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This study aimed to explore, from peer workers' perspectives, the supports and strategies they use to optimise their wellbeing and effectiveness in their roles. A qualitative descriptive study was conducted using semi-structured interviews with nine peer workers from a community managed organisation in New South Wales, Australia in 2022. Data were analysed using qualitative content analysis. Peer workers described four types of personal strategies: looking after myself; increasing my peer-related skills; recognising and using my skills; and advocating for and promoting peer work. They described five types of organisational support that helped them to use these strategies and influenced their wellbeing and performance: professional development opportunities; a mental health friendly environment; place of peer work in the organisation; team dynamics and support; and logistical support. This research can help stakeholders recognise the strategies and supports that are beneficial to peer workers and facilitate understanding and support between mental health staff. While a small, contextualised study, it could provide strategies for peer workers new to the industry and for organisations seeking to ensure the sustainability of their peer workforce and the quality of services supplied to consumers. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to test the effectiveness of a tailored quitline tobacco treatment ('Quitlink') among people receiving support for mental health conditions. Methods: We employed a prospective, cluster-randomised, open, blinded endpoint design to compare a control condition to our 'Quitlink' intervention. Both conditions received a brief intervention delivered by a peer researcher. Control participants received no further intervention. Quitlink participants were referred to a tailored 8-week quitline intervention delivered by dedicated Quitline counsellors plus combination nicotine replacement therapy. The primary outcome was self-reported 6 months continuous abstinence from end of treatment (8 months from baseline). Secondary outcomes included additional smoking outcomes, mental health symptoms, substance use and quality of life. A within-trial economic evaluation was conducted. Results: In total, 110 participants were recruited over 26 months and 91 had confirmed outcomes at 8 months post baseline. There was a difference in self-reported prolonged abstinence at 8-month follow-up between Quitlink (16%, n = 6) and control (2%, n = 1) conditions, which was not statistically significant (OR = 8.33 [0.52, 132.09] p = 0.131 available case). There was a significant difference in favour of the Quitlink condition on 7-day point prevalence at 2 months (OR = 8.06 [1.27, 51.00] p = 0.027 available case). Quitlink costs AU$9231 per additional quit achieved. Conclusion: The Quitlink intervention did not result in significantly higher rates of prolonged abstinence at 8 months post baseline. However, engagement rates and satisfaction with the 'Quitlink' intervention were high. While underpowered, the Quitlink intervention shows promise. A powered trial to determine its effectiveness for improving long-term cessation is warranted. [ABSTRACT FROM AUTHOR]

This article deals with the results of a qualitative, multiple-case study that examined the impact of peer support on motivation for change amongst service users in a drug addiction recovery program. A total of nine semi-structured interviews were carried out with patients who also worked with a peer worker as part of their involvement with the service. Participant observation and keeping a research diary were additional methods of data collection. The data collected was further processed using reflective thematic analysis. This article draws on DiClemente's (2018. Addiction and Change: How Addictions Develop and Addicted People Recover , Guilford Publications) transtheoretical model model of intentional behaviour change and McClelland's (1951. 'Personality, Sloane, New York', in The Achievement Motive , p. 28, New York, Appleton-Century-Crofts) theory of motivation and current research findings on motivation in the context of peer support. Main research question is 'What mechanisms of formal peer support influence motivation to change harmful behaviour in people who take drugs?' A key finding is that a successfully established peer-service user relationship is a key instrument and premise for building motivation for change. It also presents an overview of the basic mechanisms that build the peer-service user relationship as well as the basic mechanisms that build motivation for change. It is concluded by a discussion on these mechanisms and the current literature as well as drawing implications for practice. [ABSTRACT FROM AUTHOR]

Abstract Background People who are unhoused, use substances (drugs and/or alcohol), and who have mental health conditions experience barriers to care access and are frequently confronted with discrimination and stigma in health care settings. The role of Peer Workers in addressing these gaps in a hospital-based context is not well characterized. The aim of this evaluation was to 1) outline the role of Peer Workers in the care of a marginalized populations in the emergency department; 2) characterize the impact of Peer Workers on patient care, and 3) to describe how being employed as a Peer Worker impacts the Peer. Methods Through a concurrent mixed methods evaluation, we explore the role of Peer Workers in the care of marginalized populations in the emergency department at two urban hospitals in Toronto, Ontario Canada. We describe the demographic characteristics of patients (n = 555) and the type of supports provided to patients collected through a survey between February and June 2022. Semi-structured, in-depth interviews were completed with Peer Workers (n = 7). Interviews were thematically analyzed using a deductive approach, complemented by an inductive approach to allow new themes to emerge from the data. Results Support provided to patients primarily consisted of friendly conversations (91.4%), discharge planning (59.6%), tactics to help the patient navigate their emotions/mental wellbeing (57.8%) and sharing their lived experience (50.1%). In over one third (38.9%) of all patient interactions, Peer Workers shared new information about the patient with the health care team (e.g., obtaining patient identification). Five major themes emerged from our interviews with Peer Workers which include: (1) Establishing empathy and building trust between the patient and their care team through self-disclosure; (2) Facilitating a person-centered approach to patient care through trauma-informed listening and accessible language; (3) Support for patient preferences on harm reduction; (4) Peer worker role facilitating self-acceptance and self-defined recovery; and (5) Importance of supports and resources to help Peer Workers navigate the emotional intensity of the emergency department. Conclusions The findings add to the literature on Peer Worker programs and how such interventions are designed to best meet the needs of marginalized populations.

Background: People who are unhoused, use substances (drugs and/or alcohol), and who have mental health conditions experience barriers to care access and are frequently confronted with discrimination and stigma in health care settings. The role of Peer Workers in addressing these gaps in a hospital-based context is not well characterized. The aim of this evaluation was to 1) outline the role of Peer Workers in the care of a marginalized populations in the emergency department; 2) characterize the impact of Peer Workers on patient care, and 3) to describe how being employed as a Peer Worker impacts the Peer. Methods: Through a concurrent mixed methods evaluation, we explore the role of Peer Workers in the care of marginalized populations in the emergency department at two urban hospitals in Toronto, Ontario Canada. We describe the demographic characteristics of patients (n = 555) and the type of supports provided to patients collected through a survey between February and June 2022. Semi-structured, in-depth interviews were completed with Peer Workers (n = 7). Interviews were thematically analyzed using a deductive approach, complemented by an inductive approach to allow new themes to emerge from the data. Results: Support provided to patients primarily consisted of friendly conversations (91.4%), discharge planning (59.6%), tactics to help the patient navigate their emotions/mental wellbeing (57.8%) and sharing their lived experience (50.1%). In over one third (38.9%) of all patient interactions, Peer Workers shared new information about the patient with the health care team (e.g., obtaining patient identification). Five major themes emerged from our interviews with Peer Workers which include: (1) Establishing empathy and building trust between the patient and their care team through self-disclosure; (2) Facilitating a person-centered approach to patient care through trauma-informed listening and accessible language; (3) Support for patient preferences on harm reduction; (4) Peer worker role facilitating self-acceptance and self-defined recovery; and (5) Importance of supports and resources to help Peer Workers navigate the emotional intensity of the emergency department. Conclusions: The findings add to the literature on Peer Worker programs and how such interventions are designed to best meet the needs of marginalized populations. [ABSTRACT FROM AUTHOR]

The aim of the study was to explore how recovery is facilitated by examining components of the relationship between peer workers and adults impacted by substance use disorder and incarceration. Semistructured, in-person interviews were conducted with two groups: 8 persons active in a substance use program and 4 peer workers. The participants were asked how the relationship impacted recovery and obtaining housing. A reflexive thematic analyses was conducted. The findings from the study indicate that long-term recovery may be supported with a relationship-based approach that connects individuals with a criminal justice background experiencing SUD to peer workers with lived experience. [ABSTRACT FROM AUTHOR]

Abstract Background SMART (Self-Management and Recovery Training) Recovery is a mutual-aid program informed by cognitive behaviour therapy and motivational interviewing that provides support for a range of addictive behaviours. SMART Recovery has not been adapted to target young people with addictive behaviours despite the potential to overcome important barriers affecting youth engagement in other addiction programs. This study aimed to engage young people and SMART Recovery facilitators in qualitative interviews and focus groups to explore the potential of such a program and gain specific insights for its development. Methods We conducted qualitative interviews and a focus group with five young people (aged between 14 and 24 years) and eight key stakeholders (including seven SMART Recovery facilitators) to obtain recommendations on how best to reach, engage, and support young people with addictive behaviours in a tailored SMART Recovery program. Qualitative data was transcribed and analysed using iterative categorization. Results Five key themes were identified when developing and delivering youth-targeted SMART Recovery. [1] ‘Discussing personal experiences to promote a shared identity’ refers to the benefits of creating a forum where personal stories are used to connect with others and validate one’s experiences. [2] ‘Flexible and patient approach’ emphasises a preference for facilitators to take a more gentle, less direct approach that allows for discussion beyond addictive behaviours. [3] ‘Balancing information and skills with the space for discussion’ acknowledges that youth want to connect in a variety of ways, beyond discussion of addictive behaviours, and that they wish to lead skill sharing and development. [4] ‘Conveying a community for youth through language’ highlighted the need to focus on connecting youth and to avoid the use of generic language to engage young people. [5] ‘Group logistics and competing demands’ refers to the logistical considerations of implementing a group program for youth that takes into account their competing demands and group accessibility. Conclusion The findings point to considerations for developing youth specific mutual-aid groups, in particular a youth-targeted SMART Recovery program, such as by ensuring the conversation is youth-led and with an informal and flexible approach to guide group discussion.

