Peer wellness coaches for adults with mental illness.
Peer wellness coaches for adults with mental illness.
复制标题
患有精神疾病的成年人的同伴健康教练。
DOI：
10.1176/appi.ps.650101
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Young,AlexanderS
中科院分区：
文献类型：
--
作者：
Cohen,AmyN;Golden,JoyaF;Young,AlexanderS
With the groundswell of attention on mental health recovery and consumercentered care, consumer providers in mental illness (or “peers”) are working in various mental health settings. However, there has been too little information regarding introduction of peers into treatment settings. Our group has developed a comprehensive program to hire, train, place, and support peers as wellness coaches. As wellness coaches, peers support an online weight management curriculum specifically for the cognitive needs of people with serious mental illness. The curriculum is accessible to consumers via the Web and via interactive kiosks in the clinic. Kiosks are similar to those used for selfservice airport check-ins and feature touch-screen interaction. The interface provides audio to read the questions aloud to the patient while the text appears on the screen and provides pictures and text for response options. The kiosk prints a color report that patients and others can use to advocate for services during the clinical encounter and to track progress. Coaching through the curriculum is delivered by peers in person for the first session and then weekly by phone for six months. The coaching is strengths based and uses motivational interviewing principles. This clinical service—weight management education supported by peer coaching—is delivered as part of a comparative effectiveness trial in a usual care setting. In selecting peers, we recruited adults with lived experience with mental illness and experience as a consumer provider or health navigator. It was important to assess applicants’ willingness to learn and practice new skills and to receive ongoing supervision. The five peers who were hired had notable personal strengths and remarkable stories of recovery, but they lacked computer skills and recent employment. We developed a peer coaching manual that includes information about the online weight management program, coaching session content and techniques, and procedural roles and responsibilities (available from the authors). This manual was designed to support consistent delivery of services across peers. Peers received didactic training in the manual and experiential training in coaching. Experiential training started with peers joining a master therapist for live coaching sessions and then leading these sessions. When the master therapist considered peers ready to coach independently, peers began to deliver the curriculum themselves. We found that the training period lasted, on average, five months, which was longer than expected. The skills needed to deliver high-fidelity coaching required considerable cognitive flexibility to switch effectively between the manualized coaching protocol and each consumer’s weekly diet and exercise status update. There was much discussion and practice focused on balancing the educational material with variable progress by the consumers. As well, each peer’s lived experience, which is highly personal, could not be part of the manual but was important to incorporate into the curriculum. Once peers were ready to deliver services, individual supervision was provided weekly. Supervision includes time for both clinical issues and professional development. In addition, a master therapist is available on a daily basis for emergent issues. Clinical supervisors audit two coaching sessions a week to rate fidelity and emphasize benchmarks for session content. Without exception, supervision proved to be a challenge to peers at first; adjusting to considerable feedback on their coaching style and content of their calls was a process. Substantial time was spent understanding each peer’s lived experience. Any facilitated …
