Advertisement

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

      Context

      Peer providers with lived experiences of mental health and substance use are a growing component of the workforce responsible for the prevention and treatment of behavioral health disorders. This systematic literature review aims to better define the roles of peers and their unique contributions to behavioral health care.

      Evidence acquisition

      Researchers searched MEDLINE, CINAHL Complete, PsycINFO, Cochrane Central, and Scopus databases for studies published between January 1, 2013 and April 3, 2020. Studies were included if they (1) were experimental or observational studies, (2) included an adult population of people with a behavioral health disorder, and (3) used paid peer providers in addition to traditional behavioral health services. Researchers extracted sample demographics, intervention characteristics, outcome data, and significant associations from studies that met inclusion criteria and assessed the trends in these data in May 2020.

      Evidence synthesis

      A total of 23 articles assessing peer-provided services were included. Peers were employed most frequently in mental healthcare roles in the Department of Veterans Affairs, hospital, and community health facilities. A total of 14 studies observed significant clinical improvements in participants’ social functioning, quality of life, patient activation, and behavioral health. A majority of studies involved the supervision of peers and required peers to have completed training in service delivery.

      Conclusions

      Peers are effective providers of behavioral health treatment and relapse prevention services who encourage recovery through resilience building, empowerment, and self-advocacy. There remains a need for more evidence-based interventions on the efficacy of peers in substance use disorder treatment and the impact of formalized certification and training opportunities.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Health Resources and Services Administration, National Center for Health Workforce Policy Analysis, Substance Abuse and Mental Health Services Administration, Office of Policy, Planning, and Innovation
        National projections of supply and demand for selected behavioral health practitioners: 2013-2025.
        Health Resources and Services Administration, National Center for Health Workforce Policy Analysis, Substance Abuse and Mental Health Services Administration, Office of Policy, Planning, and Innovation, Rockville, MDNovember 2016 (Accessed July 15, 2020)
        • Reif S
        • Braude L
        • Lyman DR
        • et al.
        Peer recovery support for individuals with substance use disorders: assessing the evidence.
        Psychiatr Serv. 2014; 65: 853-861https://doi.org/10.1176/appi.ps.201400047
        • Waye KM
        • Goyer J
        • Dettor D
        • et al.
        Implementing peer recovery services for overdose prevention in Rhode Island: an examination of two outreach-based approaches.
        Addict Behav. 2019; 89: 85-91https://doi.org/10.1016/j.addbeh.2018.09.027
        • Peers
        Substance Abuse and Mental Health Services Administration.
        April 16, 2020 (Updated)
        • Jack HE
        • Oller D
        • Kelly J
        • Magidson JF
        • Wakeman SE.
        Addressing substance use disorder in primary care: the role, integration, and impact of recovery coaches.
        Subst Abus. 2018; 39: 307-314https://doi.org/10.1080/08897077.2017.1389802
        • Chinman M
        • George P
        • Dougherty RH
        • et al.
        Peer support services for individuals with serious mental illnesses: assessing the evidence.
        Psychiatr Serv. 2014; 65: 429-441https://doi.org/10.1176/appi.ps.201300244
        • Kaufman L
        • Brooks W
        • Bellinger J
        • Steinley-Bumgarner M
        • Stevens-Manser S.
        Peer specialist training and certification programs: a national overview –2014 update.
        Texas Institute for Excellence in Mental Health, School of Social Work, University of Texas at Austin, Austin, TX2014 (Accessed July 15, 2020)
        • Chapman SA
        • Blash LK
        • Mayer K
        • Spetz J.
        Emerging roles for peer providers in mental health and substance use disorders.
        Am J Prev Med. 2018; 54: S267-S274https://doi.org/10.1016/j.amepre.2018.02.019
        • Moskowitz D
        • Thom DH
        • Hessler D
        • Ghorob A
        • Bodenheimer T.
        Peer coaching to improve diabetes self-management: which patients benefit most?.
        J Gen Intern Med. 2013; 28: 938-942https://doi.org/10.1007/s11606-013-2367-7
        • Siantz E
        • Rice E
        • Henwood B
        • Palinkas L.
        Where do peer providers fit into newly integrated mental health and primary care teams? A mixed method study.
        Adm Policy Ment Health. 2018; 45: 538-549https://doi.org/10.1007/s10488-017-0843-9
        • Salzer MS
        • Darr N
        • Calhoun G
        • et al.
        Benefits of working as a certified peer specialist: results from a statewide survey.
        Psychiatr Rehabil J. 2013; 36: 219-221https://doi.org/10.1037/prj0000016
        • Davidson L
        • Bellamy C
        • Guy K
        • Miller R.
        Peer support among persons with severe mental illnesses: a review of evidence and experience.
        World Psychiatry. 2012; 11: 123-128https://doi.org/10.1016/j.wpsyc.2012.05.009
        • University of Michigan Behavioral Health Workforce Research Center
        Scopes of practice and reimbursement patterns of addiction counselors, community health workers, and peer recovery specialists in the behavioral health workforce.
        University of Michigan Behavioral Health Workforce Research Center, Ann Arbor, MISeptember 2018 (Published)
        • Siantz E
        • Henwood B
        • Baezcondi-Garbanati L.
        From physical wellness to cultural brokering: unpacking the roles of peer providers in integrated health care settings.
        Commun Ment Health J. 2018; 54: 1127-1135https://doi.org/10.1007/s10597-018-0320-2
      1. Effective Public Health Practice Project: quality assessment tool for quantitative studies. McMaster University School of Nursing. https://merst.ca/ephpp. Updated 2010. Accessed July 15, 2020.