Abstract Background Emergency Departments (EDs) have become critical ‘touchpoints’ for the identification and early engagement of patients at risk of overdose or who have an opioid use disorder (OUD). Our objectives were to examine patients’ ED experiences, identify barriers and facilitators of service uptake in ED settings, and explore patients’ experiences with ED staff. Methods This qualitative study was part of a randomized controlled trial that evaluated the effectiveness of clinical social workers and certified peer recovery specialists in increasing treatment uptake and reducing opioid overdose rates for people with OUD. Between September 2019 and March 2020, semi-structured interviews were conducted 19 participants from the trial. Interviews sought to assess participants’ ED care experiences across intervention type (i.e., clinical social worker or peer recovery specialist). Participants were purposively sampled across intervention arm (social work, n = 11; peer recovery specialist, n = 7; control, n = 1). Data were analyzed thematically with a focus on participant experiences in the ED and social and structural factors shaping care experiences and service utilization. Results Participants reported varied ED experiences, including instances of discrimination and stigma due to their substance use. However, participants underscored the need for increased engagement of people with lived experience in ED settings, including the use of peer recovery specialists. Participants highlighted that ED provider interactions were critical drivers of shaping care and service utilization and needed to be improved across EDs to improve post-overdose care. Conclusions While the ED provides an opportunity to reach patients at risk of overdose, our results demonstrate how ED-based interactions and service provision can impact ED care engagement and service utilization. Modifications to care delivery may improve experiences for patients with OUD or at high risk for overdose. Trial registration Clinical trial registration: NCT03684681.

Abstract Background Peer workers support individuals experiencing mental health challenges by drawing on their shared lived experience. Peer support has become increasingly popular for young people with anxiety and depression, but the evidence base is unclear. This systematic review aimed to understand the effectiveness of peer support for youth depression and anxiety (either primary or comorbid), and to understand in which contexts, for whom, and why peer support works. Methods A systematic search was conducted with the Orygen Evidence Finder, Embase, MEDLINE, and PsycInfo from January 1980 to July 2022. Controlled trials of interventions to improve mental health in young people (mean age 14–24), delivered by a peer worker with lived experienced of mental health challenges were included. Outcomes related to depression or anxiety were extracted and descriptive synthesis was undertaken due to the heterogeneity of studies. Study quality was rated using the Critical Appraisal Skills Programme; reporting adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results Nine randomised controlled trials with 2,003 participants were included, with seven undertaken in high income countries. One targeted depression and anxiety, two stigma-distress (any mental disorder), one first episode psychosis, four studies preventing eating disorders and one drug misuse. One study successfully reduced anxiety and depression, another reduced depression only, four reported reductions in negative affect, with the final three measuring, but not having a significant impact on depression. Study quality was rated as ‘good’ overall. Discussion Despite the uptake of youth peer support globally, there is limited evidence from controlled trials of the effect of peer support-related interventions on anxiety and depression. There is some effect on negative affect, especially for university students. Further rigorously designed trials of peer delivered interventions for young people need to be conducted with a focus on understanding the mechanisms of action underpinning peer support.

