Peer-Facilitated Transportation Training for Serious Mental Illness

Overseen By Gretchen Snethen, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Temple University

Disqualifiers: Non-English speaking, Restricted mobility, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

180 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Peer-Facilitated Transportation Training for Serious Mental Illness?

Research shows that peer-delivered interventions can improve clinical and social outcomes for people with severe mental illness, and peer support has been found to enhance engagement and completion of therapy. This suggests that peer-facilitated approaches, like transportation training, may be effective in helping individuals with serious mental illness. ^{1 2 3 4 5}

Is peer-facilitated transportation training safe for people with serious mental illness?

The research articles reviewed do not provide specific safety data for peer-facilitated transportation training, but peer-delivered interventions in general have been used in various mental health treatments without reported safety concerns. ^{2 4 5 6 7}

How is Peer-Facilitated Transportation Training different from other treatments for serious mental illness?

Peer-Facilitated Transportation Training is unique because it involves individuals with serious mental illness who have been trained to use their personal experiences to help others with similar conditions, focusing on improving transportation skills. This peer-led approach aims to enhance engagement and accessibility, which is often a challenge in traditional treatments for serious mental illness. ^{2 3 4 5 8}

What is the purpose of this trial?

The goal of this clinical trial is to test the effectiveness of a peer-facilitated travel intervention in adults with serious mental illnesses. This project aims to address the following hypotheses: 1. Individuals with SMI receiving either of the two peer-mediated travel training transportation interventions will experience an increase in transportation self-efficacy and transportation skills. 2. Participants in the intervention arms will increase their transport utilization, participate in significantly more activities in the community, and make significantly more trips in the community. 3. Individuals with SMI receiving peer-mediated travel training interventions will retain post-test levels of community participation and self-efficacy 2 months after intervention. Participants will be assigned to an 8-week travel-training intervention either using a bike-share program or public transportation. All participants will complete three data-collection research interviews.

Eligibility Criteria

This trial is for adults aged 18-65 with serious mental illness (SMI) who can ride a bicycle, score at least an 8 on travel skills, and are interested in using bike-share and public transport. They must be able to consent to the study.

Inclusion Criteria

I scored 8 or higher on a travel skills test.

I am interested in using bikeshare and public transportation.

Diagnosed with a Severe Mental Illness (SMI) confirmed via the MINI

Exclusion Criteria

My travel skills assessment score is below 8.

I do not drive or use transportation on my own.

I cannot ride a bicycle on my own due to a physical condition.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants undergo an 8-week travel-training intervention using either a bike-share program or public transportation.

8 weeks

2 visits per week (in-person)

Waitlist Control

Participants assigned to the waitlist will wait for 8 weeks before starting the intervention.

8 weeks

Follow-up

Participants are monitored for retention of community participation and self-efficacy 2 months after intervention.

2 months

Interviews at 2-month and 4-month post-baseline

Treatment Details

Interventions

• Peer Facilitated Travel Training

Trial Overview The study tests if peer-led travel training improves confidence and skills in transportation among those with SMI. Participants will learn to use either bike-share or public transport over eight weeks, followed by interviews.

Participant Groups

Group I: Public Transportation Experimental Treatment 1 Intervention

An established travel-training program developed for individuals with disabilities, including those with SMI, serves as the curriculum for the public transportation intervention arm. Participants will use SEPTA, the public transportation provider in Philadelphia and surrounding areas. We will offer an 8-week intervention which will include instruction on foundational skills needed to travel on public transportation and 1-on-1 direct training in using public transportation. Participants will meet twice weekly for direct instruction and role-playing sessions to cover the core components and the latter weeks of intervention will be focused on individual travel training instruction provided by the peer support interventionists, with participants and peer support interventionists meeting for two travel trips each week.

Group II: Bike-Share Experimental Treatment 1 Intervention

Participants in this arm will participate in an 8-week bikeshare training program, using Indego, the bike sharing service in Philadelphia. The first sessions will be aimed at increasing knowledge of the bike share program and the procedures for utilizing it successfully. Then participants will meet with a peer support specialist, who will help facilitate individualized route planning and independent ride support. Peer support specialists will use motivational interviewing during these individual sessions in order to help participants identify personally meaningful motivations for participation and to enhance their sense of self-efficacy.

Group III: Waitlist Control Active Control 1 Intervention

Half of the participants in either arm (bike-share or public transportation) will be randomly assigned to either begin the intervention immediately, or be placed on a waitlist, serving as a control arm. The waitlist will be 8 weeks long, the same timeline as the intervention. After the eighth week, participants assigned to the waitlist will then begin the intervention for the next 8 weeks. Participants assigned to starting the intervention immediately will then be placed on the waitlist for the second-8 weeks of the total study enrollment.

Who Is Running the Clinical Trial?

Temple University

Lead Sponsor

Trials

321

Recruited

89,100+

Findings from Research

Psychiatrists often prioritize medication management over psychosocial treatments for severe mental illness, but this article highlights effective psychosocial interventions for schizophrenia that can address persistent symptoms despite pharmacological treatment.

