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Peer wellness coaching is workforce innovation that empowers individuals with mental and substance use disorders to achieve recovery. This article briefly describes how this approach can help peer providers develop self-care skills to improve job tenure and promote satisfaction. Promising results of this new approach are presented. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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George H. Brice, Jr., MSW; Margaret A. Swarbrick, PhD, OT, FAOTA; and Kenneth J. Gill, PhD, CPRP
Peer wellness coaching is workforce in-
novation that empowers individuals
with mental and substance use disorders
to achieve recovery. This article briey
describes how this approach can help
peer providers develop self-care skills
to improve job tenure and promote sat-
isfaction. Promising results of this new
approach are presented. [Journal of Psy-
chosocial Nursing and Mental Health Ser-
vices, 52(1), 41-45.]
Health and wellness coaching has rapidly become a best practice ele-
ment of worksite health promotion programs. Coaching as a process
is a well-established set of techniques, but its use in the field of men-
tal health promotion among individuals with serious mental illness (SMI) is
relatively new (Chapman, Lesch, & Baun, 2007). Swarbrick, Spagnolo, Zech-
ner, Murphy, and Gill (2011) describe peer wellness coaching as the specific de-
livery of wellness coaching services by trained practitioners living with mental
disorders to their peers living with the same conditions. This emerging prac-
tice is based on the wellness model that has been developed for management
of physical comorbidities.
A key task of the wellness coach is to help the individual served explore
the eight dimensions of wellness, including emotional, social, spiritual, in-
tellectual, environmental, financial, occupational, and physical domains of
one’s life so that the individual can better understand his or her experienc-
© 2013
Journal of Psychosocial nursing • Vol. 52, no. 1, 2014
es, motives, and needs (Swarbrick,
1997, 2006). There is a specific focus
on the relevant physical wellness,
as certain areas may represent chal-
lenges such as low levels of physical
activity/sedentary lifestyle, access to
medical screenings and management
of medical condition(s), oral hygiene
and dental health practices, sleep and
rest, and reduction/elimination of
tobacco use and other addictive sub-
stances. Peers assist others in devel-
oping health-related goals and main-
taining a healthy lifestyle (Swarbrick
et al., 2011). They are trained to
promote health and wellness (in
the eight dimensions) through ap-
proaches based on empowerment,
self-direction, and mutual relation-
ships. With these methods, coaches
intervene in helping the individual
modify risk factors (e.g., diet, stress),
promote relaxation, and support bet-
ter access to primary care. Swarbrick
et al. (2011) concluded that “well-
ness coaching seems an ideal role for
peers in recovery that has potential
to address health and wellness issues
facing persons living with mental ill-
nesses who are at high risk of comor-
bid medical conditions” (p. 328).
Through education, support, and
coaching, a peer wellness coach offers
vehicles for building self-skills and
confidence. Coaching is a positive
supportive relationship. A coach op-
erates collaboratively, helping guide
the individual toward successful
and long-lasting behavioral change.
They promote self-management, so
that the individual served becomes
active in the process of health and
wellness improvement. The wellness
coach then generally helps the peer
focus on physical wellness domains
that contribute to overall balance
and health. This promotes recovery
as defined by the U.S. Substance
Abuse and Mental Health Services
Administration (2011): “A process
of change through which individuals
improve their health and wellness,
live a self-directed life, and strive to
reach their full potential” (para. 3).
Four dimensions considered founda-
tions for recovery include home, com-
munity, purpose, and health, which
focus on overcoming or managing
disease(s) as well as living in a physi-
cally and emotionally healthy way.