Background Rates of readmission are high following discharge from psychiatric inpatient care. Evidence suggests that transitional interventions incorporating peer support might improve outcomes. Peer support is rapidly being introduced into mental health services, typically delivered by peer workers (people with experiences of mental health problems trained to support others with similar problems). Evidence for the effectiveness of peer support remains equivocal, and the quality of randomised controlled trials to date is often poor. There is an absence of formal cost-effectiveness studies of peer support in mental health services. Objectives This programme aimed to develop, pilot and trial a peer support intervention to reduce readmission to inpatient psychiatric care in the year post-discharge. The programme also developed a peer support fidelity index and evaluated the impact of peer support on peer workers. Design Linked work packages comprised: (1) systematic review and stakeholder consensus work to develop a peer support for discharge intervention; (2) development and psychometric testing of a peer support fidelity index; (3) pilot trial; (4) individually randomised controlled trial of the intervention, including mixed methods process evaluation and economic evaluation; (5) mixed method cohort study to evaluate the impact of peer support on peer workers. The research team included: two experienced service user researchers who oversaw patient and public involvement; service user researchers employed to develop and undertake data collection and analysis; a Lived Experience Advisory Group that informed all stages of the research. Setting The programme took place in inpatient and community mental health services in seven mental health National Health Service trusts in England. Participants Participants included 590 psychiatric inpatients who had had at least one previous admission in the preceding 2 years; 32 peer workers who delivered the intervention; and 8 peer workers’ supervisors. Intervention Participants randomised to peer support were offered at least one session of manualised peer support for discharge prior to discharge and then approximately weekly for 4 months post-discharge. Main outcome measures The primary outcome for the trial was readmission (formal or informal) to psychiatric inpatient care (readmitted or not) within 1 year of discharge from the index admission. Secondary outcomes included inpatient and emergency mental health service use at 1 year post discharge, plus standardised measures of psychiatric symptom severity and psychosocial outcomes, measured at end of intervention (4 months post discharge). Data sources Service use data were collected from electronic patient records, standardised measures of outcome and qualitative data were collected by interview. Review methods We produced two systematic reviews of one-to-one peer support for adults in mental health services. The first included studies of all designs and identified components of peer support interventions; the second was restricted to randomised controlled trials and pooled data from multiple studies to conduct meta-analyses of the effects of peer support. Results Our systematic review indicated that one-to-one peer support improved individual recovery and empowerment but did not reduce hospitalisation. The main trial demonstrated that one-to-one peer support did not have a significant effect on readmission. There was no significant reduction in secondary service use outcomes at 1-year, or improvement in clinical or psychosocial outcomes at 4 months. Participants who received a pre-defined minimal amount of peer support were less likely to be readmitted than patients in the control group who might also have received the minimal amount if offered. Compared to care as usual, black participants in the intervention group were significantly less likely to be readmitted than patients of any other ethnicity (odds ratio 0.40, 95% confidence interval 0.17 to 0.94; p = 0.0305). The economic evaluation indicated a likelihood that peer support offered a reduction in cost in excess of £2500 per participant compared to care as usual (95% confidence interval −£21,546 to £3845). The process evaluation indicated that length and quality of first session of peer support predicted ongoing engagement, and that peer support offered a unique relationship that enables social connection. The impact study indicated that peer workers found their work rewarding and offering opportunities for personal growth but could find the work emotionally and practically challenging while expressing a need for ongoing training and career development. Limitations In the trial, follow-up rates at 4 months were poor, reducing confidence in some of our analyses of secondary outcome and in a wider societal perspective on our health economic evaluation. Conclusions One-to-one peer support for discharge from inpatient psychiatric care, offered in addition to care as usual to participants at risk of readmission, is not superior to care as usual alone in the 12 months post-discharge. Future work Further research is needed to optimise engagement with peer support and better understand experiences and outcomes for people from black and other ethnic communities. Study registration The systematic review is registered as PROSPERO CRD42015025621. The trial is registered with the ISRCTN clinical trial register, number ISRCTN 10043328. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-1212-20019) and is published in full in Programme Grants for Applied Research; Vol. 11, No. 8. See the NIHR Funding and Awards website for further award information. Plain language summary When people share similar experiences of mental health problems and provide each other with emotional or practical support this can be called peer support. In recent years peer support has been introduced into mental health services. The months after discharge from psychiatric hospital can be difficult for some people. There is research that suggests that peer support might be helpful for people at discharge. There is a lack of good quality trials of peer support in mental health services. There are no studies that tell us if peer support provides value for money. We developed new training for peer workers and a handbook guiding peer support for discharge. We tried this out in two mental health National Health Service trusts to check that we could deliver the peer support and collect the information we needed for our trial. We recruited 590 people from seven mental health National Health Service trusts while they were staying on psychiatric wards. Half of those people were randomly selected to receive peer support for discharge, and half to receive community mental health care only. We found that people offered peer support were just as likely to be readmitted to hospital in the year after they were discharged as people offered usual care only. We found that people who met their peer worker at least twice were less likely to be readmitted in the next year. Black people offered peer support were much less likely to be readmitted compared to people offered usual care than other people in the study (although numbers were small). Our results also suggested that cost of care could be slightly less for people receiving peer support. We interviewed some people who had been offered peer support who told us what they valued about peer support. We interviewed peer workers who told us the work was rewarding but could be challenging. Scientific summary Background Risk of self-harm, suicide and readmission is high in the months immediately following discharge from psychiatric inpatient care. There is some evidence that transitional interventions incorporating peer support improve outcomes, including reduced readmission rates. Peer support is rapidly being introduced into mental health services internationally, typically delivered by peer workers (PWs) (people with their own experiences of mental health problems trained to support others with similar problems). Evidence for the effectiveness of peer support in mental health services remains equivocal, and the quality of randomised controlled trials to date is often poor, with trials at risk of bias because of unclear randomisation and masking procedures and incomplete reporting of outcomes. Peer support interventions are often poorly described, including the support provided for PWs, and the mechanisms of peer support unclear. Health economic evaluations are absent from the literature. Objectives The aim of the programme is to manualise, pilot and trial a peer support intervention to enhance discharge from inpatient to community mental health care, significantly reducing readmissions and the associated cost of care. The detailed research objectives of the programme are: to refine an empirically and theoretically grounded model that explains how peer support impacts on outcomes for service users post-discharge to develop and manualise a peer support intervention to enhance discharge to develop an index to assess the fidelity of peer support interventions to conduct a high-quality randomised controlled trial of the intervention to establish the effectiveness and cost-effectiveness of a peer support intervention to enhance discharge to explore the impact on PWs of working in a peer support role. Methods A training manual for PWs and intervention handbook were developed in work package 1 (months 1–15). We produced two systematic reviews of one-to-one peer support for adults in mental health services. The first, until April 2015, included studies of all designs and was used to identify components of peer support interventions; the second, until June 2019, was restricted to randomised controlled trials and pooled data from multiple studies to conduct meta-analyses of the effects of peer support. In both searches we searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases (as well as grey literature for the review of components), using ‘peer’, ‘consumer’, ‘survivor’ or ‘prosumer’ adjacent to ‘support’, ‘supporter’, ‘provider’, ‘worker’, ‘specialist’, ‘consultant’, ‘tutor’, ‘educator’, ‘mentor’, ‘intervention’, ‘listener’, ‘mediator’, ‘counsellor’, ‘befriender’ or ‘therapist’ as search terms for peer support. Paper selection at both title and abstract, and full text stage was undertaken independently by two researchers, with data extracted to spreadsheets relevant to each review. Results for the first review were combined with consensus workshops with stakeholder panels to develop and refine the peer support for discharge intervention. We also developed and tested the appropriateness, inter-rated reliability and internal consistency of a peer support fidelity index (work package 2, months 7–24). The index was first tested in 20 peer support projects not involved in the trial, before being retested and then implemented at three timepoints in each trial site. We conducted an internal pilot of the intervention and trial procedures in two sites (work package 3, year 2 of the programme) before proceeding to full trial in seven sites (work package 4, years 3–5). Sites were inpatient and community mental health services in seven mental health National Health Service trusts in England. Participants were people admitted to psychiatric inpatient care who had at least one previous admission in the preceding 2 years (i.e. who were at increased risk of readmission), the PWs who were employed and trained at each site to deliver the intervention, and the PW co-ordinators (PWCs) who supervised PWs at each site. Participants randomised to peer support were offered a manualised peer support for discharge intervention and care as usual (CAU). Participants in the control group received CAU only (discharge summary sent to community or primary care mental health team who contacted participant within 1 week of discharge to plan ongoing care). The primary outcome for the trial was readmission (formal or informal) to psychiatric inpatient care (readmitted or not) within 1 year of discharge from the index admission. Secondary outcomes were number of voluntary admissions, involuntary admissions and total number of admissions, total number of days in hospital, time to first readmission, use of accident and emergency services for a psychiatric emergency (measured as number of episodes of liaison psychiatry contact) and number of contacts with crisis resolution and home treatment teams in the year post discharge, plus standardised measures of psychiatric symptom levels, subjective quality of life, social inclusion, hope for the future and strength of social network, measured at end of intervention (4 months post discharge). Analyses were conducted on an intention-to-treat (ITT) basis. We carried out a Complier Average Casual Effect (CACE) analysis of the primary outcome (where compliers were participants who had at least two PW meetings, at least one of which was in the community following discharge). The CACE was estimated with a two-stage estimation procedure. In the first stage, a logistic regression of treatment receipt regressed on randomisation was conducted. In the second stage, a Poisson regression of the outcome on treatment receipt was conducted. The analysis was adjusted for the same covariates as the ITT analysis. A bootstrap (1000 samples) was used to obtain bias corrected and accelerated confidence intervals (CIs). Subgroup analyses for the primary outcome were pre-specified: ethnicity (any black ethnicity, all other ethnicities); primary diagnosis at index admission (psychotic disorders, personality disorders, other eligible disorders); first language (English, other). Service use data were collected from electronic patient records (EPRs) at study site, standardised measures of outcome and qualitative data were collected by face-to-face interview by a member of the study team. Our primary economic analysis of total costs over 12 months (using EPR of mental health service use), allowing for cost of peer support, and the secondary cost-effectiveness analysis at 4 months [using self-reported quality of life to derive quality-adjusted life-years (QALYs)] were carried out from an NHS mental health service perspective. A wider ‘societal’ perspective was taken when analysing non-NHS mental health care costs over 4 months (using self-reported service use outside of mental health NHS care). All analyses were conducted on an ITT basis using generalised linear modelling (GLM) with a logarithmic link function. We conducted a mixed methods process evaluation as part of work package 4, alongside the trial. Quantitative analyses used regression models to explore pre- and post-randomisation predictors of engagement with the peer support intervention. In-depth qualitative interviews with a subsample of 39 trial participants and all 32 PWs who were involved in delivering the intervention explored their experiences of peer support and sought to elucidate and refine the change model underpinning the intervention. Interviews were undertaken by service user researchers and data analysed using a ‘co-production’ approach to integrate the full range of perspectives on the research team – clinical, academic and experiential – in interpretive workshops, producing an analytical framework that was then used to code the full set of qualitative interviews. Work package 5 was a mixed method, longitudinal cohort study which explored the impact of providing peer support on PWs (from month 31 until the end of year 5). PWs completed standardised measures of well-being and employment outcomes, and in-depth interviews at three timepoints. All data were collected by service user researchers, who played a key role in developing interview schedules, refining rating procedures for the fidelity index, and analysis and interpretation of qualitative interview data. Development of the intervention and all research procedures were informed by a Lived Experience Advisory Panel (LEAP), as well as the experiential knowledge brought by service user researchers and PWs on the research team. Results In the first (2015) systematic review we identified 97 studies (including 12 from grey literature) that contributed 44 potential components to the intervention development process. A total of 66 potential components were identified when combined with outputs of our stakeholder workshops. Through iterative rounds of consensus building and testing we developed and refined our peer support intervention, comprising a bespoke PW training programme and a detailed handbook guiding implementation. In the second (2019) review we identified 23 studies reporting 19 trials. We found that one-to-one peer support in mental health services has a small but statistically significant benefit for individual recovery [standardised mean difference (SMD) 0.22, 95% CI 0.01 to 0.42; p = 0.042] and empowerment (SMD 0.23, 95% CI 0.04 to 0.42; p = 0.020). There was no effect on clinical outcomes such as symptoms or hospitalisation; the risk of being hospitalised was reduced by 14% for those receiving peer support but was non-significant [risk ratio (RR) 0.86, 95% CI 0.66 to 1.13]. We developed a principles-based fidelity index that had good acceptability and psychometric properties. The index measures set-up, delivery and overall fidelity of peer support against four domains (principles): building trusting relationships based on shared lived experience; reciprocity and mutuality; leadership, choice and control; building strengths and making connections to community. In the trial, fidelity was good at set-up in all sites, while fidelity of delivery of peer support was lower in sites where PWs were employed in voluntary sector organisations outside of the NHS. The pilot trial indicated that progression criteria were met subject to a small number of actions to improve the rate of recruitment of participants. In the main trial we successfully recruited our target of 590 participants, and participant characteristics were well-balanced between groups. In the PW group, 136 (47.4%) participants were readmitted to psychiatric inpatient care within 12 months post-index admission, and 146 (50.2%) in the CAU group. The adjusted relative risk of readmission in the ITT analysis was 0.97 (95% CI 0.82 to 1.14; p = 0.6777), and the adjusted odds ratio (OR) was 0.93 (95% CI 0.66 to 1.30). In the CACE analysis, the relative risk of readmission according to the natural indirect effect (RR 0.88, 95% CI 0.76 to 0.99) was lower than from the ITT analysis and was significant. In subgroup analyses (see Table 6), for patients of any black ethnicity the adjusted OR of readmission was 0.40 (95% CI 0.17 to 0.94), while for any other ethnicity the OR was 1.12 (95% CI 0.77 to 1.63; interaction p = 0.0305). There were no statistically significant differences between the groups in any of the secondary outcomes assessed at 4 or 12 months. Adherence to the intervention was assessable in 268 (91.2%) participants with a mean of 1.8 [standard deviation (SD) = 2.9] face-to-face contacts with a PW in hospital, 4.4 (SD = 4.6) post discharge. There was a total of 67 serious adverse events (SAE) reported in the trial (34 in the peer support group, 33 in the CAU group) from 51 participants (26 in the peer support group, 25 in the CAU group). One SAE in the peer support group, an incident of self-harm, was reported as related to the intervention. Number and type of SAE included 12 deaths, none of which were reported as related to the study. A cost analysis of mental health service contacts over a 12-month period following discharge from inpatient care showed that, adjusting for baseline covariates, exposure to peer support was associated with a reduction in mean total costs of £2631 (95% CI −£21,546 to £3845): this amounted to a 10% reduction in mean total costs over 12-month post hospital discharge compared to usual care (95% CI −31% to 15%). Given sampling uncertainty there was an estimated 82% probability that peer support was associated with lower total costs over 12 months (or a 18% chance that usual care was the lower cost alternative). Most of the cost advantage over follow-up was due to reductions in the cost of bed day utilisation. Over 4 months, and considering patient quality of life outcomes as well as cost, peer support was also found to be cost-effective from an NHS mental health service perspective. The expected QALY gains associated with peer support were marginal: a 0.002 QALY improvement per participant, equivalent to less than a single day in full health. Participants who were heterosexual were less likely to engage with peer support than gay, lesbian or bisexual participants, OR 0.3 (95% CI 0.08 to 0.87; p = 0.029). We found that length of first contact (in minutes) was positively associated with engaging with peer support, OR 1.02 (95% CI 1.00 to 1.04; p = 0.010), and participants who went on to engage with peer support experienced more relationship building activity in that first contact. A shorter period between allocation to peer support and discharge (in days) was also associated with engagement in the intervention, OR 0.99 (95% CI 0.98 to 1.00; p = 0.002). Our qualitative process evaluation largely supports our original change model, further elucidating the distinctive nature of the peer-to-peer relationship while indicating the role that PWs played in enabling people to build relationships and make connection to community. Choice and control over how people engaged with peer support was identified as an important mediator of good experience and outcomes of peer support. Peer worker well-being, job satisfaction, team working and burn out scores were close to or better than scores for appropriate norm populations throughout the study. There were small but significant drops in well-being, personal satisfaction and satisfaction with workload after 4 months in post, and a similar small increase in burn out, but these changes were not maintained at 12 months. Satisfaction with training and job prospects were lower at 12 months. Qualitative data largely confirmed these findings with PWs indicating that they found that peer support work could be emotionally and practically challenging for the first few months but was rewarding and offered opportunities for personal growth. Conclusions We conclude that peer support for discharge, offered to participants at risk of readmission, was not superior to CAU. Peer support should not be commissioned with the expectation that it reduces readmissions for this group, although some cost-saving based on fewer days in hospital is likely. Our trial findings reflect those of our systematic review, suggesting that one-to-one peer support in mental health services is unlikely to improve clinical outcomes or reduce hospitalisation. Further research is needed to: improve implementation in order to optimise engagement with peer support establish the impact of peer support on psychosocial outcomes understand and evaluate the impacts of peer support for people from different ethnic communities (and especially to optimise benefits for black people using mental health services) understand and evaluate the impacts of peer support for people from different clinical populations establish the construct validity of our fidelity index through use with larger samples better understand the ongoing training and support needs, and career development pathway for PWs. Study registration The systematic review is registered as PROSPERO CRD42015025621. The trial is registered with the ISRCTN clinical trial register, number ISRCTN 10043328. Funding This award was funded by the UK National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-1212-20019) and is published in full in Programme Grants for Applied Research; Vol. 11, No. 8. See the NIHR Funding and Awards website for further award information. This paper presents independent research funded by NIHR. The views expressed are those of the authors and not necessarily those of the UK National Health Service (NHS), the NIHR or the Department of Health and Social Care.

