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Published Online: 2 January 2015

Mental Health and Quality of Life Among Veterans Employed as Peer and Vocational Rehabilitation Specialists

Abstract

Objective:

The study compared employment experiences, mental health recovery, and quality of life among peer specialists and vocational rehabilitation (VR) specialists hired by the U.S. Department of Veterans Affairs (VA), the VR specialists under the Homeless Veterans Supported Employment Program. Employment characteristics associated with mental health recovery were examined.

Methods:

The study was a national, observational survey of 152 peer specialists and 222 VR specialists across 138 VA health care systems in 49 states. The survey, administered over the Internet, included measures describing participant characteristics, employment factors, mental health, and quality of life. The two cohorts were compared by using t tests or chi square tests. Multiple regression analysis controlling for participant characteristics was used to identify employment factors associated with mental health and quality of life.

Results:

Peer specialists were more likely than VR specialists to share recovery stories, serve as a role model or mentor, and advocate for veterans. Activities by VR specialists tended to focus more narrowly on job skills. Overall, after adjusting for multiple comparisons, the analysis found high levels of mental health and average quality of life for both cohorts, with no significant differences between the groups. Satisfaction with amount of supervision was consistently associated with aspects of mental health recovery, including work-related and helping-related quality of life, for both cohorts.

Conclusions:

The results highlight the value of work and the importance of supervision in realizing both the adoption of recovery-oriented services and the promotion of mental health in a community of veterans serving each other.
The President’s New Freedom Commission on Mental Health (1) and the mental health strategic plan of the U.S. Department of Veterans Affairs (VA) recommend transforming the mental health system to pursue the goal of recovery. The incorporation of peer support is integral to this transformation. In the VA, veterans who currently receive or have received treatment for a mental illness have been serving as peer specialists for a number of years, providing limited services to other veterans with mental illness, often as volunteers. In 2005, the VA began hiring peer specialists as employees, and in 2008, it mandated that “all medical centers . . . must provide individual or group counseling from peer specialists for veterans treated for SMI [serious mental illness]” (2). The job description of the peer specialist includes assisting veterans with social skills, combating stigma, serving as a role model, informing veterans about community supports, assisting veterans in choosing jobs that match their strengths, overcoming job-related anxiety, and particularly important, sharing their recovery stories in order to model effective coping skills.
Three years after issuing the peer specialist mandate, the VA hired 400 vocational rehabilitation (VR) specialists through the Homeless Veterans Supported Employment Program (HVSEP). VR specialists are veterans with a history or risk of homelessness who provide employment services to homeless veterans. The VR specialists were hired under a U.S. Office of Personnel Management regulation for hiring persons with a severe physical, cognitive, or emotional disability or history of such a disability. The job description of a VR specialist includes assessing occupational areas to target job search activities, providing job skills training, assisting with search strategies and placement, helping veterans develop community supports, and persuading the individual to accept help. Although lived experience with homelessness is a hiring requirement, sharing one’s own recovery stories while working with veterans is not explicitly part of the job description. That is an important difference between peer specialists and VR specialists.
Although their job descriptions differ, VR specialists and peer specialists have similar histories of mental illness, disability, substance use disorders, and homelessness, and together they constitute a group of veterans employed by the VA in direct service roles to help other veterans in their recovery. They are peers in two respects: first, as veterans, and second, as individuals with mental health histories. However, little is currently known about their roles, their job satisfaction, or their own mental health recovery and quality of life.
The “helper” therapy principle suggests that helping someone else is associated with a therapeutic benefit to oneself (35). Personal accounts highlighting peer providers’ improved mental health and functioning—including fewer psychiatric hospitalizations and increased confidence, well-being, and job skills—support this principle (614). Being paid is also important, bringing better living conditions, better quality of life, and a sense that one’s work has purpose (1519). A survey of peer providers in Pennsylvania concluded that working as a peer provider reduced dependence on Social Security benefits and decreased need for case management, crisis services, and inpatient hospitalization (20). Moran and others (5) noted that peer providers receive 17 different types of benefits across five broad domains.
However, the specific job functions of peer providers and the extent to which they are associated with the therapeutic benefit of working as a peer remain poorly characterized, both within and outside the VA. Peer specialists, for example, are deployed in a variety of mental health programs, and their responsibilities vary. Chinman and colleagues (21) described early experiences of employing VA peer specialists to lead support groups, empower veterans to pursue goals, serve as role models, complete intakes, assist with housing, and provide advocacy. According to a survey of 291 peer providers in 28 states who were not affiliated with the VA, providing support, encouraging self-determination and personal responsibility, addressing hopelessness, communicating with providers, managing illness, addressing stigma, and developing friendships are the most prevalent activities of peer specialists (22). Jacobson and colleagues (23) reported that peer specialists provide direct service activities (experiential sharing, relationship building, and socialization and self-esteem building) and indirect activities (administration, team communication, and information gathering). These studies suggest that there continues to be variability in the mental health services provided by peers.
As the largest single health care provider in the United States, the VA offers a valuable opportunity to characterize peer support services and their effects on recovery among peer support providers. The goals of this study were to document the range of job activities performed by peer specialists and HVSEP VR specialists in the VA, compare mental health and quality of life among peer specialists and VR specialists, and explore employment characteristics associated with mental health recovery. We examined four aspects of mental health recovery: overall mental health, general self-efficacy, work-related quality of life, and helping-related quality of life. We chose these four recovery domains because they are most likely to be affected by employment according to the helper therapy principle, previous literature, and expected associations between peer support work and these domains (3,5,8,18).
This study examined important domains of mental health and quality of life that were not examined in previous studies of peer support specialists. The comparison of mental health and quality of life among peer specialists and VR specialists is of interest because the individuals who serve in these capacities have similar characteristics, yet the two jobs treat mental health histories differently. Thus the comparison can begin to answer whether the jobs are associated with differences in work satisfaction, quality of life, and mental health.