        • Armijo-Olivo S
        • Stiles CR
        • Hagen NA
        • Biondo PD
        • Cummings GG.
        Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research.
        J Eval Clin Pract. 2012; 18: 12-18https://doi.org/10.1111/j.1365-2753.2010.01516.x
        • Druss BG
        • Singh M
        • von Esenwein SA
        • et al.
        Peer-led self-management of general medical conditions for patients with serious mental illnesses: a randomized trial.
        Psychiatr Serv. 2018; 69: 529-535https://doi.org/10.1176/appi.ps.201700352
        • Rogers ES
        • Maru M
        • Johnson G
        • Cohee J
        • Hinkel J
        • Hashemi L.
        A randomized trial of individual peer support for adults with psychiatric disabilities undergoing civil commitment.
        Psychiatr Rehabil J. 2016; 39: 248-255https://doi.org/10.1037/prj0000208
        • Ellison ML
        • Schutt RK
        • Yuan LH
        • et al.
        Impact of peer specialist services on residential stability and behavioral health status among formerly homeless veterans with cooccurring mental health and substance use conditions.
        Med Care. 2020; 58: 307-313https://doi.org/10.1097/MLR.0000000000001284
        • Kelly E
        • Duan L
        • Cohen H
        • Kiger H
        • Pancake L
        • Brekke J.
        Integrating behavioral healthcare for individuals with serious mental illness: a randomized controlled trial of a peer health navigator intervention.
        Schizophr Res. 2017; 182: 135-141https://doi.org/10.1016/j.schres.2016.10.031
        • Corrigan P
        • Sheehan L
        • Morris S
        • et al.
        The impact of a peer navigator program in addressing the health needs of Latinos with serious mental illness.
        Psychiatr Serv. 2018; 69: 456-461https://doi.org/10.1176/appi.ps.201700241
        • Pfeiffer PN
        • Pope B
        • Houck M
        • et al.
        Effectiveness of peer-supported computer-based CBT for depression among veterans in primary care.
        Psychiatr Serv. 2020; 71: 256-262https://doi.org/10.1176/appi.ps.201900283
        • O'Connell MJ
        • Flanagan EH
        • Delphin-Rittmon ME
        • Davidson L.
        Enhancing outcomes for persons with co-occurring disorders through skills training and peer recovery support.
        J Ment Health. 2020; 29: 6-11https://doi.org/10.1080/09638237.2017. 1294733
        • Ludman EJ
        • Simon GE
        • Grothaus LC
        • Richards JE
        • Whiteside U
        • Stewart C.
        Organized self-management support services for chronic depressive symptoms: a randomized controlled trial.
        Psychiatr Serv. 2016; 67: 29-36https://doi.org/10.1176/appi.ps.201400295
        • Nelson CB
        • Lusk R
        • Cawood C
        • Boore L
        • Ranganathan A
        • Lyubkin M.
        Predictors of CBT-pretreatment intervention engagement and completion: evidence for peer support.
        Psychol Serv. 2019; 16: 381-387https://doi.org/10.1037/ser0000268
        • Chinman M
        • McCarthy S
        • Bachrach RL
        • Mitchell-Miland C
        • Schutt RK
        • Ellison M.
        Investigating the degree of reliable change among persons assigned to receive mental health peer specialist services.
        Psychiatr Serv. 2018; 69: 1238-1244https://doi.org/10.1176/appi.ps.201800118
        • Croft B
        • İsvan N.
        Impact of the 2nd story peer respite program on use of inpatient and emergency services.
        Psychiatr Serv. 2015; 66: 632-637https://doi.org/10.1176/appi.ps.201400266
