Browsing by Subject "Peer support"
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Item Adolescent Relationship Violence: Help-Seeking and Help-Giving Behaviors among Peers(Springer, Part of Springer Science+Business Media, 2014-04) Fry, Deborah A.; Messinger, Adam M.; Rickert, Vaughn I.; O’Connor, Meghan K.; Palmetto, Niki; Lessel, Harriet; Davidson, Leslie L.; Department of Pediatrics, Indiana University School of MedicineYoung people tend to disclose relationship violence experiences to their peers, if they disclose at all, yet little is known about the nature and frequency of adolescent help-seeking and help-giving behaviors. Conducted within a sample of 1,312 young people from four New York City high schools, this is the first paper to ask adolescent help-givers about the various forms of help they provide and among the first to examine how ethnicity and nativity impact help-seeking behaviors. Relationship violence victims who had ever disclosed (61 %) were more likely to choose their friends for informal support. Ethnicity was predictive of adolescent disclosure outlets, whereas gender and nativity were not. Latinos were significantly less likely than non-Latinos to ever disclose to only friends, as compared to disclosing to at least one adult. The likelihood of a young person giving help to their friend in a violent relationship is associated with gender, ethnicity, and nativity, with males being significantly less likely than females to give all forms of help to their friends (talking to their friends about the violence, suggesting options, and taking action). Foreign-born adolescents are less likely to talk or suggest options to friends in violent relationships. This study also found that Latinos were significantly more likely than non-Latinos to report taking action with or on behalf of a friend in a violent relationship. This research shows that adolescents often rely on each other to address relationship violence, underlining the importance of adolescents’ receipt of training and education on how to support their friends, including when to seek help from more formal services. To further understand the valuable role played by adolescent peers of victims, future research should explore both which forms of help are perceived by the victim to be most helpful and which are associated with more positive outcomes.Item Caregiver and Juvenile Justice Personnel Perspectives on challenges and importance of caregiver engagement and the potential utility of a peer navigator program in the Juvenile Justice System(BMC, 2023-08-05) Dir, Allyson L.; Pederson, Casey; Khazvand, Shirin; Schwartz, Katie; Wiehe, Sarah E.; Aalsma, Matthew C.; Psychiatry, School of MedicineBackground: For youth involved in the juvenile justice (JJ) system, caregiver involvement and engagement in the system is crucial for youth development and outcomes of JJ cases; however, there are challenges to establishing positive/productive partnerships between caregivers and JJ representatives. The current project examines perspectives of caregivers and JJ personnel regarding facilitators and barriers to establishing JJ-caregiver partnerships, as well as their perceptions of the use of a caregiver navigator program to support caregivers of system-involved youth. Results are used to inform development of a caregiver navigator program to support caregivers and help them navigate the JJ system. Results: Semi-structured interviews were conducted with caregivers of youth involved in JJ (n = 15, 53% White, 93% female), JJ personnel (n = 7, 100% White, 50% female), and JJ family advisory board members (n = 5, 100% Black, 100% female). Caregivers reported varying experiences across intake/arrest, court, and probation processes. Positive experiences were characterized by effective communication and feeling supported by JJ. Negative experiences related to feeling blamed and punished for their child's system involvement and feeling unsupported. JJ interviews corroborated caregiver sentiments and also illustrated facilitators and barriers to JJ-caregiver partnerships. Both JJ personnel and caregivers endorsed potential benefits of a peer-based caregiver navigator program to provide social, informational, and emotional support. Conclusion: Continued work is needed to improve JJ-caregiver partnerships and use of a peer-based navigator program has the potential to address barriers to caregiver engagement in the JJ system.Item The effect of a Mentor Mothers program on prevention of vertical transmission of HIV outcomes in Zambézia Province, Mozambique: a retrospective interrupted time series analysis(Wiley, 2022) Carlucci, James G.; Yu, Zhihong; González, Purificación; Bravo, Magdalena; Amorim, Gustavo; das Felicidades Cugara, Cristina; Guambe, Helga; Mucanhenga, Jaime; Silva, Wilson; Tique, José A.; Sardella Alvim, Maria Fernanda; Graves, Erin; De Schacht, Caroline; Wester, C. William; Pediatrics, School of MedicineIntroduction: Mentor Mothers (MM) provide peer support to pregnant and postpartum women living with HIV (PPWH) and their infants with perinatal HIV exposure (IPE) throughout the cascade of prevention of vertical transmission (PVT) services. MM were implemented in Zambézia Province, Mozambique starting in August 2017. This evaluation aimed to determine the effect of MM on PVT outcomes. Methods: A retrospective interrupted time series analysis was done using routinely collected aggregate data from 85 public health facilities providing HIV services in nine districts of Zambézia. All PPWH (and their IPE) who initiated antiretroviral therapy (ART) from August 2016 through April 2019 were included. Outcomes included the proportion per month per district of: PPWH retained in care 12 months after ART initiation, PPWH with viral suppression and IPE with HIV DNA PCR test positivity by 9 months of age. The effect of MM on outcomes was assessed using logistic regression. Results: The odds of 12-month retention increased 1.5% per month in the pre-MM period, compared to a monthly increase of 7.6% with-MM (35-61% pre-MM, 56-72% with-MM; p < 0.001). The odds of being virally suppressed decreased by 0.9% per month in the pre-MM period, compared to a monthly increase of 3.9% with-MM (49-85% pre-MM, 59-80% with-MM; p < 0.001). The odds of DNA PCR positivity by 9 months of age decreased 8.9% per month in the pre-MM period, compared to a monthly decrease of 0.4% with-MM (0-14% pre-MM, 4-10% with-MM; p < 0.001). The odds of DNA PCR uptake (the proportion of IPE who received DNA PCR testing) by 9 months of age were significantly higher in the with-MM period compared to the pre-MM period (48-100% pre-MM, 87-100% with-MM; p < 0.001). Conclusions: MM services were associated with improved retention in PVT services and higher viral suppression rates among PPWH. While there was ongoing but diminishing improvement in DNA PCR positivity rates among IPE following MM implementation, this might be explained by increased uptake of HIV testing among high-risk IPE who were previously not getting tested. Additional efforts are needed to further optimize PVT outcomes, and MM should be one part of a comprehensive strategy to address this critical need.Item Enablers and Barriers to Implementing ICU Follow-Up Clinics and Peer Support Groups Following Critical Illness: The Thrive Collaboratives(Wolters Kluwer, 2019-09) Haines, Kimberley J.; McPeake, Joanne; Hibbert, Elizabeth; Boehm, Leanne M.; Aparanji, Krishna; Bakhru, Rita N.; Bastin, Anthony J.; Beesley, Sarah J.; Beveridge, Lynne; Butcher, Brad W.; Drumright, Kelly; Eaton, Tammy L.; Farley, Thomas; Firshman, Penelope; Fritschle, Andrew; Holdsworth, Clare; Hope, Aluko A.; Johnson, Annie; Kenes, Michael T.; Khan, Babar A.; Kloos, Janet A.; Kross, Erin K.; Mactavish, Pamela; Meyer, Joel; Montgomery-Yates, Ashley; Quasim, Tara; Saft, Howard L.; Slack, Andrew; Stollings, Joanna; Weinhouse, Gerald; Whitten, Jessica; Netzer, Giora; Hopkins, Ramona O.; Mikkelsen, Mark E.; Iwashyna, Theodore J.; Sevin, Carla M.; Medicine, School of MedicineOBJECTIVES: Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them. DESIGN: Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data. SETTING: Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 21 sites, across three continents. SUBJECTS: Clinicians from 21 sites. MEASUREMENT AND MAIN RESULTS: Ten enablers and nine barriers to implementation of "ICU follow-up clinics" were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of "peer support groups" were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising. CONCLUSIONS: Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.Item Establishing a Novel Group-based Litigation Peer Support Program to Promote Wellness for Physicians Involved in Medical Malpractice Lawsuits(University of California, 2023) Doehring, Marla C.; Strachan, Christian C.; Haut, Lindsey; Heniff, Melanie; Crevier, Karen; Crittendon, Megan; Nault Connors, Jill; Welch, Julie L.; Emergency Medicine, School of MedicineIntroduction: Being named as a defendant in a malpractice lawsuit is known to be a particularly high-stress and vulnerable time for a physician. Medical malpractice stress syndrome (MMSS) is a consequence of being named as a physician defendant in a malpractice lawsuit. Symptoms include depression, anxiety, and insomnia, which may lead to burnout, loss of confidence in clinical decision-making, substance abuse, strain on personal and professional relationships, and suicidal ideation. Although the legal process requires strict confidentiality regarding the specific details of the legal case, discussing the emotional impact of the case is not prohibited. Given that physicians often do not choose formalized therapy with a licensed professional, there is a recognized need to provide physicians with options to support their wellness during a lawsuit. Methods: The peer support model is a promising option to address the negative impacts to wellness that physician defendants face during medical malpractice lawsuits. We developed and implemented a peer support program to provide a safe, protected space for discussion of the personal impact of a lawsuit and to normalize this experience among peer physicians. Results: Physicians were receptive to joining a peer support group to discuss the personal impacts of being named in a medical malpractice lawsuit. Participants in this novel group-based program found it helpful and would unanimously recommend it to others who are being sued. Conclusion: To our knowledge, this pilot study is the first to implement and assess a facilitated, group-based peer support model for emergency physicians who are named as defendants in malpractice