The peer wellness coach certifi-
cate program was designed to pre-
pare the workforce to address health
and wellness needs from a self-
management perspective. Individu-
als in recovery enroll in a rigorous,
90-hour, academic training program
earning six semester credits. The stu-
dents learn about the role and skills
of coaching, as distinguished from
counseling or advice giving. In the
class, they practice helping coaching
participants set and achieve wellness
and/or health-related goals by offer-
ing support, encouragement, and ask-
ing open-ended questions to identify
what is most helpful for the individ-
ual to promote his or her own health
and wellness. The coaching students
learn to ask facilitative questions to
(a) help individuals gain insight into
their personal situations and (b) find
solutions for health problems and
concerns individuals are facing. In
addition, they learn about the fac-
tors that will motivate individuals
to achieve their wellness goals, the
contribution of lifestyle factors for
health and wellness, metabolic syn-
drome, smoking cessation, nutrition,
exercise, oral health, and medication
side effects. The training program
includes a practical examination in
coaching skills or practicum experi-
ence. This training program has been
jointly offered by Rutgers School of
Health Related Professions and Col-
laborative Support Programs of New
Jersey Wellness Institute. Its start-up
was funded by a series of Transforma-
tion Transfer Initiative grants and
has now become a regular university
Individual wellness coaching sup-
port services were made available
for 26 peer providers (peer providers
working in a variety of community-
based services) with health and well-
ness concerns. The purpose was to
offer wellness coaching to assist peer
providers in managing or improving
health habits for improved employ-
ment status and to address the bar-
riers of health concerns that often
impact peer provider employment
tenure. Many participants reported
emotional and physical burdens re-
lated to working as peer providers,
including paperwork (the amount of
progress notes and having to adjust to
electronic progress notes) and driv-
ing for face-to-face contacts. Many
reported stress due to long hours
driving in the car, eating on the run,
and working in unfamiliar environ-
ments (neighborhoods) to offer mo-
bile services (assertive community
treatment, intensive case manage-
Through education, support, and coaching, a
peer wellness coach oers vehicles for building
self-skills and condence. Coaching is a
positive supportive relationship.
42 Copyright © SLACK Incorporated
ment services, and residential inten-
sive support teams). Peer providers
working in partial care programs and
crisis hospital settings also reported
stress due to paperwork and environ-
mental challenges (e.g., role clarity,
only peer working on a shift, not feel-
ing embraced as a full team member).
Although these concerns were not the
focus of wellness coaching, they peri-
odically had effects on physical health
Wellness Coaching Process and Flow
The majority of the initial sessions
focused on assessing wellness strengths
to set a goal, with planning conducted
in person. The remainder of the ses-
sions were conducted by telephone, as
well as a monthly follow-up telephone
session for 3 months. Some coaching
recipients used e-mail to provide the
wellness coach weekly updates. Each
session averaged 45 to 75 minutes in
length. Mid-week telephone check-
in sessions were scheduled between
sessions and lasted 5 to 15 minutes.
Meetings were scheduled at locations
where recipients felt most comfortable
(e.g., coffee shops, libraries). These
public venues were mutually agreed
upon and proved positive environ-
ments during the day, evening, and
weekend based on the recipients’ work
schedule. There were periodic missed
appointments due to life stressors and
other obligations; however, most re-
cipients were responsible and resched-
uled in advance.
The wellness coach collaborated
with the wellness coaching partici-
pants using the wellness self-assess-
ment tool to focus on a physical well-
ness goal (i.e., diet and nutrition,
physical activity, sleep/rest, relaxation
and stress management, and develop-
ment of health habits and routines).
Coaching recipients were assisted
to set a goal and wellness plan using
the Specific, Measureable, Achiev-
able, Realistic, and Timely (SMART)
method (Doran, 1981), which was
adapted from the field of management
Integral to the wellness coach-
ing process is setting a SMART goal
(Doran, 1981; Swarbrick, 2012). The
components of SMART goals are:
Specificity—Goals should be specif-
ic, using action words such as walking
5 days per week for 20 minutes, quitting
smoking, scheduling an appointment
with the dentist, purchasing fruit and
vegetables instead of pasta or other
Measurable—Using specific criteria
that indicate attainment or degree of
attainment of the specifically chosen
goal measures progress. For example,
how many times per week did the indi-
vidual walk 20 minutes or more? How
many fewer cigarettes did he smoke?
How many days did she eat healthy
snacks versus unhealthy ones?
Achievable—The ideal goal requires
some effort, but is within reach. The
individual should choose a goal that is
worthy of attainment. Sticking to the
Diet and nutrition • I will create healthy eating habits by maintaining a daily food, sleep, and stress log. I
will record number of hours slept, number of times I am waking up in the middle of the
night, and time and what I ate. I will record the activity during the day causing stress
and triggering eating habits.
• I will lose 5 lbs per month for the next 3 months by eating vegetables 3 days per week
and walking 20 minutes 2 days per week. Additionally, I will take lunch to work three
times per week.
Relaxation/stress management • I will listen to gospel and rhythm and blues music on Mondays, Wednesdays, and
Fridays for 1 hour. I will read for enjoyment on Saturday afternoon or evening for 30
• I will schedule relaxation 5 days per week for at least 45 minutes by logging day/
length of time and the activity (e.g., science ction DVD series, reading).