Methods

This study was a national, observational survey of VA-employed peer specialists and VR specialists and was approved by the Institutional Review Board of the Edith Nourse Rogers Veterans Hospital in Bedford, Massachusetts. Data were collected between December 2011 and June 2013.

Sample

The eligible sample included all peer specialists (N=279) and HVSEP VR specialists (N=378) employed by the VA nationwide when the study began in December 2011. Of these, 159 peer specialists (57%) and 230 VR specialists (61%) responded. Seven peer specialists and eight VR specialists were excluded from the analysis because they completed less than 50% of the survey or because they were no longer working in these roles. The final sample (N=374) consisted of 152 peer specialists and 222 VR specialists across 138 VA health care systems in 49 states.

Survey

The survey contained questions about demographic and employment information, including job tenure, hours worked per week, supervision received, and absences for general medical or mental health reasons. A checklist of job responsibilities was developed with input from VA leadership. Validated self-report instruments were used to assess employment experiences and aspects of mental health recovery. Study instruments were selected after thorough review of available measures on the basis of their relevance to the study objectives. The survey was pilot-tested on a sample of veterans employed at our research center who were not involved in the study. The survey took approximately 30 minutes to complete.

Work Limitations Questionnaire (WLQ).

The WLQ includes 25 items measuring how much health problems interfere with job performance (24). Reliability (Cronbach’s alpha) was ≥.90, with strong validity (25).

Job Satisfaction Index (JSI).

The 12-item JSI assesses satisfaction with type and amount of work, pay, coworkers, supervision, senior management, promotion opportunities, working conditions, customer satisfaction, praise, quality of work, and overall satisfaction (26).

Maslach Burnout Inventory (MBI).

The MBI assesses burnout among persons employed in human services occupations, including emotional exhaustion, depersonalization, and reduced personal accomplishment, with good reliability and convergent validity (27,28).

General Self-Efficacy Scale (GSS).

GSS items reflect problem-solving and positive coping skills. Internal consistency reliability coefficients range from .76 to .90. Criterion-related validity studies have demonstrated positive correlations with optimism, favorable emotions, and work satisfaction (29).