lawsuits. While group discussions demonstrated that symptoms of acute distress and MMSS were prevalent among physicians who were being sued, in this study physicians were receptive to and felt better after peer support sessions. Despite increasing burnout in the specialty of emergency medicine (EM) during the study time frame, burnout did not worsen in participants. Extrapolating from this pilot program, we hypothesize that formal peer support offered by EM groups can be an effective option to normalize the experience of being sued, promote wellness, and benefit physicians who endure the often long and stressful process of a medical malpractice lawsuit.Item Peer Support for Self-Management of Chronic Pain: the Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) Trial(Springer, 2020) Matthias, Marianne S.; Bair, Matthew J.; Ofner, Susan; Heisler, Michele; Kukla, Marina; McGuire, Alan B.; Adams, Jasma; Kempf, Carol; Pierce, Emilee; Menen, Tetla; McCalley, Stephanie; Johnson, Nicole L.; Daggy, Joanne; Medicine, School of MedicineBackground: Pain self-management is an effective, evidence-based treatment for chronic pain. Peer support, in which patients serve as coaches for other patients, has been effective in other chronic conditions and is a potentially promising approach to implementing pain self-management programs using fewer clinical resources. Objective: To test a peer coach-delivered pain self-management program for chronic pain. Design: Randomized controlled trial. Participants: Veterans with chronic musculoskeletal pain. Intervention: Intervention patients were assigned a trained peer coach for 6 months. Coaches, who were volunteers, were asked to contact their assigned patients, either by phone or in person, twice per month. Coaches and patients were given an intervention manual to guide sessions. The control group was offered a 2-hour pain self-management class. Main measures: The primary outcome was total pain, assessed by the Brief Pain Inventory (BPI). Secondary outcomes were anxiety, depression, pain catastrophizing, self-efficacy, social support, patient activation, health-related quality of life, and healthcare utilization. Outcomes were measured at baseline, 6 months, and 9 months. Key results: Two hundred fifteen patients enrolled (120 intervention, 95 control). Adherence to intervention protocol was low, with only 13% of patients reporting having at least the recommended 12 peer coach meetings over the 6-month intervention. BPI total decreased from baseline to 6 months and baseline to 9 months in both groups. At 9 months, this change was statistically significant (intervention, - 0.40, p = 0.018; control, - 0.47, p = 0.006). There was not a statistically significant difference between groups on BPI at either time point. No secondary outcomes improved significantly in either group after adjusting for multiple comparisons. Conclusions: Patients randomized to peer support did not differ from control patients on primary and secondary outcomes. Other peer support models that do not rely on volunteers might be more effective.Item Results from the POINT pragmatic randomized trial: An emergency department-based peer recovery coach intervention to increase opioid use disorder treatment linkage and reduce recurrent overdose(Sage, 2024) Watson, Dennis P.; Tillson, Martha; Taylor, Lisa; Xu, Huiping; Ouyang, Fangqian; Beaudoin, Francesca; O’Donnell, Daniel; McGuire, Alan B.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public HealthBackground: People with opioid use disorder (OUD) frequently present at the emergency department (ED), a potentially critical point for intervention and treatment linkage. Peer recovery support specialist (PRSS) interventions have expanded in US-based EDs, although evidence supporting such interventions has not been firmly established. Methods: Researchers conducted a pragmatic trial of POINT (Project Planned Outreach, Intervention, Naloxone, and Treatment), an ED-initiated intervention for harm reduction and recovery coaching/treatment linkage in 2 Indiana EDs. Cluster randomization allocated patients to the POINT intervention (n = 157) versus a control condition (n = 86). Participants completed a structured interview, and all outcomes were assessed using administrative data from an extensive state health exchange and state systems. Target patients (n = 243) presented to the ED for a possible opioid-related reason. The primary outcome was overdose-related ED re-presentation. Key secondary outcomes included OUD medication treatment linkage, duration of medication in days, all-cause ED re-presentation, all-cause inpatient re-presentation, and Medicaid enrollment. All outcomes were assessed at 3-, 6-, and 12-months post-enrollment. Ad hoc analyses were performed to assess treatment motivation and readiness. Results: POINT and standard care participants did not differ significantly on any outcomes measured. Participants who presented to the ED for overdose had significantly lower scores (3.5 vs 4.2, P < .01) regarding readiness to begin treatment compared to those presenting for other opioid-related issues. Conclusions: This is the first randomized trial investigating overdose outcomes for an ED peer recovery support specialist intervention. Though underpowered, results suggest no benefit of PRSS services over standard