Is This Really Peer Support?

Measuring and The Continuum Between Mutual and Professional Aid

Thomas M. Litwicki, M.Ed., LISAC

CEO, Old Pueblo Community ServicesSummer Institute, July 2014

Continuum of Non-Professional Community Based Supports

Mutual Aid Consumer Run Peer Support Professional Aid

Why Care About Mutual Aid?

2M people (0.8%) receiving treatment*

21M people (7%) have problems needing treatment, but not receiving it*

≈ 60-80M people (≈20-25%) using at risky levels

US Population:307,006,550

US Census Bureau, Population DivisionJuly 2009 estimate

*NSUDH, 2008

Mutual Aid Consumer Run Peer Support Professional Aid

Usage

Cost, Research Focus

Mutual Aid• Utilization: Over half those who reach out for help for

addiction, do so in mutual aid groups (over 2 million per year).

• Active Ingredient: Social Support, HTP• Outcomes: Participation Predicts Positive Outcomes

(Krouz, 2002)– Reduced Substance Abuse Related Health Costs (Humphreys,

1996)– Reduced Overall Health Costs (Humphreys, 2001)– Reduce Opiate Use Post Treatment (Blackwell)– improved social support networks (Humphreys & Noke, 1997)

• Causality: Lack of randomized clinical trials needed to isolate Mutual Aid as an intervention, and a lack of concensus on measuring the presence of mutual aid.

Consumer Run Organizations

• Utilization: 7,467 mental health mutual support groups and COSPs

• Outcomes: Improvements in quality of life (Chamberlin, Rogers, & Ellison, 1996), problem solving, satisfaction, social support, and coping skills (Silverman, Blank & Taylor, 1997; Lewis, 2001).

• Reductions were reported in hospitalizations (Mowbray& Tan, 1993), manic depressive symptomology, and use of traditional mental health treatment services ((Lewis, 2001).

• Active Ingredient: : Social Support, HTP• Causality: One Randomized Clinical Trial

Peer Support within Professional Organizations

• Peer Support within Professional Aid

– Usage: Most Mental Health Organizations Utilize Some Peer Support.

– Active Ingredient: Social Support

– Outcomes: Improved Outreach, Improved Family Reunification.

– Causality: Lack of Randomized Clinical Trials.

Recovery Organizations

• recovery advocacy, recovery homes, recovery schools, recovery industries, recovery ministries, recovery cafés, and recovery groups focused on art, music, theatre, sports, leisure, Internet-based social networking, and community service

Professional Aid

• Peer Support within Professional Aid

• Utilization: 13,000 Centers, Approximately 2 Million per Year

• Outcomes: Increased Days Sober, Improved Quality of Life

• Active Ingredient: Empathy Listening Skills?

• Causality: Numerous Randomized

• Clinical Trials. Better than nothing.

Understanding this Hybrid Peer/Professional Experience

• there is limited knowledge concerning the intentional integration of mutual aid and professional treatment practices, with most investigations focusing on the use of peers within professional organizations (Kostyk, Fuchs, Tabisz, & Jacyk, 1993; White, 2009) or involvement of professionals within mutual aid groups – (Maton, Leventhal, Madara, & Julien, 1989;

Paine, Suarez-Balcazar, Fawcett, &

Borck-Jameson, 1992).

Lack of Empirical Measurement

• While there is a body of theoretical descriptions of the various forms of aid, there is a lack of instrumentation capable of measuring the actual presence and degree of mutual v. professional aid.

UTILIZING THE CONTINUUM OF AID FOR ADDICTION RECOVERY

Litwicki, T., White, W., (2014) A Conceptual review of the integration of professional practices within mutual aid organizations. Journal of Groups in Addiction and Recovery. 10.1080/1556035X.2014.943553. (in press)

Method

• Define and Contrast Mutual Aid and Professional Aid– Review of Theoretical Literature on Mutual Aid– Comparison with Codes from American Counseling

Association

• Apply Continuum of Aid instrument to two new self identified mutual aid groups.– Review of philosophical positions and outline of

practices within official documents published on their website, annual reports, Federal 990 financial disclosures, interviews and personal correspondence with executive staff.

