Developing Strategies to Integrate Peer Providers into the Staff of Mental Health Agencies

Gates, Lauren B.; Akabas, Sheila H.

doi:10.1007/s10488-006-0109-4

Cited by 195 publications

(228 citation statements)

References 46 publications

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“…74,75 In some cases, differential knowledge was devalued by a lack of understanding and acceptance of its validity by the wider staff team. However, differential knowledge worked well where it was acknowledged and valued by non-peer staff who worked alongside peer workers:…”

Section: Differential Knowledgementioning

confidence: 99%

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New ways of working in mental health services: a qualitative, comparative case study assessing and informing the emergence of new peer worker roles in mental health services in England

Gillard

Edwards

Gibson

et al. 2014

Health Services and Delivery Research

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BackgroundA variety of peer worker roles are being introduced into the mental health workforce in England, in a range of organisational contexts and service delivery settings. The evidence base demonstrating the effectiveness of peer worker-based interventions is inconclusive and largely from outside England. An emerging qualitative literature points to a range of benefits, as well as challenges to introducing the peer worker role.AimsIn this study we aimed to test the international evidence base, and what is known generally about role adoption in public services, in a range of mental health services in England. We also aimed to develop organisational learning supporting the introduction of peer worker roles, identifying learning that was generic across mental health services and that which was specific to organisational contexts or service delivery settings.TeamThe research was undertaken by a team that comprised researchers from a range of academic and clinical disciplines, service user researchers, a peer worker, and managers and service providers in the NHS and voluntary sector. Service user researchers undertook the majority of the data collection and analysis. We adopted a coproduction approach to research, integrating the range of perspectives in the team to shape the research process and interpret our findings.Study designThe study employed a qualitative, comparative case study design. We developed a framework, based on existing evidence and the experiential insight of the team, which conceptualised the challenges and facilitators of introducing peer worker roles into mental health services. The framework was used to inform data collection and to enable comparisons between different organisational contexts, service delivery settings and the perspectives of different stakeholders.SettingsThe study took place in 10 contrasting cases comprising mental health NHS trusts, voluntary sector service providers and partnerships between the NHS and voluntary sector or social care providers. Peer workers were employed in a variety of roles, paid and unpaid, in psychiatric inpatient settings, community mental health services and black and minority ethnic (BME)-specific services.ParticipantsParticipants were 89 people involved in services employing peer workers, recruited purposively in approximately equal proportion from the following stakeholder groups: service users; peer workers; (non-peer) coworkers; line managers; strategic managers; and commissioners.Data collectionAll participants completed an interview that comprised structured and open-ended questions. Structured questions addressed a number of domains identified in the existing evidence as barriers to, or facilitators of, peer worker role adoption. Open-ended questions elicited detailed data about participants’ views and experiences of peer worker roles.Data analysisStructured data were analysed using basic statistics to explore patterns in implementation across cases. Detailed data were analysed using a framework approach to produce a set of analytical categories. Patterns emerging in the structured analysis informed an in-depth interrogation of the detailed data set, using NVivo 9 qualitative software (QSR International Pty Ltd, Victoria, Australia) to compare data between organisational contexts, service delivery settings and stakeholder groups. Preliminary findings were refined through discussion with a range of stakeholders at feedback workshops.FindingsMany of the facilitators of peer worker role adoption identified in the existing evidence base were also evident in mental health services in England, although there were issues around pay, leadership, shared understanding of the role, training and management where good practice was uneven. A number of examples of good practice were evident in the voluntary sector, where peer worker roles had been established for longer and organisations were more flexible. In the NHS there were a range of challenges around introducing peer worker roles into existing structures and cultures of practice. Peer workers were able to engage people with services by building relationships based on shared lived experience – the language they used was particularly important in BME-specific services – but barriers to engagement could be created where roles were overformalised.ConclusionsKey barriers to, and facilitators of, peer worker role adoption were identified, including valuing the differential knowledge and practice that peer workers brought to the role (especially around maintaining personally, rather than professionally defined boundaries); maintaining peer identity in a role of work; changing organisational structures to support peer workers to remain well in their work; and challenging organisational cultures to empower peer workers to use their lived experience. Recommendations for future research include developing a theoretical framework articulating the change mechanisms underpinning ‘what peer workers do’, piloting and formally evaluating the effectiveness and cost-effectiveness of peer worker interventions, and mixed-method research to better understand the impact of working as a peer worker.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Differential Knowledgementioning

confidence: 99%

“…75 In a number of voluntary sector organisations, employing peer workers was at the centre of the organisational ethos. Equality between different staff in different roles was seen as a vital characteristic of a healthy, caring organisational culture:…”

