Experts by Experience: Peer Support and its Use with the Homeless

Stephanie L Barker, Nick Maguire, Stephanie L Barker, Nick Maguire

Abstract

The homeless population has complex needs. Peers with experience of homelessness offer unique perspectives in supporting those experiencing homelessness. Peer support fostered and developed by professional organisations, termed intentional peer support (IPS), formalises this process. This review aims to assess the effectiveness of IPS as an intervention with young adults and adult homeless persons (including streetdwelling and those within services). PyscINFO, Web of Science, MEDLINE, and CINAHL were searched, resulting in ten studies, involving 1,829 participants. Peer support has significant impacts on quality of life, drug/alcohol use, and social support. Common elements of peer support are identified, suggesting possible processes that underlie effective peer support. Shared experiences, role modelling, and social support are suggested to be vital aspects of peer support and moderate changes in homeless clients. One study was deemed to have moderate/high quality; the remaining studies had low and moderate quality. Limitations of each are discussed.

Keywords: Drug/alcohol use; Homelessness; Peer support; Quality of life.

Conflict of interest statement

Conflict of interest

All authors declare that they have no conflict of interest.

Human and Animal Participants

This article does not contain any involvement of human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
PRISMA flowchart: Screening of articles to be included
Fig. 2
Fig. 2
Common elements of IPS