Basis-24.

The 24-item Behavior and Symptom Identification Scale (Basis-24) is a widely used, multidimensional mental health assessment instrument that was validated in a national sample of 5,800 recipients of mental health and substance abuse services and also used in several VA studies (30,31). Subscale reliability ranged from .77 to .91, with good concurrent and discriminant validity (30).

Stigmatization Scale.

The Stigmatization Scale measures personal experience of stigma (32). Scale reliability (Cronbach’s alpha) was .94, with good convergent and divergent validity (32).

Quality of Life Inventory (QOLI).

The QOLI assesses importance of and satisfaction in 16 areas of life: health, self-esteem, goals and values, money, work, play, learning, creativity, helping, love, friends, children, relatives, home, neighborhood, and community (33). It has been validated in clinical and nonclinical populations, including veterans (34). Test-retest reliability was .73; internal consistency reliability was .79 (33). Good predictive, convergent, and discriminant validity have also been demonstrated (33).

Housing stability and satisfaction.

The eight-item Housing Satisfaction Scale assesses housing satisfaction, with good reliability (α=.91) and validity (35).

Procedures

Facility directors and supervisors of eligible employees were first informed about the study; concerns were addressed by study investigators. Eligible employees were then invited to participate by an e-mail letter with a unique study ID and link to the survey Web site. The letter provided details about the voluntary and confidential nature of the study. An information sheet provided all the information about the study. Participants were instructed to complete the survey outside work hours. Nonrespondents were sent up to six reminders by e-mail or telephone. Participants received a $20 gift card.

Data Analysis

Frequency distributions were used to describe employment experiences, mental health, and quality of life of the two cohorts. Chi squares and t tests were used to assess differences in these variables between the cohorts. To account for multiple bivariate comparisons, we used a p value of .001 for reporting statistically significant differences.
To identify employment characteristics associated with mental health recovery, we first computed bivariate correlations between employment and sample characteristics with the four recovery outcomes: overall mental health, general self-efficacy, work-related quality of life, and helping-related quality of life. Employment characteristics examined included hours worked per week, hours of direct service to veterans, supervision hours, and satisfaction with amount of supervision. Time in job was not included because it was confounded with cohort; that is, most peer specialists had been employed for more than a year, whereas most VR specialists had been employed for six to 12 months, resulting in little variation within each cohort. We fit multiple regression models to identify employment characteristics associated with mental health recovery measures, controlling for sample characteristics that were significantly correlated with the recovery measures in the bivariate analysis. Separate regression models were fitted for each cohort.

Results

Sample Characteristics

A majority of peer specialists and VR specialists were men. Of the sample, African Americans constituted 41% (N=153); Latinos, 7% (N=23); and members of other racial-ethnic minority groups, 3% (N=9). Although a majority (N=308) received VA health care, more than one-third of the sample (N=133) also had private health insurance through their VA employment (Table 1).
Table 1 Characteristics of veterans employed as peer specialists or vocational rehabilitation (VR) specialists
 Peer specialists (N=152)VR specialists (N=222)   
CharacteristicN%N%χ2dfp
Age (M±SD)52.0±8.52 49.7±9.49 2.42a ≤.02
Gender    2.161ns
 Male1218016273   
 Female31206027   
Race    1.052ns
 White865712154   
 African American61409241   
 Other4352   
Latino ethnicity86157.321ns
Marital status    6.262≤.04
 Never married21144118   
 Married or with partner64426630   
 Separated, divorced, or widowed674411552   
Education    .402ns
 High school graduate, GED, or less22143114   
 Some college805311652   
 Bachelor’s degree or more50337533   
Homeless in past 12 months641992.911ns
Health insurance    10.44≤.04
 VA523410146   
 Federal employee58387534   
 Other private151073   
 Other public (Medicare or Medicaid)19132612   
 None75125   
Disability benefits    .3311ns
 Yes765010547   
 No755011753   
Services received in past 6 months       
 Any VA medical care109721999019.91≤.001
 Any non-VA medical care533453245.371≤.02
 Any VA mental health care634179361.321ns
 Any non-VA mental health care117125.521ns
 Any VA alcohol or drug use disorder treatment5342.851ns
 Any non-VA alcohol or drug use disorder treatment1111.071ns
a
t test, df=366

