Psychiatric Rehabilitation Journal 2016, Vol. 39, No. 1, 71–73
© 2015 American Psychological Association 1095-158X/16/$12.00 http://dx.doi.org/10.1037/prj0000125
BRIEF REPORT
The Companion Project: Recovery Among Volunteer Peer Support Providers in South Korea Kyunghee Ha
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Ajou University Objective: This article explores the benefits of recovery among volunteer peer providers who participated in The Companion Project—the first peer-delivered mental health services project in South Korea. Method: The effect of the program on the recovery and symptoms of peer providers (N ⫽ 31) was quantitatively analyzed using a nonequivalent control group design. A subset of 12 participants was interviewed on the perceived recovery benefits. Results: Results of the statistical analysis indicated that peer support activities affected the recovery and symptoms of peer providers. Through in-depth interviews, the following themes were identified: self-awareness and redefinition, growth through participation and role-taking, and new potential and hope. Conclusions and Implications for Practice: Peer providers experienced the benefits of recovery through relationships with peers and meaningful roles. These results contribute to an expansion of peer support in Korea and the development of new jobs for people with psychiatric disabilities. Keywords: mental health, peer providers, peer support, recovery, South Korea
Project prepared and trained people registered in the centers via two methods. First, recovery seminars were organized to share the vision and experience of recovery. They were run once per week for 22 weeks by the centers’ staff who participated in the recovery workshop using a workbook developed by the Center for Psychiatric Rehabilitation at Boston University (Spaniol, Koehler, & Hutchinson, 2009). Second, they attended self-help groups once per month for 1 year and learned about the peer provider role from experienced providers. In the following year, peer support activities began with volunteer peer providers recommended by staff. Peer providers were required to manage their own symptoms and medication, communicate appropriately, and be willing to help peers; they did not require special certification. Volunteer peer support (2– 4 hr per week) involved either peer counseling or running a recovery program. During peer counseling, providers visited a peer’s home or workplace to provide support related to emotional concerns, daily life, and leisure activities; they also assisted peers in adapting to using the centers’ services for the first time. Recovery programs were directly run by peer providers using the recovery workbook, and peer providers shared experiences, discussed difficulties, and searched for solutions to problems in providing peer support with professional staff and peer providers.
Since the 1990s, recovery, which is the “ongoing life experience” of overcoming the daily challenges of having a disability and creating a meaningful life, has become important within the mental health field (Deegan, 1988, p. 11). Personal relationships and peer support are important to successful recovery. Peer support is “a process by which persons voluntarily come together to help each other address common problems or shared concerns” (Davidson et al., 1999, p. 172). Mead, Hilton, and Curtis (2001) have also defined peer support as “a system of giving and receiving help, founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful” (p. 134). Salzer and Shear (2002) identified consumer–provider benefits within consumer-delivered services, including interpersonal competence, personally relevant knowledge, social approval, professional growth, job-related recovery, and mutual support. In the West, certified peer specialists are already prevalent; their work settings and modalities vary greatly (Salzer, Schwenk, & Brusilovskiy, 2010), and their effectiveness has been assessed (Chinman et al., 2014). The Companion Project, a joint venture with eight Community Psychiatric Rehabilitation Centers, was the first attempt to provide peer-delivered services in Korea. In the first year, The Companion
Method This article was published Online First March 23, 2015. The author has no conflicts of interest to declare. This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2011-327-B00461). Correspondence concerning this article should be addressed to Kyunghee Ha, School of Humanities and Social Science, Ajou University, Suicide and School Mental Health Institute, San 5, Wancheon-dong, Yeongtonggu, Suwon 443-749, Korea. E-mail: [email protected]
Design Quantitative and qualitative research methods were used. The effects of The Companion Project on participant recovery were assessed through a quantitative nonequivalent control group design. In-depth qualitative interviews were performed with a subset 71
HA
72 of participants to understand the subjective meaning of peer support activities.
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Participants There were 31 participants from 8 centers (15 men; 19 people over 40 years; three people who had been married; 23 people with a high school diploma or lower; 25 people with schizophrenia; 18 people who had their illness for over 11 years). Control group participants were selected by taking a nonprobability sample of users from the same centers. No statistically significant differences were found between the groups. In-depth interviews were undertaken with 12 participants who displayed similar characteristics to the overall sample.