Background: SMART (Self-Management and Recovery Training) Recovery is a mutual-aid program informed by cognitive behaviour therapy and motivational interviewing that provides support for a range of addictive behaviours. SMART Recovery has not been adapted to target young people with addictive behaviours despite the potential to overcome important barriers affecting youth engagement in other addiction programs. This study aimed to engage young people and SMART Recovery facilitators in qualitative interviews and focus groups to explore the potential of such a program and gain specific insights for its development. Methods: We conducted qualitative interviews and a focus group with five young people (aged between 14 and 24 years) and eight key stakeholders (including seven SMART Recovery facilitators) to obtain recommendations on how best to reach, engage, and support young people with addictive behaviours in a tailored SMART Recovery program. Qualitative data was transcribed and analysed using iterative categorization. Results: Five key themes were identified when developing and delivering youth-targeted SMART Recovery. [1] 'Discussing personal experiences to promote a shared identity' refers to the benefits of creating a forum where personal stories are used to connect with others and validate one's experiences. [2] 'Flexible and patient approach' emphasises a preference for facilitators to take a more gentle, less direct approach that allows for discussion beyond addictive behaviours. [3] 'Balancing information and skills with the space for discussion' acknowledges that youth want to connect in a variety of ways, beyond discussion of addictive behaviours, and that they wish to lead skill sharing and development. [4] 'Conveying a community for youth through language' highlighted the need to focus on connecting youth and to avoid the use of generic language to engage young people. [5] 'Group logistics and competing demands' refers to the logistical considerations of implementing a group program for youth that takes into account their competing demands and group accessibility. Conclusion: The findings point to considerations for developing youth specific mutual-aid groups, in particular a youth-targeted SMART Recovery program, such as by ensuring the conversation is youth-led and with an informal and flexible approach to guide group discussion. [ABSTRACT FROM AUTHOR]

Background: Emergency Departments (EDs) have become critical 'touchpoints' for the identification and early engagement of patients at risk of overdose or who have an opioid use disorder (OUD). Our objectives were to examine patients' ED experiences, identify barriers and facilitators of service uptake in ED settings, and explore patients' experiences with ED staff. Methods: This qualitative study was part of a randomized controlled trial that evaluated the effectiveness of clinical social workers and certified peer recovery specialists in increasing treatment uptake and reducing opioid overdose rates for people with OUD. Between September 2019 and March 2020, semi-structured interviews were conducted 19 participants from the trial. Interviews sought to assess participants' ED care experiences across intervention type (i.e., clinical social worker or peer recovery specialist). Participants were purposively sampled across intervention arm (social work, n = 11; peer recovery specialist, n = 7; control, n = 1). Data were analyzed thematically with a focus on participant experiences in the ED and social and structural factors shaping care experiences and service utilization. Results: Participants reported varied ED experiences, including instances of discrimination and stigma due to their substance use. However, participants underscored the need for increased engagement of people with lived experience in ED settings, including the use of peer recovery specialists. Participants highlighted that ED provider interactions were critical drivers of shaping care and service utilization and needed to be improved across EDs to improve post-overdose care. Conclusions: While the ED provides an opportunity to reach patients at risk of overdose, our results demonstrate how ED-based interactions and service provision can impact ED care engagement and service utilization. Modifications to care delivery may improve experiences for patients with OUD or at high risk for overdose. Trial registration: Clinical trial registration: NCT03684681. [ABSTRACT FROM AUTHOR]

Despite a long history of the adoption of a peer workforce in alcohol and other drug treatment service provision, there is limited peer reviewed literature on the benefits of peer worker role integration in the hospital setting. Our qualitative study explored the perceptions of people with lived experience of problematic alcohol and other drugs use and their experiences of peer worker roles in the hospital setting. Twenty semi-structured interviews with people who experienced problematic alcohol and other drug use. Transcripts were thematically analyzed and guided by a broad interest in a therapeutic alliance. We identified four themes related to how lived experience expertise within a peer worker role strengthened therapeutic alliances: (i) by building trust and credibility; (i) by building hope; (iii) the ability to approach informally; and (iv) in continuing to be accessible long term. The results partly echo earlier literature, however highlight two innovative aspects that relate to lived experience expertise that maintain therapeutic alliances in the hospital setting being, firstly, the ability to approach informally, and secondly, an opportunity for longer-term engagement. In Australia at present there is a window of opportunity to better integrate peer workers into clinical care models, and as such our results have implications for how policy makers might better approach peer worker integration and configuration to improve treatment-seeking intentions both within and beyond the hospital setting. [ABSTRACT FROM AUTHOR]

Background: Peer workers support individuals experiencing mental health challenges by drawing on their shared lived experience. Peer support has become increasingly popular for young people with anxiety and depression, but the evidence base is unclear. This systematic review aimed to understand the effectiveness of peer support for youth depression and anxiety (either primary or comorbid), and to understand in which contexts, for whom, and why peer support works. Methods: A systematic search was conducted with the Orygen Evidence Finder, Embase, MEDLINE, and PsycInfo from January 1980 to July 2022. Controlled trials of interventions to improve mental health in young people (mean age 14–24), delivered by a peer worker with lived experienced of mental health challenges were included. Outcomes related to depression or anxiety were extracted and descriptive synthesis was undertaken due to the heterogeneity of studies. Study quality was rated using the Critical Appraisal Skills Programme; reporting adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Nine randomised controlled trials with 2,003 participants were included, with seven undertaken in high income countries. One targeted depression and anxiety, two stigma-distress (any mental disorder), one first episode psychosis, four studies preventing eating disorders and one drug misuse. One study successfully reduced anxiety and depression, another reduced depression only, four reported reductions in negative affect, with the final three measuring, but not having a significant impact on depression. Study quality was rated as 'good' overall. Discussion: Despite the uptake of youth peer support globally, there is limited evidence from controlled trials of the effect of peer support-related interventions on anxiety and depression. There is some effect on negative affect, especially for university students. Further rigorously designed trials of peer delivered interventions for young people need to be conducted with a focus on understanding the mechanisms of action underpinning peer support. [ABSTRACT FROM AUTHOR]

Introduction: People experiencing severe mental illness (SMI) smoke at much higher rates than the general population and require additional support. Engagement with existing evidence-based interventions such as quitlines and nicotine replacement therapy (NRT) may be improved by mental health peer worker involvement and tailored support. This paper reports on a qualitative study nested within a peer researcher-facilitated tobacco treatment trial that included brief advice plus, for those in the intervention group, tailored quitline callback counseling and combinationNRT. It contextualizes participant life experience and reflection on trial participation and others insights for future interventions. Methods: Qualitative semi-structured interviews were conducted with 29 participants in a randomized controlled trial (intervention group n = 15, control group n = 14) following their 2-month (post-recruitment) follow-up assessments, which marked the end of the "Quitlink" intervention for those in the intervention group. Interviews explored the experience of getting help to address smoking (before and during the trial), perceptions of main trial components including assistance from peer researchers and tailored quitline Frontiers in Psychiatry 01 frontiersin.org counseling, the role of NRT, and other support received. A general inductive approach to analysis was applied. Results: We identified four main themes: (1) the long and complex journey of quitting smoking in the context of disrupted lives; (2) factors affecting quitting (desire to quit, psychological and social barriers, and facilitators and reasons for quitting); (3) the perceived benefits of a tailored approach for people with mental ill-health including the invitation to quit and practical resources; and (4) the importance of compassionate delivery of support, beginning with the peer researchers and extended by quitline counselors for intervention participants. Subthemes were identified within each of these overarching main themes. Discussion: The findings underscore the enormity of the challenges that our targeted population face and the considerations needed for providing tobacco treatment to people who experience SMI. The data suggest that a tailored tobacco treatment intervention has the potential to assist people on a journey to quitting, and that compassionate support encapsulating a recovery-oriented approach is highly valued. [ABSTRACT FROM AUTHOR]

IntroductionPeople experiencing severe mental illness (SMI) smoke at much higher rates than the general population and require additional support. Engagement with existing evidence-based interventions such as quitlines and nicotine replacement therapy (NRT) may be improved by mental health peer worker involvement and tailored support. This paper reports on a qualitative study nested within a peer researcher-facilitated tobacco treatment trial that included brief advice plus, for those in the intervention group, tailored quitline callback counseling and combination NRT. It contextualizes participant life experience and reflection on trial participation and offers insights for future interventions.MethodsQualitative semi-structured interviews were conducted with 29 participants in a randomized controlled trial (intervention group n = 15, control group n = 14) following their 2-month (post-recruitment) follow-up assessments, which marked the end of the “Quitlink” intervention for those in the intervention group. Interviews explored the experience of getting help to address smoking (before and during the trial), perceptions of main trial components including assistance from peer researchers and tailored quitline counseling, the role of NRT, and other support received. A general inductive approach to analysis was applied.ResultsWe identified four main themes: (1) the long and complex journey of quitting smoking in the context of disrupted lives; (2) factors affecting quitting (desire to quit, psychological and social barriers, and facilitators and reasons for quitting); (3) the perceived benefits of a tailored approach for people with mental ill-health including the invitation to quit and practical resources; and (4) the importance of compassionate delivery of support, beginning with the peer researchers and extended by quitline counselors for intervention participants. Subthemes were identified within each of these overarching main themes.DiscussionThe findings underscore the enormity of the challenges that our targeted population face and the considerations needed for providing tobacco treatment to people who experience SMI. The data suggest that a tailored tobacco treatment intervention has the potential to assist people on a journey to quitting, and that compassionate support encapsulating a recovery-oriented approach is highly valued.Clinical trial registrationThe Quitlink trial was registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines.

