Capturing the value of peer support : measuring recovery-oriented services

Purpose: The purpose of this paper is to examine the gap between recovery-oriented processes and clinical outcomes in peer support, an exemplar of recovery-oriented services, and offer suggestions for bridging this gap. Design/methodology/approach: This viewpoint is a brief review of literature on peer support services and gaps in outcome measurement towards building an evidence base for recovery-oriented services. Findings: Clinical outcomes like hospitalizations or symptoms remain a focus of research, practice and policy in recovery-oriented services and contribute to a mixed evidence base for peer support services, in which recovery-oriented outcomes like empowerment, self-efficacy and hopefulness have more evidentiary support. One approach is to identify the theoretical underpinnings of peer support services and the corresponding change mechanisms in models that would make these recovery-oriented outcomes mediators or process outcomes. A better starting point is to consider which outcomes are valued by the people who use services and develop an evaluation approach according to those stated goals. User driven measurement approaches and more participatory types of research can improve both the quality and impact of health and mental health services. Originality/value: This viewpoint provides a brief review of peer support services and the challenges of outcome measurement in establishing an evidence base and recommends user driven measurement as a starting point in evaluation of recovery-oriented services

What Gets Measured in Reentry Research? A Scoping Review on Community Reentry From Jail and Prison for Persons With Mental Illnesses

Research on reentry for individuals with mental illnesses leaving jails and prisons lacks outcome specificity and standardization needed to advance knowledge about the efficacy and effectiveness of interventions. This scoping review aims to provide clarity about reentry outcomes by: (a) ascertaining what outcomes are a focus in reentry research, (b) explicating how outcomes are defined, and (c) identifying commonalities or gaps in outcomes reported. A search of multiple databases yielded 415 articles for potential inclusion. After independent document review by two of the authors, 61 articles were included in the review. Recidivism was the most used construct, accounting for 58% of total outcomes and 95% of criminal legal outcomes. Behavioral health indicators were reported the second most frequently and other outcomes were rarely reported. Increasing the specificity of commonly used concepts while also expanding the breadth of outcomes considered is needed to build an evidence base this area of research

Community Participation Among Individuals with Serious Mental Illnesses Leaving Jail

Studies have found that higher levels of community participation are associated with a number of positive outcomes such as increased recovery and quality of life. People with serious mental illnesses (SMI) leaving jail face a number of barriers that limit their ability to participate in community activities. In this paper we examine whether the combined experience of mental illness and recent discharge from jail furthers the community isolation that is already experienced by individuals with serious mental illnesses. This analysis found that people with SMI recently released from jail had significantly lower levels of community participation in terms of overall number of community participation days and activities, number of time spent in activities individuals identified as important, and on measures of sufficiency related to the time spent engaged in these activities. Community participation is a key component of community re-integration for people with SMI leaving jail. The results of this study show that services for people with SMI leaving jail need to include interventions that foster engagement in community based activities

Mental illness and prison reentry intervention in a high risk context

Reentry programs for persons with serious mental illness (SMI) leaving jails or prisons have produced mixed results (Chandler & Spicer, 2006), including those for evidence-based treatments (EBT). These interventions occur in the complex nexus of the mental health and criminal justice systems and the effects of the intervention can be facilitated or constrained by the environment in which they operate (Smith, Jennings, Cimino, 2010; Solomon and Draine, 1995; Weisman, Lamberti, & Price, 2004). This dissertation explores how the economic, social, physical, and political factors that comprise the risk environment interact with an EBT for persons with SMI and contribute to poor outcomes for this population. Utilizing a multi-informant, multi-perspective framework, in-depth interviews were conducted with 28 participants and 6 staff members involved in a randomized field trial testing the effectiveness of Critical Time Intervention (CTI) for men with mental illnesses leaving prison in New Jersey. Participants completed between one and five interviews (total, 38 interviews) in order to capture the different stages of reentry. Other data collection methods included observation through attending team meetings and conducting go-along interviews and document analysis through reviewing team meeting notes and client progress notes. The risk environment posed significant challenges for participants in acquiring basic needs, including income and housing, as punitive public and social policies excluded resources to individuals based on their criminal history. These policies played within an environment with multiple opportunities to engage in illegal activities under heightened criminal justice scrutiny, but few prosocial opportunities. Case managers were also challenged to provide resources under this context and relied on emotional support as a primary component of their work. A combination of individual, interpersonal, and environmental factors combined to produce risk for reincarceration and also impinged on the intervention possibly undermining its effectiveness. As EBTs are disseminated widely, adapted to different settings, and applied to new populations, there are more opportunities for their effectiveness to be undermined by the noise of real-world settings. The risk environment in certain high-risk communities needs to be addressed or else they little chance of improving the lives of those we seek to help