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This study evaluated whether supervisory mentorship contributed to peer support specialists’ job satisfaction and burnout via pathways of role clarity and psychological empowerment after accounting...

The current study seeks to determine how peer support roles change as peer support specialists’ positions within organizations and departments mature. We followed ten peer support specialists over the course of a year, interviewing them at three points, starting approximately three months after they began working as peer support specialists. We used an inductive process to analyze our data and followed guidelines on the structuring of longitudinal qualitative trajectories to divide the data into watershed moments. Our participants worked in a variety of departments in the hospital, and their service use experiences generally echo those of their service users. Participants appear to pass through four phases over the course of their employment as peers: early beginnings, establishing the role, role narrowing, and role sustainability. Services wishing to integrate new peers must be aware of the time required for integration. Having general job descriptions limited to specifying that peers are expected to use their lived experience to support current service users may lead to uncertainty amongst new and existing staff. Without role clarity, peers may struggle to find their place. Pairing new staff with mentors may limit this burden. As roles consolidate, boundaries may emerge. If these boundaries narrow the role of the PSS, they may no longer find the role appealing. They may then choose other caregiver roles with wider or different spheres of influence. Organizations may benefit by clearly indicating if they expect peer support positions to be static or transitionary.

Objective To qualitatively evaluate the implementation of Capacity Coaching, an intervention to address the work patients must undertake to manage their conditions, implemented as a quality improvement pilot in 1 of 2 implementing US Department of Veterans Affairs medical centers. Participants and Methods Two Veterans Affairs medical centers in the Midwest sought to implement Capacity Coaching as a quality improvement pilot in their Patient-Aligned Care Teams for 6 months (April 1, 2017, through October 31, 2017). Following the pilot, we conducted a focused ethnographic evaluation (on-site data collection, January 2-4, 2018), including interviews, a focus group, and observations with staff at one site to assess the implementation of capacity coaching. Data were analyzed inductively and findings were cross-referenced with implementation theory. Results We found that implementation was feasible and achieved changes that were aligned with reducing patient work and increasing capacity. We found that the key facilitators for the implementation of this program were in participants making sense of the intervention (coherence) and working collectively to enact the program (collective action). The main challenges for the program were in planning the work of implementation and enrolling a diverse coalition of staff to expand referrals to the program (cognitive participation) and in evaluating the impact of the program on outcomes that upper leadership was interested in (reflexive monitoring). Conclusion Implementation of Capacity Coaching is feasible in clinical practice and may be a promising intervention for the care of chronic conditions. Further research should focus on testing capacity coaching using these lessons learned.

Purpose Access to mental health care and programs that address violence prevention can be a challenge for veterans residing in rural and underserved areas. A growing number of trauma-affected veterans are now returning to rural areas upon completion of military service. The Palo Alto VA Health Care System has piloted a program known as the Peer Support Program (PSP) where certified peer support specialists hold group sessions for their fellow veterans in remote, community-based outpatient clinics. Methods A total of 29 peer-support group participants and 1 certified peer specialist were interviewed. Semistructured interviews began with open-ended questions regarding participant firsthand experiences with the support group setting. These were followed by direct questions that addressed the role of the PSP, expectations for the PSP, as well as benefits and limitations of the program. We performed a domain analysis using the Spradley ethnographic method on 325 pages of compiled narrative data focusing on violence-related themes. Findings Four key themes emerged, including: 1) Violence in Military Training Not Acceptable in Civilian Life, 2) Peer Support Creates the Trust to Speak Freely, 3) Skills Are Taught to Defuse Violence, and 4) The Veteran Peer Support Specialist Relationship Is Multi-Dimensional. Conclusions These emergent themes illustrate how trauma-focused assistance rendered by peer support specialists as part of an interdisciplinary mental health team can be implemented to benefit trauma-affected individuals and their communities in the prevention of future violence.

A psychiatric advance directive (PAD) is designed to prevent involuntary mental health interventions by enabling people with serious mental illnesses to plan ahead for their own treatment during a future incapacitating crisis. This study implemented PAD facilitation in assertive community treatment (ACT) teams.We examined ACT clients' attitudes toward PAD facilitators, satisfaction with PAD facilitation, the short-term impact of PAD completion on subjective sense of empowerment and attitudes toward treatment, and whether the type of PAD facilitator made a difference.Participants were randomly assigned to be offered PAD facilitation by a peer support specialist or non-peer ACT team clinician, and interviewed at baseline (There was no evidence of bias against peer-facilitators. There was a modest positive impact of PAD facilitation on treatment attitudes and empowerment.PAD facilitation by peer support specialists and others working in community mental health settings supports recovery.

