The Treatment Relationship in Peer-Based and Regular Case Management for Clients With Severe Mental Illness

Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, United States
Psychiatric Services (Impact Factor: 2.41). 09/2006; 57(8):1179-84. DOI: 10.1176/
Source: PubMed


This study compared the quality of treatment relationships and engagement in peer-based and regular case management. It also assessed the value of positive relationship qualities in predicting motivation for and use of community-based services for persons with severe mental illness.
One hundred thirty-seven adults with severe mental illness participated in a 2x2 prospective longitudinal randomized clinical trial with two levels of case management intervention (peer and regular) and two interviews (six and 12 months). Self-report questionnaires assessed treatment relationships, motivation, and service use, and providers rated participants' initial engagement and monthly attendance in treatment.
Participants perceived higher positive regard, understanding, and acceptance from peer providers rather than from regular providers at six months only, with initially unengaged clients showing more contacts with case managers in the peer condition and decreasing contacts in the regular condition. Six-month positive regard and understanding positively predicted 12-month treatment motivation for psychiatric, alcohol, and drug use problems and attendance at Alcoholics and Narcotics Anonymous meetings.
Early in treatment, peer providers may possess distinctive skills in communicating positive regard, understanding, and acceptance to clients and a facility for increasing treatment participation among the most disengaged, leading to greater motivation for further treatment and use of peer-based community services. Findings strongly suggest that peer providers serve a valued role in quickly forging therapeutic connections with persons typically considered to be among the most alienated from the health care service system.

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Available from: Michael Rowe, May 15, 2015
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    • "To date, the evidence base for parent-delivered family support services is limited although evidence on adult peer services is growing (Corrigan 2006; Dixon et al. 2001; Min et al. 2007; Sells et al. 2006). This is changing, but slowly (Hoagwood et al. 2010). "
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    ABSTRACT: Quality measurement is an important component of healthcare reform. The relationship of quality indicators (QIs) for parent-delivered family support services to organizational social contexts known to improve quality is unexamined. This study employs data collected from 21 child mental health programs that deliver team-based family support services. Performance on two levels of QIs-those targeting the program and staff-were significantly associated with organizational social context profiles and dimensions. High quality program policies are associated with positive organizational cultures and engaging climates. Inappropriate staff practices are associated with resistant cultures. Implications for organizational strategies to improve service quality are discussed.
    Full-text · Article · May 2013 · Administration and Policy in Mental Health and Mental Health Services Research
    • "The involvement of peer support workers in service delivery is often considered a sign of a system's commitment to partnership and promotion of recovery (Richard et al. 2009). In adult mental health, results from randomized trials have demonstrated client benefits associated with peer services, including increased contact with service providers, empowerment and recovery, and lower rates of re-hospitalization (Corrigan 2006; Dixon et al. 2001; Sells et al. 2006; Min et al. 2007). The evidence base for peerdelivered (i.e., parent-delivered) services is more limited in children's mental health (Hoagwood et al. 2010) but growing. "
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    ABSTRACT: Quality indicators for programs integrating parent-delivered family support services for children's mental health have not been systematically developed. Increasing emphasis on accountability under the Affordable Care Act highlights the importance of quality-benchmarking efforts. Using a modified Delphi approach, quality indicators were developed for both program level and family support specialist level practices. These indicators were pilot tested with 21 community-based mental health programs. Psychometric properties of these indicators are reported; variations in program and family support specialist performance suggest the utility of these indicators as tools to guide policies and practices in organizations that integrate parent-delivered family support service components.
    No preview · Article · May 2013 · Administration and Policy in Mental Health and Mental Health Services Research
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    • "A range of different approaches to employing people with personal experience of mental health problems, specifically to make direct use of that lived experience in supporting others with similar problems (as peers), has been identified internationally [1]. A number of terms including Peer Support Worker, Peer Support Specialist and Consumer-Provider have been used to identify these roles. "
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    ABSTRACT: Background The provision of peer support as a component of mental health care, including the employment of Peer Workers (consumer-providers) by mental health service organisations, is increasingly common internationally. Peer support is strongly advocated as a strategy in a number of UK health and social care policies. Approaches to employing Peer Workers are proliferating. There is evidence to suggest that Peer Worker-based interventions reduce psychiatric inpatient admission and increase service user (consumer) empowerment. In this paper we seek to address a gap in the empirical literature in understanding the organisational challenges and benefits of introducing Peer Worker roles into mental health service teams. Methods We report the secondary analysis of qualitative interview data from service users, Peer Workers, non-peer staff and managers of three innovative interventions in a study about mental health self-care. Relevant data was extracted from interviews with 41 participants and subjected to analysis using Grounded Theory techniques. Organisational research literature on role adoption framed the analysis. Results Peer Workers were highly valued by mental health teams and service users. Non-peer team members and managers worked hard to introduce Peer Workers into teams. Our cases were projects in development and there was learning from the evolutionary process: in the absence of formal recruitment processes for Peer Workers, differences in expectations of the Peer Worker role can emerge at the selection stage; flexible working arrangements for Peer Workers can have the unintended effect of perpetuating hierarchies within teams; the maintenance of protective practice boundaries through supervision and training can militate against the emergence of a distinctive body of peer practice; lack of consensus around what constitutes peer practice can result in feelings for Peer Workers of inequality, disempowerment, uncertainty about identity and of being under-supported. Conclusions This research is indicative of potential benefits for mental health service teams of introducing Peer Worker roles. Analysis also suggests that if the emergence of a distinctive body of peer practice is not adequately considered and supported, as integral to the development of new Peer Worker roles, there is a risk that the potential impact of any emerging role will be constrained and diluted.
    Full-text · Article · May 2013 · BMC Health Services Research
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