sally Rogers, Sc.D.
Project Director

Overview

Numerous studies exist that document the elevated rates of physical co-morbidities those individuals with serious mental illness experience and the effect of these co-morbidities on mortality and well-being. These conditions include an increased risk and incidence of diabetes, cardio-vascular diseases, chronic obstructive pulmonary disease, obesity, and tobacco related illnesses, among others. Ultimately, these medical conditions restrict the ability of individuals to attain full recovery and participation in their communities. Promoting access to primary care and integrating physical and mental health care for this population can reduce system fragmentation, promote continuity of care, increase the chances of receiving optimal primary health care, which in turn can reduce physical co-morbidities, early mortality, and increase opportunities for full recovery and community integration.

Purpose

The goals of this project were to: 1) demonstrate the effectiveness of an individualized health access and integration intervention for individuals with severe mental illness using a nurse practitioner (NP), 2) to document the intervention components and develop an intervention manual, 3) to examine the effectiveness of this intervention on perceived health, health care utilization, and quality of primary health care using standardized measures, and 4) to replicate the intervention with a racially and ethnically diverse population.

Research Method and Major Findings

Inclusion criteria for this study included adults with psychiatric disabilities who were eligible and receiving mental health care services at a behavioral healthcare provider in Massachusetts. After screening, we enrolled a total of 200 individuals. Recruitment and enrollment took place from 2006 to 2009 and participants were followed for a year. Participants were randomly assigned to receive the experimental intervention or an enhanced services-as-usual control condition. The experimental intervention (“NP” condition) was designed to improve preventative healthcare by the use of a nurse practitioner to deal with physical health comorbidities, monitor and facilitate use of primary medical care, interpret and communicate physical and health care issues and needs with relevant mental health care and health care providers. To test the effectiveness of the intervention, we measured the following:
1) individual’s health and functioning, 2) perceived health status, 3) health locus of control and beliefs, and 4) symptoms.

Analyses using the entire sample did not show any significant differences between the experimental and control groups. Further analysis was done using three groups created based on individuals’ level of engagement in the NP intervention those who did not receive the NP intervention, those who met with the NP 1-3 times, and those who met more than 4 times. Statistically significant differences and trends were seen in the experimental groups, as compared to controls, in improved access to/utilization of primary care, coordination of information around their primary care, perception of their primary care provider, and control over one’s health.