Peer support

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See also: Support group

Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other.[1] It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, listening, or counseling. Peer Support is also used to refer to initiatives where colleagues, members of self-help organizations and others meet as equals to give each other support on a reciprocal basis.

Peer support is distinct from other forms of social support in that the source of support is a peer, a person who is similar in fundamental ways to the recipient of the support; their relationship is one of equality. A peer is in a position to offer support by virtue of relevant experience: he or she has "been there, done that" and can relate to others who are now in a similar situation. Trained peer support workers such as peer support specialists and peer counselors receive special training and are required to obtain Continuing Education Units, like clinical staff.

Underlying theory[edit]

The effectiveness of peer support is believed to derive from a variety of psychosocial processes described best by Mark Salzer in 2002:[2] social support, experiential knowledge, social learning theory, social comparison theory and the helper-therapy principle.[3]

  • Social support is the existence of positive psychosocial interactions with others with whom there is mutual trust and concern.[4] Positive relationships contribute to positive adjustment and buffer against stressors and adversities by offering (a) emotional support[5] (esteem, attachment, and reassurance),[6] (b) instrumental support (material goods and services), (c) companionship[7] and (d) information support (advice, guidance, and feedback).[8]
  • Social learning theory postulates that peers, because they have undergone and survived relevant experiences, are more credible role models for others. Interactions with peers who are successfully coping with their experiences or illness are more likely to result in positive behavior change.[11]
  • Social comparison means that individuals are more comfortable interacting with others who share common characteristics with themselves, such as a psychiatric illness, in order to establish a sense of normalcy. By interacting with others who are perceived to be better than them, peers are given a sense of optimism and something to strive toward.[12]
  • The helper-therapy principle proposes that there are four significant benefits to those who provide peer support:[13][14] (a) increased sense of interpersonal competence as a result of making an impact on another person's life; (b) development of a sense of equality in giving and taking between himself or herself and others; (c) helper gains new personally-relevant knowledge while helping; and (d) the helper receives social approval from the person they help, and others.[15]

In schools and education[edit]

Peer mentoring[edit]

Main article: Peer mentoring

Peer mentoring takes place in learning environments such as schools, usually between an older more experienced student and a new student.[16] Peer mentors appear mainly in secondary schools where students moving up from primary schools may need assistance in settling into the whole new schedule and lifestyle of secondary school life. Peer mentoring is also used in the workplace as a means of orienting new employees. New employees who are paired with a peer mentor are twice as likely to remain in their job than those who do not receive mentorship.[17]

Peer listening[edit]

This form of peer support is widely used within schools.[18][19] Peer supporters are trained, normally from within schools or universities, or sometimes by outside organizations, such as Childline's CHIPS (Childline In Partnership With Schools) program,[20] to be "active listeners".[21] Within schools, peer supporters are normally available at break or lunch times.

Peer mediation[edit]

Peer mediation is a means of handling incidents of bullying by bringing the victim and the bully together under mediation by one of their peers.[22][23][24][25]

Peer helper in sports[edit]

A peer helper in sports works with young adults in sports such as football, soccer, track, volleyball, baseball, cheerleading, swimming, and basketball. They may provide help with game tactics (e.g. keeping your eye on the ball), emotional support, training support, and social support.[26][27]

In health[edit]

In mental health[edit]

Peer support can occur within, outside or around traditional mental health services and programs, between two people or in groups. Peer support is a key concept in the recovery approach[28] and in consumer-operated services programs.[29] Consumers/clients of mental health programs have also formed non-profit self-help organizations,[30] and serve to support each other and to challenge associated stigma and discrimination.[31][32] The role of peer workers in mental health services was the subject of a conference in London in April 2012, jointly organised by the Centre for Mental Health and the NHS Confederation.[33] Research has shown that peer-run self-help groups yield improvement in psychiatric symptoms resulting in decreased hospitalization, larger social support networks and enhanced self-esteem and social functioning.[34][35]

Organizations that offer peer support services for people with mental health problems include:

In addiction[edit]

Twelve-step programs for overcoming substance misuse and other addiction recovery groups are often based on peer support.[36] Since the 1930s Alcoholics Anonymous has promoted peer support between new members and their sponsors: "The process of sponsorship is this: an alcoholic who has made some progress in the recovery program shares that experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety through AA.[37]" Other addiction recovery programs rely on peer support without following the twelve-step model.[38][39]