The review includes various promising interventions such as cognitive-behavioral therapy for psychosis (CBTp), cognitive training, and supported employment, emphasizing their potential to improve patient outcomes and support recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Beyond Psychopharmacology: Emerging Psychosocial Interventions for Core Symptoms of Schizophrenia. Weiden, PJ.[2020]

This study will evaluate the effectiveness of peer specialists delivering social skills training (SST) and cognitive behavioral social skills training (CBSST) to 252 veterans with serious mental illness (SMI), aiming to improve treatment engagement and outcomes.

The study uses a randomized trial design over 20 weeks, with the Independent Living Skills Survey as the primary outcome measure, to assess whether peer-led interventions can enhance accessibility and effectiveness compared to standard treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer specialists deliver cognitive behavioral social skills training compared to social skills training and treatment as usual to veterans with serious mental illness: study protocol for a randomized controlled trial. Mitchell-Miland, C., McCarthy, S., Chinman, M.[2022]

The study involved 352 veterans and examined the impact of meeting with either a Peer Support Specialist (PSS) or a Program Support Assistant (PSA) on engagement and completion of a Cognitive Behavioral Therapy-Pretreatment Intervention (CBT-PTI).

Results indicated that veterans who met with a PSS showed improved completion rates for CBT-PTI, suggesting that peer support may enhance treatment outcomes, although further research is needed to solidify these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of CBT-pretreatment intervention engagement and completion: Evidence for peer support. Nelson, CB., Lusk, R., Cawood, C., et al.[2020]

Peer-facilitated interventions can significantly improve physical activity levels in individuals with schizophrenia spectrum disorders, based on a meta-analysis of 14 studies involving 2099 participants.

While these interventions show promise for enhancing physical health, the overall evidence quality is low, and more research is needed to understand their impact on other health-related outcomes like self-rated health and body mass index.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer-facilitated interventions for improving the physical health of people with schizophrenia spectrum disorders: systematic review and meta-analysis. Coles, A., Maksyutynska, K., Knezevic, D., et al.[2022]

Peer-delivered interventions for individuals with severe mental illness (SMI) showed small positive effects on quality of life and hope, based on evidence from three high-quality trials involving 639 participants.

No significant benefits were found for peer-delivered interventions in treating depression, indicating that while peers may enhance outcomes for SMI, their effectiveness in depression remains unclear.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of peer-delivered interventions for severe mental illness and depression on clinical and psychosocial outcomes: a systematic review and meta-analysis. Fuhr, DC., Salisbury, TT., De Silva, MJ., et al.[2022]

A pilot study involving 49 patients with schizophrenia showed that a peer-to-peer psychoeducation program significantly increased patients' knowledge about their illness and improved their trust in physicians and medications.

The structured 5-step curriculum for training peer moderators was found to be feasible, indicating that peer-led psychoeducation could be an effective alternative to traditional professional-led sessions for improving patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer-to-peer psychoeducation in schizophrenia: a new approach. Rummel, CB., Hansen, WP., Helbig, A., et al.[2022]

The study outlines a framework called the Academic Researchers-Certified Peer Specialists mHealth Research Continuum, which guides the development and implementation of peer-delivered mobile health interventions for adults with serious mental illness, emphasizing community engagement.

Involving certified peer specialists in all phases of research not only enhances the relevance and effectiveness of the interventions but also fosters collaboration that can lead to successful funding and implementation of these services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Application of Community-Engaged Research to Inform the Development and Implementation of a Peer-Delivered Mobile Health Intervention for Adults With Serious Mental Illness. Fortuna, K., Barr, P., Goldstein, C., et al.[2022]

The BRIDGES peer-led education program, involving 160 participants over 8 weeks, significantly reduced psychiatric symptoms and improved feelings of hopefulness, self-advocacy, and empowerment after the intervention.

Participants also reported a decrease in maladaptive coping behaviors, indicating that peer-led education can enhance recovery and provide valuable support for individuals with mental health challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early outcomes and lessons learned from a study of the Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES) program in Tennessee. Pickett, SA., Diehl, S., Steigman, PJ., et al.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

Beyond Psychopharmacology: Emerging Psychosocial Interventions for Core Symptoms of Schizophrenia. [2020]

2. England pubmed.ncbi.nlm.nih.gov

Peer specialists deliver cognitive behavioral social skills training compared to social skills training and treatment as usual to veterans with serious mental illness: study protocol for a randomized controlled trial. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Predictors of CBT-pretreatment intervention engagement and completion: Evidence for peer support. [2020]

4. Australia pubmed.ncbi.nlm.nih.gov

Peer-facilitated interventions for improving the physical health of people with schizophrenia spectrum disorders: systematic review and meta-analysis. [2022]

5. Germany pubmed.ncbi.nlm.nih.gov

Effectiveness of peer-delivered interventions for severe mental illness and depression on clinical and psychosocial outcomes: a systematic review and meta-analysis. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Peer-to-peer psychoeducation in schizophrenia: a new approach. [2022]

7. Canada pubmed.ncbi.nlm.nih.gov

Application of Community-Engaged Research to Inform the Development and Implementation of a Peer-Delivered Mobile Health Intervention for Adults With Serious Mental Illness. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Early outcomes and lessons learned from a study of the Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES) program in Tennessee. [2019]