Peer to Community Support for Mental Health and Substance Use Disorders

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Western University, Canada

Disqualifiers: Under 16, No homelessness, others

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

Compensation: Varies

Number of Visits: 4

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new support model called the Peer to Community (P2C) Model, designed to assist individuals with mental health and substance use challenges in integrating into the community after homelessness. The P2C Model combines peer support, occupational therapy, and social work to help individuals form meaningful connections and develop income-generating ideas. Those who have recently moved into stable housing after being homeless for at least a month and acknowledge mental health or substance use issues may be suitable for this trial. Participants will be randomly assigned to receive the P2C Model immediately or after six months while continuing with usual care. As an unphased trial, this study provides a unique opportunity to contribute to innovative community support strategies.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. It seems likely that you can continue your usual care while participating.

What prior data suggests that the Peer to Community Model is safe for individuals with mental health and substance use disorders?

Research has shown that the Peer to Community (P2C) Model relies on safe and supportive methods. It incorporates peer support, social work, and occupational therapy to help individuals integrate into the community. The model draws from established approaches like Housing First and harm reduction, which have proven safe and beneficial for those with mental health and substance use challenges.

Studies have found that peer support can enhance feelings of connection and belonging, crucial for mental health. Participants in peer support often feel more supported and understood, suggesting that the P2C model should be comfortable for them. No specific reports of negative effects related to the P2C model have emerged in this setting. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Peer to Community (P2C) model because it offers a fresh approach to supporting individuals with mental health and substance use disorders. Unlike traditional treatments that often rely on individual therapy or medication, the P2C model emphasizes community-based peer support, fostering a sense of belonging and shared experience. This approach can enhance engagement and improve outcomes by leveraging the power of community connections and lived experiences. Additionally, participants initially receiving usual care get the chance to transition to P2C support, potentially bringing new insights into the model's effectiveness compared to standard treatments.

What evidence suggests that the Peer to Community (P2C) Model is effective for mental health and substance use disorders?

Research has shown that the Peer to Community (P2C) Model, which participants in this trial may receive, helps people rejoin the community after experiencing homelessness. This approach combines peer support, where individuals with similar experiences assist each other, with guidance from occupational therapists and social workers. It is based on five main principles, including Housing First and harm reduction, which focus on providing stable housing and minimizing the negative effects of substance use. Early signs suggest that this model can enhance community integration and offer meaningful support by fostering relationships and encouraging participation in activities. Although the model hasn't been widely tested yet, its components have shown promise in assisting individuals with mental health and substance use challenges. ^{2 6 7 8 9}

Who Is on the Research Team?

Carrie Anne Marshall, PhD

Principal Investigator

Western University

Are You a Good Fit for This Trial?

This trial is for individuals over 16 who have recently secured a tenancy after being homeless and acknowledge having mental illness or substance use difficulties. They must have been homeless for at least one month in the past year.

Inclusion Criteria

Have secured a tenancy within the last three months or are in the midst of moving into a tenancy following homelessness

I am over 16 years old.

Have experienced homelessness for at least one month in the past year

Exclusion Criteria

Have not experienced homelessness for at least one month in the past year

Do not acknowledge living with a mental illness and/or substance use difficulty

I am younger than 16 years old.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 month

Baseline Data Collection

Baseline interviews and data collection including demographic and standardized measures

1 week

1 visit (in-person)

Intervention

Implementation of the P2C model for the intervention group, with weekly meetings and consultations

12 months

Weekly visits (in-person)

Waitlist Control

Participants in the control group receive care as usual and are waitlisted for 6 months before receiving the P2C intervention

6 months

Follow-up

Participants are monitored for changes in community integration, substance use, meaningful activity engagement, and mental well-being

12 months

Interviews at baseline, 3, 6, 9, and 12 months

What Are the Treatments Tested in This Trial?

Interventions

• Care as Usual (UC)
• Peer to Community (P2C) Model

Trial Overview The Peer to Community (P2C) Model, which includes peer support, occupational therapy, social work consultation, and opportunities for social enterprise, is being tested against usual care. Participants are randomly assigned to either receive P2C immediately or after a six-month waitlist period.

How Is the Trial Designed?

Group I: P2C Intervention Experimental Treatment 1 Intervention

Participants in this condition will receive the P2C model.

Group II: Care as Usual Active Control 1 Intervention

Participants in this group will receive care as usual supports, and will be waitlisted to receive P2C model supports after 6 months.

Who Is Running the Clinical Trial?

Western University, Canada

Lead Sponsor

Trials

270

Recruited

62,500+

Providence Care Hospital, Kingston, ON, Canada

Collaborator

Trials

1

Recruited

30+

Trellis HIV and Community Care, Kingston, ON, Canada

Collaborator

Trials

1

Recruited

30+

Published Research Related to This Trial

In a study of 137 adults with co-occurring psychosis and substance use disorders, adding peer recovery supports to standard care improved engagement in treatment and reduced alcohol use over time.

At three months, skills training alone helped reduce symptoms and alcohol use, while peer support enhanced social connections and outpatient service use; by nine months, it further decreased symptoms and inpatient readmissions, highlighting the long-term benefits of peer support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhancing outcomes for persons with co-occurring disorders through skills training and peer recovery support. O'Connell, MJ., Flanagan, EH., Delphin-Rittmon, ME., et al.[2020]

Peer-administered interventions (PAIs) significantly reduce depression symptoms, with a moderate effect size of 0.5043 based on a meta-analysis of 23 studies.