References

    1. Barker, S. L., Maguire, N., Bishop, F., & Stopa, L. (2017). Critical elements of peer support and the experience of peer supporters helping the homeless. Manuscript in prep.
    1. Bean KF, Shafer MS, Glennon M. The impact of housing first and peer support on people who are medically vulnerable and homeless. Psychiatric Rehabilitation Journal. 2013;36(1):48–50. doi: 10.1037/h0094748.
    1. Bennett, A., Beresford, P., Betts, C., Brady, G., Clelland, D., Cummings, J.,⋯ Sanders, A. (2005). ODPM: Housing, Planning, Local Government and the Regions Committee 1(3).
    1. Boisvert RA, Martin LM, Grosek M, Clarie AJ. Effectiveness of a peer-support community in addiction recovery: participation as intervention. Occupational Therapy International. 2008;15(4):205–220. doi: 10.1002/oti.257.
    1. Bradstreet S. Harnessing the ‘lived experience’: Formalising peer support approaches to promote recovery. Mental Health Review Journal. 2006;11(2):33–37. doi: 10.1108/13619322200600019.
    1. Campbell, J. (2008). Key ingredients of peer programs identified. In Alternatives 2008 Conference, Buffalo, New York. Retrieved March 2015.
    1. Chambers, D., Rodgers, M., Golder, S., Pepper, C., Todd, D., & Woolacott, N. (2009). Centre for Reviews and Dissemination.
    1. Craig TK, Johnson SD, McCrone P, Afuwape S, Hughes E, Gournay K, Thornicroft G. Integrated care for co-occurring disorders: Psychiatric symptoms, social functioning, and service costs at 18 months. Psychiatric Services. 2008;59(3):276–282. doi: 10.1176/ps.2008.59.3.276.
    1. Creamer MC, Varker T, Bisson J, Darte K, Greenberg N, Lau W, Forbes Guidelines for peer support in high-risk organizations: an international consensus study using the Delphi method. Journal of Traumatic Stress. 2012;25(2):134–141. doi: 10.1002/jts.21685.
    1. Davidson L, Chinman M, Sells D, Rowe M. Peer support among adults with serious mental illness: a report from the field. Schizophrenia Bulletin. 2006;32(3):443–450. doi: 10.1093/schbul/sbj043.
    1. Deering KN, Shannon K, Sinclair H, Parsad D, Gilbert E, Tyndall MW. Piloting a peer-driven intervention model to increase access and adherence to antiretroviral therapy and HIV care among street-entrenched HIV-positive women in Vancouver. AIDS Patient Care and STDs. 2009;23(8):603–609. doi: 10.1089/apc.2009.0022.
    1. Dennis C-L. Peer support within a health care context: a concept analysis. International Journal of Nursing Studies. 2003;40(3):321–332. doi: 10.1016/S0020-7489(02)00092-5.
    1. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal of Epidemiology and Community Health. 1998;52(6):377–384. doi: 10.1136/jech.52.6.377.
    1. Faulkner A, Basset T, Ryan P. A long and honourable history. The Journal of Mental Health Training, Education and Practice. 2012;7(2):53–59. doi: 10.1108/17556221211236448.
    1. Felton CJ, Stastny P, Shern DL, Blanch A, Donahue SA, Knight E, Brown C. Consumers as peer specialists on intensive case management teams: impact on client outcomes. Psychiatric Services. 1995;46(10):1037–1044. doi: 10.1176/ps.46.10.1037.
    1. Finlayson, S., Boleman, V., Young, R., & Kwan, A. (2016). HHPA: Saving Lives, Saving Money. Groundswell Homeless Healthcare Reports.
    1. Fitzpatrick S, Kemp P, Klinker S. Single homelessness: An overview of research in Britain. Bristol: The Policy Press; 2000.
    1. Fogarty LA, Heilig CM, Armstrong K, Cabral R, Galavotti C, Gielen AC, Green BM. Long-term effectiveness of a peer-based intervention to promote condom and contraceptive use among HIV-positive and at-risk women. Public Health Reports. 2001;116:103–119. doi: 10.1093/phr/116.S1.103.
    1. Fors SW, Jarvis S. Evaluation of a peer-led drug abuse risk reduction project for runaway/homeless youths. Journal of Drug Education. 1995;25(4):321–333. doi: 10.2190/TU92-LX8W-G7FD-9LEM.
    1. Fukui S, Davidson LJ, Holter MC, Rapp CA. Pathways to recovery (PTR): impact of peer-led group participation on mental health recovery outcomes. Psychiatric Rehabilitation Journal. 2010;34(1):42–48. doi: 10.2975/34.1.2010.42.48.
    1. Gabrielian S, Yuan A, Andersen RM, McGuire J, Rubenstein L, Sapir N, Gelberg L. Chronic disease management for recently homeless veterans: a clinical practice improvement program to apply home telehealth technology to a vulnerable population. Medical Care. 2013;51(3 Suppl 1):S44–S51. doi: 10.1097/MLR.0b013e31827808f6.
    1. Galanter M, Dermatis H, Egelko S, De Leon G. Homelessness and mental illness in a professional- and peer-led cocaine treatment clinic. Psychiatric Services. 1998;49(4):533–535. doi: 10.1176/ps.49.4.533.
    1. Groundswell. (2015). Homeless Health Peer Advocacy. Retrieved November 18, 2016. .
    1. Hewett N, Halligan A. Homelessness is a healthcare issue. Journal of the Royal Society of Medicine. 2010;103(8):306–307. doi: 10.1258/jrsm.2010.10k028.
