In December 2013, a participant in a study I was conducting arrived for what would be her 11th group therapy session for her substance abuse. She looked different this time: she was wearing lipstick, and she had braids and colorful barrettes in her hair.
The woman explained that earlier in the week, she’d gone out to buy beer. But on the way, something clicked. Thanks to what she’d learned in treatment, she reversed course and instead bought a small Christmas tree for the upcoming holiday—something she hadn’t done in a long while. She said she was happy, and she added that she hadn’t been able to say that in five years.
It was a small moment, but her success story is one of many from patients who participated in a PCORI-funded study that looked at the effectiveness of peer-delivered trauma treatment. Patients were randomized to either groups led by peer support workers—individuals who have gone through recovery themselves and have received training—or groups led by clinicians with master’s degrees.
Our goal was to see whether the peer-led groups were as successful as those led by clinicians at helping participants decrease substance abuse and posttraumatic stress disorder symptoms while improving coping skills and mental and physical health. We found that they were, which presents an exciting possibility—that peer support workers might be able to fill critical gaps in areas where healthcare professionals are in short supply.
A Population in Crisis
One area where that is the case is New Mexico. The US Department of Health and Human Services has designated all but one of New Mexico’s counties as Health Professional Shortage Areas, meaning they don’t have enough healthcare professionals for their population size.
Compounding the problem, the state’s drug overdose death rate ranks among the nation’s worst, and it has tripled since 1990 to about 25 deaths per 100,000 people. The epidemic is staggering in Rio Arriba County—home of my study’s participants—at 85.8 deaths per 100,000 from 2011-2015.
Simply put, the status quo isn’t working, and we have a compelling need for innovative approaches to healthcare delivery.
Peer support workers can reduce the impact of a lack of healthcare professionals, and we can begin to make real progress in the fight against epidemic healthcare problems.
From writing the application for PCORI funding to implementing the study, I partnered with patients and staff at Inside Out, a nonprofit recovery center focused on treating opiate addiction in northern New Mexico. We recruited adults with a history of PTSD, substance abuse, or both to participate in the study. We also partnered with The Life Link, a community mental health center, in Santa Fe.
Patients were involved in many ways, including participant recruitment and engagement, implementation of the intervention, and data collection. Our study asked participants very personal questions about things such as substance abuse, homelessness, and incarceration. I’ve noticed in my research over the years that patients are more likely to feel comfortable answering those questions when they come from someone they see as a peer and as nonjudgmental, versus a clinician who may not seem relatable.
We ended up enrolling 291 participants living with PTSD or substance abuse; nearly two-thirds had both. We assigned them to either the peer-led group or the clinician-led group, and then we divided those groups by gender, creating four groups.
So, what exactly is a peer support worker? Our two peer leaders didn’t have academic training in counseling or psychology, but they completed 40 hours of training and passed a certification test. Training topics included recovery, resilience, stress management, and communication skills. They also received training in the intervention.
Each group, whether peer- or clinician-led, held one session per week for 12 weeks before starting over for another 12 weeks. The sessions covered topics that weren’t sequential, so new patients could join at any time.
We asked patients about substance abuse, PTSD symptoms, coping, and mental and physical health. We collected this information at the beginning of treatment, and three and six months after treatment. We found no differences in results between the clinician-led and peer-led groups. In both types of groups, participants experienced significant decreases in drug addiction severity and PTSD symptoms, and significant improvements in mental health functioning and coping skills.
We were pleased to see little difference between the groups. Peer-led groups actually scored higher in a secondary outcome: therapeutic alliance, or the strength of the relationship between the caregiver and the patient. It’s not surprising that patients in the peer-led groups reported a deeper bond with their group leader compared with patients in clinician-led groups. This speaks to what I’d noticed in my earlier research: patients are more comfortable and more likely to engage with someone they can relate to.
With training and supervision, people with lived experience can deliver treatment as effectively as those with advanced degrees. Peer support workers can reduce the impact of a lack of healthcare professionals, and we can begin to make real progress in the fight against epidemic healthcare problems.
Looking ahead to PCORI’s third Annual Meeting, October 31–November 2, we asked several speakers and attendees to reflect on the meeting’s theme, “Delivering Results, Informing Choices.” Join the conversation by using #PCORI2017 on Twitter.
The views expressed here are those of the author and not necessarily those of PCORI.