Many individuals with psychiatric disabilities face workplace challenges that motivate them to pursue self-employment, but accessible self-employment support is lacking. Using participatory action research, Reclaiming Employment (RE), an online interactive platform that provides self-employment education for people who experience mental health-related challenges around work, was developed to address these gaps. An observational pilot study of RE examined usage, usability, self-efficacy, and self-employment income of 97 participants who used RE for six months. RE users rated the platform at above average usability, although those who experienced long-term unemployment rated the platform significantly lower compared to wage or self-employed users. In longitudinal regression models, we found use of RE was significantly associated with increases in some ESE subscales and mean ESE.
Read MoreThis qualitative study explored recently certified peer specialist (CPS) experiences navigating the job market to find postcertification employment, experiences with employment once in the workforce, and reflections on CPS training. Qualitative data were collected as part of a multistate, 3-year observational prospective cohort study of CPS graduate employment trajectories. We conducted 25 in-depth, semistructured interviews with a subsample of recent CPS graduates. Data were analyzed using constant comparative methods informed by grounded theory Participants described factors that supported or undermined securing employment, which included a shortage of CPS positions, their professional networking skills, financial considerations, and a position's alignment with CPS values. Once employed, participants described how relationships with supervisors and coworkers, which ranged from supportive to confused about the value of the peer specialist role, impacted their work. In general, participants held their CPS training and certification in high regard.
Read MoreThe Health Resources and Services Administration has identified 5,833 Mental Health Professional Shortage Areas (MHPSAs), many of which are rural, and could be served by Certified Peer Specialists (CPSs). This paper examines the relationship between CPS employment and MHPSA residency. Data are from a 2020 survey of 572 CPS certified in one of four states. A higher proportion of those living in MHPSAs were employed in peer support jobs (rather than other job types or unemployed) compared to those living in non-MHPSAs. MHPSA residential status was not a significant predictor of employment status but was significantly associated with greater likelihood of employment in peer support compared to other jobs, both for the entire sample, and among those currently employed. The greater likelihood of working in peer support among those residing in MHPSAs suggests that CPSs may leverage their credential to address shortages. As a result, peer support may become a more necessary part of the traditional service array. Policies that enable CPS to practice in MHPSAs should be encouraged.
Read MoreThis brief report describes data from the Peer Respite Essential Features survey, conducted biannually from 2014 to 2020, which explores the peer respite model and program challenges. Peer respites nationwide were invited to participate if they met specific guidelines, resulting in 32 programs across 14 states in 2020. Characteristics including funding, guest accommodations and policies, and how the programs were impacted by the COVID-19 pandemic are discussed.
Read MoreCertified Peer Specialists (CPSs) serve a critical role in the behavioral health workforce, but little is known about their job quality or financial well-being. Compared to Bureau of Labor Statistics data on comparable non-peer Community/Social Service occupations, peer support jobs are lower wage and have shorter job tenure. Compared to the general workforce, peer support jobs are more often part-time. Compared to a national survey of all adults in the United States, CPS report lower FWB regardless of job type and are at risk of financial hardship. In multivariable analyses and compared to non-peer support jobs, peer support jobs were not associated with significantly higher wages, more full-time status, longer tenure, or greater FWB. Higher wage jobs among CPS were associated with higher education, being a Veteran, and residence in an urban/suburban region rather than small town or rural setting. Full-time work was associated with not receiving federal disability benefits. CPS FWB was associated with higher hourly wage, older age, Latinx ethnicity, Veteran status, and better physical health. CPSs are at risk of financial hardship. Among recently certified CPSs, working in peer support jobs was not associated with higher wages or greater financial wellbeing compared to CPSs working in other jobs.
Read MoreThis study uses survey data from certified peer specialists (CPS) who were currently employed in any type of job, providing peer support services or not. Using the Maslach Burnout Inventory (MBI) and Areas of Worklife Survey (AWS), along with other measures of personal and job characteristics, relationships of predictors variables to burnout measures were described in unadjusted and adjusted linear regression models. Scores on each of the averaged burnout measures differed significantly between those employed in peer services jobs and those in other job types, with those in peer services jobs reporting lower exhaustion, cynicism, and higher professional efficacy.
Read MoreThis study of over 680 certified peer specialists (CPS) in four states found that those who are unemployed are more likely to be receiving Social Security disability benefits, be veterans, use outpatient counseling or therapy, and not disclose their mental health status in the workplace. In this study, the benefits of peer support jobs, compared to non-peer support jobs, include longer job tenure, availability of employee benefits, and higher job satisfaction.
Read MoreThis chapter provides an overview of what can be done in the future to address the prevention and control of mental and behavioral disorders. It begins with a description of what has come before, examining progress and pitfalls. This is followed by a discussion of the evolution needed to bring about Winslow's vision of mental health care as an integral part of the public health. It examines the growing role of such factors as the social determinants of health; attention to the full spectrum of mental health and illness from prevention through recovery across the life span; the importance of resilience in preventing behavioral problems; the still evolving key role of consumers in treatment and recovery; and the policy changes needed to embrace mental health as an intrinsic part of the public health.