care. Given the scope of PRSS, future work in this area should assess more recovery- and harm reduction-oriented outcomes, as well as the potential benefits of integrating PRSS within multimodal ED-based interventions for OUD.Item Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) in western Kenya: a study protocol of a cluster randomized trial(BioMed Central, 2019-09-09) Mercer, Tim; Njuguna, Benson; Bloomfield, Gerald S.; Dick, Jonathan; Finkelstein, Eric; Kamano, Jemima; Mwangi, Ann; Naanyu, Violet; Pastakia, Sonak D.; Valente, Thomas W.; Vedanthan, Rajesh; Akwanalo, Constantine; Medicine, School of MedicineBACKGROUND: Hypertension is a major risk factor for cardiovascular disease (CVD), yet treatment and control rates for hypertension are very low in low- and middle-income countries (LMICs). Lack of effective referral networks between different levels of the health system is one factor that threatens the ability to achieve adequate blood pressure control and prevent CVD-related morbidity. Health information technology and peer support are two strategies that have improved care coordination and clinical outcomes for other disease entities in other settings; however, their effectiveness and cost-effectiveness in strengthening referral networks to improve blood pressure control and reduce CVD risk in low-resource settings are unknown. METHODS/DESIGN: We will use the PRECEDE-PROCEED framework to conduct transdisciplinary implementation research, focused on strengthening referral networks for hypertension in western Kenya. We will conduct a baseline needs and contextual assessment using a mixed-methods approach, in order to inform a participatory, community-based design process to fully develop a contextually and culturally appropriate intervention model that combines health information technology and peer support. Subsequently, we will conduct a two-arm cluster randomized trial comparing 1) usual care for referrals vs 2) referral networks strengthened with our intervention. The primary outcome will be one-year change in systolic blood pressure. The key secondary clinical outcome will be CVD risk reduction, and the key secondary implementation outcomes will include referral process metrics such as referral appropriateness and completion rates. We will conduct a mediation analysis to evaluate the influence of changes in referral network characteristics on intervention outcomes, a moderation analysis to evaluate the influence of baseline referral network characteristics on the effectiveness of the intervention, as well as a process evaluation using the Saunders framework. Finally, we will analyze the incremental cost-effectiveness of the intervention relative to usual care, in terms of costs per unit decrease in systolic blood pressure, per percentage change in CVD risk score, and per disability-adjusted life year saved. DISCUSSION: This study will provide evidence for the implementation of innovative strategies for strengthening referral networks to improve hypertension control in LMICs. If effective, it has the potential to be a scalable model for health systems strengthening in other low-resource settings worldwide.Item The use of peer support groups for emergency physicians during the COVID-19 pandemic(Wiley, 2023-02-19) Nault Connors, Jill; Thornsberry, Tanner; Hayden, Julie; Kroenke, Kurt; Monahan, Patrick O.; Draucker, Claire; Wasmuth, Sally; Kelker, Heather; Whitehead, Anne; Welch, Julie; Surgery, School of MedicineObjective: To test the feasibility, receptivity, and preliminary effectiveness of peer support groups for emergency medicine physicians during the COVID-19 pandemic and gain a better understanding of their experiences with peer support. Methods: This pilot study used a quasi-experimental design to assess change in symptoms of distress, anxiety, depression and burn-out before and after participating in a virtual, group-based peer support intervention for a duration of 8 weeks. Pre-post change analyses were performed using two-sided, paired t tests. Feasibility was measured by attendance data to demonstrate the use of the intervention. Receptivity was measured using a global change rating and net promoter score at the end of each session and 8-week period, respectively. During the final session, qualitative data on physician experience was collected and then analyzed using conventional content analysis. Results: Twenty-four emergency medicine physicians participated in the pilot study. The attendance goal was met by 20 (24, 83%) physicians and 19 (22, 86%) physicians reported they would recommend peer support groups to a friend of colleague. Positive standardized response mean effect sizes indicated modest improvement in nine of 12 symptom measurements with marginal significance (p < 0.10) for improvement in guilt [20, Effect Size (ES) = 0.45] and depression (21, ES = 0.39). Qualitative findings revealed high overall benefit with few adverse impacts of participation. Conclusions: Results demonstrate high physician receptivity, feasibility, and benefit from participation in peer support groups. Promising signs of improvement in distress, anxiety, depression, and burn out symptoms warrant additional studies with larger sample sizes and more robust research designs to establish the evidence base for peer support in the physician population.