Physical activity • I will do weekly physical activity (warm up, karate, and calisthenics) for 30 minutes (3
days) and create a exible exercise schedule.
• I will go to the YMCA on Tuesdays and Thursdays and continue my 3 to 4 days per
week of aerobic activity.
• I will do aerobic yoga activity for 20 to 30 minutes, 6 days per week.
• I will work on strength training twice per week, on Tuesdays and Saturdays, 6 p.m. and
1 p.m., respectively.
Sleep/rest • I will try to go to bed weekdays at 11 p.m. and record the actual time each night.
Journal of Psychosocial nursing • Vol. 52, no. 1, 2014
long-term commitment required to
achieve a goal is more likely if the goal
is seen as worthy. For instance, aiming
to lose 20 lbs by the end of the month
is unrealistic and unhealthy. Setting a
goal to lose 3 to 4 lbs over a month-
long period and aiming to lose 3 to 4 lbs
the next month, and so on, is a more
achievable goal.
Realistic—This means that it is pos-
sible to accomplish. It is not a syn-
onym for “easy.” The goal needs to
be realistic for the individual at the
present time. A goal of never again
eating pastries, chips, and chocolate
may not be realistic for someone who
really enjoys these foods. Reducing the
number and portion size of sweet and
salty snacks consumed per week may
be more realistic.
Time-framed—This means provid-
ing clear target dates for completion
of work toward the goal. A wellness
coach will ask, “What will you be
doing [in relation to your goal] in 1
week? In 1 month? In 3 months? In 6
months?” Even if a goal is not achieved
in a specific time frame, it should be
reviewed and reassessed regularly with
new time frames considered.
The majority (59%) of participants
set a goal focused on diet and nutrition
and 32% focused on physical activity.
Other goals focused on relaxation/
stress management as well as sleep
and rest. The Table lists some of the
physical wellness goals participants set
and achieved as a result of the wellness
coaching service. An aspect of the
wellness coaching process is helping
the participant assume the responsibil-
ity to set a goal that is written in the
SMART format, which outlines in-
cremental steps to successfully accom-
plish the goal. The average contacts
per person were 10 sessions (range
= 4 to 17). Fifty-nine percent fully
achieved their goal, and 28% partially
achieved their goal. A few participants
encountered setbacks and ended the
coaching session. Several individuals
inquired about receiving the wellness
coaching service but declined on in-
take, noting that due to work demands
they did not believe they had time to
hone their wellness.
Overall, coaching recipients
seemed to value the structure and sup-
port provided by wellness coaching, as
well as the opportunity to check in to
help pursue and achieve their wellness
goal(s). The check-in process helped
in terms of accountability and assis-
tance, allowing participants to modify
their goals and plans. Coaching recipi-
ents were often surprised to learn how
to identify strengths they overlooked
in themselves and how areas of need
could transition to strengths by iden-
tifying natural supports and resources.
Many developed tools and strategies,
including food, sleep, and relaxation
logs, to self-monitor. Two coaching
participants acquired light boxes (a
resource used to manage seasonal af-
fective disorder) in collaboration with
their psychiatrist and agency insurance
company. Several participants sched-
uled appointments to obtain blood
work, annual physical examinations,
and dental work that they had been
neglecting. Many were able to set and
follow home exercise programs using
readily available television exercise
programs. Others accessed a library
card to obtain DVDs and CDs to save
money (financial domain). Another
coaching participant was able to ac-
cess a free temporary gym membership
and then received coaching to help
budget for a permanent gym member-
ship. Three coaching participants are
now making increased significant use
of their existing gym membership.
Wellness coaching seemed to help
individuals develop some key self-
care skills for managing the stresses
and strains of working while living
with a mental and medical condition
more effectively. Six coaching recipi-
ents were close to quitting their jobs
during the wellness coaching period.
One individual left a part-time posi-
tion moving to a volunteer position,
which was more feasible at that time.
One recipient of coaching services
took a break from coaching to access
inpatient and outpatient treatment,
then re-engaged coaching services and
was able to work to partially achieve
her goal. For several individuals, it ap-
peared that the wellness coaching pre-
vented them from quitting their jobs.
These recipients of wellness coaching
services conveyed that they did not
want to quit their jobs and appreciated
the peer wellness coach support. The
wellness coaching support seemed to
help them remain focused on the self-
care practices to counteract the stress
and associated physical health effects
(e.g., sleep disturbance, eating on the
Brice, G.H., Jr., Swarbrick, M.A., & Gill, K.J. (2014). Promoting Wellness of Peer Providers
Through Coaching. Journal of Psychosocial Nursing and Mental Health Services, 52(1),
1. Trained peer wellness coaches are eective in engaging their peers to deal
with serious comorbidities.