Work Experience

A majority of both cohorts worked full-time (≥31 hours per week), with more than half their time devoted to direct service to veterans. Seventy-four percent (N=110) of the peer specialists were certified peer specialists, compared with 14% (N=32) of VR specialists. Peer specialists (N=116, 76%) were more likely than VR specialists (N=35, 16%) to have tenure of longer than a year. Peer specialists reported fewer hours of supervision compared with VR specialists, with 19 (13%) reporting none. Most respondents reported missing no more than one week of work in the previous six months for general medical, mental health, or other reasons, with no difference between cohorts. [A detailed summary of work characteristics of both cohorts is provided in a table in the online data supplement to this article.]

Job Activities

Attending staff meetings, writing progress notes, and using the computerized record system were reported by more than 80% of both cohorts (Table 2). However, peer specialists were more likely than VR specialists to share recovery stories, serve as a role model or mentor, teach social skills, advocate for veterans, and perform other activities related to their role as a peer. Although many VR specialists also endorsed these activities, more VR specialists than peer specialists reported activities focused on helping veterans find and keep jobs.
Table 2 Job activities reported by veterans employed as peer specialists or vocational rehabilitation (VR) specialists
 Peer specialists (N=152)VR specialists (N=222)  
ActivityN%N%χ2ap
Attend staff meetings1368920191<1.00ns
Use computerized record system1328719387<1.00ns
Provide 1:1 mentoring133871315935.27≤.001
Share recovery experiences130851115049.69≤.001
Write notes, memos, etc.1288419186<1.00ns
Challenge negative self-talk128841225534.84≤.001
Teach social skills124821315921.19≤.001
Serve as role model125826429102.95≤.001
Help veterans set goals1238117579<1.00ns
Advocate for veterans12180984446.75≤.001
Participate in conference calls118782069317.91≤.001
Lead groups117772612162.70≤.001
Teach problem solving11374914140.47≤.001
Help community integration10972964329.52≤.001
Transport veterans8858160728.12≤.002
Conduct outreach activities865713762<1.00ns
Help regarding disability benefits734894421.18ns
Help veterans find work593921798162.05≤.001
Help with job skills59391958899.50≤.001
Facilitate peer training543513654.01≤.001
Perform clerical work (copying and filing)473194425.01≤.025
Serve on committees442917829.96≤.001
Present at conferences422843193.51≤.06
Perform other patient care activities27183717<1.00ns
Supervise peer providers1171113.38≤.001
a
df=1

Job Satisfaction, Work Limitations, and Burnout

Both peer specialists and VR specialists reported high overall job satisfaction, with no difference between cohorts. VR specialists reported significantly greater satisfaction with pay and promotion opportunities compared with peer specialists (Table 3). Cohen’s effect sizes (ES) for differences in satisfaction with pay (ES=.63) and promotion opportunities (ES=.74) were considered medium to large (36). There were no differences between the cohorts in work limitations or job burnout [see table in the online data supplement].
Table 3 Mean scores on the 12-item Job Satisfaction Index among veterans employed as peer specialists or vocational rehabilitation (VR) specialistsa
 Peer specialists (N=152)VR specialists (N=222)  
ItemMeanSDMeanSDt testbp
Type of work4.421.004.39.94<1.00ns
Amount of work4.201.074.211.03<1.00ns
Pay2.981.373.641.26–4.65≤.001
Relationships with coworkers4.231.124.29.97<1.00ns
Quality of direct supervision4.071.334.35.96–2.19≤.03
Quality of senior managers3.581.363.971.14–2.88≤.004
Opportunities for promotion2.441.443.421.26–6.73≤.001
Working conditions3.891.314.041.05–1.12ns
Perceived customer satisfaction4.22.984.16.83<1.00ns
Amount of praise you receive3.931.254.101.05<1.00ns
Quality of your work4.55.754.41.761.70ns
Overall satisfaction4.26.944.37.88–1.17ns
a
Possible scores range from 1, not at all satisfied, to 5, very satisfied.
b
df=369

