A STRATEGIC ROLE FOR PEER SUPPORT SPECIALISTS: SUPPORTING PARTICIPATION DURING TREATMENT (PART II)

Poor participation in treatment is common and costly for the client, the healthcare system and for the community.  Part I of this blog entry described common forms of poor participation (dropout, “non-compliance”, poorly motivated participation).  Part II now talks about by Peer Support Specialits are ideally positioned to address this problem, and strategies for success.

 PREDICTORS OF POOR PARTICIPATION

Factors predictive of poor participation (Jin, Sklar, Min Sen Oh & Chuen, 2008) include

·       High treatment cost (monetary, time, discomfort, etc.)

·       The client placing a low value on the anticipated treatment outcome

·       The client having cognitive problems that increase failure to remember to follow through

·       Clients with lower levels of education

·       Clients with lower health literacy

·       Being a member of a group with healthcare disparities (nonwhite, immigrant, rural, LGBTQ, etc.)

·       Low social support, low family involvement

·       Client beliefs that (1) they have relatively low vulnerability to the illness, (2) the chance is low that the illness will

result in negative outcomes for them, or (3) there is a low chance that the treatment will result in a positive

outcome

·       The relationship between the client and the provider—lower levels of client trust and provider empathy predict

higher rates of noncompliance

·       Services that have long waiting lists

WHY PEERS ARE STRATEGICALLY POSITIONED TO HELP

Peer Support Specialists are ideally suited to address these predictors and thus reduce poor participation. Consider the following advantages of Peer Support Specialists:

1.      They represent treatment success, building the expectation among clients that treatment will result in a positive outcome.

2.      They have personal experience of illness and recovery, and remind clients of their vulnerability to illness and the real cost of negative outcomes.

3.      They provide social support and help clients build their broader social support.

4.      They can raise clients’ health literacy through education.

5.      They can provide targeted support for clients who are members of groups with healthcare disparities.

6.      They can help recognize clients at risk for dropout, noncompliance, and poor participation, and intervene with those clients to address ambivalence about treatment.

COMMON TYPES OF RECOVERY STORIES FOR ENCOURAGING FULL ENGAGEMENT

You will want variations of your recovery stories that encourage full participation. Common themes include

 1.      The Benefits of Treatment Success. Clients often have trouble imagining what treatment success will feel like. Recovery stories that spotlight the benefits of treatment, as well as the limitations, will help clients fully engage in services.

 2.      The Full Costs of Being Ill. Clients often fail to recognize the costs they are paying for being ill and what those costs will be in the future. Recovery stories that give specific information about those costs will help clients make good decisions about engaging in care.

 3.      The Need for Full Engagement. Showing clients the difference between halfhearted and full engagement in recovery and treatment will help them see that they have choices in how they participate in care.

 4.      The Cost of Dropping Out. Dropping out of treatment is often an impulsive decision based on something that is either anxiety producing or frustrating related to treatment. Clients who drop out often don’t carefully think through what the cost will be, and often regret their decision at a later time. Recovery stories that spotlight the costs, and the risks of impulsive decisions to drop out, will help clients make better decisions in this area.

 5.       The Cost of Noncompliance. Again, recovery stories that give concrete examples of the cost of not following through with treatment plans or treatment recommendations will help clients make better decisions.

 6.      Building a Collaborative, Positive Relationship with Providers. Poor participation in treatment is often caused by low trust and poor collaboration with providers. Recovery stories that focus on the value of a positive collaborative relationship with providers, and ways to build those positive alliances, will be valuable in helping clients fully engage in needed services.

REFERENCES
Jin, J., Sklar, G. E., Min Sen Oh, V. & Chuen Li, S. (2008). Factors affecting therapeutic compliance: A review from the patient’s perspective. Therapeutics and clinical risk management, 4(1), 269-286.