This article examines a special peersocial support program, which provides support to high-risk dually diagnosed chents. A pilot study of 10 randomly selected clients in the study group, and 51 in the comparison group, who had been in community care 1 year prior to this investigation was carried out. Service was provided for a 6-month period Findings suggest that coupling peer social support with intensive case management is associated with positive system outcomes. The number of crisis events of the comparison group far exceeded that of the study group. The number of hospitalizations was dramatically lower for the study group. Chents in the study group reported improved quality of life and perceived their physical and emotional well-being as improved over the course of the study. This pilot study indicates that peer support has a potential of improving system and clients' outcome; however, further replication is required.

High-risk clients present a major challenge to the service system and to direct practice. The literature, however, provides us with technologies that are less than effective in working with high-risk clients. Understanding the subjective reality of high-risk clients, advocating for them, and forming a bond with them may enhance practice with this special population. A successful practice model should be based on a combined approach of advocacy/empowerment and primary relationship. Two case studies are provided to illustrate this approach.