Mental Health and Quality of Life

Low levels of mental health problems (BASIS-24 scores) were reported across cohorts (Table 4). Quality-of-life scores were categorized into four levels (very low, low, average, and high), each with corresponding score ranges. Both cohorts scored high on helping-related quality of life. VR specialists also scored high on work-related quality of life based on normative data (33). In most other areas, scores were average. However, scores were in the low range for health and play and in the very low range for money. After adjustment for multiple comparisons with a significance level of p<.001, there were no significant differences between the cohorts in mental health or quality of life.
Table 4 Mean scores on measures of mental health and quality of life among veterans employed as peer specialists or vocational rehabilitation (VR) specialists
 Peer specialists (N=152)VR specialists (N=222)  
MeasureMeanSDMeanSDt testap
Self-efficacyb34.243.8533.863.73<.001ns
Stigmac25.245.6223.815.572.48.01
Housing satisfactiond4.00.823.97.81<1.00ns
Mental health domaine      
 Overall.93.62.80.592.06.04
 Depression/functioning1.02.78.90.761.54ns
 Interpersonal relationships.95.76.93.71<1.00ns
 Emotional lability1.04.85.83.742.50.01
 Psychotic symptoms.49.62.37.641.87ns
 Alcohol or drug use.35.59.23.492.16.03
Quality of life domainf      
 Health1.493.541.433.44<1.00ns
 Self-esteem3.072.993.183.02<1.00ns
 Goals and values3.332.543.272.61<1.00ns
 Money.312.55.722.461.56ns
 Work3.222.783.872.452.45.01
 Play1.512.961.572.86<1.00ns
 Learning2.612.782.682.64<1.00ns
 Creativity2.082.372.422.491.32ns
 Helping3.952.003.732.41<1.00ns
 Love2.193.621.583.891.53ns
 Friends2.333.042.352.88<1.00ns
 Children2.223.212.393.40<1.00ns
 Relatives1.892.642.292.811.40ns
 Home2.493.292.393.30<1.00ns
 Neighborhood2.242.661.812.751.53ns
 Community1.982.351.772.73<1.00ns
a
df=372
b
Measured by the General Self-Efficacy Scale. Possible scores range from 10 to 40, with higher scores indicating greater self-efficacy.
c
Measured by the Stigmatization Scale. Possible scores range from 9 to 45, with higher scores indicating greater stigma.
d
Measured by the Housing Satisfaction Scale. Possible scores range from 1 to 5, with higher values indicating greater satisfaction.
e
Measured by the Behavior and Symptom Identification Scale. Possible scores range from 0 to 4, with lower scores indicating better mental health.
f
Measured by the Quality of Life (QOL) Inventory. Possible scores are grouped by QOL level (very low, –6.0 to .8; low, .9 to 1.5; average, 1.6 to 3.5; and high, 3.6 to 6.0).

