Effectiveness of Peer-Delivered Trauma Treatment in a Rural Community: A Randomized Non-inferiority Trial

Abstract

This randomized controlled non-inferiority trial explored the effectiveness of Seeking Safety (SS) delivered by peer providers compared to its delivery by licensed behavioral health clinicians. The study enrolled 291 adults with PTSD and/or substance use disorders. Data were collected at 3 and 6-months post start of treatment. With respect to long-term outcomes, at 6 months PTSD symptoms decreased by 5.1 points [95% CI (− 9.0, − 1.1)] and by 4.9 points [95% CI (− 8.6, − 1.1)] and coping skills increased by 5.5 points [95% CI (0.4, 10.6)] and by 5.6 points [95% CI (0.8, 10.4)], in the peer- and clinician-led groups, respectively. This study demonstrated non-inferiority of peer-delivered SS compared to clinician-delivered SS for reducing PTSD symptoms and similar outcomes for both groups with respect to coping skills. A confirmatory study on the effectiveness of peer-delivered trauma-specific services is warranted, especially given the potential for increasing access to such treatment in underserved rural communities.Electronic supplementary materialThe online version of this article (10.1007/s10597-019-00443-3) contains supplementary material, which is available to authorized users.

A Systematic Review of the Roles and Contributions of Peer Providers in the Behavioral Health Workforce

“…17−30 Study participants comprised a majority sample of White (15 studies) 18,22,24−36 male individuals (15 studies), 19,22,23,25 −30,33−35,37−39 with a mean age of 45 years (age range = 30.6−55.3 years) who were single, divorced, or never married (6 studies). 19,23,28,31,37,38 Nonspecified serious mental illness (12 studies), [17][18][19][20][21]23,27,28,31,32,35,36 depression (11 studies), 17,[20][21][22]24,[31][32][33]35,37,39 schizophrenia/ schizoaffective disorder (11 studies), 17,20,21,23,27, 31,32,35 −37,39 and SUD (11 studies) 18,19,23,[25][26][27][29][30][31]34,38 were the most prevalent behavioral health conditions experienced by the study participants. Other frequently observed behavioral health conditions were bipolar disorder (8 studies) 17,20,…”

“…21,24,25,31,35 In addition, 11 studies focused on populations previously having received or currently receiving inpatient care or hospitalization for a mental health or SUD, 18,23,27,28,[31][32][33]35,36,38,39 and 6 focused on individuals previously having or currently experiencing homelessness. 19,26,27,29,37,38 A majority ( 16) of studies included participants receiving usual care as a control. [17][18][19][20][21][22][23][24]26,28,[30][31][32]35,37,38 Within the context of this review, usual care refers to a continuation of nonpeer-provided medical or behavioral health services received before study enrollment that includes outpatient psychotherapy, rehabilitation services, and case management.…”

“…[17][18][19][20][21][22][23][24]26,28,[30][31][32]35,37,38 Within the context of this review, usual care refers to a continuation of nonpeer-provided medical or behavioral health services received before study enrollment that includes outpatient psychotherapy, rehabilitation services, and case management. 17,20,37 A total of 5 studies used program services delivered by an individual other than a peer provider as a control, including behavioral health providers and personal associates of participants, 21,25,29,33,34 and 3 studies used matching models to identify a control group through retrospective data. 27,36,39 Appendix Table 2 (available online) contains an overview of the instruments utilized in the included studies.…”

“…18,19,26,28 Data collection periods ranged from 3 to 87 months, with an average of 29.8 months (2.5 years). The majority (11 studies) reported data collection having occurred at 3 timepoints, 17,19,20,22,23,29,31,32,34,37,38 with measurements most commonly occurring at baseline, at 3 months, and at 6 months after intervention. A total of 21 studies provided sources for covariate data, with the most frequently referenced data sources being self-reported information provided at study baseline (14 studies), [17][18][19][20][21][22][23][24]26,28,[31][32][33]38 medical records (10 studies), 19,22,25,28,[30][31][32][33][34]39 and county-derived or regional network demographic and service use data (3 studies).…”

“…A majority of studies ( 16) required peer providers to have completed training in service delivery. 17,18,20,22,24,27 −34,37−39 A total of 8 studies utilized certified peer providers, 17,22,24,29,31,33,36,37 5 of which used state-certified peers. 17,22,29,31,33 Certification courses ranged in duration from 1 day to 1 month, with some studies requiring peers to have attended up to 75 hours of training.…”