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Community engagement is important for research, yet many researchers do not routinely seek feedback from people with lived experience. A key barrier to this engagement is that the resources required to create an advisory board may be unavailable to individual investigators, and creating an advisory board for a single study may often be impractical. In this column, the authors describe how to create a standing research advisory board that can serve as a shared resource for researchers and community members and provide a psychosis research advisory board example to aid discussion.

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The current demand for mental health services is exacerbated by an ongoing shortage of behavioral health care providers in the United States. The 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. Random effects logistic regression models were used to test the relationship between MHPSA residence and employment outcomes. Of 166 unique counties identified by participant zip codes, 47 were characterized as being MHPSAs with 14% of participants residing in one of these counties. 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 (68% vs. 54%, p = .020). MHPSA residential status was not a significant predictor of employment status (OR = 1.14, p = .728) but was significantly associated with greater likelihood of employment in peer support compared to other jobs, both for the entire sample (OR = 2.13, p = .026), and among those currently employed (OR = 2.90, p = .032). 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.

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Certified peer specialists (CPS) are mental health professionals who draw their expertise from lived experience with mental illness and mental distress. They tale a nonmedical, nonclinical approach to providing support to community members with mental health difficulties and in doing so, emphasize the role of social environmental factors that contribute to mental distress. Their perspectives are contrary to the biomedical perspective of mainstream psychiatry. While there is a significant body of literature on CPS, there is a dearth of research on how CPS engage in and perceive the broader mental health system. They resist the biomedicalization of mental illness by moving past labels and the language of pathology to facilitate recovery from mental illness and to resist stigma. Drawing from in-depth interviews with peer specialists, participant observation of a peer-run organization, and a survey of peer specialists across the United States, I ask the following research questions: How and why are CPS challenging the medical model of mental illness? How do CPS consider social environmental factors in the etiology of distress and what are the potential implications for resistance to both biomedicalization and stigmatization? My data suggest that CPS, in their critiques of the medical model and the mental health system, are actively resisting the biomedicalization of mental illness and focus on social environmental factors that contribute to experiences of distress. This research has meaningful implications for research on CPS and hope for recovery from mental illness.

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Peer Specialists (PS) often work in outpatient mental health programs serving transition age youth (TAY). This study examines program managers' perspectives on efforts to strengthen PS' professional development. In 2019, we interviewed program managers (n = 11) from two Southern California Counties employed by public outpatient mental health programs (n = 8) serving TAY and conducted thematic analyses. We present themes and illustrative quotes. PS' roles are highly flexible; thus, PM support PS to strengthen skills to address organization-facing and client-facing responsibilities. PM addressed time management, documentation, PS integration into the organization, and workplace relationships. Trainings to better support clients included addressing cultural competency to serve LGBTQ TAY and racial/ethnic subgroups. Diverse supervision modalities address PS' diverse needs. Supporting PS' technical and administrative skills (e.g., planning, interpersonal communication skills) may aid their implementation of a complex role. Longitudinal research can examine the impact of organizational supports on PS' job satisfaction, career trajectories, and TAY clients' engagement with services.

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OBJECTIVE: The purpose of this qualitative study was to examine the experiences of certified peer specialists (CPSs) in delivering telehealth services during the COVID-19 pandemic. METHODS: Fourteen semistructured interviews with CPSs were conducted from August to November 2020. Data were analyzed by using thematic analysis. RESULTS: Helpful support from employers during the transition to telehealth included clear communication and access to training on telehealth technologies. Main barriers and facilitators were related to interpersonal relationships and logistical factors. CPSs reported that telehealth allowed them to continue to support the peers they serve but that the quality of interactions was not as good as with in-person services. Logistical challenges included inadequate equipment and Internet access. CONCLUSIONS: To support CPSs in delivering telehealth, employers can engage them in open and transparent communication about guidelines for service delivery, provide training and equipment, and allow them the flexibility to tailor service delivery modalities to the peers they serve.

