Another group of studies found that peer-delivered services produced some superior outcomes when compared to services offered solely by nonconsumer providers. Programs that utilized peer providers resulted in a reduction in the use of hospital and crisis services when compared to traditional programs (Clarke et al., 2000; Edmunson, Bedell, Archer & Gordon, 1982; Klein, Cnaan, & Whitecraft 1998). Clarke and colleagues (2000) compared an assertive community treatment (ACT) team that included peer providers with a traditional ACT team without peer providers and found that individuals served by the team with peer providers had both fewer hospitalizations and fewer instances of using crisis services. Klein and colleagues (1998) compared consumers who received both intensive case management and peer-provided social supports with a group who only received case management services. Like the Clarke et al. study (2000), the peer-enhanced group had fewer hospitalizations and used crisis services less frequently than the control group.
Another study compared the outcomes of persons recently discharged from hospitals and referred to traditional community health services to those who received these same services, but also received support from a peer provider (Edmunson et al., 1982). They found fewer hospitalizations among those receiving services enhanced by a peer provider. Dumont and Jones (2002) compared outcomes of consumers utilizing a peer-provided crisis intervention program to those of consumers utilizing traditional crisis intervention services. They found that the group served by peers had fewer days in the hospital and were more satisfied with the services they received than the control group.
In each of these studies (Clarke et al., 2000; Dumont & Jones, 2002; Edmunson et al., 1982), it was unclear whether the peer provider groups did better because they received services from peer providers, or because they received an enhanced form of case management that included additional services (Schmidt, 2005; Solomon & Draine, 2001).
Peer providers were more effective in achieving positive gains in terms of a number of quality-of-life measures including greater satisfaction with housing and financial situation, fewer life problems, and reduced substance abuse among the consumers served (Felton et al., 1995; Klein et al., 1998). Kaufman (1995) examined the outcomes of a peer partnership employment program and found that those assigned to the program achieved superior vocational outcomes when compared to recipients of traditional vocational rehabilitation services. Craig, Doherty, Jamieson-Craig, Boocock, and Attafua (2004) compared two assertive outreach teams that provided case management to a group of high-risk individuals. One of the teams employed peer providers. They found that the consumers who received peer-provided services were better engaged with the team, participated more actively in treatment programs, and had more success in terms of achieving goals identified on their treatment plans.
Between 1998 and 2003 a major, multisite study called the Consumer Operated Service Program Research Initiative (COSP) was funded by SAMHSA's Center for Mental Health Services. The goal of the COSP study was to compare the utilization of peer-operated services as an adjunct to traditional mental health services with the utilization of traditional mental health services alone. Eight peer-operated programs participated in the study and consumers were involved with every aspect of the research project including its design. The service recipient outcomes examined included housing, employment, social inclusion, well-being, and empowerment. As this book was going to press in 2006, the results of this study were still being analyzed. However, initial findings suggest that consumer-operated programs are cost effective and produce positive outcomes beyond traditional services, particularly in the area of well-being (Campbell, 2002; Clay, 2005).
One important benefit of conducting the COSP study was the analysis of common ingredients utilized by various types of consumer-operated programs. The sites in the COSP study included drop-in centers, peer mentoring programs, and education/advocacy programs. Despite the wide variety of program models, six domains of common ingredients were identified:
• Program structure emphasizing consumer control, participant responsiveness, and the capacity to link service recipients to other services
• An environment that is safe, accessible, informal, and provides reasonable accommodations
• A belief system emphasizing the benefits of mutual support, empowerment, choice, recovery, respect for diversity, and spiritual growth
• Formal and informal peer support strategies including opportunities to share personal stories and raise consciousness, as well as to provide crisis prevention, peer mentoring, and teaching
• Education focusing on self-management/problem solving, skills practice, and job readiness
• Advocacy (both self-advocacy and peer advocacy).
The identification of common ingredients led to the development of a fidelity instrument, which was named the COSP Fidelity Assessment Common Ingredients Tool or FACIT (Johnsen, Teague & McDonel Herr, 2005).
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