Employment Characteristics and Mental Health Recovery

Three employment characteristics—satisfaction with amount of supervision, hours of direct service provided, and hours of supervision received—showed significant correlations with aspects of mental health recovery at the bivariate level and were included in the regression analysis. The regression analysis controlled for demographic characteristics, mental health services received in the past six months, and disability status. Satisfaction with amount of supervision was positively associated with both work-related and helping-related quality of life for both cohorts (Table 5). Satisfaction with amount of supervision was also significantly associated with self-efficacy among VR specialists but not among peer specialists. Hours of direct service provided were positively associated with work-related quality of life, but the association was significant only for VR specialists. Hours of supervision received were not significantly associated with any of the recovery outcomes in the multivariate analyses.
Table 5 Association of employment characteristics and indicators of mental health recovery among veterans employed as peer specialists or vocational rehabilitation (VR) specialistsa
 Overall mental healthSelf-efficacyWork-related QOLbHelping-related QOLb
 Peer specialistsVR specialistsPeer specialistsVR specialistsPeer specialistsVR specialistsPeer specialistsVR specialists
Employment characteristicβcSEβcSEβcSEβcSEβcSEβcSEβcSEβcSE
Hours of direct service–.002.051.02.04–.17.35.02.28.45.25.39*.16–.01.19.01.18
Hours of supervision received.02.05–.02.05–.17.36.11.31–.19.27–.05.18–.23.19–.12.20
Satisfaction with amount of supervision–.09.04–.05.04.52.30.88**.29.56*.22.99***.17.33*.16.91***.19
Intercept1.68***.421.61***.3639.8***2.8730.6***2.48–.792.1–3.63*1.433.34*1.54–.971.60
a
Employment characteristics were measured as ordinal variables and treated as continuous in the analysis. The regression model included age, gender, race, education, use of mental health services in past 6 months, and disability status as controlling variables.
b
Quality of life
c
Regression coefficient
*
p<.05, **p<.01, ***p<.001

Discussion

The main goal of this study was to examine employment experiences, mental health, and quality of life among veterans employed as peer or VR specialists with similar lived experiences of mental illness, substance abuse, and homelessness. Consistent with the helper therapy principle and the understanding that recovery is possible, the results suggest that both cohorts had high levels of job satisfaction, mental health, and quality of life, with very few differences between the cohorts. BASIS-24 scores indicated that the participants had better mental health than several other VA samples, including veterans who participated in a compensated work therapy program and a national sample of veterans who had recently returned from deployment (37,38), but their mental health was not as good compared with a national community sample (39).
Participants’ quality-of-life scores were substantially higher than scores of veterans and nonveterans in clinical samples (40,41). The high scores for helping- and work-related quality of life were consistent both with the idea that the work was valued (20,42) and with the fact that 50% to 60% reported not receiving mental health or substance abuse services in the past six months, suggesting that many participants had experienced a remission of their mental health condition.
Differences in how participants described their roles were consistent with the importance of sharing recovery stories as part of the peer specialist job description (21,23). VR specialists were also less likely to report one-to-one mentoring, teaching problem-solving and social skills, and helping with community integration, even though these are important competencies for employment. It is possible that VR specialists performed these tasks, but because of differences in training, they did not use the same language as peer specialists to describe these skills. For example, the peer-related job activities mentioned in the survey are explicitly taught in the peer specialist certification training, which was completed by peer specialists at five times the rate among VR specialists. Differences in the specific language used to describe job activities, therefore, could explain why VR specialists did not endorse all of their job activities.
The differences in the job descriptions of the two cohorts, especially regarding disclosure and sharing of recovery stories, raise the question of whether disclosure is more appropriate or beneficial in some positions than in others. Traditionally, mental health providers do not routinely disclose personal information, and they are prohibited from doing so in some treatment traditions. It may be important to revisit whether more reciprocal relationships are beneficial to both recipients and providers of care and, if so, when and how the provider should disclose personal information.
Although there were no significant differences between the cohorts in overall or in most specific aspects of job satisfaction, there were significant differences in satisfaction with pay and opportunities for advancement, with VR specialists rating these areas higher compared with peer specialists. The VR specialists were hired at higher pay grades with an established promotion track, whereas the peer specialists were hired at lower pay grades with little or no promotion potential. To address this disparity, in 2012, the VA began to upgrade peer specialist positions, which may diminish differences in satisfaction with pay and promotion.
A recent qualitative study identified occupational characteristics associated with recovery among peer specialists, including developing skills and competencies, feeling respected as a professional, career development, finding meaning, and developing a sense of identity as a peer provider (5,43). Optimal supervision may help individuals develop these skills. In our sample, the relationship between satisfaction with amount of supervision and recovery was more consistent among VR specialists than among peer specialists. One explanation for the stronger association among VR specialists is that they required more supervision to address training needs because significantly fewer VR specialists than peer specialists were certified peer specialists. Another factor could be that VR specialists required supervision to develop sufficient competence in specific vocational skills, for example, job development, contributing to improved self-efficacy and work- and helping-related quality of life. However, because this study is cross-sectional, causality cannot be inferred from the significant associations we found. In other words, individuals with higher self-efficacy and better mental health may be more satisfied with the supervision they receive.
Concerns about quality, consistency, and quantity of supervision by peer specialists and their supervisors are documented in the literature (21,44). The VA has taken steps to address these concerns, including development of a peer support training manual for veterans and their supervisors and a contract with the Depression and Bipolar Support Alliance to provide certified peer specialist training and national conferences for training of peer specialists.
Although this was a national survey of peer specialists and VR specialists from 92% of VA hospitals in 49 states, it had limitations. The survey response rate was only 59%, and we did not have information about nonrespondents. Thus results may not be generalizable to all VA peer specialists and VR specialists. Similarly, results may not be generalizable to peer specialists employed in non-VA health care systems. Although the percentage of women (24%) in our sample was greater than the percentage of women veterans (10%), it was far smaller than the percentage of women in other recent studies of peer specialists (55%−64%) (20,42,43). Exploration of gender differences would further enhance our understanding of how these roles can best help both recipients and providers of care.