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BACKGROUND: eHealth tools have the potential to meet the mental health needs of individuals who experience barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase their engagement with eHealth. OBJECTIVE: This pilot study aims to test the feasibility and acceptability of a novel, completely automated web-based system to recruit, screen, enroll, assess, randomize, and then deliver an intervention to a national sample of military veterans with unmet mental health needs; investigate whether phone-based peer support increases the use of web-based problem-solving training compared with self-directed use; and generate hypotheses about potential mechanisms of action for problem-solving and peer support for future full-scale research. METHODS: Veterans (N=81) with unmet mental health needs were recruited via social media advertising and enrolled and randomized to the self-directed use of a web-based problem-solving training called Moving Forward (28/81, 35%), peer-supported Moving Forward (27/81, 33%), or waitlist control (26/81, 32%). The objective use of Moving Forward was measured with the number of log-ins. Participants completed pre- and poststudy measures of mental health symptoms and problem-solving confidence. Satisfaction was also assessed post treatment. RESULTS: Automated recruitment, enrollment, and initial assessment methods were feasible and resulted in a diverse sample of veterans with unmet mental health needs from 38 states. Automated follow-up methods resulted in 46% (37/81) of participants completing follow-up assessments. Peer support was delivered with high fidelity and was associated with favorable participant satisfaction. Participants randomized to receive peer support had significantly more Moving Forward log-ins than those of self-directed Moving Forward participants, and those who received peer support had a greater decrease in depression. Problem-solving confidence was associated with greater Moving Forward use and improvements in mental health symptoms among participants both with and without peer support. CONCLUSIONS: Enrolling and assessing individuals in eHealth studies without human contact is feasible; however, different methods or designs are necessary to achieve acceptable participant engagement and follow-up rates. Peer support shows potential for increasing engagement in web-based interventions and reducing symptoms. Future research should investigate when and for whom peer support for eHealth is helpful. Problem-solving confidence should be further investigated as a mechanism of action for web-based problem-solving training. TRIAL REGISTRATION: ClinicalTrials.gov NCT03555435; http://clinicaltrials.gov/ct2/show/NCT03555435.

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INTRODUCTION: A multi-disciplinary, community-university-government collaboration resulted in the development of Oral Health for Community Workers, a brief, oral health online e-learning module. The e-learning module was designed to improve oral health literacy among frontline health workers who are members of underserved communities, and to address oral health disparities in safety net medical and behavioral health settings. METHODS: Community-based participatory methods were used to design and evaluate the e-learning module. Participants took pre-, post-, and 3-month follow-up surveys. RESULTS: Oral health literacy and confidence in incorporating oral health into practice improved. Satisfaction with the module was high. DISCUSSION: Oral Health for Community Workers is now sustained as a standard module within Community Health Worker, Peer Support Specialist, and Peer Recovery Coach Certification and continuing education offerings in Michigan.

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Compared to peers in the general population, persons aging with serious mental illnesses (SMIs) face physical health disparities, increased isolation, and decreased subjective experiences of quality of life and wellbeing. To date, limited intervention research focuses on addressing specific needs of persons aging with SMIs and no interventions targeted for that population are informed by the theory and science of positive psychology. With the aim of co-producing a positive-psychology-based program to enhance wellbeing for older adults with SMIs, the author held a series of focus groups and individual interviews with six certified older adult peer specialists. Analysis of the data developed in-depth insights into helpful processes, values, and priorities of individuals aging with SMIs, as well as the creation of a wellbeing-enhancing course curriculum.

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As the peer specialist workforce continues to expand, it is critical to better understand peer providers' working conditions and workplace experiences. The current study utilized a targeted non-probability sample of 801 peer specialists to explore whether key organizational climate and support variables would yield distinct multivariate groups, and to investigate the correlates of these groups. Analyses yielded a seven-group solution, with peer run organizations comprising a substantially greater proportion of the groups with high organizational climate and support scores. In direct comparisons, peer-run programs outranked all other groups in the areas of perceived organizational climate, supports for career development and perceived service quality.