2. Physical wellness domains (e.g., eating well, sleep and rest, physical activity,
accessing screening and medical care) are an important area of focus to
prevent burnout and promote a better quality of life.
3. Peer wellness coaching is a collaborative approach to empower participants
to create and sustain positive health habits.
Do you agree with this article? Disagree? Have a comment or questions?
Send an e-mail to the Journal at
44 Copyright © SLACK Incorporated
run, unhealthy food choices) of their
current employment.
Other recipients of wellness coach-
ing services seemed to appreciate the
peer wellness coaches’ insight regard-
ing their own history of direct service
work. This was not the focus or in-
tent of the wellness coach; however,
some shared personal experiences as
a tool to re-engage recipients in the
coaching process. The wellness coach
helped frame the demanding challeng-
es of direct service and its value. One
participant did not want to be viewed
as a quitter or perceived as letting the
consumer movement down in the role
as a peer provider. Furthermore, he
did not want to leave the job with-
out having another position lined up
because his salary was needed toward
the family household budget. Another
recipient of wellness coaching services
did not want to lose her job and in-
dependence by needing to move in
with her parents. Another individual
had self-esteem concerns and difficulty
incorporating supervisorial feedback,
although she did enjoy providing peer
support in her position as a peer pro-
vider. She developed strategies for in-
corporating this feedback positively,
instead of taking it personally.
Many of the peer providers sought
wellness coaching due to physical
health concerns they thought were
leading them to burnout in their posi-
tion. Most valued their role as a peer
provider and wanted to improve physi-
cal well-being to meet the challenges
for career advancement. The wellness
coaching helped them focus on the
self-care practices for personal health
and wellness. Some were able to use
the wellness coaching to learn how
to self-advocate with supervisors, col-
leagues, and supporters to meet their
health and wellness goals. Some also
found the time management strategies
helpful (i.e., scheduling a paperwork
day, seeking writing tips, depersonal-
izing and implementing progress note
feedback, and accepting that the na-
ture of the position is a lot of paper-
work). They identified that their own
lack of self-care was getting in the
way. Most who were struggling in their
work position remained employed.
Support, resources, and a focus on a
wellness self-care plan enabled them
to restore balance between their per-
sonal life and job responsibility.
Psychiatric nurses can refer indi-
viduals who are struggling with co-
occurring health conditions to well-
ness coaching services. Nurses can be
significant members of teams that edu-
cate individuals about health behav-
iors (e.g., diabetes management, blood
pressure control, and self-care skills).
Nurses can also apply wellness coach-
ing skills, including the collaborative
focus on health and wellness.
Wellness coaching helped peer
providers assume personal responsi-
bility to focus on health issues affect-
ing their employment. The wellness
coaching approach can be effective in
helping people develop health-related
goals to maintain a healthy lifestyle.
This approach allows individuals to
set and attain physical wellness goals
(e.g., sleep and rest, diet and nutrition,
physical activity, relaxation/stress
management) that can affect the oth-
er seven dimensions (emotional, spiri-
tual, intellectual, occupational, social,
environment, and financial) of well-
being. Psychosocial-mental health
nurses can partner with peer wellness
coaches to support individuals living
with a mental or substance use disor-
der who encounter co-occurring medi-
cal conditions that impact life span
and quality of life.
Chapman, L.S., Lesch, N., & Baun, M.P. (2007).
The role of health and wellness coaching in
worksite health promotion. American Journal
of Health Promotion, 21(Suppl.), 1-10, iii.
Doran, G.T. (1981). There’s a S.M.A.R.T. way
to write management’s goals and objectives.
Management Review, 70(11), 35-36.
Swarbrick, M. (1997). A wellness model for
clients. Mental Health Special Interest Section
Quarterly, 20, 1-4.
Swarbrick, M. (2006). A wellness approach. Psy-
chiatric Rehabilitation Journal, 29, 311-314.
Swarbrick, M. (2012). Introduction to wellness
coaching. Freehold, NJ: Collaborative Sup-
port Programs of New Jersey Inc., Institute
for Wellness and Recovery Initiatives.
Swarbrick, M., Spagnolo, A., Zechner, M., Mur-
phy, A., & Gill, K. (2011). Wellness coach-
ing: A new role for peers. Psychiatric Rehabili-
tation Journal, 34, 328-331.