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Social work research must more consistently link case and cause, iteratively developing processes for bringing micro-, mezzo-, and macrostreams of information together. We further argue that meaningful engagement with the initiative requires social work scholars and practitioners to actively scale up practice and research inquiry. We detail two key strategies for employing a scaled-up social work practice and research ethos: (a) employing a critical economic lens and (b) engaging with diverse publics.
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This pre-post study examined mental health service utilization and cost before and after participating in self-direction. Findings from this modest pre-post examination of self-direction suggest that mental health self-direction can result in more person-driven, individualized services without increasing costs.
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This Open Forum describes the National Survey of Peer-Run Organizations, which was conducted in 2012 to gather information about peer-run organizations and programs, organizational operations, policy perspectives, and service systems. A total of 895 entities were identified and contacted as potential peer-run organizations. Information was obtained for 715 (80%) entities, and 380 of the 715 responding entities met the criteria for a peer-run organization.
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The paper describes how peer interviewers were recruited, hired, trained, and supervised. The authors discuss some benefits and challenges associated with the approach. Peer interviewer benefits and challenges: the shared lived experience between the peer interviewers and study participants contributed to increased comfort and a high response rate overall. The study opened up professional opportunities for peers, but inconsistent work hours were a challenge and resulted in turnover and difficulty filling vacant positions. The lead evaluator and supervisors worked closely with peer interviewers to ensure conflict of interest was mitigated to reduce bias.
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This paper describes data collection methods and demonstrates how participatory strategies to involve people with psychiatric histories intersected with Internet research to achieve study aims. People with psychiatric histories were involved in designing and implementing a web-based survey to collect data on peer-run organizations' operations and views on national policy. Participatory approaches were used throughout design, data collection analysis, and dissemination. The extensive involvement of people with psychiatric histories in project design and implementation were important strategies that contributed to this study's success.
Read MoreThis study sought to identify risk factors for child protective services (CPS) involvement among parents with serious mental illnesses. Compared with parents without CPS contact, parents with a CPS contact were more likely to be nonwhite and to be less educated. They were also more likely to have less attachment-related social support, more parenting-related needs in numerous areas, and more substance use–related issues and to have experienced adverse childhood and traumatic events. One-quarter of the parents with CPS contact reported not having a mental disorder diagnosis at the time of the first contact, and those in the CPS group were less likely to have taken medications at the time of the first contact than were parents who did not have a CPS contact.
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The recovery movement has evolved from a more radical view in the early days, to participatory involvement in systems, to returning to alternative models of care that are more independent. Now as more peer specialists work in systems, there is an increased emphasis on non-medical alternatives and the cycle continues. Regardless, recovery, self-determination, choice, etc. are always at the centre. This paper notes the interesting cycles of recovery-orientation and how they spin around the values/tenets of the movement’s early roots.
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Lack of comprehensive medical care coverage and mental health symptoms were associated with increased odds of perceived difficulties in accessing medical care; personal empowerment was negatively associated with perceived difficulties attributed to stigma; education was positively associated. The findings highlight unmet need for medical care in this population and the need to recognize stigma as a barrier medical care. Interventions to empower patients and educate medical providers about wellness for people with serious mental illness could help to reduce barriers.
Read MoreThis study examined the relationship between the culturally determined beliefs and expectations of four ERD groups (African Americans, Latinos, Portuguese-speakers, and Haitians, total N = 160) and the technical quality of treatment for depression provided in four “culturally-specific” primary care clinics. Using data from the Experiences of Care and Health Outcomes survey, chart reviews and focus groups, the study addressed a set of questions related to the psychometric properties of perceived care measures and the technical quality of care. The groups differed in preferred cultural elements except all preferred inclusion of religion. They did not differ in overall perceived quality.
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Peer-run organizations provided a range of supports and educational and advocacy activities and varied in their capacity and resources. Some variation was explained by the degree of consumer control. These organizations seemed to be operating consistently with evidence on peer-run models. The reach of peer-run organizations, and the need for in-depth research, continues to grow.
Read MorePeer respites are voluntary, short-term residential programs designed to support individuals experiencing or at risk of a psychiatric crisis. These programs posit that for many mental health services users, traditional psychiatric emergency department and inpatient hospital services are undesirable and avoidable when less coercive or intrusive community-based supports are available. Intended to provide a safe and homelike environment, peer respites are usually situated in residential neighborhoods. These programs are starting to spread across the United States, yet there is very little rigorous research on whether they are being implemented consistently across sites and which processes and outcomes may lead to benefits for persons experiencing psychiatric crises and for overburdened mental health systems. This Open Forum outlines implementation and research issues that peer respites face.
Read MoreThis study sought to understand whether knowledge of the Affordable Care Act (ACA) was associated with willingness of mental health peer-run organizations to become Medicaid providers. Through the 2012 National Survey of Peer-Run Organizations, organizational directors reported their organization's willingness to accept Medicaid reimbursement and knowledge about the ACA. Organizations had both ideological and practical concerns about Medicaid reimbursement. Concerns about Medicaid reimbursement can potentially be addressed through alternative financing mechanisms that should be able to meet the needs of peer-run organizations.
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