    1. Higgins, J. P., & Green, S. (2008). Cochrane Handbook for Systematic Reviews of Interventions (Vol. 5). Wiley
    1. Lloyd-Evans B, Mayo-Wilson E, Harrison B, Istead H, Brown E, Pilling S, Kendall A systematic review and meta-analysis of randomised controlled trials of peer support for people with severe mental illness. BMC Psychiatry. 2014;14(1):39. doi: 10.1186/1471-244X-14-39.
    1. Maguire, N., Johnson, R., Vostanis, P., & Keats, H. (2010). Meeting the psychological and emotional needs of homeless people. London.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine. 2009;151(4):264–269. doi: 10.7326/0003-4819-151-4-200908180-00135.
    1. Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Baird Process evaluation of complex interventions: Medical Research Council guidance. British Medical Journal. 2015;350:h1258. doi: 10.1136/bmj.h1258.
    1. National Lived Experience Advisory Council. (2016). Nothing about us without us: Seven principles for leadership and inclusion of people with lived experience of homelessness. Toronto: The Homeless Hub Press. .
    1. Pilote L, Tulsky JP, Zolopa AR, Hahn JA, Schecter GF, Moss AR. Tuberculosis prophylaxis in the homeless. A trial to improve adherence to referral. Archives of Internal Medicine. 1996;156(2):161–165. doi: 10.1001/archinte.1996.00440020063008.
    1. Repper J, Carter T. A review of the literature on peer support in mental health services. Journal of Mental Health. 2011;20(4):392–411. doi: 10.3109/09638237.2011.583947.
    1. Resnick SG, Rosenheck RA. Integrating peer-provided services: a quasi-experimental study of recovery orientation, confidence, and empowerment. Psychiatric Services. 2008;59(11):1307–1314. doi: 10.1176/ps.2008.59.11.1307.
    1. Rice E, Tulbert E, Cederbaum J, Barman AA, Milburn NG. Mobilizing homeless youth for HIV prevention: a social network analysis of the acceptability of a face-to-face and online social networking intervention. Health Education Research. 2012;27(2):226–236. doi: 10.1093/her/cyr113.
    1. Salzer MS. Consumer-delivered services as a best practice in mental health care delivery and the development of practice guidelines. Psychiatric Rehabilitation Skills. 2002;6(3):355–382. doi: 10.1080/10973430208408443.
    1. SAMHSA. (2015). Peer Support and Social Inclusion. Retrieved November 24, 2016. .
    1. Solomon P. Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal. 2004;27(4):392–401. doi: 10.2975/27.2004.392.401.
    1. Song F, Parekh S, Hooper L, Loke YK, Ryder J, Sutton AJ, Harvey Dissemination and publication of research findings: an updated review of related biases. Health Technology Assessment. 2010;14(8):1–193. doi: 10.3310/hta14080.
    1. Stewart M, Reutter L, Letourneau N, Makwarimba E. A support intervention to promote health and coping among homeless youths. Canadian Journal of Nursing Research. 2009;41(2):54–77.
    1. Tardy CH. Social support measurement. American Journal of Community Psychology. 1985;13(2):187–202. doi: 10.1007/BF00905728.
    1. Tracy K, Burton M, Miescher A, Galanter M, Babuscio T, Frankforter T, Rounsaville B. Mentorship for Alcohol Problems (MAP): a peer to peer modular intervention for outpatients. Alcohol and alcoholism. 2012;47(1):42–47. doi: 10.1093/alcalc/agr136.
    1. Tracy K, Guzman D, Burton M. Treatment Process and Participant Characteristic Predictors of Substance Use Outcome in Mentorship for Addiction Problems (MAP) Journal of Alcohol & Drug Dependence. 2014;2(171):2.
    1. Tulsky JP, Pilote L, Hahn JA, Zolopa AJ, Burke M, Chesney M, Moss AR. Adherence to isoniazid prophylaxis in the homeless: a randomized controlled trial. Archives of Internal Medicine. 2000;160(5):697–702. doi: 10.1001/archinte.160.5.697.
    1. van Vugt MD, Kroon H, Delespaul PA, Mulder CL. Consumer-providers in assertive community treatment programs: associations with client outcomes. Psychiatric Services. 2012;63(5):477–481. doi: 10.1176/appi.ps.201000549.
    1. Wallcraft J, Rose D, Reid J, Sweeney A. On our own terms: Users and survivors of mental health services working together for support and change. London: Sainsbury Centre for Mental Health; 2003.
    1. Weissman EM, Covell NH, Kushner M, Irwin J, Essock SM. Implementing peer-assisted case management to help homeless veterans with mental illness transition to independent housing. Community Mental Health Journal. 2005;41(3):267–276. doi: 10.1007/s10597-005-5001-2.
    1. Wright N, Oldham N, Francis K, Jones L. Homeless drug users’ awareness and risk perception of peer “take home naloxone” use–a qualitative study. Substance Abuse Treatment, Prevention, & Policy. 2006;1:28. doi: 10.1186/1747-597X-1-28.

Source: PubMed

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