U.S. Substance Abuse and Mental Health Ser-
vices Administration. (2011, December 22).
SAMHSA announces a working definition
of “recovery” from mental disorders and sub-
stance use disorders [Press release]. Retrieved
Mr. Brice is Instructor and Trainer, Dr. Swarbrick
is Assistant Professor, and Dr. Gill is Chairman, Rut-
gers University School of Health Related Profes-
sions, Scotch Plains, New Jersey.
The authors have disclosed no potential
conicts of interest, nancial or otherwise. This
project was partially funded by New Jersey
Department of Human Services contract FY12
#60173, which was funded by the U.S. Substance
Abuse and Mental Health Services Administration/
Center for Mental Health Services Employment
Development Initiative.
Address correspondence to Margaret A.
Swarbrick, PhD, OT, FAOTA, Assistant Professor,
Rutgers University School of Health Related
Professions, Department of Psychiatric
Rehabilitation and Counseling Professions, 1776
Raritan Road, Scotch Plains, NJ 07076-2928;
Received: February 24, 2013
Accepted: August 5, 2013
Posted: October 8, 2013
Journal of Psychosocial nursing • Vol. 52, no. 1, 2014
... Previous research on wellnessfocused support services found that people who participated in wellness coaching valued the structure and support and were able to develop self-care skills that helped them better manage stressful situations (Brice et al., 2014) and achieve their personally meaningful health and wellness goals (Swarbrick et al., 2016). Th e 10-day stay in Wellness Respite helps guests start to take small steps toward goals, and the 30-day follow-up from staff aft er guests leave the respite includes continued support and problem-solving related to goals guests set while at the respite. ...
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The need for behavioral health care prevention, treatment, and recovery supports, including crisis alternatives, has grown and is now receiving federal support through enhanced funding. When a person experiences severe emotional distress, crisis alternatives are a viable option instead of inpatient hospitalization to address the distress and restore balance. Peer respite programs are voluntary, short-term, crisis alternatives for people experiencing mental distress. Models have evolved in response to funding and regulatory requirements, yet research is limited. The current article describes a unique peer-led program, Wellness Respite, in operation for 7 years, including data from recent satisfaction surveys and the role of nurses in the program. Implications of a home-like, short-term crisis alternative and the role of the nurse are emphasized. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
... However, according to Morant et al. [16], the original family and social systems approach to home-based crisis intervention appears to have been diluted in CRT practice. Several studies have found that many carers report a positive attitude toward community-based care, and this may be related to the accessibility of services and the opportunity for carers to be included during the provision of health services [23,24]. Nonetheless, despite its arguably positive contributions, community-based care may increase the burden of caregiving if the received support and follow-up of carers are inadequate [25,26]. ...
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Background Crisis resolution team (CRT) care in adult mental health services is intended to provide accessible and flexible short-term, intensive crisis intervention to service users experiencing a mental health crisis and involve their carers (next of kin). Research on users’ and especially carers’ experiences with CRT care is scarce and is mostly qualitative in nature. Methods Altogether, 111 service users and 86 carers from 28 Norwegian CRTs were interviewed with The Service User and Carer Structured Interviews of the CORE Crisis Resolution Team Fidelity Scale Version 2. Their experiences with different aspects of CRT care were reported with descriptive statistics, and differences between service users’ and carers’ experiences were analyzed with the Mann-Whitney U Test. Results The service users and carers reported that the CRT care mostly reflected their needs and what they wanted. The experiences of service users and carers were mostly similar, except for significant differences in received information and how the termination of CRT care appeared. Both groups experienced the organization of the CRT care as accessible, with continuity, reliability, and flexibility, but without a high intensity of care. Both groups found the content of the CRT care supportive, sensitive, with a choice of treatment type and a range of interventions beyond medication, but a lack of written treatment plans and discharge plans. Carers were rarely involved in discharge meetings. Regarding the role of CRTs within the care system, both groups agreed upon the lack of facilitation of early discharge from inpatient wards and lack of home treatment, but both groups confirmed some collaboration with other mental health services. Conclusion Service users and carers found that the CRTs were accessible, reliable, flexible, supportive, sensitive, and provided a range of interventions beyond medication. Limitations were lack of a high intensity of care, limited written treatment and discharge plans, limited provision of home treatment, and lack of gatekeeping of acute beds. Both groups experienced the CRT care as mostly similar, but with significant differences regarding involvement in care planning and discharge preparation.
