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

28 Participants Needed

Trial Summary

What is the purpose of this trial?

This study has been designed to conduct a pilot evaluation of a novel model of support aimed at promoting community integration (CI) following homelessness. This model is called the Peer to Community Model (P2C). The P2C model is an outreach peer support model aimed at facilitating CI for individuals living with concurrent disorders following homelessness. This approach uses relationship-building and engagement in meaningful activity facilitated by peer support specialists (PSS) in concert with occupational therapy (OT) and social work (SW) consultation. This model includes four distinct components: 1) peer support delivered in a community space dedicated to the program or community locations at a maximum ratio of 10:1; 2) OT and SW offering consultation to PSSs and service users; 3) a weekly support meeting for PSSs, OT and SW aimed at providing a venue for problem-solving through complex cases and providing mutual emotional support in the context of service delivery with a complex population; and 4) opportunities for social enterprise (developing ideas for income generation) within the community space. \*\*\*NOTE: This is a single model of support that includes the components identified above - these are not separate interventions, but various components of one intervention designed in previous research by the study team. In this clinical trial, the investigators will implement the P2C model for the first time. The study team will conduct a pilot study using an open randomized controlled trial, crossover design. A total of 20 participants will be assigned randomly to the intervention group, where they will receive P2C supports at baseline, and 20 participants will be assigned to a waitlist condition for six months, after which time, they will be offered the P2C intervention. Participants will be interviewed at baseline and every three months using mixed (qualitative and quantitative) interviews. Waitlisted participants will be interviewed during these same intervals using the same interview protocols, and while waiting, will receive care as usual.

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 data supports the effectiveness of the Peer to Community (P2C) Model treatment for mental health and substance use disorders?

Research shows that peer support services, where individuals in recovery help others with similar challenges, can reduce hospital readmissions and improve community living for those with mental health and substance use disorders. Additionally, peer-led support has been found to enhance engagement in care and reduce substance use over time. ^{1 2 3 4 5}

Is the Peer to Community Support model safe for mental health and substance use disorders?

Research on peer-delivered interventions, which are similar to the Peer to Community Support model, suggests they are generally safe for people with mental health and substance use disorders. These interventions often involve individuals in recovery helping others, and no significant safety concerns have been reported in the studies reviewed. ^{1 2 6 7 8}

How is the Peer to Community (P2C) Model treatment different from other treatments for mental health and substance use disorders?

The Peer to Community (P2C) Model is unique because it emphasizes peer-led support, where individuals with lived experience of mental health and substance use disorders help others through mentoring and education. This approach fosters a non-judgmental, inclusive environment that enhances self-management and recovery skills, differing from traditional clinical treatments that may not involve peer support. ^{4 5 9 10 11}

Research Team

Carrie Anne Marshall, PhD

Principal Investigator

Western University

Eligibility Criteria

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

I am over 16 years old.

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

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

I am younger than 16 years old.

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

Timeline

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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 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]

References

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

Peer support services for individuals with serious mental illnesses: assessing the evidence. [2014]

2. 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]

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

Peer support for persons with co-occurring disorders and community tenure: a survival analysis. [2022]

4. Switzerland 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. [2023]

5. England pubmed.ncbi.nlm.nih.gov

Enhancing outcomes for persons with co-occurring disorders through skills training and peer recovery support. [2020]

6. England pubmed.ncbi.nlm.nih.gov

Assessing a digital peer support self-management intervention for adults with serious mental illness: feasibility, acceptability, and preliminary effectiveness. [2023]

7. England pubmed.ncbi.nlm.nih.gov

Meta-analysis of the effects of peer-administered psychosocial interventions on symptoms of depression. [2015]

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

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

9. England pubmed.ncbi.nlm.nih.gov

'Like a family in the end': Improving mental health Recovery skills through Peer-to-Peer communication in Darwin, Australia. [2023]

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

Initial evaluation of the Peer-to-Peer program. [2022]

11. England 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. [2019]