Section: Peer Worker Roles and Organisational Changementioning

confidence: 99%

New ways of working in mental health services: a qualitative, comparative case study assessing and informing the emergence of new peer worker roles in mental health services in England

Gillard

Edwards

Gibson

et al. 2014

Health Services and Delivery Research

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“…There is qualitative evidence that suggests that the absence of a clear job description for peer workers creates challenges for team working (Kemp 2012). In a survey of managerial and human resources staff in agencies employing peer workers in the USA, role conflict and confusion, allied to poorly defined job structure, were identified as undermining role integration (Gates 2007). In addition, where new roles become a repository of unwanted tasks for the team, it has been noted how the role can become diluted (Bach 2000); for example, a peer worker might not have sufficient time to focus on core relational aspects of the role if generic support tasks take up the bulk of their time.…”

Section: Distinctiveness Of the Peer Worker Rolementioning

confidence: 99%

Peer workers in mental health services: literature overview

Gillard¹,

Holley²

2014

Adv. psychiatr. treat

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SummaryPeer worker roles are being introduced in mental health services in the UK and internationally, to support individuals in their recovery. There is substantial qualitative evidence that demonstrates benefits at an individual level and some evidence of impact on service use and costs, although there are currently few high-quality randomised controlled trials supporting these findings, especially from the UK. A growing body of research indicates that careful consideration of organisational issues regarding the introduction of peer worker roles – the distinctiveness and shared expectations of the role, strategic alignment, organisational support – might maximise their impact. Properly supported and valued peer workers are an important resource to the multidisciplinary team, offering experiential knowledge and the ability to engage patients in their treatment through building relationships of trust based on shared lived experience.LEARNING OBJECTIVESAppreciate the origins of the peer worker role and how the role has been introduced into mental health services to date.Understand the evidence for the benefits of peer worker roles, for patients, peer workers and mental health service delivery.Demonstrate awareness of the organisational and team-level barriers to and facilitators of introducing peer workers into, or alongside, existing multidisciplinary mental health teams.

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“…A utilization factor that is already well established is the importance of clear roles for peers specialists and HR policies that provide guidance for confidentiality and professional boundaries [7,16]. Creating a very specific and clear role for the peer specialist must be accomplished in the context of the team and their services.…”

Section: Discussionmentioning

confidence: 99%

“…The research exploring peer support services identifies these implementation challenges as pessimistic attitudes toward recovery among traditional staff, role conflict and confusion among peer providers, and concerns related to professionalism, i.e. confidentiality of client information and consumer/provider boundary issues [6][7][8]. These studies advise using implementation strategies that focus primarily on integrating peer specialists into the agency workforce.…”

Section: Introductionmentioning

confidence: 99%

Maximizing Utilization of Peer Specialists in Community Mental Health: The Next Step in Implementation

Davis

Pilgrim

2015

J. Psychosoc. Rehabil. Ment. Health

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The successful implementation of peer support services in community mental health centers requires the maximum utilization of peer specialists in order to meet the needs of the consumer, the agency and the peer specialist so that they receive the full benefits of their employment. This study identifies factors that positively and negatively impact the referral to and utilization of peer support services by traditional providers and strategies for achieving optimal utilization.

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Developing Strategies to Integrate Peer Providers into the Staff of Mental Health Agencies

Cited by 195 publications

References 46 publications

New ways of working in mental health services: a qualitative, comparative case study assessing and informing the emergence of new peer worker roles in mental health services in England

New ways of working in mental health services: a qualitative, comparative case study assessing and informing the emergence of new peer worker roles in mental health services in England

Peer workers in mental health services: literature overview

Maximizing Utilization of Peer Specialists in Community Mental Health: The Next Step in Implementation

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