Introduction: One of the most challenging aspects of conducting intervention trials among people who experience severe mental illness (SMI) and who smoke tobacco, is recruitment. In our parent "QuitLink" randomized controlled trial (RCT), slower than expected peer researcher facilitated recruitment, along with the impact of COVID-19 pandemic restrictions, necessitated an adaptive recruitment response. The objectives of the present study were to: (i) describe adaptive peer researcher facilitated recruitment strategies; (ii) explore the effectiveness of these strategies; (iii) investigate whether recruitment strategies reached different subgroups of participants; and (iv) examine the costs and resources required for implementing these strategies. Finally, we offer experience-based lessons in a Peer Researcher Commentary. Methods: People were included in the RCT if they smoked at least 10 cigarettes a day and were accessing mental health support from the project's two partnering mental health organizations in Victoria, Australia. The majority of people accessing these services will have been diagnosed with SMI. Recruitment occurred over 2 years. We began with peer facilitated recruitment strategies delivered face-to-face, then replaced this with direct mail postcards followed by telephone contact. In the final 4 months of the study, we began online recruitment, broadening it to people who smoked and were accessing support or treatment (including from general practitioners) for mental health and/or alcohol or other drug problems, anywhere in the state of Victoria. Differences between recruitment strategies on key participant variables were assessed. We calculated the average cost per enrolee of the different recruitment approaches. Results: Only 109 people were recruited from a target of 382: 29 via face-to-face (March 2019 to April 2020), 66 from postcards (May 2020 to November 2020), and 14 from online (November to December 2020 and January to March 2021) strategies. Reflecting our initial focus on recruiting from supported independent living accommodation facilities, participants recruited face-to-face were significantly more likely to be living in partially or fully supported independent living (n = 29, <0.001), but the samples were otherwise similar. After the initial investment in training and equipping peer researchers, the average cost of recruitment was AU$1,182 per participant—~US$850. Face-to-face recruitment was the most expensive approach and postcard recruitment the least (AU$1,648 and AU$928 per participant). Discussion: Peer researcher facilitated recruitment into a tobacco treatment trial was difficult and expensive. Widely dispersed services and COVID-19 restrictions necessitated non-face-to-face recruitment strategies, such as direct mail postcards, which improved recruitment and may be worthy of further research. Clinical Trial Registration: The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines. The trial sponsor was the University of Newcastle, NSW, Australia. [ABSTRACT FROM AUTHOR]

The study deals with the employment of people diagnosed with mental illness in the position of peer worker. The aim is to demonstrate through semi-structured interviews the involvement of peer workers in the social services for people diagnosed with mental illness and to identify the influences that affect the success of peer workers involvement in services. The results of the interviews were divided into two categories (Position Specifics, Ethical Aspects) and four subcategories (Professionalism, Risk Moments, Stigmatization, Shared Values) using the Coding Method. The individual subcategories were further subdivided in detail. The results show that the most negative influence on the successful involvement of peer workers is the unclear definition of the job role and responsibilities and further, from an ethical point of view, it is the fear of subsequent labelling (stigmatization) in the search for a new job. A positive ethical influence is the sharing of social values (hope, recovery, friendship, sharing, etc.), which supports the peer worker. The study could help anchor the role in practice and could be the basis for further research in human resources management, social work and management. [ABSTRACT FROM AUTHOR]

Peer support may be a valuable way to support recovery in borderline personality disorder (BPD). This study investigates the role of peer workers in services supporting consumers with BPD. We studied peer work delivered in five different types of mental health services, including outpatient mental health and independent peer-run services. Surveys were conducted with peer workers (n = 5), consumers of the peer work (n = 14) and clinicians in the same service (n = 4). Qualitative responses were analysed using interpretative thematic analysis. Consumers with BPD receiving peer support benefitted by feeling understood, hopeful and less isolated. Peer workers were described as role modelling a meaningful life, understanding the unique experiences associated with BPD, and providing skills in the context of their own personal experiences. Peer workers providing peer support benefitted by being reminded to practise their own wellbeing skills, and experienced challenges when responding to consumer risk and trauma experiences. Clinicians increased their understanding of BPD through discussions with peer workers. Findings show evidence regarding the unique contributions of peer support for consumers with BPD. Challenges were experienced by peer workers, and they recommended peer supervision being more accessible and available. Future research is required to evaluate mechanisms in peer support that contribute to recovery in consumers with BPD. [ABSTRACT FROM AUTHOR]

IntroductionOne of the most challenging aspects of conducting intervention trials among people who experience severe mental illness (SMI) and who smoke tobacco, is recruitment. In our parent “QuitLink” randomized controlled trial (RCT), slower than expected peer researcher facilitated recruitment, along with the impact of COVID-19 pandemic restrictions, necessitated an adaptive recruitment response. The objectives of the present study were to: (i) describe adaptive peer researcher facilitated recruitment strategies; (ii) explore the effectiveness of these strategies; (iii) investigate whether recruitment strategies reached different subgroups of participants; and (iv) examine the costs and resources required for implementing these strategies. Finally, we offer experience-based lessons in a Peer Researcher Commentary.MethodsPeople were included in the RCT if they smoked at least 10 cigarettes a day and were accessing mental health support from the project's two partnering mental health organizations in Victoria, Australia. The majority of people accessing these services will have been diagnosed with SMI. Recruitment occurred over 2 years. We began with peer facilitated recruitment strategies delivered face-to-face, then replaced this with direct mail postcards followed by telephone contact. In the final 4 months of the study, we began online recruitment, broadening it to people who smoked and were accessing support or treatment (including from general practitioners) for mental health and/or alcohol or other drug problems, anywhere in the state of Victoria. Differences between recruitment strategies on key participant variables were assessed. We calculated the average cost per enrolee of the different recruitment approaches.ResultsOnly 109 people were recruited from a target of 382: 29 via face-to-face (March 2019 to April 2020), 66 from postcards (May 2020 to November 2020), and 14 from online (November to December 2020 and January to March 2021) strategies. Reflecting our initial focus on recruiting from supported independent living accommodation facilities, participants recruited face-to-face were significantly more likely to be living in partially or fully supported independent living (n = 29,

Abstract Background Peer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions. Method We searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data. Results Twenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery. Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support. Conclusions One-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support. Trial registration Prospero identifier: CRD42015025621 .

Abstract Background Consumer peer workers are individuals with lived experience of mental health issues and recovery who are employed to use their lived experience to support others. The consumer peer workforce has expanded substantially in recent years. While some research has explored the workplace experiences of peer workers, no previous studies have explored job satisfaction, burnout or turnover intention for this workforce. Methods Consumer peer workers in New South Wales, Australia were invited to complete a survey designed to explore their workplace experiences. The survey included measures of job satisfaction, burnout, turnover intention, job demands and job resources, and satisfaction with supervision, professional development and opportunities for career progression. Questions also explored positive and negative aspects of positions. Analyses included exploration of the relationships between of job satisfaction, burnout, turnover intention, job demands and job resources as well as tabulation of common positive and negative aspects of positions. Results were also compared with findings from a previous study exploring workplace experiences of other mental health workers. Results A total of 67 peer workers participated in the study. Overall job satisfaction, burnout (disengagement and exhaustion) and turnover intention for peer workers was not significantly different to other mental health workers. Job satisfaction, disengagement, exhaustion and turnover intention were all significantly inter-related. Job resources of social support, job control, feedback, and rewards and recognition were associated with positive workplace experiences and the job demand of “physical environment” was most substantially associated with poorer workplace experiences. The most common positive aspect of positions was “connecting with consumers” and the most common negative aspect of positions was “attitudes of clinicians / workplace culture”. Access to supervision from a senior peer worker was associated with more positive workplace experiences. Conclusions This research demonstrates that while consumer peer workers do not appear to experience poorer job satisfaction or higher levels of burnout or turnover intention than other mental health workers, a range of challenges do exist. Efforts to further expand the peer workforce (especially senior peer worker roles) and to promote more positive attitudes and workplace cultures are likely to promote better workplace experiences for peer workers.