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BACKGROUND: In recent years the use of peer specialists in the delivery of mental health of care across the US has increased. Although data on the benefits of using peer specialists is limited and/or equivocal, states are making policy and funding decisions to support the expansion of peer specialist services. This data is even more limited in the state of Florida where no studies were found to document the effect of peer specialists on mental health care outcomes. The purpose of this study was to assess whether local decisions to use peer specialists can be supported through the measurement of outcomes of service utilization and mental health functioning when peer specialists are involved in the treatment of individuals living with serious mental illness. METHODS: The study was conducted using service data collected by South Florida Behavioral Health Network (SFBHN). SFBHN is the Managing Entity for publicly funded mental health and substance abuse services in Miami-Dade and Monroe Counties in Florida. We compared mental health outcomes and service utilization between individuals who received peer specialist services (n = 367) and a treatment as usual group (n = 1468) matched on gender, age and severity of diagnosis in the period July 2013 and June 2015. Multilevel models were used to evaluate the functioning outcomes between the groups. Service utilization was assessed using negative binomial regression. RESULTS: Individuals in the treatment group receiving peer specialist services utilized more ambulatory/lower levels of care services and had more frequent crisis stabilization unit admissions. Those in the treatment group also displayed more functional difficulties with a variety of practical activities, employment and housing and violent temper, hostility, threatening behaviors. CONCLUSIONS: The findings of the study further support existing evidence documenting the mixed benefits of using peer services compared to treatment as usual care. Policy makers and other stakeholders are encouraged to advance mental health recovery by examining outcomes more comprehensively. Future research should include examination of the subjective benefits of peer support for recipients, understanding the impact on service utilization and a better definition of the roles, supervision and expectations of peer support programs.

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OBJECTIVE: Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population. METHODS: This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months. RESULTS: At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant. CONCLUSIONS: The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.

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Mental health peer specialists are individuals with serious mental illnesses who receive training to use their lived experiences to help others with serious mental illnesses in clinical settings. This Open Forum discusses the state of the research for mental health peer specialists and suggests a research agenda to advance the field. Studies have suggested that peer specialists vary widely in their roles, settings, and theoretical orientations. Theories of action have been proposed, but none have been tested. Outcome studies have shown benefits of peer specialists; however, many studies have methodological shortcomings. Qualitative descriptions of peer specialists are plentiful but lack grounding in implementation science frameworks. A research agenda advancing the field could include empirically testing theoretical mechanisms of peer specialists, developing a measure of peer specialist fidelity, conducting more rigorous outcomes studies, involving peer specialists in executing the research, and assessing various factors that influence implementing peer specialist services and testing strategies that could address those factors.

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Overweight and obesity disproportionally impact people with serious mental illness (SMI). Healthy lifestyle interventions can improve the health of people with SMI but may need to be adapted for this population. The aims of this study were: to (1) examine the feasibility and acceptability of delivering the Peer-based Group Lifestyle Balance (PGLB) intervention and (2) describe intervention adaptations for people with SMI in supportive housing. Peer specialists and social workers co-facilitated 12 weekly PGLB sessions for 14 supportive housing clients. We conducted structured interviews and collected qualitative data through field notes and two focus groups. Frequencies and measures of central tendencies were used to describe participant characteristics and PGLB feasibility and acceptability measures. Qualitative data was analyzed using directed content analysis. Participants on average attended 8 of 12 sessions, and reported that services were satisfactory and helpful. Intervention adaptations, ongoing throughout the study, focused on adding peer-specialists as co-facilitators, increasing individualized support and developing strategies to address socioeconomic barriers impacting participants' ability to engage in healthy lifestyle changes. Study findings suggest that participants with SMI in supportive housing perceived PGLB as feasible and acceptable. Expanding the relevance and reach of peer-based healthy lifestyle interventions in community settings serving people with SMI requires careful adaptations to the socioeconomic realities of this population and the complexities of living with co-morbid health and mental health conditions.

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The recovery model is wielding a welcome influence in the mental healthcare system. Despite its potential impact, systematic studies of the recovery construct as viewed by consumers and former consumers of mental health services have only recently begun to permeate the literature. We have embarked on an ongoing collaboration with the Georgia Mental Health Consumer Network to study the recovery experiences of Certified Peer Specialists (CPSs). As a first step, we evaluated the psychometric characteristics of a new measure of the recovery construct in CPSs. CPSs (N=84) enrolled in the GMHCN completed the Maryland Assessment of Recovery in Serious Mental Illness (MARS) along with measures of resilience, coping styles, community living, social support, internalized stigma, psychopathology, and personality. Recovery as measured by the MARS was associated with resilience, coping behaviors, quality of social support, community living, internalized stigma, and severity of psychopathology. Recovery did not demonstrate a statistically significant association with personality. Recovery appeared to mediate the effect of psychopathology and episodic stressors on community functioning. Our psychometric study supports the psychometric soundness of the MARS and the construct validity of recovery.

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