CPSs as agents of systems transformation
Mental health systems that have embraced the recovery model have endeavored to give consumers greater voice in organizational policies and practices by using CPSs as members of the treatment team.11-13 CPSs are individuals who have had experience with mental illness but have embarked on a self-directed journey of recovery. They are thus in a unique role that allows them to provide insights and perspectives for mental health providers, patients and their families, and other stakeholders (Table 1).
After training and certification, Project GREAT CPSs:
• Provide direct support and give voice to patients
• Educate and provide feedback for residents and other trainees on how to listen, collaborate, empower, and foster a partnership with patients
• Represent the efforts of Project GREAT in the larger community through membership on advisory boards
There has been growing support among professionals for using CPSs to provide recovery-based services for patients with mental illness as well as recovery-based training for practitioners.2,14 The empirical support for such peer-led interventions is somewhat limited; however, studies of CPS-driven services and training have demonstrated an association with better outcomes.15
The positive impact of CPS-driven educational efforts on patients is seen in the peer-led Wellness Recovery Action Plan (WRAP) training initiative in Minnesota and Vermont.16 In the study, CPSs who had been trained and had used WRAP for symptom self-management provided a training intervention for 381 patients. Participants showed improvements on domains such as recovery attitudes, knowledge of symptoms (eg, early indicators of decompensation), and implementation of coping skills.
A 12-week recovery education workbook program delivered by CPSs was compared with assertive community treatment on a range of outcomes.17 Participants who completed the 12-week recovery education program reported a higher level of hope, empowerment, and improvement in recovery attitudes (the study assessed attitudes consistent with patient-defined recovery rather than clinical recovery).
Pickett and colleagues18 reported on the effects of an 8-week, CPS-led educational intervention—Building Recovery of Individual Dreams and Goals through Education and Support—on outcomes such as symptom severity, hopefulness, empowerment, social support, self-advocacy, coping, and recovery. The educational intervention was presented to 160 participants who completed pre- and post-outcome assessments. Participants reported improvements in symptoms, hopefulness, empowerment, self-advocacy, coping, and overall recovery following the intervention, although pre-post effect sizes were modest and ranged from .26 to .44 for significant effects.