Psychiatry Graduate Student Reham Shalaby Launches Study of Innovative AHS Peer Support Program

The effectiveness of a novel four-year-old Alberta Health Services (AHS) program to support those struggling with addictions and mental health issues is the subject of a new study by a student in the Department of Psychiatry's Graduate Program.

01 September 2019

The effectiveness of a novel four-year-old Alberta Health Services (AHS) program to support those struggling with addictions and mental health issues is the subject of a new study by a student in the Department of Psychiatry's Graduate Program.

The study - "Enhancing peer support experience for patients discharged from acute psychiatric care: A randomized controlled pilot trial" - is being conducted by Master's student Reham Shalaby.

Dr. Rabab AbouElMagd Ahmed, Adjunct Clinical Professor in Psychiatry, is the research coordinator. Dr. Vincent Agyapong, Clinical Professor and Director, Residents Quality Improvement Projects, Department of Psychiatry, and AHS Edmonton Zone Clinical Section Chief, Community Mental Health, is supervising the project.

Shalaby's study is focused on evaluating the effectiveness of AHS's Peer Support Program, which currently employs 26 Peer Support Workers in the Edmonton Zone. The program was launched in 2015 by AHS Addiction and Mental Health, Edmonton Zone, and is currently managed by Michelle Knox, AHS Program Manager for Housing and Recovery Supports.

Peer Support Workers, who are embedded in multidisciplinary teams at clinics and AHS programs throughout the city, harness the knowledge and insights gleaned from their own lived experience in overcoming addictions and mental health challenges to support clients who are struggling with similar issues of their own. (See accompanying story for more background on the Peer Support Program).

Shalaby hopes to enroll a total of 180 patients who have been discharged from Acute Psychiatric Care units at local hospitals and as many as 25 Peer Support Workers in the randomized controlled trial by the beginning of 2020.

"We began the recruitment several ago from all of the Edmonton Acute Care Psychiatric units at local hospitals, including Grey Nuns Hospital, Misericordia, the Royal Alexandra Hospital, Alberta Hospital Edmonton and University of Alberta Hospital. We're now up to about 52 patients and six Peer Support Workers who have agreed to work with us," she says.

"The enrollment process will continue over a six-month period. It started in June and is supposed to end by the beginning of 2020. We are targeting 180 patients, and if we don't reach this target by the new year, we might consider extending the enrollment period."

If all goes according to plan, the study should be completed by early 2021.

The goal of the study is to determine whether participants who have access to both Peer Support Workers - including up to eight visits over a six-month period - as well as daily supportive text messages over the same six-month period, achieve superior overall health outcomes compared to other subgroups in the study.

The three other subgroups in the study are comprised of those who receive only one of the above-mentioned sources of support - either access to Peer Support Workers or regular supportive text messages, also over a specified six-month period - and finally, a control group that simply receives conventional, treatment-as-usual follow-up care.

"We will allocate the patients into these four main groups according to randomization tables, which ensures a fair opportunity for each participant to be in any of the four assigned groups," she explains.

The text messages will be organized under eight separate categories, targeting individual patients according to their specific conditions and preferences.

"For example, if a patient has Depression we'll link him or her to text messages for Depression. If they are diagnosed with Schizophrenia we'll link them to messages for Psychotic disorders. For patients who have multiple conditions or co-morbidities, we'll ask them about their preferences and to identify the most distressing condition for them."

Patients in each group will subsequently complete evaluation measures (in terms of recovery, general symptomatology and functional outcomes) at five intervals, including at baseline, six weeks, 12 weeks, six months and at 12 months.

Health service utilization data as well as clinician-rated measures will also be used to assess the progress of patients. The resulting data gathered from patients will be analyzed with descriptive and inferential statistics, repeated measures and correlational analyses. The experience of Peer Support Workers will be captured through focus groups and subsequent qualitative assessments.

"For patients who receive Peer Support Worker services plus text messages, our hypothesis is that they will demonstrate best results on the different scales, including psychiatric as well as physical parameters, such as BMI (Body Mass Index) and blood glucose levels," Shalaby says.

"For the Peer Support Workers, we also believe that they will do better and their overall health condition will improve. This will be captured through diverse follow-up measurements."

Evidence suggests there are high attrition rates among Peer Support Workers. A lack of formalized training opportunities, and inadequate incentives for these workers to continue in their roles at various sites may be among the reasons for it. Shalaby says she hopes her study will provide additional evidence needed to address these issues.

Prior to enrolling in the Graduate Program in the Department of Psychiatry, Shalaby completed medical school at Alexandria University in Egypt and worked as a public health Physician in Egypt and Kuwait. She was subsequently appointed to various management positions at Alexandria University Hospitals.

"My passion for Neuropsychiatry led me to do some training in this field in Egypt, which enriched my knowledge and practice in this specialty. Regarding Canadian medical exams, I have passed most of them and I'm fully hopeful to pursue a Residency position at the University of Alberta, and to practice as an independent Physician in this lovely province."