Peer recovery support services (PRSS) for substance use disorder (SUD) are a flexible and evidence-based intervention employed across multiple settings and for a variety of populations. These services have expanded over the past two decades, but there is little research on recruitment and training of prospective peer workers – the peer to career pipeline. This study observed training outcomes for applicants to a peer worker scholarship program in Texas. A total of 448 participants provided baseline personal history information, and a subset of participants (n = 239) completed optional psychosocial surveys. Logistic regression analysis tested associations of personal history and psychosocial variables with three training stage completion outcomes: classroom training completion, placement at an internship site, and full certification. The greatest decline in advancement between stages occurred in the transition between classroom training (78.1 % of participants completed) and internship placement (43.3 % of participants completed). Participants were diverse in terms of race/ethnicity and life experiences salient to the peer worker role, but Hispanic/Latinx peer workers were under-represented. Past work with a SUD peer worker, age, and having a bachelor's degree were each positively associated with training stage completion across multiple models, while having basic technological access, being a woman, and veteran status were each positively associated with training stage completion in only one model. Years since recovery initiation date, non-monosexual orientation, White race, and quality of life were each negatively associated with training stage completion in only one model. The existing peer workforce may be a key source of recruitment for new peer workers; thus retention of existing workers is key to ensuring continued expansion of these services. Additional support may be required to recruit and retain younger peer worker trainees, men trainees, Hispanic/Latinx trainees, trainees who lack basic technological access, or trainees without bachelor's degrees. Unanswered questions about the peer workforce remain and must be addressed to ensure that an appropriately diverse workforce is recruited, that disparities in training outcomes are minimized or prevented, and that existing peer workers are well-supported. • Securing an internship is the greatest barrier in the peer to career pipeline. • Current peer workers may be an important source of training support. • Several key groups are under-recruited or may need more support during training. [ABSTRACT FROM AUTHOR]

Abstract Background Suicide is a major public health issue worldwide. Those who have made a recent suicide attempt are at high risk for dying by suicide in the future, particularly during the period immediately following departure from a hospital emergency department. As such the transition from hospital-based care to the community is an important area of focus in the attempt to reduce suicide rates. There is a need for evaluation studies to test the effectiveness of interventions directed to this stage (termed ‘aftercare’ interventions). Methods A controlled non-randomised two group (intervention vs treatment-as-usual control) design, using an intention-to-treat model, will evaluate the effectiveness of a suicide prevention aftercare intervention providing follow-up after presentations to a hospital emergency department as a result of a suicide attempt or high risk for suicide. The intervention is a community-based service, utilising two meetings with a mental health clinician and follow-up contacts by peer workers via a combination of face-to-face and telephone for four weeks, with the option of extension to 12 weeks. Seventy-five participants of the intervention service will be recruited to the study and compared to 1265 treatment-as-usual controls. The primary hypotheses are that over 12 months, those who participate in the aftercare follow-up intervention are less likely than controls to present to a hospital emergency department for a repeat suicide attempt or because of high risk for suicide, will have fewer re-presentations during this period and will have lower all-cause mortality. As a secondary aim, the impact of the intervention on suicide risk factors for those who participate in the service will be evaluated using pre- and post-intervention repeated measures of depression, anxiety, stress, hopelessness, belongingness, burdensomeness, and psychological distress. Enrolments into the study commenced on 1 November 2017 and are anticipated to cease in November 2019. Discussion The study aims to contribute to the understanding of effective interventions for individuals who have presented to a hospital emergency department as a result of a suicide attempt or at high risk for suicide and provide evidence in relation to interventions that incorporate peer-workers. Trial registration ACTRN12618001701213. Registered on 16 October 2018. Retrospectively registered.

Abstract Background Peer support can enable patient engagement with healthcare services, particularly for marginalised populations. In this randomised controlled trial, the efficacy of a peer support intervention at promoting successful engagement with clinical services for chronic hepatitis C was assessed. Methods In London, UK, potential participants were approached through outreach services for problematic drug use and homelessness. Individuals positive for hepatitis C virus (HCV) after confirmatory testing were randomised using an online service to the intervention (peer support) or standard of care. The primary outcome of interest was successful engagement with clinical hepatitis services. The study was non-blinded. Absolute differences were calculated using a generalised linear model and the results compared to logistic regression. Results Three hundred sixty-four individuals consented to participate. One hundred one had chronic hepatitis C and were randomised, 63 to receive the intervention (peer support). A successful outcome was achieved by 23 individuals in this arm (36.5%) and seven (18.4%) receiving the standard of care, giving an absolute increase of 18.1% (95% confidence interval 1.0–35.2%, p value = 0.04). This was mirrored in the logistic regression (odds ratio 2.55 (0.97–6.70), p = 0.06). No serious adverse events were reported. Conclusions Peer support can improve the engagement of patients with chronic HCV with healthcare services. Trial registration ISRCTN24707359. Registered 19th October 2012.

Introduction For the first time in N. Macedonia we had the experience to include peer workers as an equal members in the newly formed community mental health teams. For the purpose of the RECOVER-e project we engaged 2 patients to be the new peer workers. Objectives To evaluate the initial period of peer worker involvement in the community mental health teams and to identify the next steps for them. Methods Conducting interviews with the peer workers. Results One important aspect that is worth mentioning is their motivation to continue their work in the community mental health teams and continue to improve. Another finding is their will to establish a user led organisation. A user led organisation in the field of mental health in our country is rare to be find, with only a couple of them functioning in N. Macedonia. So if our peer workers can make it, it would be a great step in the right direction. Conclusions Overall, taking into consideration all that the peer workers have achieved in the last period, including the ups and downs of being the first official peer workers in N. Macedonia, they are looking forward to improve their knowledge and continue building their practical experience. A great plus of it all is that they have a financial stability for this troubled pandemic period. Disclosure No significant relationships.

Although the inclusion of individuals with lived experience is encouraged within the research process, there remains inconsistent direct involvement in many mental health fields. Within the eating disorders field specifically, there is a very strong and increasing presence of lived experience advocacy. However, due to a number of potential challenges, research undertaken in consultation or in collaboration with individuals with lived experience of an eating disorder is scarce. This paper describes the significant benefits of the inclusion of individuals with lived experience in research. The specific challenges and barriers faced in eating disorders research are also outlined. It is concluded that in addition to existing guidelines on working with lived experience collaborators in mental health research, more specific procedures are required when working with those with eating disorders. [ABSTRACT FROM AUTHOR]

Background: Consumer peer workers are individuals with lived experience of mental health issues and recovery who are employed to use their lived experience to support others. The consumer peer workforce has expanded substantially in recent years. While some research has explored the workplace experiences of peer workers, no previous studies have explored job satisfaction, burnout or turnover intention for this workforce. Methods: Consumer peer workers in New South Wales, Australia were invited to complete a survey designed to explore their workplace experiences. The survey included measures of job satisfaction, burnout, turnover intention, job demands and job resources, and satisfaction with supervision, professional development and opportunities for career progression. Questions also explored positive and negative aspects of positions. Analyses included exploration of the relationships between of job satisfaction, burnout, turnover intention, job demands and job resources as well as tabulation of common positive and negative aspects of positions. Results were also compared with findings from a previous study exploring workplace experiences of other mental health workers. Results: A total of 67 peer workers participated in the study. Overall job satisfaction, burnout (disengagement and exhaustion) and turnover intention for peer workers was not significantly different to other mental health workers. Job satisfaction, disengagement, exhaustion and turnover intention were all significantly inter-related. Job resources of social support, job control, feedback, and rewards and recognition were associated with positive workplace experiences and the job demand of "physical environment" was most substantially associated with poorer workplace experiences. The most common positive aspect of positions was "connecting with consumers" and the most common negative aspect of positions was "attitudes of clinicians / workplace culture". Access to supervision from a senior peer worker was associated with more positive workplace experiences. Conclusions: This research demonstrates that while consumer peer workers do not appear to experience poorer job satisfaction or higher levels of burnout or turnover intention than other mental health workers, a range of challenges do exist. Efforts to further expand the peer workforce (especially senior peer worker roles) and to promote more positive attitudes and workplace cultures are likely to promote better workplace experiences for peer workers. [ABSTRACT FROM AUTHOR]

Introduction: Smoking is a major cause of disease burden and reduced quality of life for people with severe mental illness (SMI). It places significant resource pressure on health systems and financial stress on smokers with SMI (SSMI). Telephone-based smoking cessation interventions have been shown to be cost effective in general populations. However, evidence suggests that SSMI are less likely to be referred to quitlines, and little is known about the effectiveness and cost effectiveness of such interventions that specifically target SSMI. The Quitlink randomized controlled trial for accessible smoking cessation support for SSMI aims to bridge this gap. This paper describes the protocol for evaluating the cost effectiveness of Quitlink.Methods: Quitlink will be implemented in the Australian setting, utilizing the existing mental health peer workforce to link SSMI to a tailored quitline service. The effectiveness of Quitlink will be evaluated in a clustered randomized controlled trial. A cost-effectiveness evaluation will be conducted alongside the Quitlink clustered randomized controlled trial (RCT) with incremental cost-effectiveness ratios (ICERs) calculated for the cost (AUD) per successful quit and quality adjusted life year (QALY) gained at 8 months compared with usual care from both health care system and limited societal perspectives. Financial implications for study participants will also be investigated. A modeled cost-effectiveness analysis will also be conducted to estimate future costs and benefits associated with any treatment effect observed during the trial. Results will be extrapolated to estimate the cost effectiveness of rolling out Quitlink nationally. Sensitivity analyses will be undertaken to assess the impact on results from plausible variations in all modeled variables.Discussion: SSMI require additional support to quit. Quitlink utilizes existing peer worker and quitline workforces and tailors quitline support specifically to provide that increased cessation support. Given Quitlink engages these existing skilled workforces, it is hypothesized that, if found to be effective, it will also be found to be both cost effective and scalable. This protocol describes the economic evaluation of Quitlink that will assess these hypotheses.Ethics and dissemination: Full ethics clearances have been received for the methods described below from the University of Newcastle (Australia) Human Research Ethics Committee (H-2018-0192) and St Vincent’s Hospital, Melbourne (HREC/18/SVHM/154). The trial has been registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619000244101). Participant consent is sought both to participate in the study and to have the study data linked to routine health administrative data on publicly subsidized health service and pharmaceutical use, specifically the Medicare Benefits and Pharmaceutical Benefits Schemes (MBS/PBS). Trial findings (including economic evaluation) will be published in peer reviewed journals and presented at international conferences. Collected data and analyses will be made available in accordance with journal policies and study ethics approvals. Results will be presented to relevant government authorities with an interest in cost effectiveness of these types of interventions.

