Peer support - A systematic review of the effectiveness and cost-effectiveness of peer-based in

Peer support is the support provided and received by those who share similar attributes or types of experience. Peer support can be an informal process between individuals and/or can be provided through formalised interventions in which peer supporters seek to promote health and/or build people’s resilience to different stressors.94_{There is a range of different peer support interventions reported in the prison}

literature. As an overview, peer support in a prison setting involves peer support workers providing practical help and/or social support to other prisoners in a paid or voluntary capacity.25_{Peer support roles}

can include befriending, carrying out domestic duties for other prisoners (e.g. fetching meals), liaison with prison staff, translation, providing basic information and signposting to other services.25,149_{Some peer}

support interventions, such as the Peer Support Team (PST) programme in Canada, involve peers providing emotional support to alleviate stress.153_{In the UK, the Listener scheme is a specific peer support}

intervention focused on the prevention of suicide and self-harm (seeListener scheme). Some peer support interventions involve group work, such as self-help groups on substance misuse.32

Six studies151–156_{contained quantitative evidence on the effects of peer interventions on prisoners. These all}

reported on the Canadian PST programme and used similar evaluation designs and outcome measures. The PST programme is a Canadian model that has been developed and delivered across a number of Canadian prisons. It is specifically targeted at women prisoners and is based on a holistic, women-centred approach to health care that aims to be culturally sensitive and to develop women’s autonomy and self-esteem.138,141_{The evaluation designs comprised a before-and-after study using questionnaires for}

prisoners (peer deliverers and recipients) and a qualitative study using interviews and focus groups with peer deliverers, recipients, non-recipients and staff.

Self-esteem/confidence

Three studies151,153,155_{used the Rosenberg Self-Esteem Scale to measure prisoners}_’_{self-esteem. No}

statistically significant effect of the peer intervention was seen when the findings from the three studies were pooled (weighted MD 1.51, 95% CI–0.84 to 3.86; three studies,n=83), although the sample size was small and there was substantial heterogeneity (I2₌_{81%), meaning that the result should be treated}

with caution (Figure 12).

Strong qualitative evidence was also apparent in relation to improvements in the peer deliverers’self-esteem, self-worth and confidence as a result of the role.38,151–154,156_{The sense of being trusted by the prison}

authorities to counsel and support prisoners in distress was reported to enable peer deliverers to regain their self-respect.25,152_{The notion that peers became more empowered consequentially was alluded to.}151–153,155,156

Perceptions of the prison environment

The Correctional Environment Status Inventory assesses prisoners’perceptions of the prison environment. Responses were measured before and after the PST intervention in three studies.151,153,155_Domains

assessed were staff involvement, staff treatment, staff cohesion, orientation and offender relationships. No statistically significant effect of the PST was seen in the pooled results of the three studies across any of the 16 questions asked.

Study or subgroup Rosenberg Self-Esteem Scale Blanchette 1998

151

Delveaux and Blanchette 2000

153

Subtotal (95% CI) Heterogeneity:

χ 2 = 10.62, df = 2 ( p = 0.005); I 2 = 81%

Test for overall effect:

z = 1.26 ( p = 0.21)

Test for subgroup differences: not applicable

Mean 19.7 2.03 SD 5.5 6.0 Total 15 14 52 Mean 14.0 2.01 SD 2.5 6.0 Total 5 11 31 Weight 44.1% 24.7% 100.0% IV, fixed 95% CI 5.70 (2.16 to 9.24) 0.02 (– 4.72 to 4.76)

Syed and Blanchette 2000

155 15.57 6.02 23 18.8 6.75 15 31.2% – 3.23 (– 7.44 to 0.98) 1.51 (– 0.84 to 3.86) Before After MD IV, fixed 95% CI MD – 10 – 5 0 5 10

Favours peer support

Favours control FIGURE 12 Peer Support Team intervention: self-esteem.

they had never used a peer counsellor in a crisis situation. In this study the average rating for helpfulness of peer counsellors was 4 on a scale of 1–5.

The other study154_{reported that inmates in the intake unit were very satisfied with the quality of the}

information delivered by PST members during their weekly visits (mean=4.05 on a 5-point scale) and rated PST members highly in terms of their listening skills (mean=4.58), problem-solving skills

(mean=3.94), approachability (mean=4.56) and communication skills (mean=4.22). Expectations of the PST were also well met (mean=4.28) and those who had previously requested peer support reported that the sessions were very useful (mean=4.43) in helping them deal with their issues.

Staff reported that PST members were effective in handling crisis interventions (mean=4.00), providing services to inmates (mean=3.62) and serving as role models (mean=3.73). It was also felt that the PST programme training was efficient in preparing PST members for PST duties (mean=3.77) and in reinforcing the positive effects of other programmes for PST members (mean=3.62) and for other inmates (mean=3.62). Staff were moderately satisfied with the sharing of PST procedures (mean=3.62) and PST activities and schedules (mean=3.58) with key institutional personnel.

Hours of support delivered per week

In one study154_{PST members estimated that they provided 3}_–_{5 hours of support to others per week}

on average.

Time to response

In one study154_{staff responded to inmate calls for peer support within 11}_–_{30 minutes and PST members}

were reported to respond within the same timescale.

Level of trust

In one study154_{a fairly high level of trust in PST members was reported (mean}₌_{3.79 on a 5-point scale)}

and staff generally felt confident in referring an inmate to a PST member. However, 75% of staff surveyed indicated that their trust level varied depending on individual PST members.

Knowledge

For prisoners trained to be peer support workers/counsellors, there were qualitative data from two studies151,153_{that showed reported increases in knowledge. Indeed, in one of these studies}151_{a number of}

respondents noted that knowledge acquired from the training was applicable to improving relationships with their children, partners and others in the community.

Effects on recipients

As well as the impacts on the trained peer support workers/counsellors, there were indications of positive effects for the recipients of the intervention. Peer support was reported to have helped prisoners

practically, emotionally or both151_{and in one study}140_{it was demonstrated that this type of intervention}

could be particularly beneficial for prisoners during the early part of their sentence. Those who had used peer support reported using it as an avenue to vent and to overcome feelings of anxiety, loneliness, depression and self-injury151,152,156_{and there were indications that this may be potentially beneficial in}

preventing suicides in prison.38

One study indicated attitudinal and behaviour changes in the recipients of a peer counselling intervention. Player and Martin’s145_{research showed that a drug treatment intervention (that included the support of}

trained prison counsellors) had caused changes in prisoners’reported attitudes to drugs and alcohol. This translated to a self-reported reduction in drug and alcohol use. The one-to-one sessions with trained peer counsellors were regarded as the most‘helpful aspect’of the recovery process (p. 3).

Additional themes from qualitative research

In several studies25,151–153,156_{there were indications of peer deliverers gaining a better self-awareness and}

perspective on their life as well as developing the skills to deal with their own health and offending issues. There was limited information on the impact that the role would have on future reoffending. Only in one study25_{was it suggested that the experiences of being a peer support worker would be beneficial in}

reducing the likelihood of reoffending.

The demands placed on peer support workers/counsellors by other prisoners gave individuals a sense of purpose in prison25,38,149_{and this was beneficial for combating boredom while serving the prison}

sentence.25,38_{However, there were indications that the role could be challenging and onerous and the}

burden of care of supporting many prisoners could be problematic.38

In document A systematic review of the effectiveness and cost-effectiveness of peer-based interventions to maintain and improve offender health in prison settings (Page 75-78)