... Studies within the context of mental health recovery have generally identified shared experience, credibility, role modeling, trust, hope, and social support as critical ingredients of peer support Cook et al. 2012;Davidson et al. 2006;Gidugu et al. 2015;Solomon 2004). While some well-articulated peer-delivered program models exist for addressing health and wellness, such as Peer wellness coaching and peer navigator programs (Brice et al. 2014;Corrigan et al. 2017;Swarbrick et al. 2011Swarbrick et al. , 2016, few studies have empirically explored the unique contributions that peer specialists bring to physical health interventions designed to address the physical health needs faced by this population. Further, there often remains an ambiguity and lack of clarity regarding peer specialists' roles in general which contributes to an underutilization or mis-utilization of peer specialists (Cabral et al. 2014;Gates and Akabas 2007;Chinman et al. 2008;Mowbray et al. 1996;Salzer et al. 2010), particularly when peer specialists are integrated into more mainstream mental health agencies (Gillard et al. 2017). ...
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This qualitative study explored peer specialists’ contributions to a healthy lifestyle intervention for obese/overweight individuals with serious mental illness (SMI) living in supportive housing. Intervention participants, peer specialists, and supervisors were interviewed and a grounded model emerged from the data identifying essential interpersonal attributes of the peer specialist-participant relationship. Peer specialists’ disclosure of their own experiences making health behaviors changes was critical for building participants’ motivation and ability to try lifestyle changes. Findings can inform peer specialist training and practice standards and facilitate the expansion of peer-delivered interventions to improve the physical health of people with SMI.
... Peer supports may be uniquely positioned to provide these interventions alongside or independent of staff, acting as wellness coaches to motivate, increase engagement, and support service recipients through modeling healthy lifestyle choices and actively participating in the activities (Brice, Swarbrick, & Gill, 2014;Roberts & Bailey, 2011;Verhaeghe et al., 2011). From an organizational perspective, steps should be taken to ensure that a given program meets stakeholder needs and can be supported by adequate funding (Lundgren, Amodeo, Chassler, Krull, & Sullivan, 2013). ...
Persons with a serious mental illness have more physical health problems and shorter life expectancy compared to the general population, in part due to modifiable at-risk health behaviors like obesity. This study provides a systematic review and meta-analysis of the available evidence on the efficacy of weight management interventions when compared to treatment as usual. Fourteen studies were included in the meta-analysis, analyzing data from a total of 1779 participants. Across all studies, an effect in favor of the intervention groups, with a reduction in mean absolute weight of −2.01 kg, compared to control groups (95% CI: −2.93 kg to −1.10 kg, p< 0.001) over a period ranging from 3 months to 12 months. Subgroup meta-analyses indicate programs that incorporate individual sessions and are implemented at the onset of illness may have the greatest impact on weight management for this population. Despite the statistically significant findings of mean weight change in the intervention groups compared to controls, the reported weight loss only equates to a 2% change from the initial body weight. This falls short of the clinically significant target of 5% weight loss in order to reduce related health complications. The current research was not consistent in capturing data on other metrics that could supplement mean weight loss in assessing positive health outcomes. Due the current health epidemic faced by this population, it is imperative for future research to include adequate follow-up periods, provide protocols, and employ better control methods.
... This step is essential because lack of clarity and specificity about the roles of peer providers can threaten the effectiveness of peer support interventions (Davidson, 2015). We anticipate that in addition to experience and basic training in the principles of peer support, further training will be needed to develop core coaching skills, such as the one offered to peer wellness coaches (Brice, Swarbrick, & Gill, 2014;Swarbrick, Murphy, Zechner, Spagnolo, & Gill, 2011). The participant workbook and provider manuals developed by the We Can Save program in New York State can provide the core content about financial services and supports, a process to foster financial hope and self-efficacy through the sharing of personal stories, and tools to develop a financial wellness plan (Jimenez et al., 2011;Stengel et al., 2012). ...
