BACKGROUND/RATIONALE:
The VHA is in the process of transforming its mental health care system. As part of this transformation significant resources have been committed to integrating peer providers and veterans at risk for homelessness into existing mental health services as peer support technicians and vocational rehabilitation specialists. Recovery models, specifically the helper therapy principle, postulate that employment as a peer specialist benefits not only the recipients of services, but also the providers themselves. However, there is very little research examining the impact of being a peer provider on the mental health, functioning and community integration of veterans in these types of positions. The existing literature focuses on outcomes of peer provider training programs, and on personal accounts of being a peer provider. There is currently no systematic empirical evidence regarding the impact of working as a peer specialist on one's own recovery. This is the first study to examine mental health recovery outcomes of peer specialists. The current employment of peer support technicians offers a unique opportunity to systematically examine the mental health and community functioning of veterans working in these roles.

OBJECTIVE(S):
Study objectives are to: 1) examine job functions, responsibilities, performance and satisfaction of veterans employed in VA as peer support technicians and vocational rehabilitation specialists hired through the homeless veterans supported employment program (HVSEP: 2) examine recovery and community integration including, mental health symptoms and functioning, housing, and quality of life of these veterans; 3) examine change in job performance and mental health/recovery over one-year, and 4) identify factors associated with job-related and mental health/recovery outcomes over a one-year period.

METHODS:
This is an observational cohort study in which three cohorts were surveyed at enrollment, 6 months and 12 months later to address the impact of working as a peer support technician, vocational rehab specialist or in the CWT program. The sample included 152 peer support technicians and 222 HVSEP vocational rehab specialists. All currently employed peer support technicians at the time the study began were invited to participate. We used quantitative and qualitative methods including reliable and valid measures of mental health, quality of life and job performance. Questionnaires were administered via a secure website or mailed surveys (for CWT participants). Semi-structured telephone interviews were conducted on a subsample of participants to obtain in depth information about their jobs with specific emphasis on understanding how their skills and experience can be optimally used to contribute to the program in which they are working and to maximize their impact on veterans' mental health. Interviews were transcribed and will be analyzed using grounded theory methods and discourse analysis. Change in mental health and recovery measures will be assessed by comparing change from enrollment to one-year follow-up. Regression models were used to identify factors associated with higher levels of job satisfaction and mental health/recovery outcomes after one year.

FINDINGS/RESULTS:
Across both cohorts, most participants were employed full time. Peer specialists were more likely than VR specialists to share recovery stories, serve as a role model or mentor and advocate for veterans. Activities by VR specialists tended to focus more narrowly on job skills. Overall, after adjusting for multiple comparisons, the analysis found high levels of mental health and average quality of life for both cohorts with no significant differences between the groups. Satisfaction with amount of supervision was consistently associated with aspects of mental health recovery including work-related and helping-related quality of life, for both cohorts.

IMPACT:
This research will: 1) provide systematic information about the impact of employment as a peer support technician and vocational rehab specialist hired through the homeless veterans supported employment program (HVSEP) on the work life, mental health, functioning and quality of life of veterans in these roles; and 2) provide information about how to enhance the roles of veterans in these positions to maximize their value in the VA mental health care delivery system.

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External Links for this Project

NIH Reporter

Grant Number: I01HX000580-01A1
Link: https://reporter.nih.gov/project-details/8196636

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PUBLICATIONS:

Journal Articles

1. Chang BH, Dusek JA, Benson H. Psychobiological changes from relaxation response elicitation: long-term practitioners vs. novices. Psychosomatics. 2011 Nov 1; 52(6):550-9. [view]

Conference Presentations

1. Chinman MJ. A Cluster Randomized Trial Evaluating Implementation and Outcomes of Mental Health Peer Specialists. Paper presented at: National Institute of Mental Health National Conference on Mental Health Services Research; 2016 Aug 1; Bethesda, MD. [view]
2. Eisen SV, Clark JA, Schultz MR, Chang B, Resnick S, Armstrong M, Mueller L, Sweeney P. Employment as a Mental Health Peer Support Technician in the Veterans Health Administration (VHA). Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 24; Baltimore, MD. [view]
3. Chinman MJ. Peer Specialists: Implementation, evidence, and effective supervision. Paper presented at: Pillars of Peer Support Services Annual Summit; 2014 Oct 8; Atlanta, GA. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational
Keywords: none
MeSH Terms: none