Ten Reasons for Expanding Family Peer Support and Family Peer Support Providers
In some parts of Europe, there is a history of Peer Support Specialist positions being staffed both by people in recovery, and by family members of people who have recovered from a mental illness. This appears less common in the US. For example, the VA is the largest single employer of Peer Support Specialists and uses peer support in many of its programs. None of the 1500+ VA peer support specialists are primarily family members.
Family peer support is not uncommon in the US. Applications of family peer support has grown both in terms of the number of family peer support groups, and the range of clinical areas that are the focus of these groups (Haines, 2018). Despite this growth, there is an opportunity for much greater involvement of family peer supports in terms of Peer Support Specialist positions who are primarily family members and represent the family member perspective
Consider the following reasons for dramatically expanding Peer Support Specialist positions that specifically target family members.
1. Most People do not Experience Illness Alone. The burden of illness is almost always shared by family members. Family members are often suffering the impact of these illnesses and peer support for family members can help them manage this suffering. Family members are also involved in interpreting symptoms and determining the need for help.
2. Most People do not Participate in Treatment Alone. The challenges of treatment and recovery are commonly shared by family members. In particular, healthcare decisions are typically made collaboratively between clients and their family members. Family and friends are typically involved in identifying and interpreting early symptoms of illness, thinking through whether treatment should be sought, and ensuring it is sought when appropriate (Reczek, Thomeer, Gebhardt-Kram & Umberson, 2020). We may think about treatment decisions as individual (Moloney, 2017), but we almost always involve family members, either as sources of information or in helping us think through decisions. Peer support for family members can help them play their role in their relative’s treatment and treatment decisions in a way that results in a better chance of recovery
3. For Some Clients, Family Members Can Be Key Barriers to Recovery. Research has found that family members can be barriers to treatment and to the recovery of their relatives, discouraging them from having hope of success, from participating in treatment and from pursuing recovery. Many interventions should address family members as potential barriers if positive outcomes are to be achieved (Drebing et al., 2012)
4. Peer Support Networks for Family Members Have Naturally Developed Over Time and Reflect the Important Needs of Family Members. These include groups for mental health and substance use disorders such as Alanon, Naranon, Alateen, NAMI Family-to-Family, as well as support groups for family members of people with cancer, HIV, diabetes, heart disease, and others. Most are free for family members, and the fact that these interventions, which have no profit motive, are so common supports the view that there is a felt need for this type of support.
5. Family Education Has Been Shown to Be Effective in Promoting Patient Health Recovery. Family peer support involves mutual education about both objective information about illness and treatment, and about the experience of illness and recovery. Family education interventions have been found to be correlated with positive clinical outcomes in a range of illnesses. (Baig, Benitez, Quinn, & Burnet, 2015; Dixon et al., 2011).
6. Peer Support Among Family Members Can Reduce the Negative Impact of Illness on Those Family Members. Family members are also impacted by illness, both in terms of the stress caused by illness in a loved one, the need to take over duties of their relative, and the potential for greater role changes over time. Caregiving duties have also been found to have health costs, with illnesses that result in heavy caregiver burden being associated with greater risk of illness and mortality (Janson et al., 2022).
7. Family Peer Support Results in Improvement in the Recovery of the Client. These benefits include better patient functioning and reduced duration of symptoms (Wang, Chen, & Deng, 2022).
8. Family Peer Support Results in Better Use of Healthcare Services by the Client. This includes, better communication between family members and healthcare providers, greater likelihood of referral to other needed services (Hopkins, Kuklych, Pedwell, & Woods, 2021). and reduced likelihood of rehospitalization (Wang, Chen, & Deng, 2022).
9. Family Peer Support Results in Better Outcomes for the Family Members. These include receiving more emotional support and empathy; reduced stress, reduced loneliness, reduced isolation and stigma (Hopkins, Kuklych, Pedwell, & Woods, 2021).
10. Healthcare Organizations are Often Poor at Including Family Members in Treatment. Busy healthcare professionals often neglect to include family members in treatment discussions, leaving family members feeling disconnected from treatment and wondering if their role and contribution is even recognized (Martin, Ridley, & Gillieatt, 2017; Taylor, Mellotte, Griffiths, Compton, & Valsraj, 2016). Family peer support provides a concrete means of including families, and gives a concrete message to clients, to clinicians and to the family members that the family has a key role is supporting treatment and recovery.
Consider the following strategies for supporting the growth and integration of family peer support in your program/organization.
1. Educate yourself and others about the evidence for the need of family peer support. Review the research evidence about the impact of family support interventions.
2. Create/expand positions for family peer support specialists.
a. If you have positions, consider expanding the scope of their work and the number of positions.
b. If you don’t have positions, consider developing new family peer support positions.
c. Consider using an existing model of family support positions and groups for your organizations. The Family-to-Family program (Leggatt, 2007), developed first in Australia is just one model program that has already developed and could be a model for your program.
d. Consider how to help ensure your state regulations around Peer Support Specialist positions are flexible enough to allow family peer support roles.
e. Consider using volunteer roles to supplement opportunities for family members who want to be involved in providing time-limited family peer support but who are not willing to pursue a Peer Support Specialist certification.
f. Consider collaboration with your Quality Assurance Program, which is responsible to meeting Joint Commission and CARF treatment standards, that include an emphasis on family education and peer support.
3. Create opportunities for family peer support groups.
a. Research what is available in the community and at your facility, and publicize those opportunities.
b. Talk with community-based family peer support groups and see if they would be willing to coordinate efforts, including holding meetings on your site.
c. Ensure providers know about these opportunities, and create routine referral procedures to these groups for family members of your clients.
4. Ensure family education programs are available.
a. It is likely that there are at least some family education programs in place. Review these and look for opportunities for additional programs. Collaborate with these programs so that they include family Peer Support Specialists as part of their education program.
5. Educate all staff at your program about the value of family peer support and Peer Support Specialists.
a. Provide education on the research on family peer support.
b. Create opportunities for family members to present to providers about the needs of family members.
There is a large opportunity to move the field of peer support forward by including family members as providers. Look for opportunities to build a conversation about this trend and ways that we can take advantage of it to benefit our clients and their families.
REFERENCES
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Baig, A. A., Benitez, A., Quinn, M. T., & Burnet, D. L. (2015). Family interventions to improve diabetes outcomes for adults. Annals of the New York Academy of Sciences, 1353(1), 89-112.
Dixon, L. B., Lucksted, A., Medoff, D. R., Burland, J., Stewart, B., Lehman, A. F., ... & Murray-Swank, A. (2011). Outcomes of a randomized study of a peer-taught family-to-family education program for mental illness. Psychiatric Services, 62(6), 591-597.
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Hopkins, L., Kuklych, J., Pedwell, G., & Woods, A. (2021). Supporting the support network: The value of family peer work in youth mental health care. Community Mental Health Journal, 57, 926-936.
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Martin, R. M., Ridley, S. C., & Gillieatt, S. J. (2017). Family inclusion in mental health services: reality or rhetoric?. International Journal of Social Psychiatry, 63(6), 480-487.
Taylor, R., Mellotte, H., Griffiths, M., Compton, A., & Valsraj, K. (2016). Carers matter: promoting the inclusion of families within acute inpatient settings. Journal of Psychiatric Intensive Care, 12(2), 69-77.
Wang, Y., Chen, Y., & Deng, H. (2022). Effectiveness of Family-and Individual-Led Peer Support for People With Serious Mental Illness: A Meta-Analysis. Journal of Psychosocial Nursing and Mental Health Services, 60(2), 20-26.