Background As digital peer support is quickly expanding across the globe in the wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice, such as social work, psychiatry, and psychology, limited research has been done to develop and promote digital peer support competencies. Objective The goal of this study is to introduce the coproduction of core competencies that can guide digital peer support. Methods Peer support specialists were recruited through an international listserv and participated in a 1-hour virtual focus group. A total of four focus groups were conducted with 59 peer support specialists from 11 US states and three countries. Results Analysis was conducted using the rigorous and accelerated data reduction (RADaR) technique, and 10 themes were identified: (1) protecting the rights of service users, (2) technical knowledge and skills in the practice of digital peer support, (3) available technologies, (4) equity of access, (5) digital communication skills, (6) performance-based training, (7) self-care, (8) monitoring digital peer support and addressing digital crisis, (9) peer support competencies, and (10) health literacy (emerging). The authors present recommendations based on these themes. Conclusions The introduction of digital peer support core competencies is an initial first step to promote the standardization of best practices in digital peer support. The established competencies can potentially act as a guide for training and skill development to be integrated into US state peer support specialist competencies and to enhance competencies endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Peer support specialists (i.e., lay interventionists representing one of the fastest-growing mental health workforce) are increasingly using technologies to support individuals with mental health challenges between clinical encounters. The use of technology by peers has been significantly increased During COVID-19. Despite the wide array of technologies available, there is no framework designed specifically for peer support specialists and service users to select technologies to support their personal recovery. The objective of the study was to develop a Decision-Support Tool for Peer Support Specialists and Service Users to facilitate shared decision-making when choosing technologies to support personal recovery. The study used an iterative co-production process, including item formulation and a series of group cognitive interviews with peer support specialists and service users (n=9; n=9, n=4). The total sample included 22 participants: peer support specialists (n=18, 81.8%) and service users (n=4, 18.2%). The final version of the Decision-Support Tool for Peer Support Specialists and Service Users (D-SPSS), includes 8 domains: (1) privacy and security; (2) cost; (3) usability; (4) accessibility; (5) inclusion and equity; (6) recovery principles; (7) personalized for service users’ needs; and (8) device set-up. Our study found that involving peer support specialists and service users in the design and co-production phase of a decision-support tool is feasible and has the potential to empower both peer support specialists and service users, and potentially increase engagement in the use of technologies that support individuals’ recovery from traditional clinical encounters. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Peer support specialists have proven to be a cost‐effective and clinically effective workforce in improving patient quality of life and symptom management, while decreasing avoidable emergency room visits and care overutilization. This study used publicly available datasets to map and type locations where peer services are provided, and determine how state policies are associated with peer support provision. We transcoded the 2018 National Survey on Substance Abuse Treatment Services (N‐SSATS) and 2018 National Mental Health Services Survey (N‐MHSS) directories, yielding a list of street addresses and characteristics for substance use disorder treatment (SUDTx) and mental health treatment (MHTx) facilities nationwide. We then pulled all state regulations for peer provider licensing/certification, service authorization, and Medicaid reimbursement from public, online repositories. Stepwise regressions associated these regulations with the proportion of SUDTx and MHTx facilities in the state offering peer services to determine what effect, if any, state policies may have on the peer workforce. Behavioral health treatment facilities offering services in 2018, specifically such facilities offering peer support services. The transcoding uncovered 9,294 MHTx facilities and 12 074 SUDTx facilities, nationwide. Approximately 25% of MHTx facilities (2311/9294) and 56% of SUDTx facilities (6806/12 074) self‐reported offering peer support services in 2018. Most counties had at least one facility offering peer services, with more densely populated counties having more of such facilities. Facilities offering peer services were more concentrated in urban hubs, like Detroit, Chicago, Los Angeles, etc., as opposed to rural or frontier areas. In MHTx facilities, peer services were included in the greatest proportion in community mental health centers (35%, 782/2194), multisetting health facilities (31%, 102/332), and residential treatment centers for adults (26%, 138/528). In SUDTx facilities, peer services were included in the greatest proportion in residential treatment (79%, 2203/2776), residential detoxification (76%, 618/817), and outpatient day treatment facilities (71%, 1145/1614). Stepwise regression found Medicaid reimbursement rates positively associated with peer service provision (P

