Outpatient psychiatric care and peer support work (APPeer)
The project investigates how peer support workers can be sustainably implemented in the context of outpatient psychiatric care in Spitex organizations and develops possible solutions.
Factsheet
- Lead school School of Health Professions
- Institute(s) Nursing
- Research unit(s) Innovation in the Field of Mental Health and Psychiatric Care
- Funding organisation Others
- Duration (planned) 01.10.2023 - 30.06.2024
- Project management Dr. Anna Hegedüs
- Head of project Dr. Anna Hegedüs
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Project staff
Nora Christa Ambord
Dr. Anna Hegedüs
Dr. Christian Burr
Sabine Rühle Andersson
Melina Hasler -
Partner
Verein Förderprogramm und Sozialfonds für ambulante Peer-Begleitung Psychische Gesundheit VFSPB
Spitex oberes Worblental
Spitex Region Bern Nord ReBeNo
Spitex Region Brugg AG
Ebnet Stiftung - Keywords Psychiatric care, Outpatient setting, Outreach services, Mental health, Recovery, Peer support, Peer support worker, Experienced Involvement, Spitex, Implementation, Participatory Research, Implementation Science
Situation
People with mental illness frequently experience severe impairments in their usual way of life and quality of life. Community mental health nurses play an important role in supporting these people. Peer support workers (PSW) are individuals with lived experience of mental health problems and of service use who utilize their acquired knowledge and skills to support others challenged by similar conditions. Peer support is considered a central component for the recovery of people with mental illness. It is considered as very enriching, low-threshold and cost-effective. It thus creates a multitude of benefits for clients, PSW, organizations and the healthcare system. While peer support is mainly established and accepted in the inpatient and day-clinic settings in Switzerland, it is rarely used in outpatient settings. So far, there is no scientifically based knowledge about the structure of the implementation process and the challenges faced by Spitex organizations by implementing peer support. The APPeer project aims to fill this gap and to develop solutions on how to sustainably implement PSWs in the context of Spitex organizations. In doing so, it contributes to its dissemination and optimization.
Course of action
We conducted a qualitative study based on the principles of implementation research with three cases (Spitex organizations) and a participatory research approach. The participating Spitex organizations used PSWs in the outreach, one-to-one support of clients. They were accompanied and supported by the INGA project (e.g. in preparation, recruitment, implementation in the organization and further development). The three participating Spitex organizations were at different stages of the implementation process at the time. Thus, a cross-sectional survey could be used to examine the entire process of implementation. Three investigation methods were combined with each other: 1. expert interviews with Spitex managers, PSWs and nurses in the Spitex organizations. 2. focus group discussion with responsible persons of the INGA project 3. participant observation of PSWs and client sessions The analysis was based on qualitative content analysis. Subsequently, the findings were discussed and validated in a participatory workshop with responsible persons of the INGA project, Spitex employees, PSWs and stakeholders. Solutions for the dissemination and sustainable implementation of outreach peer support work in the context of psychiatric Spitex were developed.
Result
The interviewees saw the use of experienced knowledge as a central aspect in establishing an additional connection with clients on a relational level. The PSWs adapted the content of their supports to the needs of the clients. They all had different educational backgrounds but completed the (Swiss) nursing assistant course in order to be able to bill though health insurance. The interviewees were dissatisfied with this service billing. The low working hours of the PSWs made integration into the team more difficult. The nursing staff and managers criticized the PSWs' lack of psychiatric knowledge. The INGA project provided important networking and pioneering work and was seen as very supportive by the Spitex organizations, especially in the initial phase of implementation. In the long term, there was sometimes a lack of clarity about responsibilities. It also became apparent that an in-depth reflection on the values and attitudes of recovery and peer support work rarely took place. Peer support work was mainly seen as an isolated intervention rather than an issue that has an impact on the entire organization and its culture and values. People from INGA's consulting service and particularly committed employees and those with a lot of prior knowledge were identified as change agents for the implementation. Project funding is essential for the start and implementation phase.
Looking ahead
A more extensive introduction of peer support work should take place as part of a recovery-oriented transformation of the entire organization in order to utilize experienced knowledge at all levels. Targeted training and further education of employees enables a deeper exploration of the recovery principles which support the transformation process. External support should be designed in a way that does not hinder internal processes. It is also important to analyze the added value of peer support work through qualitative and quantitative research. Such research findings could form the basis for discussions with funding organizations and secure sustainable funding for peer support work.