PAIs are as effective as non-peer-administered treatments and significantly outperform no-treatment conditions, suggesting they are a valuable option for depression treatment, especially when delivered purely by peers rather than in conjunction with professionals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Meta-analysis of the effects of peer-administered psychosocial interventions on symptoms of depression. Bryan, AE., Arkowitz, H.[2015]

The peer-led self-help (PLSH) program at Bellevue Hospital significantly improved aftercare referral acceptance (93% vs. 74%) and attendance (52% vs. 30%) among patients with no prior psychiatric hospitalizations, indicating its effectiveness in supporting recovery.

Chronically impaired patients with a history of psychiatric hospitalizations also benefited from the PLSH approach, with a higher referral acceptance rate (96% vs. 81%) compared to those in standard psychiatric units, suggesting that this model could reduce recidivism and lower overall healthcare costs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a model for the treatment of combined mental illness and substance abuse: the Bellevue model for peer-led treatment in systems change. Dermatis, H., Galanter, M., Trujillo, M., et al.[2019]

Peer recovery support services (PRSS) show promise in improving outcomes for individuals with substance use disorder (SUD), including reduced substance use, lower relapse rates, and increased treatment satisfaction, based on a systematic review of various studies.

However, the existing research has significant methodological limitations, such as inconsistent definitions of peer roles and a lack of appropriate comparison groups, highlighting the need for more rigorous studies to better understand the efficacy and implementation of PRSS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching. Eddie, D., Hoffman, L., Vilsaint, C., et al.[2023]

Peer support services, particularly those where peers are added to traditional services or deliver structured curricula, show moderate evidence of effectiveness in improving recovery outcomes for individuals with serious mental illnesses or co-occurring disorders, based on a review of 20 studies.

Peers were found to be more effective than professional staff in reducing inpatient use and enhancing recovery outcomes, although the effectiveness of peers in existing clinical roles was less consistent, indicating a need for more rigorous studies to clarify these roles.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer support services for individuals with serious mental illnesses: assessing the evidence. Chinman, M., George, P., Dougherty, RH., et al.[2014]

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]

The PeerTECH intervention, a digital peer support program for adults with serious mental illness, was found to be feasible and acceptable, showing significant improvements in self-efficacy and personal empowerment over a 12-week period with 21 participants.

Preliminary evidence suggests that this intervention can enhance self-management skills for both medical and psychiatric conditions, indicating its potential as a valuable tool in supporting recovery for individuals with serious mental illnesses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing a digital peer support self-management intervention for adults with serious mental illness: feasibility, acceptability, and preliminary effectiveness. Fortuna, KL., Myers, AL., Ferron, J., et al.[2023]

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]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT05884749

Peer to Community (P2C) Model: A Pilot Randomized Controlled ... This study has been designed to conduct a pilot evaluation of a novel model of support aimed at promoting community integration (CI) following homelessness.

2. withpower.com withpower.com/trial/phase-substance-related-disorders-4-2023-ab56d

Peer to Community Support for Mental Health and Substance ... This study has been designed to conduct a pilot evaluation of a novel model of support aimed at promoting community integration (CI) following homelessness.

3. centerwatch.com centerwatch.com/clinical-trials/listings/NCT05884749/peer-to-community-p2c-model-a-pilot-randomized-controlled-trial?activelyRecruiting=false&page=34&id=219&slug=addictions

Peer to Community (P2C) Model: A Pilot Randomized Controlled ... This study has been designed to conduct a pilot evaluation of a novel model of support aimed at promoting community integration (CI) following homelessness.

4. researchgate.net researchgate.net/publication/382040833_Co-Designing_the_Peer_to_Community_P2C_Model_An_Intervention_for_Promoting_Community_Integration_Following_Homelessness

(PDF) Co-Designing the “Peer to Community (P2C) Model” The (P2C) model is informed by five philosophies: 1) Housing First; 2) harm reduction; 3) trauma and violence-informed care; 4) person-centred care; and 5) the ...

5. ojs.lib.uwo.ca ojs.lib.uwo.ca/index.php/ijoh/article/download/17806/15008/59144

Co-Designing the “Peer to Community (P2C) Model” The “P2C” model is a time-unlimited intervention involving peer support, social work, and occupational therapy designed to facilitate community integration for ...

6. researchgate.net researchgate.net/publication/382021032_Co-Designing_the_Peer_to_Community_P2C_Model_An_Intervention_for_Promoting_Community_Integration_Following_Homelessness

(PDF) Co-Designing the “Peer to Community (P2C) Model” The (P2C) model is informed by five philosophies: 1) Housing First; 2) harm reduction; 3) trauma and violence-informed care; 4) person-centred ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4830464/

The future of mental health care: peer-to-peer support and ... Results: People with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging ...

8. communitycatalyst.org communitycatalyst.org/resource/peers-speak-out/

Priority Outcomes for Substance Use Treatment and Services The findings show individuals most care about survival, improving their quality of life and mental health, reducing harmful substance use, ...

9. ojs.lib.uwo.ca ojs.lib.uwo.ca/index.php/ijoh/article/view/17806

Co-Designing the “Peer to Community (P2C) Model” The (P2C) model is informed by five philosophies: 1) Housing First; 2) harm reduction; 3) trauma and violence-informed care; 4) person-centred ...