Impact of Peer Specialist Services on Residential Stability and Behavioral Health Status Among Formerly Homeless Veterans With Cooccurring Mental Health and Substance Use Conditions

Abstract

Objectives: This study tested the impacts of peer specialists on housing stability, substance abuse, and mental health status for previously homeless Veterans with cooccurring mental health issues and substance abuse. Methods: Veterans living in the US Housing and Urban Development—Veterans Administration Supported Housing (HUD-VASH) program were randomized to peer specialist services that worked independently from HUD-VASH case managers (ie, not part of a case manager/peer specialist dyad) and to treatment as usual that included case management services. Peer specialist services were community-based, using a structured curriculum for recovery with up to 40 weekly sessions. Standardized self-report measures were collected at 3 timepoints. The intent-to-treat analysis tested treatment effects using a generalized additive mixed-effects model that allows for different nonlinear relationships between outcomes and time for treatment and control groups. A secondary analysis was conducted for Veterans who received services from peer specialists that were adherent to the intervention protocol. Results: Treated Veterans did not spend more days in housing compared with control Veterans during any part of the study at the 95% level of confidence. Veterans assigned to protocol adherent peer specialists showed greater housing stability between about 400 and 800 days postbaseline. Neither analysis detected significant effects for the behavioral health measures. Conclusions: Some impact of peer specialist services was found for housing stability but not for behavioral health problems. Future studies may need more sensitive measures for early steps in recovery and may need longer time frames to effectively impact this highly challenged population.

A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness

“…One randomised controlled trial (Corrigan et al, 2017) examined an ethnically matched peer-navigator programme compared to the usual care among homeless African Americans with serious mental illness and measured psychological distress using the Texas Christian University Health Forms (TCU-HF). Investigators found that those in the intervention group reported better im- Conversely, one randomised controlled trial (Ellison et al, 2020) examined a peer-specialist intervention compared to usual care among homeless veterans receiving housing vouchers and measured symptoms of mental illness using the 24-item Behaviour And Symptom Identification Scale (BASIS-24) up to 12 months and found no statistically significant between-group difference (p > .05). Another randomised controlled trial (Nyamathi et al, 2001) examined an ethnically matched female peer-mentorship programme compared to usual care among homeless women and their intimate partners, measuring psychological well-being over 6 months using the Mental Health Index (MHI-5) and found no statistically significant improvement among those receiving peer support compared to the usual care (Regression coefficient B = −5.17 (SE 2.2); p = .019).…”

Explaining Service Use and Residential Stability in Supported Housing

“…Service episodes were then counted for the 3 months before study enrollment and for the 9 months after enrollment—when most participants completed the project (some continued to receive services for another 3 mo due to interruptions in their period of service caused by peer specialist turnover). 24 …”

A Systematic Review of the Roles and Contributions of Peer Providers in the Behavioral Health Workforce

“…17−30 Study participants comprised a majority sample of White (15 studies) 18,22,24−36 male individuals (15 studies), 19,22,23,25 −30,33−35,37−39 with a mean age of 45 years (age range = 30.6−55.3 years) who were single, divorced, or never married (6 studies). 19,23,28,31,37,38 Nonspecified serious mental illness (12 studies), [17][18][19][20][21]23,27,28,31,32,35,36 depression (11 studies), 17,[20][21][22]24,[31][32][33]35,37,39 schizophrenia/ schizoaffective disorder (11 studies), 17,20,21,23,27, 31,32,35 −37,39 and SUD (11 studies) 18,19,23,[25][26][27][29][30][31]34,38 were the most prevalent behavioral health conditions experienced by the study participants. Other frequently observed behavioral health conditions were bipolar disorder (8 studies) 17,20,…”

“…21,24,25,31,35 In addition, 11 studies focused on populations previously having received or currently receiving inpatient care or hospitalization for a mental health or SUD, 18,23,27,28,[31][32][33]35,36,38,39 and 6 focused on individuals previously having or currently experiencing homelessness. 19,26,27,29,37,38 A majority ( 16) of studies included participants receiving usual care as a control. [17][18][19][20][21][22][23][24]26,28,[30][31][32]35,37,38 Within the context of this review, usual care refers to a continuation of nonpeer-provided medical or behavioral health services received before study enrollment that includes outpatient psychotherapy, rehabilitation services, and case management.…”

“…19,26,27,29,37,38 A majority ( 16) of studies included participants receiving usual care as a control. [17][18][19][20][21][22][23][24]26,28,[30][31][32]35,37,38 Within the context of this review, usual care refers to a continuation of nonpeer-provided medical or behavioral health services received before study enrollment that includes outpatient psychotherapy, rehabilitation services, and case management. 17,20,37 A total of 5 studies used program services delivered by an individual other than a peer provider as a control, including behavioral health providers and personal associates of participants, 21,25,29,33,34 and 3 studies used matching models to identify a control group through retrospective data.…”