Accelerating Best Practices in Peer Support Around the World

National Implementation of Peer Support Programs for Veterans

Clayton Velicer, MPH

In April, one of our blogs highlighted Buddy-to-Buddy, a peer support intervention at the University of Michigan that helps citizen soldiers overcome barriers to treatment, maintain adherence to treatment, and navigate the health system.

Since this blog was written, there have been calls for increased funding and resources to implement peer support programs for the veteran population. In Texas, state lawmakers recently passed legislation that appropriated an additional $4 million in the 2014-15 Department of State Health Services budget to help service members, veterans and their families connect with peer volunteers. It is estimated that the funding will add 1,500 peer-to-peer volunteers to the workforce next year. In New York, special funding was recently awarded to expand peer support programs aimed at veterans with post-traumatic stress disorder following a successful pilot program in 4 counties. On August 10th, President Obama addressed the Disabled American Veterans and discussed his administration’s work to better serve our troops and military families, delivering the healthcare that was promised. With respect to mental health care for veterans, the White House staff reported:

“In the FY2014 budget, the President committed nearly $7 billion – a 7.2 per­cent increase above the 2013 enacted level — to continue VA’s focus on expanding and transform­ing mental health services for veterans to ensure accessible and patient-centered care. Additionally,in June, President Obama announced that VA met their hiring goal to increase their capacity to provide timely mental health services to veterans. VA hired 1,669 mental health professionals and is on track to hire an additional 800 peer-to-peer specialists by December 31, 2013”

Furthermore, the US Department of Veterans Affairs has called for summits to be held in each state to formulate strategies “to help build or sustain collaborative efforts with community providers to enhance mental health and well-being for Veterans and their families.” During one of these summits in Philadelphia, peer mentoring was suggested as an area for increased focus.

How effectively is peer support being implemented at the national level?

A recent article by Chinman and colleagues assessed the Department of Veterans Affairs’ (VA) initiative to hire peer specialists to work with clinical teams to support others with serious mental illnesses.

The study examined challenges, facilitators, and progress of peer support implementation by surveying 92 VA Local Recovery Coordinators (LRC) from across the nationwide VA mental health system. 70% reported that they had hired a peer specialist, but 62% reported experiencing difficulty hiring peer specialists compared to other VA employees. The barriers to hiring peer specialists were lack of support from clinical (62%) and administrative (55%) leadership, knowledge of the VA mandate to hire peer specialists (63%), and lack of funding (53%).

With respect to implementation and impact, 51% of LRCs reported that implementation is “going well”, and 96% stated that the peer specialists are having a positive impact on veteran care.

The most frequent open-ended responses about implementation status was that the peer specialists were “highly regarded” by the veterans, that they are working in many areas of the mental health system, and that they are of great assistance to other staff. Sites that did not have a peer specialist responded that they believed the specialist had the potential to positively impact veteran care.

Chinman and colleagues conclude that the VA has made substantial progress in employing peer specialists, increasing by more than 2.5 times the number employed since 2007. LRCs have stated that implementation is going well in many places and that peer specialists are having an impact consistent with the role associated with peer support (role modeling, forging strong relationships with veterans, bridging between staff and patients).

The VA has made substantial progress in employing peer specialists, increasing by more than 2.5 times the number employed since 2007

However, as mental health providers strive to increase the use of peer support for veterans, it remains critical to understand best practices and develop an evidence base. There remain barriers to implementation, including support from clinical and administrative staff and lack of funding. Furthermore, there is a need to develop a strong evidence base that compares the impact of peer specialists versus other forms of care. A recent article by Eisen and Colleagues found comparable mental health outcomes from a peer-led recovery group, a clinician-led recovery group, and usual treatment over 3 months with 240 veterans.  However, the authors acknowledge that longer follow-up may be needed to fully understand the benefits of peer support. With peer support for veterans continuing to be in the news and calls for increased workforce, we ask our readers to share their resources and findings regarding the use of peer support with veteran populations.

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