Literature in Canada and other countries suggests that insufficient evidence supporting the effectiveness of peer support has impeded its growth and wider-scale use. When an unsolicited proposal was submitted to the Board of the Mental Health Commission of Canada (MHCC), an evaluative component was identified as an integral part of the proposed five year project. This was reaffirmed in the project outline submitted to the MHCC management team in June 2010 wherein it was stated that “it can be expected that evidence-based frameworks will need to be developed before organizations are willing to invest in peer based initiatives such as peer support and mental health education.”
Consistent with the value of empowerment, it was determined that peer supporters would have a primary role in shaping the evaluation strategy for peer support. They were involved in conceptualizing and deciding the questions for the evaluation designed to assess its effectiveness. A consultation session was also held with several mental health clinicians representing an important stakeholder group for advancing peer support.
The ultimate purpose of the evaluation is not only to assess the effectiveness of peer support but also to enhance knowledge and strategies for designing and implementing peer support programs and to improve the overall function of peer support throughout Canada.
The consultations with peer supporters that took place in the fall of 2010 identified key outcomes to evaluate the effectiveness of peer support – each of them tied to a substantial number of indicators. The comprehensive survey that was subsequently issued to the peer support community nationwide asked recipients if they agreed with the outcomes and indicators that had been determined by their peers. For each outcome and its accompanying indicators, respondents indicated whether they agreed, partially agreed or disagreed, and respondents were also invited to submit written comments.
Developing an Evidence Base
The initial focus will be on quality improvement activities in organizations that have agreed to implement peer support programs based on the national standards of practice. To inform the quality improvement process, periodic employee surveys will be conducted to see whether changes have occurred in participating organizations with regard to mental health service use, work productivity, and attitudes towards mental illness. In addition, the quality improvement process will involve examining outcomes for the individual seeking mental health support and the peer supporter, i.e., wellbeing, empowerment and engagement.
Toward a Multi-Year Evaluation
One of PSACC’s major responsibilities is to oversee evaluation and research pertaining to recovery based mental health peer support. In view of conducting a multi-year evaluation for peer support programs that are implemented based on the national standards of practice, data collection instruments and outcome measures are being refined beginning with the initial evaluation sites. These methodologies will be enhanced as more organizations voluntarily join in this study. These first steps build the research capacity and lay the groundwork for the development of future research.
Organizations that agree to follow the standards of practice protocol for their peer support programs are invited to become an evaluation site.
Data Collection and Confidentiality
Each participating organization will be responsible to support the quality improvement activity such that data can be gathered in a voluntary, timely and confidential manner consistent with instructions provided by PSACC. The evaluation team will be responsible for analyzing this data.
Where practical and feasible, data collection may be done by confidential electronic means. Resulting data will be held in a secure and confidential manner by PSACC.
Publication of Evaluation Results and Confidentiality
PSACC will protect the integrity of program confidentiality by keeping individual program results anonymous.
Each individual organization will receive the results of its specific quality improvement outcomes, and also the aggregated, de-identified results from similar mental health peer support programs, as they become available. In the future, pooled results from a range of unidentified sites will also be the basis for scientific publications.