Background Engaging peer support to augment and enhance traditional mental health services presents novel opportunities to improve service engagement and delivery. However, there has not been an in-depth analysis of the processes and methods behind the coordination of physical health and mental health care by peer support specialists. Study aim To explore the potential of peer support specialists in community mental health centers and as a means to improve coordination of physical health and mental health services for people with a serious mental illness. Methods We conducted 28 semi-structured qualitative interviews with peer support specialists and mental healthcare professionals in community mental health centers in two states (blinded for review) in the United States. Data were triangulated to explore peer support specialists and mental health professionals' perspectives. Results We found five themes characterizing the role of peer support services in the coordination of physical health and mental health services for individuals with serious mental illness: (1) Advocacy in interprofessional meetings, clinical teams, and advisory councils; (2) Sharing lived experiences and connecting with available resources and services; (3) Preparing for mental health and physical health care visits; (4) Mutuality; and (5) Affiliations, funding, and sustainability of peer support services. Conclusion This study suggests that peer support specialists can uniquely contribute to the coordination of physical health and mental health services for individuals with serious mental illness.

As the certified peer support specialist (CPSS) workforce matures, their roles evolve, leading to gaps in knowledge about their activities. This study aimed to address these gaps through a survey on CPSS activities, self-rated skills, job satisfaction, and financial well-being. The project team recruited a community advisory board of CPSSs to lead survey development. A survey link was e-mailed to all known CPSSs in the state of Michigan (N=1,128), yielding 394 respondents (35% response rate), of whom 319 were included in the analysis. The highest skill self-ratings included sharing recovery stories (rated very strong by 80%); the lowest included vocational support (rated very strong by 33%). More than 75% were satisfied with their workplace supportiveness; less than one-half were satisfied with their promotion opportunities. When asked if they could generate adequate funds to address a common financial shock, 115 of 301 respondents (38%) were "certain" they could not, suggesting financial vulnerability. These results support developing career ladder opportunities for CPSSs.

PurposeThe purpose of this paper is to evaluate a Peer Support Specialist (PSS) and NHS practitioner co-produced “Enabling Recovery” group that supports service-users’ recovery whilst providing pathways for appropriate transition from mental health teams.Design/methodology/approachThe sample included 23 service-users (f=10,m=13) with a range of mental health conditions. The evaluation set out to assess how the attendees experienced the group and the impact of the group on subsequent contact with services. The design involved a content analysis of focus groups and group evaluation forms; an assessment of direct and indirect contacts made in the three months prior, and following, the group; and a record of the number of discharges and referrals made following the group.FindingsGroup content and social contact were rated as most helpful and cognitive demands and paperwork as least helpful. Number of direct and indirect contacts significantly reduced, four attendees were discharged due to improved mental health and 17 began accessing third-sector/community organisations.Research limitations/implicationsFuture evaluations could seek feedback from service-users who disengaged from the group and indirect contacts could be broadened to include service initiated contacts.Practical implicationsFindings suggest that PSS and NHS Practitioner co-produced group interventions are effective in reducing service demand and increasing service-user satisfaction.Originality/valueThis paper adds a novel contribution to the PSS literature offering support to the utility of co-produced PSS interventions in an NHS setting.

Following discharge, patients hospitalized for depression are at high risk for poor retention in outpatient care and adverse outcomes.Pilot tests a post-hospital monitoring and enhanced support program for depression.48 patients at a Veterans Affairs Medical Center discharged following a depression-related inpatient stay received weekly visits or phone calls for 6 months from their choice of either a family member/friend (n = 19) or a certified peer support specialist (n = 29). Participants also completed weekly automated telephone monitoring calls assessing depressive symptoms and antidepressant medication adherence.Over 90% of participants were more satisfied with their care due to the service. The mean change from baseline to 6 months in depression symptoms was -7.9 (p 0.05) according to the Patient Health Questionnaire and -11.2 (p 0.05) according to the Beck Depression Inventory-II for those supported by a family member/friend, whereas those supported by a peer specialist had mean changes of -3.5 (p 0.05) and -1.7 (p 0.10), respectively.Increased contact with a chosen support person coupled with automated telephone monitoring after psychiatric hospitalization is an acceptable service for patients with depression. Those who received the service, and particularly those supported by a family member/friend, experienced reductions in symptoms of depression.