Assessments Symptoms were measured using the Colorado Symptom Index (Boothroyd & Chen, 2008) and recovery was measured with the Korean version of the Mental Health Recovery Scale (Bullock, 2005). In-depth interviews (60 –90 min) were semistructured and open-ended, and focused on participants’ experiences and perceptions of the benefits of their peer support activities.
Analysis Fisher’s exact test and independent t tests were performed to compare the experimental and control groups, and differences between pre- and postmeasurement scores. In-depth interviews were audiotaped, verbatim transcripts produced, and standard thematic analysis used.
Results Quantitative Analyses The experimental group showed a mean decrease in symptom scores (M ⫽ 2.13, SD ⫽ .90) while the control group showed a slight increase (M ⫽ 2.62, SD ⫽ .93). The difference between the two groups was statistically significant, t ⫽ ⫺2.02, p ⬍ .05. The experimental group showed increased recovery scores (M ⫽ 4.09, SD ⫽ .65) while the control group showed a slight decrease (M ⫽ 3.36, SD ⫽ .67); the statistically significant difference between groups, t ⫽ 3.15, p ⬍ .01 indicated that peer support activities were associated with improved recovery. Statistical significance was also observed for the following recovery factors: learning/self-redefinition, t ⫽ 2.48, p ⬍ .05, basic functioning, t ⫽ 2.64, p ⬍ .05, overall wellbeing, t ⫽ 3.52, p ⬍ .01, new potential, t ⫽ 2.90, p ⬍ .01, spirituality, t ⫽ 2.06, p ⬍ .05, and advocacy/enrichment, t ⫽ 3.11, p ⬍ .01. These results demonstrate specific areas in which peer support was associated with better recovery in participants with psychiatric disabilities.
Qualitative Analyses The participant interviews revealed three key themes. Self-awareness and redefinition. Participants showed increased self-understanding and acceptance through peer support, including understanding and empathizing with their peers. One participant called it a “mirror effect.” Participants no longer per-
ceived themselves as patients but as peer support providers, redefining themselves as active participants rather than passive recipients. Participants also discovered their self-worth when peers thanked them for the positive changes they had experienced. Growth through participation and roles. The biggest differences between peer-delivered services and self-help groups were the increased roles and responsibilities undertaken by peer supporters. Although participants reported negative experiences, their capacities to tolerate and work with these difficulties gradually improved as they shared these difficulties with experts and peers, and worked to find solutions during regular supervision. Participants reported developing the strength to withstand difficulties while improving their own knowledge and skills. New potential and hope. Participants discovered new potential in themselves and gained hope for recovery; they refined life goals, such as becoming employed or obtaining further education, and made specific plans to achieve them. Some participants expressed interest in careers in social work or counseling, while others became interested in human rights or advocacy organizations.
Discussion The present study explored the benefits of peer support activities for recovery among people with psychiatric disabilities in South Korea. Quantitative analysis indicated significant effects for both symptoms and recovery among peer support providers. Qualitative analyses yielded themes of positive experiences for peer providers: self-awareness and redefinition, growth through participation and roles, and new potential and hope. Common experiences and supportive relationships with peers are some of the most important factors in promoting recovery. In addition, being a peer supporter and under regular supervision could promote growth with participants coming to perceive their identity as “providers” rather than “patients.” One limitation was that providers were unpaid volunteers. Community Chest of Korea funding was available for only 2 years, and alternative plans are needed to maintain the program. One possibility is new government funding to establish peer provider services as a major project of the Independent Living Center; the other is hiring people with psychiatric disabilities from mental health institutions as peer support providers. To achieve this, it will be necessary to develop principles and define services for a certified workforce (Daniels, Bergeson, Fricks, Ashenden, & Powell, 2012). Currently, both options are being undertaken as pilot projects with the aim of promoting peer support.