For anxiety and depression[edit]

In Canada, the LEAF (Living Effectively with Anxiety and Fear) Program is a peer-led support group for cognitive-behavioral therapy of persons with mild to moderate panic disorders.[40]

In a 2011 meta-analysis of seven randomized trials that compared a peer support intervention to group cognitive-behavioral therapy in patients suffering from depression, peer support interventions were found to improve depression symptoms more than usual care alone and results may be comparable to those of group cognitive behavioral therapy. These findings suggest that peer support interventions have the potential to be effective components of depression care, and they support the inclusion of peer support in recovery-oriented mental health treatment.[41]

Several studies have shown that peer support reduces fear during stressful situations such as combat[42][43] and domestic violence[44] and may mitigate Posttraumatic stress disorder.[45][46] The 1982 Vietnam-Era Veterans Adjustment Survey showed that PTSD was highest in those men and women who lacked positive social support from family, friends, and society in general.[47][48]

In chronic illness[edit]

Peer support has been beneficial for many people living with diabetes. Diabetes encompasses all aspects of people's lives, often for decades. Support from peers can offer emotional, social, and practical assistance that helps people do the things they need to do to stay healthy.[49] Peer support groups for diabetics complement and enhance other health care services.[50]

Peer support has also been provided for people with cancer[51] and HIV.[52][53][54] The Breast Cancer Network of Strength trains peer counselors to work with breast cancer survivors.[55]

For first responders[edit]

Peer support programs have also been implemented to address stress and psychological trauma among law-enforcement personnel[56][57] and firefighters.[58] Peer support is an important component of the critical incident stress management program used to alleviate stress and trauma among disaster first responders.[59]

For people with disabilities[edit]

Peer support is considered to be a key component of the independent living movement and has been widely used by organizations that work with people with disabilities, including the Amputee Coalition of America (ACA) and Survivor Corps. Since 1998 the ACA has operated a National Peer Network for survivors of limb loss. The Blinded Veterans Association has recently launched Operation Peer Support (OPS), a program designed to support men and women returning to the US blinded or experiencing significant visual impairment in connection with their military service. Peer support has also benefited survivors of traumatic brain injury and their families.[60] There is also FacingDisability for Families Facing Spinal Cord Injuries [1], which has a peer counseling program in addition to 1,000 videos drawn from interviews of people with spinal cord injuries, their families, caregivers and experts.

For survivors of trauma[edit]

Peer support has been used to help survivors of trauma,[61][62] such as refugees, cope with stress[63] and deal with difficult living conditions.[64] Peer support is integral to the services provided by the National Center for Trauma-Informed Care. Other programs have been designed for female victims of domestic violence[65] and for women in prison.[66]

Survivor Corps defines peer support for trauma survivors as "Encouragement and assistance provided by a colleague who has overcome similar difficulties to engender self-confidence and autonomy and to enable the survivor to make his or her own decisions and implement them."[67] Peer support is a fundamental strategy in the rehabilitation of landmine survivors[68][69] in Afghanistan, Bosnia, El Salvador and Vietnam. A study of 470 amputee survivors of war-related violence in six countries showed that nearly one hundred percent said they had benefited from peer support.[70]

A peer support program operated by the Centre d’Encadrement et de Développement des Anciens Combattants in Burundi with support from the Center for International Stabilization and Recovery and Action on Armed Violence has assisted survivors of war-related violence, including women with disabilities,[71] and female ex-combatants[72] since 2010. A similar program in Rwanda works with survivors of the Rwandan genocide.[73] Peer support has been recommended as a fundamental part of victim assistance programs for survivors of war-related violence.[74]

A 1984 study on the impact of peer support and support groups for victims of domestic violence showed that 146 battered women found women's peer support groups the most helpful source of a range of available treatments. The women in these groups appeared to give direct advice and to act as role models.[75] A 1986 study on 70 adolescent mothers considered to be at risk for domestic violence showed that peer support improved cognitive problem-solving skills, self-reinforcement, and parenting competence.[76]

Pandora's Aquarium,[77] an online support group operating as part of Pandora's Project, offers peer support to survivors of rape and sexual abuse and their friends and family.