Objective Given the proliferation of peer-delivered services and its growing but insufficient empirical base, we undertook a randomized trial to examine the effects of such services on individuals with severe psychiatric disabilities undergoing a civil commitment. Method We recruited n = 113 individuals who were civilly committed for inpatient treatment. Randomly assigned experimental participants were paired with a trained peer specialist to receive intensive 1-on-1 support to assist them with both their recovery and the conditions of their mandated court-ordered services. Individuals in the control group were invited to receive other supportive, peer-delivered services, such as social and group educational activities, but excluding individual peer support. We assessed a variety of outcomes including social supports, quality of life, recovery, symptoms, and functioning. Results Mounting a randomized trial in this setting and with participants who were court-ordered for inpatient treatment proved challenging in terms of recruitment, service provision, retention in the intervention, and attrition from the research. Intent-to-treat analyses revealed no significant differences in outcomes by study condition. As-treated analyses comparing high- and low-use peer support groups with control group participants found significant differences favoring peer support recipients in quality of life and functioning but no differences in other study outcomes. Conclusions and implications for practice Difficulties with ensuring the quality of the peer support in this study may be in part responsible for our failure to see more-definitive and -positive results. As the peer support specialist profession evolves, an understanding of its effective ingredients and mechanisms must be elucidated to allow for more-rigorous studies. (PsycINFO Database Record

Background Peer support specialists offering mental health and substance use support services have been shown to reduce stigma, hospitalizations, and health care costs. However, as peer support specialists are part of a fast-growing mental health and substance use workforce in innovative integrated care settings, they encounter various challenges in their new roles and tasks. Objective The purpose of this study was to explore peer support specialists’ experiences regarding employment challenges in integrated mental health and substance use workplace settings in New Hampshire, USA. Methods Using experience-based co-design, nonpeer academic researchers co-designed this study with peer support specialists. We conducted a series of focus groups with peer support specialists (N=15) from 3 different integrated mental health and substance use agencies. Audio recordings were transcribed. Data analysis included content analysis and thematic analysis. Results We identified 90 final codes relating to 6 themes: (1) work role and boundaries, (2) hiring, (3) work-life balance, (4) work support, (5) challenges, and (6) identified training needs. Conclusions The shared values of experience-based co-design and peer support specialists eased facilitation between peer support specialists and nonpeer academic researchers, and indicated that this methodology is feasible for nonpeer academic researchers and peer support specialists alike. Participants expressed challenges with agency restrictions, achieving work-life balance, stigma, and low compensation. We present actionable items to address these challenges in integrated mental health and substance use systems to potentially offset workforce dissatisfaction and high turnover rates.

Perinatal opioid use disorder (OUD) has increased drastically since 2000 and is associated with myriad adverse outcomes. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends using peer support services to promote sustained remission from substance use disorders (SUDs). Integrating peer support specialists into perinatal OUD treatment has the potential to improve maternal and child health. However, there is limited published research on the experiences of pregnant and parenting women with peer support specialists during SUD treatment. The purpose of this study was to: (1) describe experiences of perinatal women undergoing OUD treatment with peer support specialists; (2) describe recommendations for improving or enhancing peer support services. For this qualitative descriptive study, we conducted two focus groups in a private location in a clinic that serves postpartum women with OUD (N = 9) who were parenting a child under the age of 5. The focus groups were voice recorded, professionally transcribed, and analyzed in MAXQDA using content analysis. Four themes emerged from the data: Feeling Supported by Peer Support Specialists, Qualities of an ‘Ideal’ Peer Support Specialist, Strategies to Improve Interactions with Peer Support Specialists, and Importance of Communication Across the Perinatal Period. Participants reported that PSSs had a strong, positive impact on their recovery. Postpartum women report overall positive experiences receiving peer support services during their pregnancy and postpartum period. However, participants offered suggestions to improve their interactions with PSSs, such as clarifying the boundaries between peer supporters and clients. Pregnant and postpartum women in OUD treatment have the potential to benefit from access to PSS throughout their perinatal period. Future research is needed to determine the impact of PSS on sustained recovery for perinatal women with OUD.

