HIV PEER SUPPORT: Framework For Future Services in South London

Transcription

1 HIV PEER SUPPORT: Framework For Future Services in South London CONTACT: Scott Lupasko Director, Counselling & Peer Support Services metrocentreonline.org Charity #

2 INTRODUCTION This document is a summary of the key recommendations from a consultation event held by METRO and Catholics for AIDS Prevention and Support (CAPS) on 18 January, The event was organised in part, as a response to uncertainties about the future of HIV Peer Support Services in South London, most specifically those commissioned by the South London HIV Partnership (SLHP). It was attended by providers and users of such services and independently facilitated by Peach Consultancy. This summary proposes a framework of key principles for peer support that is outcome focused and patient centred and endorsed by a range of provider organisations: METRO, Catholics for AIDS Prevention and Support (CAPS), Terrence Higgins Trust (THT), Body and Soul, Southwest London Fellowship (SWLF), African Advocacy Foundation (AAF), French African Welfare Association (FAWA), Positively UK, African Positive Outlook, Positive Parenting and Children (PPC) and Living Well. The framework was developed collaboratively during the January 18 consultation event. Its aim is to inform future commissioning of Peer Support Services across South London, and beyond. A full copy of the January 18 consultation report can be accessed on the METRO website. BACKGROUND Peer support is an essential part of HIV long-term care Peer support for people living with HIV (PLHIV) is about those with this lifelong condition providing support to one another through sharing knowledge and experiences and offering social, emotional and/or practical help. It can take the form of one-to-one mentoring or counselling and groupwork, involving trained peer educators. Peer support groups allow some of the most excluded and stigmatised groups to experience positive health, social, and economic outcomes. In South London, peer-led activities including those targeted at Black African, Francophone African, men who have sex with men (MSM), Catholics, families, and young people have proved beneficial. Peer support within the SLHP has provided grass roots connections with some of the most disadvantaged and excluded people to a range of other specialised and mainstream services including and beyond healthcare. METRO HIV PEER SUPPORT REPORT 2

3 Peer support meets a range of emotional, social and practical support needs for PLWH, without stigma and in a safe and positive environment. It provides a holistic, continuous emotional support base for users rather than only intervening at moments of crisis. It is empowering, affirming, collaborative and responsive. It supports long term care and adherence. Peer support is effective in meeting national & international standards & local need The Greater Involvement of People Living with HIV (GIPA) principle, which is endorsed by UNAIDS and backed by 189 United Nations member countries, including the UK Government, as part of the Declaration of Commitment on HIV/AIDS. It recognises peer support groups as effective interventions for PLWH, and that this principle be applied as an ethical requirement at all levels of policy formation and service delivery. Additionally Standard 9 of the BHIVA Standards of Care for People Living with HIV 2013 relating to selfmanagement states that: People living with HIV should be enabled to maximise selfmanagement of their physical and mental health, their social and economic well-being, and to optimise peer-support opportunities. Investment in peer support was identified in the LSL HIV Care and Support Review as important to mitigate against destabilisation. Additionally it is recognised by the NHS Commissioning Board in its recent consultation on Patient & Public Involvement and Engagement. THE FRAMEWORK: KEY PRINCIPLES FOR FUTURE PEER SUPPORT MODELS Joint Working Providers should work together within a larger, single peer support service in order to reduce duplication and consolidate outcome measurement. A single peer support service commissioned as a consortium of smaller providers, would mean that areas of expertise could be delineated to ensure that there was no duplication. Moreover, a jointly organised service would also work to ensure proper geographic coverage and efficiencies as different providers could, through central administration and distribution of funds, share space and resources as required in order to ensure equality of access. A larger service could have a single, integrated outcome measurement tool. A jointly organised service would thus have an intake/assessment function with pan-service outcomes as well as sub-service specific outcomes determined through assessment. Dividing outcomes in this way could help reduce the burden of measurement and gathering on group providers. Joint working is not intended to compromise any organisation s independence or expertise. Rather by reducing duplication and consolidating necessary administrative functions, participant organisations will be better able to provide unique services while ensuring outcomes are recorded and measured properly and without unnecessary resource drain. METRO HIV PEER SUPPORT REPORT 3