For veterans with PTSD[edit]

Researchers at the Palo Alto VA National Center for PTSD reviewed the literature on peer interventions for PTSD and found that studies fell into three categories, which the researchers referred to as "peer outreach for those exposed to traumatic events;” “paraprofessional peer delivery of a trauma-focused intervention” and “peer support for recovery from PTSD".[78] Peer support outreach for those exposed to traumatic events referred to programs that sought to identify and outreach to those suffering from or at risk for mental health problems following a traumatic event as a means of connecting those people to mental health services. Paraprofessional peer deliver of a trauma-focused intervention referred to programs offering early intervention after disaster that included trauma-focused therapy such as Critical Incident Stress Debriefing (CISD). Peer support for recovery from PTSD referred to programs in which someone with lived experience of PTSD, who had experienced a significant reduction in symptoms, provided formal services to those who had not recovered from the condition as significantly. Another review of existing literature found that carefully recruited, trained, supervised, and supported paraprofessionals can deliver mental health interventions effectively, and may be valuable in communities with fewer resources for mental healthcare.[79]

Researchers at the Palo Alto VA National Center for PTSD also conducted focus groups at the VA Palo Alto Health Care System Trauma Recovery Programs, a PTSD Residential Rehabilitation Program, and a Women's Trauma Recovery Program to determine veteran and staff perceptions of informal peer support interventions already in place.[80] Four themes were identified, including "peer support contributing to a feeling of social connectedness," "positive role modeling by the peer support provider," "peer support augmenting care offered by professional providers," and "peer supporter acting as a 'culture broker' and orienting recipients to mental health treatment."

For veterans and their families[edit]

Several programs exist that provide peer support for military veterans in the US[81][82][83] and Canada.[84][85][86] In 2010 the Military Women to Women Peer Support Group was established in Helena, MT.[87]

The Tragedy Assistance Program for Survivors (TAPS) provides peer support, crisis care, casualty casework assistance, and grief and trauma resources for families of members of the US military. Operation Peer Support (OPS) is a program for US military veterans who were blinded or have significant visual impairment.

In January 2013 Senator Patty Murray, Chairman of the United States Senate Committee on Veterans' Affairs, sponsored an amendment of the National Defense Authorization Act (S.3254) that would require peer counseling as part of a comprehensive suicide prevention program for US veterans.[88]

See also[edit]

References[edit]