Within the Veterans Health Administration (VHA), 15-30% of patients seen in primary care are identified as hazardous drinkers, yet the vast majority of these patients receive no intervention. Time constraints on providers and patient-level barriers to in-person treatment contribute to this problem. The scientific literature provides a compelling case that mobile-based interventions can reduce hazardous drinking and underscores the role of peer support in behavioral change. Here, we describe the benefits of using a clinical app-Step Away-to treat hazardous drinking among VHA primary care patients as well as an approach to customizing the app to maximize its engagement and effectiveness with this population. We highlight the value of integrating use of Step Away with telephone support from a trained VHA peer support specialist. This type of integrated approach may provide the key therapeutic components necessary to generate an effective and easily implemented alcohol use intervention that can be made available to VHA primary care patients who screen positive for hazardous drinking but are unwilling or unable to attend in-person treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mental illness is a major public health concern negatively affecting persons across multiple domains. To address this, health care systems have prioritized access to care and use of empirically supported treatments to better serve those with psychiatric concerns. Rates of dropout from psychotherapy are high, especially in routine clinical settings. Peer support has been promulgated as fostering treatment engagement and completion due to a connection forged from common experience (e.g., military service, psychiatric diagnosis, etc.). As such, the Veterans Health Administration has invested heavily in peer support, although there is limited direct evidence that it enhances treatment engagement or completion. The current study advances upon prior research, showing positive effects of a Cognitive Behavioral Therapy-Pretreatment Intervention (CBT-PTI) on individual therapy outcomes (Lusk, Lyubkin, Chermack, Sanborn, & Bowersox, 2016), by comparing CBT-PTI initial engagement and completion among 352 veterans who met with either a Peer Support Specialist or a Program Support Assistant. Logistic regressions were used to assess the effects of significant unadjusted predictors on CBT-PTI initial engagement and completion, and Mann-Whitney tests were used to further describe differences between veterans who met with PSA versus PSS. Support for the role of PSS was found for CBT-PTI completion, and there was a trend for engagement, although further research is needed. This study provides preliminary support for the use of PSS in fostering CBT-PTIs in routine clinical settings, although further study is warranted to confirm and expand support. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Suicide rates in the United States have been increasing in recent years, and the period after an inpatient psychiatric hospitalization is one of especially high risk for death by suicide. Peer support specialists may play an important role in addressing recommendations that suicide prevention activities focus on protective factors by improving hope and connectedness. The present study developed a peer specialist intervention titled Peers for Valued Living (PREVAIL) to reduce suicide risk, incorporating components of motivational interviewing and psychotherapies targeting suicide risk into recovery-based peer support. A randomized controlled pilot study was conducted to assess the acceptability, feasibility, and fidelity of the intervention. A total of 70 adult psychiatric inpatients at high risk for suicide were enrolled into the study. Participants were randomized to usual care (n = 36) or to the 12-week PREVAIL peer support intervention (n = 34). Those in the PREVAIL arm completed an average of 6.1 (SD = 5.0) peer sessions over the course of 12 weeks. Fidelity was rated for 20 peer support sessions, and 85% of the peer specialist sessions demonstrated adequate fidelity to administering a conversation tool regarding hope, belongingness, or safety, and 72.5% of general support skills (e.g., validation) were performed with adequate fidelity. Participants' qualitative responses (n = 23) were highly positive regarding peer specialists' ability to relate, listen, and advise and to provide support specifically during discussions about suicide. Findings demonstrate that a peer support specialist suicide prevention intervention is feasible and acceptable for patients at high risk for suicide. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Preventive parenting interventions delivered by parent peer specialists may be a viable alternative to professional-led interventions and offer an advantage of increasing access in medically underserved areas. The objective of this pilot study was to assess the feasibility and preliminary outcomes of a 10-session, peer specialist-delivered preventive parenting intervention (Smart and Secure Children) for child disruptive behavior. The intervention was evaluated among a small sample of parents (N = 15) of preschoolers (2–5 years) residing in medically underserved communities. Pediatricians referred families to the intervention, which was delivered in primary care practices within medically underserved communities. To determine feasibility, we calculated percentages of pediatricians who referred parents to the intervention, parent peer specialists who completed 40-h interventionist and leadership training, and the average number of sessions attended by parents. Enrolled parents completed questionnaires assessing child disruptive behavior, parenting stress and parenting competence at pre-and post-intervention. Descriptive statistics demonstrated the majority of pediatricians within the clinics referred families, and all parent peer specialists completed training to deliver the intervention. On average, 60% of sessions were attended by parents. Pairwise t-tests showed pre-to-post-intervention improvements in number of child disruptive behaviors perceived as a problem by parents, parenting stress and parenting competence. No significant change was found in parent-reported frequency of child disruptive behaviors. Results suggests adequate feasibility of the Smart and Secure Children Intervention, and that it holds promise for improving parenting stress and competence, and decreasing the number of child behaviors that are perceived as a problem by parents. Future directions for research are discussed.

