Program Development Guide
Models of Peer Support
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2. Models of Peer Support
Models of Peer Support
Who is a peer supporter?
A peer supporter is a person who has knowledge from their own experiences with a condition, or of the circumstances of those they help, or has received training to be empathic and understanding in helping. For example, in diabetes management a peer supporter is typically a person with diabetes or a person affected by diabetes (e.g. immediate family member or caregiver).
Complementarity on a Two-Way Partnership: A Delegation of Peer Supporters at the American Association of Diabetes Educators Conference
|This report highlights the complementarity of the work performed by peer supporters and diabetes educators by examining similarities in their roles, challenges in practice, and strategies for improvement. It provides a good example how peer supporters can complement health care professionals.|
What is the role of a peer supporter?
A peer supporter complements, supplements, and extends the work of health care professionals by providing practical, social and emotional support. Depending on the social and cultural contexts, in many cases, peer supporters like community health workers (CHWs) can also help with important tasks such as providing simple health care services and participating in community advocacy activities. These tasks are beyond the scope of the Four Key Functions of peer support but are essential for the populations that peer supporters serve and settings where they work. Fundamentally, peer supporters fill gaps within a health system, yet their role is distinct and does not replace the role of health care professionals.They complement and enhance the role of providers by helping others to implement and sustain needed health behaviors.
What are common peer support models?
Example models based on how peer support is being delivered:
Professional-led group visits with peer exchange: In this model, patients who share the same condition are brought together with a health care provider or team of providers to address their self-management challenges.
Support groups: Support groups are gatherings of people who share common experiences, situations, problems or conditions. In these gatherings, people are able to mutually offer emotional and practical support.
One-on-one individual support: Peer support is provided through one-on-one basis. Delivered through face-to-face or by phone, this offers opportunities for very individualized approaches that are tailored to a participant’s needs. It is often used when a program targets individuals with high needs, who require intense interventions such as individual counseling and frequent follow up.
One-to-family, or family-to-family support: In some cultures where family values and relationship is extremely important (e.g., Chinese), peer support may need to be provided to the family of a participant in order to facilitate behavioral change. When serving certain populations, peer support for the whole family or their caregivers such as kids with asthma, children with Type 1 diabetes and adults with Alzheimer’s is crucial. The support for families (including caregivers) can be through a peer supporter’s home visits or family-to-family support.
Telephone-based peer support: This type of peer support is provided through regular phone calls.
Mobile Phone-based support: This type of peer support is provided through a combination of phone calls and text messages.
Web- and email-based support: These programs use the Internet to mobilize peer support, including Internet-based support groups and e-mail reminders.
|FEATURED PROGRAM MODEL RESOURCES
|Heisler, M. (2006) Building Peer Support Programs to Manage Chronic Disease: Seven Models for Success. California Health Care Foundation|
|Website of the National Council of La Raza (NCLR) and its Institute for Hispanic Health|
|Peers for Progress’ Report: Global evidence for peer support: Humanizing health care (pp23-24 on CHWs)|
|VA’s Peer Specialist Toolkit|
|Center to Reduce Health Disparities’ Patient Navigation Program|
Notably, many programs integrate multiple modes of interventions that complement each other, such as combination of structural, protocol guided support (e.g., regular check-in phone calls) and informal or flexible activities (e.g., exercise together). The key is to incorporate proactive and ongoing support with a focus on increasing reach and engagement over time.
Example models based on evidence-based programs:
Peer coaches: Utilizing health coaching techniques, individuals who share the same disease condition are trained to be peer coaches and meet one-on-one with participants to listen, discuss concerns and strategies, and provide support. One example is a peer health coach program conducted by Thomas Bodenheimer and colleagues, a Peers for Progress grantee project in San Francisco that has helped low-income, minority patients manage their diabetes in a primary care setting.
Promotores de Salud: The promotores model is an approach to peer support in health promotion that enhances the strong, existing social helper networks that are common in Latino culture. In addition to the social networks that connect Latino communities, strong family values reinforce peer support that promotes social solidarity, family-centeredness, and social and community engagement. Thus, promotores serve individuals, families and communities together. This model is the foundation for the Peers for Progress project at Alivio Medical Center in Chicago, IL. To learn more about the promotores model, visit the website of the National Council of La Raza (NCLR) and the Institute for Hispanic Health.
Community Health Workers (CHW): Community health workers are community members who work to bridge the gap between their respective communities and health care professionals. They do not necessarily have a chronic condition, but they often share language, culture and community with those they serve. To learn more about CHWs, read the section entitled Under a Big Umbrella: Community Health Workers (pg. 23–24) in Peers for Progress’ Global Evidence for Peer Support: Humanizing Health Care. Also, see the program model of Thai Village Health Volunteers at the end of this section.
Peer Support Specialists (Peer Specialists): Peer Support Specialists (PSSs) are an emerging peer support workforce for the behavioral health services. They typically are in recovery from mental illness and/or substance use disorder. With formal training, PSSs provide support to those who can benefit from their experience, and the services they provide can be reimbursed through Medicaid and other payer systems. The Veterans Administration (VA) Health System employing Peer Specialists is a well-established model. Check out the Peer Specialist Toolkit to learn more about VA’s Peer Specialists and their services.
