Peers on Assertive Community Treatment Teams: Convergent and Divergent Perceptions of Role, Interprofessional Collaboration and Community Integration

Background and purpose

Assertive Community Treatment (ACT) is an evidence based practice model that provides life-long treatment, rehabilitation and support to persons with severe mental illness (SMI) who experience difficulties in independent living.  Ongoing research indicates that ACT reduces rates of hospitalization and increase independent community living.  However, ACT in New York State (NYS) is no longer considered a service for life, but rather as one serviceon the road to community integration and recovery. Therefore there is a critical need to enhance the work of ACT to identify community extenders that can enhance the focus on transition towards community integration.

A growing body of literature suggests that support from peers with common life experiences can serve as community extenders and as such enhance both recovery and community integration. Peers are hired to work on ACT teams in increasing numbers, yet little is known of how best to 1) define the role, 2) integrate peers with rest of the staff and 3) how this impacts the work towards community integration. This study seeks to illuminate convergent and divergent perceptions of the peer role and contributions towards community integration.

Method

Semi-structured in-depth interviews with a convenience sample of eighteen peers and ten team leaders on ACT teams across NYS were conducted. Verbatim notes were recorded during each interview. Following this initial process, the constant comparative method was utilized to elucidate similarities and differences in categories and major themes among peers and team leaders.

Results

Data from interviews showed clear convergent and divergent perceptions of the role of peers on ACT Teams. Overall six prominent convergent perceptions emerged with each three facilitating and hindering themes.  Facilitating themes showed a unified perception of the unique contributions of peers to facilitate community integration: 1) engagement, 2) modeling hope for recovery and 3) bridging and transitioning to community resources.  Additionally, both groups agreed that factors hindering integrating peers with the team were 1) lack of definition of peers’ tasks, 2) inequity in pay and hours hired, and 3) stigma and lack of respect from coworkers.  

Peers and team leaders showed a clear divergent in perceptions of peer work in four key areas: 1) confusion around peer work versus clinical work, 2) trust towards peers (peers’ access to medical records, establishing clear boundaries with ACT participants, 3) the peers’ stage of recovery while working on the ACT team, and 4) how to provide/participate in supervision.    

Conclusions/ Implication

Team leaders and peers alike agree that peers are uniquely poised to serve as community extenders who can contribute to the interprofessional team and thereby facilitate community integration. They also converge on identifying structural factors that prevent peers from working effectively.  Yet, they diverge on a number of critical areas that may be related to non-peer workers’ underlying attitudes towards recovery–based practice.  Implications for further research suggest a need to establish a clear scope of practice for peers on ACT. Furthermore, education of all non-peer providers is needed to enhance the capacity for greater collaboration on interprofessional teams.