In this special issue entitled Peer-Delivered Services: Current Trends and Innovations, we provide further information about the growing peer workforce, as well as new and innovative developments in peer-delivered services. In order to do that, we must first define our terms: We consider peer-delivered services to be a broad umbrella of services designed and delivered by individuals with a “lived experience” of mental or substance use challenges. We offer new information to the field in this special issue about peer support and how peer support specialists have evolved to address unmet needs and to attend to social determinants that affect wellness and recovery. We also address the challenges that a relatively new workforce and service innovation can present, as well as directions for continued research, evaluation, and growth. Our intention in this special issue is to examine the who, what, where, and how of peer support specialist services as they currently exist in the United States.

Purpose of the article American university and college campus law enforcement, like their peers in American munipal law enforcement agencies, find themselves interacting frequently with civilians experiencing mental health disturbances. An innovative model for law enforcement, the Crisis Intervention Team (CIT) model, has been developed to address the difficulties law enforcement professionals and civilians in mental health crisis face during encounters. (Margolis & Shtull, 2012) This article explores how CIT can enhance police response to mental health crisis on the college campus. Methodology/methods Methods of applied research were conducted, borrowing from a benchmarking model and including interviews with multiple key informants representing law enforcement and mental health. Informants were affiliated with three universities and multiple municipal jurisdictions in Virginia, USA. Scientific goal The goal was to assess the relevance of CIT on the college campus and explore creative approaches to enhancing campus police response to mental health crisis. Findings The results supported the scholarly literature regarding the efficacy of the CIT model. Creative adaptations to the CIT model for campus possibly can be implemented to address concerns of mental health crisis on campus. Conclusions CIT is a highly innovative model requiring extensive collaboration between law enforcement, mental health agencies, and mental health advocates. As standard qualitative research was not conducted, the sample size of key informants may not have reached saturation. However, findings from the interviews support the body of literature on CIT. The implementation of CIT on the college campus could possibly help to alleviate difficulties on campus arising from mental health crisis, including reducing inappropriate arrest or disciplinary action, improving campus safety, addressing concerns related to threat assessment and management, and enhancing collaborative efforts on campus and with resources in the broader community.

Kathy is a 52-year-old mother of two living in Pennsylvania. She has been diagnosed with bipolar disorder and narcotic dependence and in this chapter discusses how her mental illness and being in and out of treatment impacted her parenting. Today she describes coming “full circle” in her relationship with her children, and she works as a certified peer support specialist.

Background Integrating the best available evidence into program standards is essential if system-wide improvements in the delivery of community-based mental health services are to be achieved. Since the beginning of the Assertive Community Treatment (ACT) program movement, program standards have included a role for the community. In particular, ACT program standards have sought to ensure that members of the local community are involved in governance and that former clients participate in service delivery as "Peer Support Specialists". This paper reports on the extent to which ACT program standards related to community participation have been implemented and identifies barriers to full compliance. Methods Qualitative and quantitative data were collected through a telephone survey of ACT Program Coordinators in Ontario, Canada, using a census sample of the existing 66 ACT programs. A thematic approach to content analysis was used to analyze respondents' qualitative comments. Quantitative data were analyzed using SPSS 16.0 and included means, frequencies, independent t-tests and Pearson Correlations. Results An 85% response rate was achieved. Of the 33 program standards, the two that received the lowest perceived compliance ratings were the two standards directly concerning community participation. Specifically, the standard to have a functioning Community Advisory Body and the standard requiring the inclusion of a Peer Support Specialist. The three major themes that emerged from the survey data with respect to the barriers to fully implementing the Community Advisory Body were: external issues; standard related issues; and, organizational/structural related issues. The three major themes concerning barriers to implementing the Peer Support Specialist role were: human resource related issues; organizational/structural related issues; and, standard related issues. Conclusions The reasons for low compliance of ACT programs with community participation standards are complex and are tied to structural and human resources barriers (both internal and external to the ACT programs) as well as to the requirements of the standards themselves. In order for improvements to the mental health system to be achieved there is a need to identify and address these barriers. Failure to do so will result in less than optimal client, family and economic efficiency outcomes.