References Boothroyd, R. A., & Chen, H. J. (2008). The psychometric properties of the Colorado Symptom Index. Administration and Policy in Mental Health and Mental Health Services Research, 35, 370 –378. http://dx.doi.org/ 10.1007/s10488-008-0179-6 Bullock, W. A. (2005). Mental Health Recovery Measure (MHRM). In T. Campbell-Orde, J. Chamberlain, J. Carpenter, & H. S. Leff (Eds.), Measuring the promise of recovery: A compendium of recovery measures (Vol. 2, pp. 36 – 41). Cambridge, MA: The Evaluation Center. Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental illnesses: Assessing the evidence. Psy-
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
RECOVERY AMONG VOLUNTEER PEER SUPPORT PROVIDERS chiatric Services, 65, 429 – 441. http://dx.doi.org/10.1176/appi.ps .201300244 Daniels, A. S., Bergeson, S., Fricks, L., Ashenden, P., & Powell, I. (2012). Pillars of peer support: Advancing the role of peer support specialists in promoting recovery. The Journal of Mental Health Training, Education and Practice, 7, 60 – 69. Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D., & Tebes, J. K. (1999). Peer support among individuals with severe mental illness: A review of the evidence. Clinical Psychology: Science and Practice, 6, 165–187. http://dx.doi.org/10.1093/clipsy.6.2.165 Deegan, P. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11, 11–19. http://dx.doi.org/10.1037/ h0099565 Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical perspective. Psychiatric Rehabilitation Journal, 25, 134 –141. http://dx .doi.org/10.1037/h0095032
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Salzer, M. S., Schwenk, E., & Brusilovskiy, E. (2010). Certified peer specialist roles and activities: Results from a national survey. Psychiatric Services, 61, 520 –523. http://dx.doi.org/10.1176/ps.2010.61.5.520 Salzer, M. S., & Shear, S. L. (2002). Identifying consumer-provider benefits in evaluations of consumer-delivered services. Psychiatric Rehabilitation Journal, 25, 281–288. http://dx.doi.org/10.1037/h0095014 Spaniol, L., Koehler, M., & Hutchinson, D. (2009). The recovery workbook: Practical coping and empowerment strategies for people with psychiatric disabilities. Boston, MA: Center for Psychiatric Rehabilitation.
Received February 14, 2014 Revision received January 12, 2015 Accepted January 12, 2015 䡲
© 2015 American Psychological Association 1095-158X/16/$12.00 http://dx.doi.org/10.1037/prj0000125
BRIEF REPORT
The Companion Project: Recovery Among Volunteer Peer Support Providers in South Korea Kyunghee Ha
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Ajou University Objective: This article explores the benefits of recovery among volunteer peer providers who participated in The Companion Project—the first peer-delivered mental health services project in South Korea. Method: The effect of the program on the recovery and symptoms of peer providers (N ⫽ 31) was quantitatively analyzed using a nonequivalent control group design. A subset of 12 participants was interviewed on the perceived recovery benefits. Results: Results of the statistical analysis indicated that peer support activities affected the recovery and symptoms of peer providers. Through in-depth interviews, the following themes were identified: self-awareness and redefinition, growth through participation and role-taking, and new potential and hope. Conclusions and Implications for Practice: Peer providers experienced the benefits of recovery through relationships with peers and meaningful roles. These results contribute to an expansion of peer support in Korea and the development of new jobs for people with psychiatric disabilities. Keywords: mental health, peer providers, peer support, recovery, South Korea
Project prepared and trained people registered in the centers via two methods. First, recovery seminars were organized to share the vision and experience of recovery. They were run once per week for 22 weeks by the centers’ staff who participated in the recovery workshop using a workbook developed by the Center for Psychiatric Rehabilitation at Boston University (Spaniol, Koehler, & Hutchinson, 2009). Second, they attended self-help groups once per month for 1 year and learned about the peer provider role from experienced providers. In the following year, peer support activities began with volunteer peer providers recommended by staff. Peer providers were required to manage their own symptoms and medication, communicate appropriately, and be willing to help peers; they did not require special certification. Volunteer peer support (2– 4 hr per week) involved either peer counseling or running a recovery program. During peer counseling, providers visited a peer’s home or workplace to provide support related to emotional concerns, daily life, and leisure activities; they also assisted peers in adapting to using the centers’ services for the first time. Recovery programs were directly run by peer providers using the recovery workbook, and peer providers shared experiences, discussed difficulties, and searched for solutions to problems in providing peer support with professional staff and peer providers.