Seven Domains

• Experience v. Expert

Knowledge Base

• Peer v. Professional

Leadership

• Reciprocal v. Unidirectional

Helping Technique

• Egalitarian Peer Governance v. Hierarchal Professional Governance

Goverance

• Voluntary Association v. Allowance for Coerced or Mandated Association

Client/Member Association w/in Organization

• Closed v. Regulated Open Fiscal Policy

Fiscal Policy

• Individual Anonymity v. Mandated Reporter

Reporting Practices

Mutual Aid Organizations

Anonymity (no records)

Professional Helping Method and Management

Expert Knowledge

• “to support individuals who have chosen to abstain, or are considering abstinence from any type of addictive behaviors (substances or activities), by teaching how to change [emphasis added] self-defeating thinking, emotions, and actions; and to work towards long-term satisfactions and quality of life”

– SMART Recovery Website

• Requirement that facilitators receive

training.

Governance and Fiscal Policy

• No Requirement of members on the governance board or committees.

• All Committees Report to Board.

• Acceptance of outside donations and sales of advertisements on the website and newsletter.

• Embedded within professional treatment centers– Sales of license in U.K.

Mutual Helping Method

Professional Management

Peer Meeting Leadership and Experiential Knowledge

• “MM is a lay person led support group, though professionals may coordinate and help establish groups” (Moderation Management, 2012a).

• description of MM meetings as a “supportive mutual-help environment…made up of individuals who help each other by sharing personal experiences (not professional training)”

• meeting structure and content is based on a “nine step professionally reviewed program,”

Impact from Degree of Mutual v. Professional Aid

• (1) what is the influence of this model’s impact on group emergence, growth, and dissolution, (2) what are the ethical concerns that arise from the integration of professional and non-professional governance and financial strategies, and (3) what effects might the hybrid model exert on membership characteristics.

Impact on Growth

53

316

0

50

100

150

200

250

300

350

Meeting Growth

SMART

AA

Long Term Growth of Hybrid

10

33

25

0

5

10

15

20

25

30

35

Y 1 Y 6 Y 8

Nu

mb

er

of

Me

etin

gs

Number of SA Meetings After Professional Invovlement

Dissolution of a Hybrid (SA)

26

36

0

5

10

15

20

25

30

35

40

Months to Dissolution

Professional Led

Peer Led

Salem, 2008

National Affiliation Matters?

National Affiliation

Benefit of Professional Involvement

Salem (2008)

Political v. Professional Support?

State or Local Political

Involvement

Professional Growth

Archibald, 2008

Ethical Concerns

Ethical Concerns

Effect on Membership Characteristics

CA (2007)MM (Klaw et al., 2006) SMART (2012)

White 85% 97.6% 92%

Hispanic 6% nc 1.7%

Black/African American 19% nc 0.06%

Native Am 5% nc 1.50%

Asian 1% nc 0.80%

Other 1% Nc 1.90%

Education 50% did not attend

college

77.2% two or four year

degree

73.5% College Graduate

Future Research and Policy Implications

• Based on the probability that non-professional peer interventions may improve wellness outcomes for large segments of the population, with little or no cost to the public, it seems reasonable that communities would strive to increase their ability to encourage and support emergence, growth, and maintenance of this method.

Thank You

Mutual Aid Citations

• Kyrouz, 2002, Review of Literature on Effectiveness of Self Help Mutual Aid Groups.

• Humphreys, K. and R. H. Moos (1996) "Reduced Substance-Abuse-Related Health Care Costs among Voluntary Participants in Alcoholics Anonymous." Psychiatric Services, 47, 709-713.

• Humphreys, K. & Moos, R. (2001). Can Encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study. Alcoholism: Clinical and Experimental Research, 25, 711-716

• Blackwell. ttp://www.blackwell-synergy.com/toc/add/0/0?