Patient Navigators: Derived from cancer fields, the National Cancer Institute defines “Patient Navigators” as “trained, culturally sensitive health care workers who provide support and guidance throughout the cancer care continuum.” They assist individuals with cancer, survivors and their families in “navigating” the complex health system so those they serve can get the care and support needed. To learn more, check out Center to Reduce Health Disparities’ Patient Navigation Program webpage.
The evidence-based models presented here aim to provide a sample of the many best practices available and many names that peer supporters may be called in order to better serve their targeted audiences.
In addition to these models, non-professionals may be trained to implement group classes and curricula such as in the American Lung Association’s Freedom from Smoking program. Perhaps most well-known among these is the Stanford Chronic Disease Self-Management Program.
Thai Village Health Volunteers
Contributed by Boosaba Sanguanprasit, Chanuantong Tanasugarn, and Sarah Kowitt
Acclaimed as “one of the most outstanding legacies of primary health care in the past three decades”, the Village Health Volunteer (VHV) program has been instrumental in contributing to the progress of health development in Thailand. The VHV program first began in the 1960s. Since that time, with the growing focus on primary health care and the “health for all” movement, the VHVs have been expanded to every province and village in Thailand. In 2010, there were more than 800,000 active volunteers providing coverage to over 12 million households in the country.
Their Place in the Community
VHVs are well-respected in their communities. After acceptance through a formal application process, each volunteer receives three days of pre-training in health promotion, disease prevention, and health education and subsequent training as needed. Following these trainings, each VHV supports approximately 10 households by linking their community and the health care system. Their health promotion activities range from advocating for simple preventive measures, such as measuring blood pressure and providing information, to fostering wider health-related community development, capacity building, and health interventions. The picture at right shows an example of finding synergies between individual health and community needs – an old bicycle hooked up to a generator drives a pump to irrigate a community vegetable garden, while providing a resource for healthy exercise!
An Evolving Program
With advances in Thailand’s development and changes in demographics, the focus of VHV activities has shifted from preventing transmission of infectious disease, such as malaria and tuberculosis, to managing chronic diseases and caring for the elderly. For instance, a recent initiative funded by Peers for Progress extended the skills of VHVs to address diabetes in many communities. After receiving booster trainings in diet, exercise, stress management, communication skills, and motivation, VHVs and health staff worked with community members to identify health and behavioral challenges associated with diabetes, set appropriate goals, and identify ways to achieve these goals. Interventions at each site were designed by taking into consideration the characteristics of the people, VHVs, and local traditions.99 With health benefits for community members and strong support from local administrative bodies, the projects were heralded as a success and are likely to continue in other villages across Thailand.
Directions Moving Forward
Spending only 3.5% of its GDP on health care, Thailand and its VHV model have achieved remarkable results in disease prevention and health promotion markers. Endowed with an inherent ability to understand the needs of their community, take action, and provide support for individuals, VHVs have been key leaders in connecting their communities to primary care. Future research should concern itself with how other aspects of the program, such as supervision from public health officials and monetary incentives, are affecting the activities of the VHVs and the support provided to community members.
|Puentes hacia una mejor vida / Bridges to a Better||Program profile of a Peers for Progress grantee in San Diego, CA|
|Coaching for Life||Program profile of a Peers for Progress grantee in San Francisco, CA|
|ENCOURAGE||Program profile of a Peers for Progress grantee in Birmingham, AL|
|PLEASED||Program profile of a Peers for Progress grantee in Detroit, MI|
|Australasian Peers for Progress Diabetes Project||Program profile of a Peers for Progress grantee in Melbourne, Australia|
|Care Companions Program||Program profile of a Peers for Progress grantee in Texas|
|PEARL||Program profile of a Peers for Progress grantee in Hong Kong, China|
|RAPSID||Program profile of a Peers for Progress grantee in Cambridgeshire, United Kingdom|
|Peer Champion Program||Program profile of a Peers for Progress grantee in Uganda|
|Diabetes Buddies Program||Program profile of a Peers for Progress grantee in South Africa|
|Cancer Connect in Victoria Australia||This program utilizes a targeted telephone-based peer support intervention for people with cancer, which includes trained volunteers who have been through a similar cancer experience plus assistance in volunteer matching.|
|Public Health Seattle and King County: Asthma and Diabetes Programs||These are community health programs that serve low-income, ethnically diverse families in Seattle and King counties.|
|Community-Based Peer Support for Diabetes in Anhui China||This program uses group support, with the strengths of the community and health system, to help people with diabetes in Anhui, China.|
|Peer Educator Networks (P.E.N.) in Cambodia||This program shows how innovation can provide new answers in the struggle to provide accessible and affordable care, as well as support for people with diabetes in a low-resource setting.|
|Diabetes Sisters||This U.S.-based program provides education and support for women with diabetes.|
|Circles of Care||This is an advanced stage cancer peer support program for African Americans in North Carolina.|
|Diabetes Management through Peer Support and Community Outreach from the Patient-Centered Medical Home||A diabetes peer support program for low-income Latino adults in Chicago, IL.|
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