Objective: People with psychiatric disabilities experience substantial economic exclusion, which hinders their ability to achieve recovery and wellness. The purpose of this article is to describe a framework for a peer-supported economic empowerment intervention grounded in empirical literature and designed to enhance financial wellness. Method: The authors followed a 3-step process, including (a) an environmental scan of scientific literature, (b) a critical review of relevant conceptual frameworks, and (c) the design of an intervention logic framework based on (a) and (b), the programmatic experience of the authors, and input from peer providers. Results: We identified 6 peer provider functions to support individuals with psychiatric disabilities to overcome economic inclusion barriers, achieve financial wellness goals, and lessen the psychosocial impact of poverty and dependency. These include (a) engaging individuals in culturally meaningful conversations about life dreams and financial goals, (b) inspiring individuals to reframe self-defeating narratives by sharing personal stories, (c) facilitating a financial wellness action plan, (d) coaching to develop essential financial skills, (e) supporting navigation and utilization of financial and asset-building services, and (f) fostering mutual emotional and social support to achieve financial wellness goals. Conclusions and implications for practice: Financial wellness requires capabilities that depend on gaining access to financial and asset-building supports, and not merely developing financial skills. The proposed framework outlines new roles and competencies for peer providers to help individuals build essential financial capabilities, and address social determinants of mental health and disability. Research is currently underway to pilot-test and refine peer-supported economic empowerment strategies. (PsycINFO Database Record
... Although initially developed as a peer-provided service, wellness coaching is being adapted to train nonpeer service providers, who then incorporate wellness coaching into their roles and, as desired by people using services, include wellness goals and plans in the larger service planning process. The PWC training also has been adapted to address different job roles, including the peer workforce (Brice, Swarbrick, & Gill, 2014), and addressing the needs of older adults and youth. This model of incorporating health and wellness into existing services is being adopted in other states by government authorities (Missouri, Oklahoma), the City University of New York (Nelson & Shockley, 2013), the New York Peer Bridger training, and through managed care (Pennsylvania). ...
Objective: This paper provides examples of the development, implementation, and funding of peer-delivered health and wellness services in three states, a key strategy to address the health disparities facing people living with mental health and substance use disorders served by the public behavioral healthcare system. Methods: Information was compiled from the authors' experiences as champions in three states (Georgia, Michigan and New Jersey) and the National Association of State Mental Health Program Directors, as well as documents from and discussions with local state and national sources. Results: Key issues for the implementation and expansion of peer-delivered health and wellness services include defining the model to be disseminated, providing training to prepare the peer workforce, accessing funding for implementation, and establishing clear expectations to sustain the services and maintain quality over time. Conclusions and Implications for Practice: Peer-delivered health and wellness services can help address the health disparities facing people who are living with mental health and substance use disorders through a variety of innovative models tailored to local needs and circumstances.
... Peer workers, who work from their personal experience of mental health challenges, service use, and Recovery (Recovery is capitalized in this context to differentiate between clinical concepts of recovery; that is, peer-informed concepts of Recovery representing a life that is chosen that allows someone to live beyond the limitations of illness, that may or may not include cessation of symptoms), provide benefits including improved health outcomes, enhanced quality of life, and a reduction in service costs (Brice, Swarbrick, & Gill, 2014;Davies, Gray, & Butcher, 2014;Perry, Gilbert, & Rawlinson, 2013;Repper & Carter, 2011;Walker, Perkins, & Repper, 2014). Peer workers are not required to have formal qualifications. ...
Purpose: The aim of this article was to present views and opinions of people employed to work from their personal experience of significant mental health challenges (peer workers). The specific focus was on their capacity to contribute meaningfully to mental health service provision and in rural areas and associated barriers. Design and methods: Grounded Theory was the methodology utilized. In-depth interviews were conducted with peer workers throughout Australia. Findings: Participants described significant barriers to the provision of quality mental health services in rural and regional locations. The two main areas identified were the following: transport and distance, and lack of mental health staff and services. Conclusions: The identified barriers place limitations on the capacity of peer workers to maximize effectiveness in rural settings. Peer workers could potentially play an important role in overcoming shortages of staff and services and improving mental health service delivery.
Background Smoking continues to be a major health concern among persons with mental illnesses. Aims This pilot study compared smoking outcomes between wellness-coaching for smoking cessation and a control group. Methods Thirty-one individuals were enrolled in an educational group on smoking cessation and 23 completed an eight-session manualized education. Following this educational group, 11 of 23 participants were randomly assigned to wellness coaching for four months and 12 to a control condition. ANCOVAs were used to compare group differences in smoking outcomes. Results Fagerström Nicotine Dependence Index (FTND) score of the participants who received the wellness coaching intervention decreased significantly as compared to the control group, indicating a lower level of nicotine dependence. The outcomes of average number of cigarettes smoked daily and breath carbon monoxide level showed tendencies towards reductions for wellness coaching, although not statistically significant compared to the control condition. Conclusions Suggestions are shared about the feasibility of wellness coaching as well as barriers and challenges learned in implementing such an intervention to assist individuals with mental illnesses in quitting or reducing smoking.