Since the 1990s, recovery, which is the “ongoing life experience” of overcoming the daily challenges of having a disability and creating a meaningful life, has become important within the mental health field (Deegan, 1988, p. 11). Personal relationships and peer support are important to successful recovery. Peer support is “a process by which persons voluntarily come together to help each other address common problems or shared concerns” (Davidson et al., 1999, p. 172). Mead, Hilton, and Curtis (2001) have also defined peer support as “a system of giving and receiving help, founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful” (p. 134). Salzer and Shear (2002) identified consumer–provider benefits within consumer-delivered services, including interpersonal competence, personally relevant knowledge, social approval, professional growth, job-related recovery, and mutual support. In the West, certified peer specialists are already prevalent; their work settings and modalities vary greatly (Salzer, Schwenk, & Brusilovskiy, 2010), and their effectiveness has been assessed (Chinman et al., 2014). The Companion Project, a joint venture with eight Community Psychiatric Rehabilitation Centers, was the first attempt to provide peer-delivered services in Korea. In the first year, The Companion
Method This article was published Online First March 23, 2015. The author has no conflicts of interest to declare. This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2011-327-B00461). Correspondence concerning this article should be addressed to Kyunghee Ha, School of Humanities and Social Science, Ajou University, Suicide and School Mental Health Institute, San 5, Wancheon-dong, Yeongtonggu, Suwon 443-749, Korea. E-mail: [email protected]
Design Quantitative and qualitative research methods were used. The effects of The Companion Project on participant recovery were assessed through a quantitative nonequivalent control group design. In-depth qualitative interviews were performed with a subset 71
HA
72 of participants to understand the subjective meaning of peer support activities.
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Participants There were 31 participants from 8 centers (15 men; 19 people over 40 years; three people who had been married; 23 people with a high school diploma or lower; 25 people with schizophrenia; 18 people who had their illness for over 11 years). Control group participants were selected by taking a nonprobability sample of users from the same centers. No statistically significant differences were found between the groups. In-depth interviews were undertaken with 12 participants who displayed similar characteristics to the overall sample.
Assessments Symptoms were measured using the Colorado Symptom Index (Boothroyd & Chen, 2008) and recovery was measured with the Korean version of the Mental Health Recovery Scale (Bullock, 2005). In-depth interviews (60 –90 min) were semistructured and open-ended, and focused on participants’ experiences and perceptions of the benefits of their peer support activities.
Analysis Fisher’s exact test and independent t tests were performed to compare the experimental and control groups, and differences between pre- and postmeasurement scores. In-depth interviews were audiotaped, verbatim transcripts produced, and standard thematic analysis used.
Results Quantitative Analyses The experimental group showed a mean decrease in symptom scores (M ⫽ 2.13, SD ⫽ .90) while the control group showed a slight increase (M ⫽ 2.62, SD ⫽ .93). The difference between the two groups was statistically significant, t ⫽ ⫺2.02, p ⬍ .05. The experimental group showed increased recovery scores (M ⫽ 4.09, SD ⫽ .65) while the control group showed a slight decrease (M ⫽ 3.36, SD ⫽ .67); the statistically significant difference between groups, t ⫽ 3.15, p ⬍ .01 indicated that peer support activities were associated with improved recovery. Statistical significance was also observed for the following recovery factors: learning/self-redefinition, t ⫽ 2.48, p ⬍ .05, basic functioning, t ⫽ 2.64, p ⬍ .05, overall wellbeing, t ⫽ 3.52, p ⬍ .01, new potential, t ⫽ 2.90, p ⬍ .01, spirituality, t ⫽ 2.06, p ⬍ .05, and advocacy/enrichment, t ⫽ 3.11, p ⬍ .01. These results demonstrate specific areas in which peer support was associated with better recovery in participants with psychiatric disabilities.