Introduction: Although smokers with severe mental illnesses (SSMI) make quit attempts at comparable levels to other smokers, fewer are successful in achieving smoking cessation. Specialized smoking cessation treatments targeting their needs can be effective but have not been widely disseminated. Telephone delivered interventions, including by quitlines, show promise. However, few SSMI contact quitlines and few are referred to them by health professionals. Mental health peer workers can potentially play an important role in supporting smoking cessation. This study will apply a pragmatic model using peer workers to engage SSMI with a customized quitline service, forming the “Quitlink” intervention.Methods: A multi-center prospective, cluster-randomized, open, blinded endpoint (PROBE) trial. Over 3 years, 382 smokers will be recruited from mental health services in Victoria, Australia. Following completion of baseline assessment, a brief intervention will be delivered by a peer worker. Participants will then be randomly allocated either to no further intervention, or to be referred and contacted by the Victorian Quitline and offered a targeted 8-week cognitive behavioral intervention along with nicotine replacement therapy (NRT). Follow-up measures will be administered at 2-, 5-, and 8-months post-baseline. The primary outcome is 6 months continuous abstinence from end of treatment with biochemical verification. Secondary outcomes include 7-day point prevalence abstinence from smoking, increased quit attempts, and reductions in cigarettes per day, cravings and withdrawal, mental health symptoms, and other substance use, and improvements in quality of life. We will use a generalized linear mixed model (linear regression for continuous outcomes and logistic regression for dichotomous outcomes) to handle clustering and the repeated measures at baseline, 2-, 5-, and 8-months; individuals will be modeled as random effects, cluster as a random effect, and group assignment as a fixed effect.Discussion: This is the first rigorously designed RCT to evaluate a specialized quitline intervention accompanied by NRT among SSMI. The study will apply a pragmatic model to link SSMI to the Quitline, using peer workers, with the potential for wide dissemination.Clinical Trial Registration:Trial Registry: The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines.Trial Sponsor: University of Newcastle, NSW, Australia.

Compared to the general population and to males with mental health disorders, women with these disorders face more obstacles in psychiatric and mental health care settings. This strongly encourages mental health policies and psychiatric care to consider specific strategies that prevent gender bias in treatment among women with mental health issues. A growing body of research demonstrates the benefits of having peer workers-professionals with a lived experience of mental health issues who use their own experiences of mental distress to support others with comparable experiences-in mental health services. We postulate that peer support can become an important and integrated aspect of preventing and addressing discrimination against women in psychiatry and mental health care. First, women peer workers may combine their lived experiences as service users and as women to provide unique, experience- and gender-based support to women users who experience discrimination. Non-women or women peer workers who did not experience gender discrimination in psychiatric settings may nevertheless benefit from the integration of gender education in their curriculum and, in turn, bring a feminist lens to their work to achieve this mission. Second, using their experience as service users, peer workers have the credible ability to communicate and translate women patients' needs to the medical staff, and thus facilitate concrete, need-based adjustments of services. Third, peer workers' involvement as instructors in medical schools could provide early awareness of injustices experienced by women in psychiatry and mental health care. Further research is required to test the effectiveness of peer workers in addressing discrimination against women in real-world clinical settings. More broadly, from a diversity perspective, we believe that peer workers are one of the critical elements in the fight against discrimination in psychiatry and mental health., (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Smoking is a major cause of disease burden and reduced quality of life for people with severe mental illness (SMI). It places significant resource pressure on health systems and financial stress on smokers with SMI (SSMI). Telephone-based smoking cessation interventions have been shown to be cost effective in general populations. However, evidence suggests that SSMI are less likely to be referred to quitlines, and little is known about the effectiveness and cost effectiveness of such interventions that specifically target SSMI. The Quitlink randomized controlled trial for accessible smoking cessation support for SSMI aims to bridge this gap. This paper describes the protocol for evaluating the cost effectiveness of Quitlink. Methods: Quitlink will be implemented in the Australian setting, utilizing the existing mental health peer workforce to link SSMI to a tailored quitline service. The effectiveness of Quitlink will be evaluated in a clustered randomized controlled trial. A cost-effectiveness evaluation will be conducted alongside the Quitlink clustered randomized controlled trial (RCT) with incremental cost-effectiveness ratios (ICERs) calculated for the cost (AUD) per successful quit and quality adjusted life year (QALY) gained at 8 months compared with usual care from both health care system and limited societal perspectives. Financial implications for study participants will also be investigated. A modeled cost-effectiveness analysis will also be conducted to estimate future costs and benefits associated with any treatment effect observed during the trial. Results will be extrapolated to estimate the cost effectiveness of rolling out Quitlink nationally. Sensitivity analyses will be undertaken to assess the impact on results from plausible variations in all modeled variables. Discussion: SSMI require additional support to quit. Quitlink utilizes existing peer worker and quitline workforces and tailors quitline support specifically to provide that increased cessation support. Given Quitlink engages these existing skilled workforces, it is hypothesized that, if found to be effective, it will also be found to be both cost effective and scalable. This protocol describes the economic evaluation of Quitlink that will assess these hypotheses. Ethics and dissemination: Full ethics clearances have been received for the methods described below from the University of Newcastle (Australia) Human Research Ethics Committee (H-2018-0192) and St Vincent's Hospital, Melbourne (HREC/18/SVHM/154). The trial has been registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619000244101). Participant consent is sought both to participate in the study and to have the study data linked to routine health administrative data on publicly subsidized health service and pharmaceutical use, specifically the Medicare Benefits and Pharmaceutical Benefits Schemes (MBS/PBS). Trial findings (including economic evaluation) will be published in peer reviewed journals and presented at international conferences. Collected data and analyses will be made available in accordance with journal policies and study ethics approvals. Results will be presented to relevant government authorities with an interest in cost effectiveness of these types of interventions. [ABSTRACT FROM AUTHOR]

Peer workers are increasingly being engaged in contemporary mental healthcare. To become a peer worker, patients must evolve from having a patient identity to a peer worker identity. This study aims to understand how mental health peer workers experience their transition and how it affects their view of themselves and their direct working context. A grounded theory approach was used. Seventeen mental health peer workers in Belgium were recruited through theoretical sampling. Semi‐structured interviews were conducted and analysed according to the constant comparative method. The results indicate that novice peer workers experience peer work as an opportunity to liberate themselves from the process of mental suffering and realise an acceptable form of personal self‐maintenance. As peer workers become more experienced, they are confronted with external factors that influence their self‐maintenance and personal development. Experiencing clarity in their duties and responsibilities, equality, and transparency in the workplace reinforce their experience of self‐maintenance and positively influence their self‐development. Experiencing a lack of clarity in their duties and responsibilities, inequality, and lack of openness discourage peer workers' self‐development process. These experiences challenge their personal motivations to become peer workers, which are usually linked to building a meaningful life for themselves. The insights can encourage organisations to build up a supportive environment collaboratively with peer workers and ensure that peer workers can exert their authentically unique role in mental healthcare. [ABSTRACT FROM AUTHOR]

Introduction: Although smokers with severe mental illnesses (SSMI) make quit attempts at comparable levels to other smokers, fewer are successful in achieving smoking cessation. Specialized smoking cessation treatments targeting their needs can be effective but have not been widely disseminated. Telephone delivered interventions, including by quitlines, show promise. However, few SSMI contact quitlines and few are referred to them by health professionals. Mental health peer workers can potentially play an important role in supporting smoking cessation. This study will apply a pragmatic model using peer workers to engage SSMI with a customized quitline service, forming the "Quitlink" intervention. Methods: A multi-center prospective, cluster-randomized, open, blinded endpoint (PROBE) trial. Over 3 years, 382 smokers will be recruited from mental health services in Victoria, Australia. Following completion of baseline assessment, a brief intervention will be delivered by a peer worker. Participants will then be randomly allocated either to no further intervention, or to be referred and contacted by the Victorian Quitline and offered a targeted 8-week cognitive behavioral intervention along with nicotine replacement therapy (NRT). Follow-up measures will be administered at 2-, 5-, and 8-months post-baseline. The primary outcome is 6 months continuous abstinence from end of treatment with biochemical verification. Secondary outcomes include 7-day point prevalence abstinence from smoking, increased quit attempts, and reductions in cigarettes per day, cravings and withdrawal, mental health symptoms, and other substance use, and improvements in quality of life. We will use a generalized linear mixed model (linear regression for continuous outcomes and logistic regression for dichotomous outcomes) to handle clustering and the repeated measures at baseline, 2-, 5-, and 8-months; individuals will be modeled as random effects, cluster as a random effect, and group assignment as a fixed effect. Discussion: This is the first rigorously designed RCT to evaluate a specialized quitline intervention accompanied by NRT among SSMI. The study will apply a pragmatic model to link SSMI to the Quitline, using peer workers, with the potential for wide dissemination. Clinical Trial Registration: Trial Registry: The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines. Trial Sponsor: University of Newcastle, NSW, Australia. [ABSTRACT FROM AUTHOR]

Abstract: In a mental healthcare that embraces a recovery‐oriented practice, the employment of mental health peer workers is encouraged. Although peer workers are increasingly working together with nurses, there is a lack of research that explores how nurses and peer workers perceive their role‐related competences in clinical practice. The aim of this study was to clarify and understand these self‐perceptions in order to identify the specificity and potential complementarity of both roles. This insight is needed to underpin a successful partnership between both vocations. A qualitative descriptive research design based on principles of critical incident methodology was used. Twelve nurses and eight peer workers from different mental healthcare organizations participated. A total of 132 reported cases were analysed. Rigour was achieved through thick description, audit trail, investigator triangulation and peer review. Nurses relate their role‐related competences predominantly with being compliant with instructions, being a team player and ensuring security and control. Peer workers relate their role‐related competences with being able to maintain themselves as a peer worker, building up a relationship that is supportive for both the patient and themselves, and to utilize their lived experience. Both nurses and peer workers assign a major role to the team in determining their satisfaction with their competences. Consequently, what is perceived as important for the team appears to overshadow their self‐assessment of competences. The findings highlighted the importance of paying more attention to identity construction, empowerment and role competence development of nurses and peer workers in their respective education and ongoing training. [ABSTRACT FROM AUTHOR]