Conclusions

Health care systems have moved to adopt the recovery model by hiring individuals with lived experience of mental illness. Peer providers deliver unique services, and working as a peer provider enhances one’s own recovery. As the largest single health care system in the United States, the VA is in a position to address challenges of employing peer specialists (45), including fostering a recovery environment in which the roles of peers are understood and valued. Our findings highlight the generally successful recovery of veteran peer specialists and the important role that supervision may play in a community of veterans serving each other. Further research would help clarify the role of supervision and its association with recovery both within and outside the VA.

Supplementary Material

File (appi.ps.201400105.ds001.pdf)

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: Breakfast in the Garden, by Frederick Carl Frieseke, circa 1911. Oil on canvas, 26 x 325/16 inches. Daniel J. Terra Collection, 1987.21. Terra Foundation for American Art, Chicago/Art Resource, New York City.

Psychiatric Services
Pages: 381 - 388
PubMed: 25555066

History

Received: 14 March 2014
Revision received: 1 August 2014
Accepted: 11 September 2014
Published online: 2 January 2015
Published in print: April 01, 2015

Authors

Details

Susan V. Eisen, Ph.D.
Dr. Eisen, Dr. Schultz, and Dr. Clark are with the Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, and Dr. Eisen and Dr. Clark are also with the Department of Health Policy and Management, Boston University School of Public Health, Boston (e-mail: [email protected]). Dr. Mueller is with the Mental Illness Research, Education and Clinical Center (MIRECC), Edith Nourse Rogers Memorial Veterans Hospital. Dr. Chang is with the U.S. Department of Veterans Affairs (VA) Boston Healthcare System, Boston, and the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Dr. Resnick is with the MIRECC, VA New England Healthcare System, West Haven, Connecticut, and the Yale University School of Medicine, New Haven, Connecticut. Some of the results reported in this article were presented at the Academy Health Annual Meeting, Baltimore, June 23–25, 2013.
Lisa N. Mueller, Ph.D.
Dr. Eisen, Dr. Schultz, and Dr. Clark are with the Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, and Dr. Eisen and Dr. Clark are also with the Department of Health Policy and Management, Boston University School of Public Health, Boston (e-mail: [email protected]). Dr. Mueller is with the Mental Illness Research, Education and Clinical Center (MIRECC), Edith Nourse Rogers Memorial Veterans Hospital. Dr. Chang is with the U.S. Department of Veterans Affairs (VA) Boston Healthcare System, Boston, and the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Dr. Resnick is with the MIRECC, VA New England Healthcare System, West Haven, Connecticut, and the Yale University School of Medicine, New Haven, Connecticut. Some of the results reported in this article were presented at the Academy Health Annual Meeting, Baltimore, June 23–25, 2013.
Bei Hung Chang, Ph.D.
Dr. Eisen, Dr. Schultz, and Dr. Clark are with the Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, and Dr. Eisen and Dr. Clark are also with the Department of Health Policy and Management, Boston University School of Public Health, Boston (e-mail: [email protected]). Dr. Mueller is with the Mental Illness Research, Education and Clinical Center (MIRECC), Edith Nourse Rogers Memorial Veterans Hospital. Dr. Chang is with the U.S. Department of Veterans Affairs (VA) Boston Healthcare System, Boston, and the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Dr. Resnick is with the MIRECC, VA New England Healthcare System, West Haven, Connecticut, and the Yale University School of Medicine, New Haven, Connecticut. Some of the results reported in this article were presented at the Academy Health Annual Meeting, Baltimore, June 23–25, 2013.