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  2. ^ Salzer, Mark (2002). "Consumer-delivered services as a best practice in mental health care and the development of practice guidelines". Psychiatric rehabilitation skills 6: 355–382. .
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  8. ^ Phyllis Solomon, "Peer support/peer provided services underlying processes, benefits, and critical ingredients", Psychiatric Rehabilitation Journal, 2004;27(4):392-401; issn 1095-158X, doi 10.2975/27.2004.392.401, pmid 15222150
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  13. ^ Riessman, F. (1965). "The 'Helper-therapy' principle." Social Work, 10, 27-32,
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  15. ^ From Salzer and Shear, S. L. (2002), p. 282.
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  17. ^ Kaye, Sharon; Jordan-Evans (2005). Love 'Em or Lose Em: Getting Good People to Stay. San Francisco: Berrett-Koehler Publishers. p. 117. ISBN 978-1-57675-327-9. 
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  21. ^ Joel H. Brown, Marianne D'Emidio-Caston, Bonnie Benard, Resilience Education, Corwin Press, 2001. ISBN 978-0-7619-7626-4
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  50. ^ Michelle Heisler, "Building Peer Support Programs to Manage Chronic Disease: Seven Models for Success", California Healthcare Foundation, December 2006.
  51. ^ Peer Support Network, an internet-based peer support service for newly diagnosed cancer patients, cancer survivors and their caregivers.
  52. ^ Peer Adherence Support Manual, A Manual for Program Managers and Supervisors of Peer Workers; Harlem Adherence to Treatment Study, Harlem Hospital Peer Support for HIV Treatment Adherence, 2003.
  53. ^ AIDS Information Center, Uganda
  54. ^ Fidaner C, Eser SY, Parkin DM (2001), Peer to Peer. HIV & AIDS Peer Educators Trainers' Guide for IMPACT Implementing Agencies in Nigeria. Family Health International.
  55. ^ BCNS's Breast Cancer Survivor Match Program
  56. ^ Rachelle Katz, Daniel I. Cohen and Ronnie M. Hirsh, Cop to Cop: A Peer Support Training Manual for the Law Enforcement Officer, Peer Support Press; 2nd edition, January 1, 2000. ISBN 978-0-9669496-3-6
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  58. ^ Dowdall-Thomae, Cynthia; Culliney, Sean; Piechura, Jeff, "Peer Support Action Plan: Northwest Fire and Rescue," International Journal of Emergency Mental Health, vol. 11, no. 3, pp. 177-184, Summer 2009.
  59. ^ Jones, Norma S C; Majied, Kamilah, "Disaster mental health: a critical incident stress management program (CISM) to mitigate compassion fatigue," Journal of Emergency Management, vol. 7, no. 4, pp. 17-23, July/August 2009.
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  62. ^ Project ABLE's Trauma Survivor Peer Support Project in Oregon
  63. ^ Josi Salem-Pickartz, 2008: Strengthening community mental health resources by training refugees as peer counsellors – a manual for trainers, Intervention, The War Trauma Foundation and the Al Himaya Foundation for Trauma Recovery, Growth and Resilience.
  64. ^ Nancy Baron, On the road to peace of mind War Trauma Foundation, 2009. ISSN 1571–8883.
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  66. ^ Blanchette, K., Eljdupovic-Guzina, G. (1998). "Results of a pilot study of the Peer Support Program for Women Offenders." Edmonton, Research Branch, Correctional Service of Canada.
  67. ^ Jerry White, I Will Not Be Broken, (published in paperback as Getting Up When Life Knocks You Down,).
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  69. ^ Beth Sperber Richie, Angela Ferguson, Zahabia Adamaly, Dalia El-Khoury, Maria Gomez, "Paths to Recovery: Coordinated and Comprehensive Care for Landmine Survivors," Journal of Mine Action Dec 2002, 6.3: 66-69.
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  77. ^ "Pandora's Aquarium". pandys.org. 2011. Retrieved August 29, 2011. 
  78. ^ Jain S, McLean C, Adler EP, Lindley, SE, Ruzek, JI, Rosen CS. "Does the Integration of Peers into the Treatment of Adults with Posttraumatic Stress Disorder Improve Access to Mental Health Care? A Literature Review and Conceptual Model." J Trauma Stress Disor Treat. 2013 Aug; 2:3
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  80. ^ Jain S, McLean C, & Rosen C. "Is there a role for peer support delivered interventions in the treatment of veterans with post-traumatic stress disorder?" Military Medicine. 2012; 177:5
  81. ^ Vets4Vets, a non-partisan organization dedicated to helping Iraq and Afghanistan-era veterans to heal from the psychological injuries of war through the use of peer support.
  82. ^ Statewide Advocacy for Veterans' Empowerment (SAVE)
  83. ^ Resnick, Sandra Gail; Rosenheck, Robert A: "Integrating peer-provided services: a quasi-experimental study of recovery orientation, confidence, and empowerment," Psychiatric Services, vol. 59, no. 11, pp. 1307-1314, November 2008.
  84. ^ The Operational Stress Injury Social Support (OSISS) Program for Canadian Veterans. See also "Evaluation of the OSISS Peer Support Network," Dept. of National Defence and Veterans Affairs Canada, January 2005.
  85. ^ Heber, A., Grenier, S., Richardson, D., Darte, K. (2006). "Combining Clinical Treatment and Peer Support: A Unique Approach to Overcoming Stigma and Delivering Care." In Human Dimensions in Military Operations – Military Leaders’ Strategies for Addressing Stress and Psychological Support; Neuilly-sur-Seine, France, Canadian Department Of National Defence.
  86. ^ Richardson, J. D., K. Darte, et al. (2008). "Operational Stress Injury Social Support: a Canadian innovation in professional peer support." Can Mil J 9: 57-64.
  87. ^ Eve Byron, "Helena area is home to 1st ‘Military Women to Women Peer Support Group’ for those with PTSD," Independent Record, The Billings Gazette, August 3, 2010.
  88. ^ "MILITARY SUICIDE: Murray Effort to Create Standardized Suicide Prevention Program Signed into Law by President Obama."

External links[edit]