        • Chinman M
        • Oberman RS
        • Hanusa BH
        • et al.
        A cluster randomized trial of adding peer specialists to intensive case management teams in the Veterans Health Administration [published correction appears in J Behav Health Serv Res. 2015;42(1):122].
        J Behav Health Serv Res. 2015; 42: 109-121https://doi.org/10.1007/s11414-013-9343-1
        • Crisanti AS
        • Murray-Krezan C
        • Reno J
        • Killough C.
        Effectiveness of peer-delivered trauma treatment in a rural community: a randomized non-inferiority trial.
        Community Ment Health J. 2019; 55: 1125-1134https://doi.org/10.1007/s10597-019-00443-3
        • Samuels EA
        • Bernstein SL
        • Marshall BDL
        • Krieger M
        • Baird J
        • Mello MJ.
        Peer navigation and take-home naloxone for opioid overdose emergency department patients: preliminary patient outcomes [published correction appears in J Subst Abuse Treat. 2019;99:8].
        J Subst Abuse Treat. 2018; 94: 29-34https://doi.org/10.1016/j.jsat.2018.07.013
        • Pfeiffer PN
        • King C
        • Ilgen M
        • et al.
        Development and pilot study of a suicide prevention intervention delivered by peer support specialists.
        Psychol Serv. 2019; 16: 360-371https://doi.org/10.1037/ser0000257
        • O'Connell MJ
        • Sledge WH
        • Staeheli M
        • et al.
        Outcomes of a peer mentor intervention for persons with recurrent psychiatric hospitalization.
        Psychiatr Serv. 2018; 69: 760-767https://doi.org/10.1176/appi.ps.201600478
        • Pfeiffer PN
        • Valenstein M
        • Ganoczy D
        • Henry J
        • Dobscha SK
        • Piette JD.
        Pilot study of enhanced social support with automated telephone monitoring after psychiatric hospitalization for depression.
        Soc Psychiatry Psychiatr Epidemiol. 2017; 52: 183-191https://doi.org/10.1007/s00127-016-1288-2
        • Samuels EA
        • Baird J
        • Yang ES
        • Mello MJ.
        Adoption and utilization of an emergency department naloxone distribution and peer recovery coach consultation program.
        Acad Emerg Med. 2019; 26: 160-173https://doi.org/10.1111/acem.13545
        • Castellanos D
        • Capo M
        • Valderrama D
        • Jean-Francois M
        • Luna A.
        Relationship of peer specialists to mental health outcomes in South Florida.
        Int J Ment Health Syst. 2018; 12: 59https://doi.org/10.1186/s13033-018-0239-6
        • Landers G
        • Zhou M.
        The impact of Medicaid peer support utilization on cost.
        Medicare Medicaid Res Rev. 2014; 4 (mmrr.004.01.a04)https://doi.org/10.5600/mmrr.004.01.a04
        • Salzer MS
        • Rogers J
        • Salandra N
        • et al.
        Effectiveness of peer-delivered center for independent living supports for individuals with psychiatric disabilities: a randomized, controlled trial.
        Psychiatr Rehabil J. 2016; 39: 239-247https://doi.org/10.1037/prj0000220
        • Nyamathi A
        • Salem BE
        • Farabee D
        • et al.
        Impact of an intervention for recently released homeless offenders on self-reported re-arrest at 6 and 12 months.
        J Addict Dis. 2017; 36: 60-71https://doi.org/10.1080/10550887.2016.1147796
        • Bouchery EE
        • Barna M
        • Babalola E
        • et al.
        The effectiveness of a peer-staffed crisis respite program as an alternative to hospitalization.
        Psychiatr Serv. 2018; 69: 1069-1074https://doi.org/10.1176/appi.ps.201700451