Peer-support services, including Parent Support and Training, have traditionally subscribed to a strict definition of what it means to qualify as a peer, and therefore as a provider of these services. This article examines views of peer and non-peer stakeholders in Kansas CMHCs on additional characteristics of “peer-ness.” The findings of this analysis result in a call for a broadening of the definition of “peer” in order to creatively meet the needs of families in the current service climate while still providing support for upholding the family-driven paradigm that brought about inclusion of parent voice in the treatment process—a hallmark of the PST service.
Parent Support and Training (PST) is a peer-to-peer service provided in the Kansas Community Mental Health Centers (CMHC) child services system of care for parents of children experiencing serious emotional disturbance (SED). The purpose of PST is to provide support, education, and assistance navigating the mental health system from a peer who has previously experienced similar challenges. Central to the philosophy behind the intervention is the idea that parents should have a voice at the table as an equal part of the treatment team in the provision of mental health services to their children.
In the spirit of this family-driven value, parents of children with a serious emotional disorder (SED) who were either providing or receiving PST services were included as a stakeholder group in a recent study using Concept Mapping methodology to establish stakeholder consensus on the core components of the model of PST service as provided in CMHCs in Kansas (Johnson, Byers, Byrnes, Davis-Groves, & McDonald, 2013). Including this group of stakeholders ensured the inclusion of parent voice not only in the provision of services but also in the development of a service model. This process was successful in establishing stakeholder consensus on the core components of the Kansas PST model. However, some differences arose consistent with differences in the literature regarding what provider qualifications identify one as a “peer.” These differences led to additional research questions in an effort to explore this issue and implications for practice. The following research questions are examined in this article: 1) Are there significant mean differences in importance ratings of PST provider qualifications for different stakeholder groups, specifically parents of children with SED who are receiving or providing PST services versus all other stakeholders? 2) Are there significant differences in importance ratings of PST provider qualifications within the caregiver stakeholder group? This article empirically examines these differences in an effort to elevate parent voices for consideration in ongoing model development and implementation, thus upholding the family-driven principles underlying Parent Support and Training Services.
2. Background
2.1. History of family-driven support services
Family involvement within mental health treatment for children with emotional or behavioral disturbances has advanced substantially in the past 20 years. Historically, children with serious emotional disturbance (SED) were thought to come from dysfunctional families with parents contributing to the problem (Friesen and Koroloff, 1990, Knitzer, 1993 and Osher et al., 2001). The children's mental health systems of care and family movements of the late 1980s dispelled that myth, heralding a paradigm shift in which family members began to be recognized as experts who possess knowledge for solutions to challenges (Osher & Osher, 2002). Both movements asserted that parents have a right to be involved in the design and delivery of services and supports necessary for their youth to live in communities rather than institutions. Both also advocated that parents cope more effectively when adequate, individualized supports are available (Friesen et al., 1988, Friesen and Koroloff, 1990 and Stroul and Friedman, 1988).
Then in 1989, the first national organization was formed to represent family voices in provision of mental health services—The National Federation of Families for Children's Mental Health (NFFCMH) (Spencer, Blau, & Mallery, 2010). This was followed by the establishment of funding by family advocates to develop a national network of state-level, family-run organizations to provide information and support to families and youth with mental health needs (Spencer et al., 2010). Momentum continued to build for honoring family voice in mental health systems of care when in 2002 a family leader – Jane Adams, from the Kansas Chapter of NFFCMH and Board President – participated in the New Freedom Commission on Mental Health. The work of the Freedom Commission produced goals to transform mental health care in America, including a specific goal stating that “mental health care must be consumer and family driven” (Spencer et al., 2010 and New Freedom Commission on Mental Health, 2003). Subsequently, in 2004, The Substance Abuse Mental Health Services Administration (SAMHSA) asked the NFFCMH to define Family Driven care (Spencer et al., 2010). In response to this request, the following definition of the term “Family Driven” was developed:
Family driven means families have a primary decision making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory, and nation. This includes: choosing culturally and linguistically competent supports, services, and providers; setting goals; designing, implementing and evaluating programs; monitoring outcomes; and partnering in funding decisions (Spencer et al., 2010 p. 177).