Abstract: There is growing recognition in mental health for the perspective of individuals with lived experience of mental health problems and mental health service use. As peer workers, these individuals can use their specific experience to benefit and support peers and professional caregivers, and to participate at all levels of mental health‐care systems. The aim of the present study was to develop a conceptual framework representing the driving forces of peer workers to fullfil their position in mental health‐care systems. A qualitative interview approach was employed using principles of grounded theory. Over a period of 5 months in 2014–2015, semistructured interviews were conducted with 14 peer workers in residential and community mental health‐care systems. The emerged conceptual framework reveals that peer workers strive towards constructing a positive identity. This process is powered by driving forces reflecting a desire for normalization and an urge for self‐preservation. Peer workers realize a meaningful employment by using their lived experience perspective as an asset, liberating themselves out of restrictive role patterns, and by breaking down stigma and taboo. As a precondition to engage in these normalization processes, peer workers perceive they need to secure their self‐preservation by balancing the emergence of adverse emotional fluctuations. The conceptual framework can inform the development of work contexts in which peer workers have an authentic and meaningful contribution, while being offered sufficient support and learning opportunities to manage their well‐being. [ABSTRACT FROM AUTHOR]

Abstract: In Australia and internationally, Peer Workers are increasingly being incorporated into the mental health workforce. Underpinning this trend is the conviction that the inclusion of workers with lived experience in overcoming mental health challenges is central to transforming service delivery. Given there are few identified Australian studies into the experiences of Peer Workers, this paper reports findings from qualitative interviews conducted in a Partners In Recovery programme in one regional area in Australia. The interviews formed part of a larger mixed‐method study evaluating Peer Worker roles in the programme. Thematic analysis of interview transcripts with Peer Workers and other staff employed in the programme (n = 22) was undertaken. Central to the five themes that emerged was the concept of lived experience expertise in overcoming mental health challenges. The themes were: (i) role variance, (ii) the challenges and opportunities for Peer Worker, (iii) the processes Peer Workers employed as they attempted to shape an identify and language, (iv) the inconsistencies and challenges of employing lived experience as a defining feature of the peer worker role, and (v) the nature of trust arising from lived experience relationships. From this study, it is evident that the Peer Worker role remains underdeveloped. The difficulties experienced by Peer Workers in establishing a homogenous identity and role is not unique. The process and lack of clarity around role identity revealed from the narratives, parallels the experiences of Mental Health Nursing. [ABSTRACT FROM AUTHOR]

Copyright of Scientific Annals of the 'Al. I. Cuza' University, Iasi. Sociology & Social Work / Analele Stiintifice ale Universitatii 'Al. I. Cuza' Iasi Sociologie si Asistenta Sociala is the property of Alexandru Ioan Cuza University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Scientific Annals of the 'Al. I. Cuza' University, Iasi. Sociology & Social Work / Analele Stiintifice ale Universitatii 'Al. I. Cuza' Iasi Sociologie si Asistenta Sociala is the property of Alexandru Ioan Cuza University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Engagement of community members to act as peer workers is a key feature of many community-centred health promotion programmes. However, little is known about their experiences beyond the commonly reported themes of fulfilment through helping people in need and improvement of personal confidence, self-esteem and self-care. This gap in the literature is of particular interest given increasing involvement of peer workers in community-centred programmes addressing health disparities, such as uptake of cancer screening. This paper aims to explore experiences of the peer leaders who worked for the Cancer Awareness: Ready for Education and Screening ( CARES) project to promote awareness, knowledge, and uptake of breast and cervical cancer screening among under-/never-screened women who belonged to ethnic minority, recent immigrant and low-income communities in Toronto, Canada. In 2013, three focus groups were conducted with 14 peer leaders to explore their experiences. All were immigrant women between 30 and 50 years of age. All discussions were audio recorded and transcribed verbatim. We used situational maps and analysis to create a visual representation of the data, and to investigate peer leaders experiences. Situational analysis was chosen to bring to light dominant and also silent underlying aspects which define the meaning of being a peer leader. The first level of analysis identified main themes that characterised peer leaders' experience: (i) Helping others (women, friends and family) and themselves by improved self-confidence, self-awareness and self-care and (ii) Redefining professional and social positions through their project activities leading to professional development and networking. The second level of analysis explored the redefining process and identified some peer leaders' negotiations in relation to knowledge (science vs. myth), beliefs (fear vs. assurance) and boundaries (private vs. work). Adding to the literature on the peer workers' experience, the findings are discussed in relation to empowerment of peer workers, training implications and theoretical contributions. [ABSTRACT FROM AUTHOR]

Background: A variety of peer worker roles are being introduced into the mental health workforce in England, in a range of organisational contexts and service delivery settings. The evidence base demonstrating the effectiveness of peer worker-based interventions is inconclusive and largely from outside England. An emerging qualitative literature points to a range of benefits, as well as challenges to introducing the peer worker role. Aims: In this study we aimed to test the international evidence base, and what is known generally about role adoption in public services, in a range of mental health services in England. We also aimed to develop organisational learning supporting the introduction of peer worker roles, identifying learning that was generic across mental health services and that which was specific to organisational contexts or service delivery settings. Team: The research was undertaken by a team that comprised researchers from a range of academic and clinical disciplines, service user researchers, a peer worker, and managers and service providers in the NHS and voluntary sector. Service user researchers undertook the majority of the data collection and analysis. We adopted a coproduction approach to research, integrating the range of perspectives in the team to shape the research process and interpret our findings. Study design: The study employed a qualitative, comparative case study design. We developed a framework, based on existing evidence and the experiential insight of the team, which conceptualised the challenges and facilitators of introducing peer worker roles into mental health services. The framework was used to inform data collection and to enable comparisons between different organisational contexts, service delivery settings and the perspectives of different stakeholders. Settings: The study took place in 10 contrasting cases comprising mental health NHS trusts, voluntary sector service providers and partnerships between the NHS and voluntary sector or social care providers. Peer workers were employed in a variety of roles, paid and unpaid, in psychiatric inpatient settings, community mental health services and black and minority ethnic (BME)-specific services. Participants: Participants were 89 people involved in services employing peer workers, recruited purposively in approximately equal proportion from the following stakeholder groups: service users; peer workers; (non-peer) coworkers; line managers; strategic managers; and commissioners. Data collection: All participants completed an interview that comprised structured and open-ended questions. Structured questions addressed a number of domains identified in the existing evidence as barriers to, or facilitators of, peer worker role adoption. Open-ended questions elicited detailed data about participants’ views and experiences of peer worker roles. Data analysis: Structured data were analysed using basic statistics to explore patterns in implementation across cases. Detailed data were analysed using a framework approach to produce a set of analytical categories. Patterns emerging in the structured analysis informed an in-depth interrogation of the detailed data set, using NVivo 9 qualitative software (QSR International Pty Ltd, Victoria, Australia) to compare data between organisational contexts, service delivery settings and stakeholder groups. Preliminary findings were refined through discussion with a range of stakeholders at feedback workshops. Findings: Many of the facilitators of peer worker role adoption identified in the existing evidence base were also evident in mental health services in England, although there were issues around pay, leadership, shared understanding of the role, training and management where good practice was uneven. A number of examples of good practice were evident in the voluntary sector, where peer worker roles had been established for longer and organisations were more flexible. In the NHS there were a range of challenges around introducing peer worker roles into existing structures and cultures of practice. Peer workers were able to engage people with services by building relationships based on shared lived experience – the language they used was particularly important in BME-specific services – but barriers to engagement could be created where roles were overformalised. Conclusions: Key barriers to, and facilitators of, peer worker role adoption were identified, including valuing the differential knowledge and practice that peer workers brought to the role (especially around maintaining personally, rather than professionally defined boundaries); maintaining peer identity in a role of work; changing organisational structures to support peer workers to remain well in their work; and challenging organisational cultures to empower peer workers to use their lived experience. Recommendations for future research include developing a theoretical framework articulating the change mechanisms underpinning ‘what peer workers do’, piloting and formally evaluating the effectiveness and cost-effectiveness of peer worker interventions, and mixed-method research to better understand the impact of working as a peer worker. Funding: The National Institute for Health Research Health Services and Delivery Research programme.

Background People who inject drugs have been central to the development of harm reduction initiatives. Referred to as peer workers, peer helpers, or natural helpers, people with lived experience of drug use leverage their personal knowledge and skills to deliver harm reduction services. Addressing a gap in the literature, this systematic review focuses on the roles of people who inject drugs in harm reduction initiatives, how programs are organized, and obstacles and facilitators to engaging people with lived experience in harm reduction programs, in order to inform practice and future research. Methods This systematic review included searches for both peer reviewed and gray literature. All titles and abstracts were screened by two reviewers. A structured data extraction tool was developed and utilized to systematically code information concerning peer roles and participation, program characteristics, obstacles, and facilitators. Results On the basis of specific inclusion criteria 164 documents were selected, with 127 peer-reviewed and 37 gray literature references. Data extraction identified key harm reduction program characteristics and forms of participation including 36 peer roles grouped into five categories, as well as obstacles and facilitators at systemic, organizational, and individual levels. Conclusions Research on harm reduction programs that involve people with lived experience can help us better understand these approaches and demonstrate their value. Current evidence provides good descriptive content but the field lacks agreed-upon approaches to documenting the ways peer workers contribute to harm reduction initiatives. Implications and ten strategies to better support peer involvement in harm reduction programs are identified. [ABSTRACT FROM AUTHOR]