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Purpose The purpose of this paper is to examine the gap between recovery-oriented processes and clinical outcomes in peer support, an exemplar of recovery-oriented services, and offer suggestions for bridging this gap. Design/methodology/approach This viewpoint is a brief review of literature on peer support services and gaps in outcome measurement towards building an evidence base for recovery-oriented services. Findings Clinical outcomes like hospitalizations or symptoms remain a focus of research, practice and policy in recovery-oriented services and contribute to a mixed evidence base for peer support services, in which recovery-oriented outcomes like empowerment, self-efficacy and hopefulness have more evidentiary support. One approach is to identify the theoretical underpinnings of peer support services and the corresponding change mechanisms in models that would make these recovery-oriented outcomes mediators or process outcomes. A better starting point is to consider which outcomes are valued by the people who use services and develop an evaluation approach according to those stated goals. User driven measurement approaches and more participatory types of research can improve both the quality and impact of health and mental health services. Originality/value This viewpoint provides a brief review of peer support services and the challenges of outcome measurement in establishing an evidence base and recommends user driven measurement as a starting point in evaluation of recovery-oriented services.
Individuals with major mental disorders could benefit from low cost, functional ways to support healthy lifestyles. Walking is a popular, preferred, accessible, and safe physical activity for many people. Walking is free, requiring no specialized equipment or membership fee, and is important to support engagement in other daily living activities. The current study explores the benefits of walking and strategies for promoting walking among community-dwelling individuals with major mental disorders. Key issues include strengthening engagement, tracking progress, and sustaining participation to achieve goals related to walking. The authors propose ways that nurses can support increased walking behavior for improved health and well-being in this population. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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Swarbrick, M. (March 1997). A wellness model for clients. Mental Health Special Interest Section Quarterly, 20, 1-4.
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This brief report presents the conceptual framework for the development of the peer wellness coach role including the definition of a new job role for peer providers and an overview of the knowledge and skills required for this role. People with serious mental illnesses are at greater risk of living with untreated chronic medical conditions that severely impact their quality of life and result in premature mortality. Wellness coaching represents an intervention that can help individuals persist in the pursuit of individually chosen health and wellness goals. Literature and our personal and professional experiences developing this role and training are presented. Wellness coaching seems an ideal role for peers in recovery that has potential to address health and wellness issues facing persons living with mental illnesses who are at high risk of comorbid medical conditions.
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There is a significant paradigm in the field of public mental health practice that encompasses a wellness approach. This paper will present a wellness approach by comparing it to the traditional medical model. A personal application of the wellness approach will be discussed.
Health and wellness coaching has rapidly become a best practice element of worksite health promotion programs. Coaching as a process is a very old technology, but its use in the field of health promotion is relatively new. Coaching can be provided in different forms or modalities yet currently lacks a rigorous science base or a defined set of standards or common elements. In larger worksite settings several variants or forms of coaching are usually provided to employee populations. The need for more proactive and direct forms of intervention in health promotion is contributing to the rapid growth of coaching programs. There are currently an assortment of coaching strategies or techniques that are in common use in most coaching interventions. A main contention of current coaching practice is that coaching that uses facilitation strategies rather than prescriptive advice is more effective at producing long term behavior change. The congruence and size of wellness incentives with the coaching process are likely to be of significant importance. From a long term perspective, coaching is likely to become a staple of worksite health promotion practice.
Rutgers University School of Health Related Professions, Department of Psychiatric Rehabilitation and Counseling Professions
  • Swarbrick
  • Phd
  • Faota Ot
  • Assistant Professor
Swarbrick, PhD, OT, FAOTA, Assistant Professor, Rutgers University School of Health Related Professions, Department of Psychiatric Rehabilitation and Counseling Professions, 1776
Scotch Plains, NJ 07076-2928; e-mail: swarbrma@shrp.rutgers
  • Raritan Road
Raritan Road, Scotch Plains, NJ 07076-2928; e-mail: Received: February 24, 2013
Introduction to wellness coaching
  • M Swarbrick
  • Swarbrick M.
Swarbrick, M. (2012). Introduction to wellness coaching. Freehold, NJ: Collaborative Support Programs of New Jersey Inc., Institute for Wellness and Recovery Initiatives.
A wellness model for clients
  • M Swarbrick
  • Swarbrick M.