4 One-to-one and group support One-to-one support is useful and necessary, but provides a very different type of support from that found in groups. Although one-to-one models are more naturally equipped to measure outcomes based on the length and style of the intervention (Stanford s PSMP and METRO s MetroSafe programmes were cited as examples) they cannot and should not replace group support. Rather, a combination of one-to-one and group provision could be integrated into a single, larger service model. Such a service could sit centrally, within the assessment/intake function, as a core service, with groups acting as satellite services offering variation and expertise. In the best-case scenario, the one-to-one offer could be more focused on clinical outcomes and groups providing specialised and back-up support, based on outcomes gathered during provision. This of course would not preclude exclusive use of groups by service users, but merely provide a template for provision and outcome measurement where a central one-to-one service gathered data that justified and allowed freedom within group provision. Outcomes-focused Outcomes are the changes, benefits, learning or other effects that happen as a result of an intervention. They can be wanted or unwanted, expected or unexpected. They are often hard to count or prove, and normally rely on an understanding of the initial situation or problem for comparison. Clinical Commissioning Groups and local authorities are accountable for outcomes related to specific targets identified in the main in the Public Health Outcomes Framework (PHOF) and the local joint health and wellbeing strategy. Patient centred outcomes are those that are important to individual patients, most often focused on quality of life and functional wellbeing. The need to measure outcomes against agreed clinical targets must be balanced with the necessities of providing a focused, client-oriented service as well as the resource limitations on the individual providers. In developing the idea of primary, pan-service and secondary, sub-service outcomes, the following examples can be given. In the Primary Service Model relevant information to meet targets identified in the PHOF were the client accessing peer support through a centralised intake point (much like the current First Point SLHP service ), would be pre-gathered as well as specific peer support related information determining which more specialist service would suit and the resultant outcomes template to engage As determined through assessment, the secondary outcomes would comprise those determined as most relevant according to a model of social support, BHIVA Guidelines METRO HIV PEER SUPPORT REPORT 4

5 and GIPA, as well as those specific to a given demographic and group s area of expertise. Social support is an umbrella term for a variety of pathways linking involvement in social relationships to well-being Building on this model, a client could, for example, access peer support specifically geared to their role as a parent. An initial assessment may indicate other issues (adherence, healthy living, etc.), which could be dealt with specifically in a one-to-one programme or less specifically in a parents group. The client could choose both one-toone and group support, or only one-to-one or only group support. Should the client choose both, only the secondary outcomes determined by the peer support group as its specialist outcomes with highlights made known to it based on the incoming individual s assessment, would be transferred to the group, with the primary outcomes staying with the one-to-one programme. However, should the client not want one-to-one support, this information, though with less expectation of being dealt with specifically, would be transferred to the group as part of the client s profile. Similarly, should the client decide to only have one-to-one support, the more specialist issues would be dealt with during it, with the specialist group facilitators able to provide support to the one-to-one mentor if necessary. The above is an example of how such a system could work based on providing the flexibility and choice of one-to-one and group support; acknowledging the specialist nature of group support in dealing with specific issues; providing a system geared to gather the most possible outcomes both clinical and patient-centred - in the most rigorous manner possible though without compromising user experience as central. Centralised information gathering and handling This is implicit in all of the above though needs to be stated explicitly. It is to be noted that the current hub and spoke model of peer support within the SLHP is based on this assumption of a central provider/administrator responsible for gathering information and reporting to commissioners. The proposals generated from the 18 January event thus support this model, though with more sensitively developed outcomes templates and division of expertise. Greater use of volunteers Some groups currently use volunteers in their provision, while others do not. However, in accordance with the GIPA principle and from opinion gathered on the 18 January event, a more standardised and active volunteer participation mechanism would be beneficial to any peer support service. These volunteers could work as mentors in one-to-one support services or as group helpers (as is currently the case in some groups). However, by standardising volunteer involvement and allowing people to enter peer support as volunteers or to become volunteers as part of their support journey, ownership and METRO HIV PEER SUPPORT REPORT 5

6 patient involvement could only be increased to the benefit of the SLHP as a whole. Outcomes relating to volunteering would thus be part of the centralised outcome template. CLOSING RECOMMENDATIONS The consultation event succeeding in unifying the views of a sector that contains both large and small providers and is more often than not used to working individually, without the type of centralised administration that both allows efficient monitoring of outcomes and economies of scale. METRO thus recommends that any future specification of Peer Support Services for PLHIV in South London incorporate the above principles in order to allow those bidding to provide peer support to include the expertise and viewpoints of the sector as a whole into any proposed service model. Specifications that did not allow for smaller providers to play a role within a more efficient centralised, larger system would cause a great loss to both the sector and the individuals it aims to support. For although the current austerity requires the types of efficiencies that can only be accomplished through a centralised approach, this can be achieved without the loss of diversity and choice CONTACT: Scott Lupasko Director of Peer & Counselling Services scott@metrocentreonline.org metrocentreonline.org METRO HIV PEER SUPPORT REPORT 6