Sandra G. Resnick, Ph.D.
Dr. Eisen, Dr. Schultz, and Dr. Clark are with the Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, and Dr. Eisen and Dr. Clark are also with the Department of Health Policy and Management, Boston University School of Public Health, Boston (e-mail: [email protected]). Dr. Mueller is with the Mental Illness Research, Education and Clinical Center (MIRECC), Edith Nourse Rogers Memorial Veterans Hospital. Dr. Chang is with the U.S. Department of Veterans Affairs (VA) Boston Healthcare System, Boston, and the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Dr. Resnick is with the MIRECC, VA New England Healthcare System, West Haven, Connecticut, and the Yale University School of Medicine, New Haven, Connecticut. Some of the results reported in this article were presented at the Academy Health Annual Meeting, Baltimore, June 23–25, 2013.
Mark R. Schultz, Ph.D.
Dr. Eisen, Dr. Schultz, and Dr. Clark are with the Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, and Dr. Eisen and Dr. Clark are also with the Department of Health Policy and Management, Boston University School of Public Health, Boston (e-mail: [email protected]). Dr. Mueller is with the Mental Illness Research, Education and Clinical Center (MIRECC), Edith Nourse Rogers Memorial Veterans Hospital. Dr. Chang is with the U.S. Department of Veterans Affairs (VA) Boston Healthcare System, Boston, and the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Dr. Resnick is with the MIRECC, VA New England Healthcare System, West Haven, Connecticut, and the Yale University School of Medicine, New Haven, Connecticut. Some of the results reported in this article were presented at the Academy Health Annual Meeting, Baltimore, June 23–25, 2013.
Jack A. Clark, Ph.D.
Dr. Eisen, Dr. Schultz, and Dr. Clark are with the Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, and Dr. Eisen and Dr. Clark are also with the Department of Health Policy and Management, Boston University School of Public Health, Boston (e-mail: [email protected]). Dr. Mueller is with the Mental Illness Research, Education and Clinical Center (MIRECC), Edith Nourse Rogers Memorial Veterans Hospital. Dr. Chang is with the U.S. Department of Veterans Affairs (VA) Boston Healthcare System, Boston, and the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester. Dr. Resnick is with the MIRECC, VA New England Healthcare System, West Haven, Connecticut, and the Yale University School of Medicine, New Haven, Connecticut. Some of the results reported in this article were presented at the Academy Health Annual Meeting, Baltimore, June 23–25, 2013.

Competing Interests

Dr. Eisen receives a proportion of licensing fees collected by the copyright holder for use by private organizations of one of the outcome measures used in this research. However, government agencies use the instrument free of charge. Consequently, there was no financial remuneration for use of the measure in this research. The other authors report no financial relationships with commercial interests.

Funding Information

VA Health Services Research & Development: IIR 10-332
This study was supported by VA Health Services Research and Development grant IIR 10-332 and the Edith Nourse Rogers Memorial Veterans Hospital. The authors thank Dan O’Brien-Mazza, M.S., and Anthony Campinell, Ph.D., for their support of this study and Patrick Furlong, B.A., Moe Armstrong, M.B.A., M.A., Alexandra Howard, B.S., Kevin Henze, Ph.D., Patricia Sweeney, Psy.D., and Matthew Chinman, Ph.D., for their contributions to this study. The views expressed in this article are those of the authors and do not necessarily represent the views of the VA.

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