Qualitative Analyses The participant interviews revealed three key themes. Self-awareness and redefinition. Participants showed increased self-understanding and acceptance through peer support, including understanding and empathizing with their peers. One participant called it a “mirror effect.” Participants no longer per-
ceived themselves as patients but as peer support providers, redefining themselves as active participants rather than passive recipients. Participants also discovered their self-worth when peers thanked them for the positive changes they had experienced. Growth through participation and roles. The biggest differences between peer-delivered services and self-help groups were the increased roles and responsibilities undertaken by peer supporters. Although participants reported negative experiences, their capacities to tolerate and work with these difficulties gradually improved as they shared these difficulties with experts and peers, and worked to find solutions during regular supervision. Participants reported developing the strength to withstand difficulties while improving their own knowledge and skills. New potential and hope. Participants discovered new potential in themselves and gained hope for recovery; they refined life goals, such as becoming employed or obtaining further education, and made specific plans to achieve them. Some participants expressed interest in careers in social work or counseling, while others became interested in human rights or advocacy organizations.
Discussion The present study explored the benefits of peer support activities for recovery among people with psychiatric disabilities in South Korea. Quantitative analysis indicated significant effects for both symptoms and recovery among peer support providers. Qualitative analyses yielded themes of positive experiences for peer providers: self-awareness and redefinition, growth through participation and roles, and new potential and hope. Common experiences and supportive relationships with peers are some of the most important factors in promoting recovery. In addition, being a peer supporter and under regular supervision could promote growth with participants coming to perceive their identity as “providers” rather than “patients.” One limitation was that providers were unpaid volunteers. Community Chest of Korea funding was available for only 2 years, and alternative plans are needed to maintain the program. One possibility is new government funding to establish peer provider services as a major project of the Independent Living Center; the other is hiring people with psychiatric disabilities from mental health institutions as peer support providers. To achieve this, it will be necessary to develop principles and define services for a certified workforce (Daniels, Bergeson, Fricks, Ashenden, & Powell, 2012). Currently, both options are being undertaken as pilot projects with the aim of promoting peer support.
References Boothroyd, R. A., & Chen, H. J. (2008). The psychometric properties of the Colorado Symptom Index. Administration and Policy in Mental Health and Mental Health Services Research, 35, 370 –378. http://dx.doi.org/ 10.1007/s10488-008-0179-6 Bullock, W. A. (2005). Mental Health Recovery Measure (MHRM). In T. Campbell-Orde, J. Chamberlain, J. Carpenter, & H. S. Leff (Eds.), Measuring the promise of recovery: A compendium of recovery measures (Vol. 2, pp. 36 – 41). Cambridge, MA: The Evaluation Center. Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental illnesses: Assessing the evidence. Psy-
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
RECOVERY AMONG VOLUNTEER PEER SUPPORT PROVIDERS chiatric Services, 65, 429 – 441. http://dx.doi.org/10.1176/appi.ps .201300244 Daniels, A. S., Bergeson, S., Fricks, L., Ashenden, P., & Powell, I. (2012). Pillars of peer support: Advancing the role of peer support specialists in promoting recovery. The Journal of Mental Health Training, Education and Practice, 7, 60 – 69. Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D., & Tebes, J. K. (1999). Peer support among individuals with severe mental illness: A review of the evidence. Clinical Psychology: Science and Practice, 6, 165–187. http://dx.doi.org/10.1093/clipsy.6.2.165 Deegan, P. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 11, 11–19. http://dx.doi.org/10.1037/ h0099565 Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical perspective. Psychiatric Rehabilitation Journal, 25, 134 –141. http://dx .doi.org/10.1037/h0095032
73
Salzer, M. S., Schwenk, E., & Brusilovskiy, E. (2010). Certified peer specialist roles and activities: Results from a national survey. Psychiatric Services, 61, 520 –523. http://dx.doi.org/10.1176/ps.2010.61.5.520 Salzer, M. S., & Shear, S. L. (2002). Identifying consumer-provider benefits in evaluations of consumer-delivered services. Psychiatric Rehabilitation Journal, 25, 281–288. http://dx.doi.org/10.1037/h0095014 Spaniol, L., Koehler, M., & Hutchinson, D. (2009). The recovery workbook: Practical coping and empowerment strategies for people with psychiatric disabilities. Boston, MA: Center for Psychiatric Rehabilitation.
Received February 14, 2014 Revision received January 12, 2015 Accepted January 12, 2015 䡲
