Mixed Methods Evaluation of a Peer Respite Program

Behavioral Health

Assessing peer-led alternatives to psychiatric hospitalization

People with their own experience of mental illness have a unique expertise to help others manage behavioral health conditions in ways that facilitate recovery and reduce hospitalization, involvement in the criminal justice system, and homelessness. Working with the Santa Cruz County behavioral health department, we evaluated the effects of Second Story, a peer-run crisis respite program, on clients’ long-term recovery and well-being.

Impact

Looking at guests who stayed at the peer-run Second Story at any point between May 2011 and December 2014, we found that even a short stay significantly reduced the number of hours of subsequent emergency and inpatient service use.

Our overall findings suggest that peer respites are an effective and person-centered alternative to traditional crisis services.

Services
  • Evaluation
  • Data Collection and Analysis
  • Dissemination

Combining Quantitative Data with Narratives of Lived Experience

Funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), the Second Story peer-run crisis respite program sought an independent evaluation of its effectiveness, and selected HSRI for the work.

Second Story provides short-term 24-hour residential support for mental health service users experiencing self-defined crises. The program is staffed entirely by people with lived experience of mental health issues who are trained in Intentional Peer Support, a trauma-informed service delivery paradigm emphasizing mutuality, reciprocity, and growth.

Working with the Santa Cruz County behavioral health department, we conducted a mixed methods evaluation, drawing on:

  • Semi-structured interviews with peer support specialists and guests at Second Story
  • Survey data from guests collected by people with lived experience trained in research methods, looking at:
    • Quality of life
    • Social connectedness
    • Functioning
    • Recovery
    • Substance use
    • Trauma and violence
    • Housing, education, and employment
    • Quantitative client-level data from Santa Cruz County behavioral health department 

We also compared multi-year service utilization data from clients who had stayed at Second Story to a comparison group we constructed through propensity score matching.  

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Second story provides crisis respite and prevention services in a home-like setting, emphasizing community and connection. It gives Santa Cruz mental health clients “an opportunity to experience what change feels like, and to learn new responses through relationships with each other.”

Involving Peers at All Phases

We developed our evaluation plan with the assistance of a peer researcher, structuring the plan to ensure that people with lived experience were involved as much as possible throughout the evaluation process. We also hired a small team of peer interviewers to act as local evaluation liaisons and ambassadors. These peer partners introduced the study to Second Story guests and staff, coordinated data collection activities, and administered the surveys. Notably, the respite guests reported feeling more comfortable working with peer interviewers than with research staff who did not disclose their personal lived experience.

Not only did the study provide job opportunities and experiences for peer researchers, it also improved the quality of the research through more valid survey data and a higher-than-average response rate, giving us a better understanding of the efficacy of the intervention.

(You can check out an article on this experience, co-authored by HSRI’s Bevin Croft, one of the evaluation team members: “Peer interviewers in mental health services research” in The Journal of Mental Health Training, Education and Practice.)

Developing the Evidence Base

Our findings—that respite guests were 70% less likely to use inpatient or emergency services than those who didn’t use respite services, and that respite days were associated with significantly fewer inpatient and emergency service hours—provided a glimpse into the impact of this innovative program model. We concluded that an expansion of the peer-run respite model in community mental health systems could lead to reductions in overall service costs, increase meaningful choices for recovery, and decrease the mental health system’s reliance on more coercive, less person-centered modes of service delivery.

“I would have gone to the hospital if I hadn’t gone to Second Story. There have been times where it has helped me avert the hospital.”

Second Story Guest

interviewed during a site visit

Supporting Best Practices as Peer Respites Proliferate

As peer-run respites grow in popularity and spread across the US, we’ve shared our findings from Second Story in academic journal articles and other publications, including the “Impact of the Second Story Peer Respite Program on Use of Inpatient and Emergency Services” in the journal Psychiatric Services.

We’ve also worked with our colleague Laysha Ostrow, CEO of Live & Learn, to develop materials and toolkits to assist with program development, implementation, research and evaluation. Laysha has compiled these and many other resources at www.peerrespite.net:

Peer Respites: A Research and Practice Agenda,” an Open Forum piece in the journal Psychiatric Services, outlining implementation and research issues that peer respites face

Peer Respite Toolkit – to help programs document their operations and outcomes and to build evidence for the efficacy of peer respites 

Peer Respite Characteristics – to share information on the characteristics of peer respites

Results from the 2016 Peer Respite Essential Features Survey - to provide public information for planning, funding, and sustainability of current and future peer respites

Client(s):

funded by a Mental Health Transformation Grant from SAMHSA’s Center for Mental Health Services

Project Partner(s):

Laysha Ostrow, Live & Learn, Inc.

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