Peers for Progress Annual Letter

Dear Friends,

We hope that your holidays were joyous and relaxing, and that 2011 is looking promising to you. The past year was very successful for Peers for Progress, the program of the American Academy of Family Physicians Foundation dedicated to promoting peer support for prevention, health, and health care around the world. In the following paragraphs, we would like to share some highlights in Peers for Progress’ own support and in the network we are developing around the world.

In many ways, 2010 saw impressive advances in our networking and promotion of exchange of knowledge about peer support around the world. A major activity was the October meeting in Kuala Lumpur, Malaysia that included not only our fourteen Peers for Progress grantees from nine countries, but additional representatives of other leading peer support programs and leaders of key organizations interested in peer support, including the International Diabetes Federation and the World Organization of Family Physicians. Over 60 individuals convened in Kuala Lumpur, representing Australia, Cambodia, Cameroon, Chile, China, South Africa, India, Iraq, Malaysia, the Netherlands, Pakistan, Sri Lanka, Thailand, Uganda, the United Kingdom, and the United States. Over the three-day meeting, they formed a learning community of collaborating experts spanning key areas of health (e.g., diabetes, cancer, HIV, maternal and child health, mental health) and settings of peer support programs (e.g., rural populations, programs for women and children, ethnic minorities). They identified and discussed critical aspects of peer support interventions, their effects, dissemination, and sustainability. Most gratifying, there was tremendous enthusiasm in this impressive and diverse group for the value of the kind of exchange they had begun. Already, several international collaborative projects have emerged from the connections cultivated in Kuala Lumpur. So, this meeting gave clear endorsement to the value of Peers for Progress’ dedication to growing a network of peer support leaders from around the world.

Other global networking during 2010 included a series of trips to Australia, Chile, China, France, Germany, and Mexico along with contacts in the United Kingdom and the Netherlands. In each of these, we met with national organizations interested in peer support and in working with us to enhance both the quality of their peer support programs as well as their recognition and sustained funding. A prime example of this was our visit to Beijing in August to participate in the International Symposium on Diabetes Education and Management of the Chinese Diabetes Society that attracted over one thousand participants. In addition to presenting several lectures on diabetes patient education and peer support, we met with diabetes leaders from China, pictured here, who were interested in developing peer support programs, such as among older adults in Anhui Provence or as extensions of diabetes education classes in Nanjing. This represents something of a new direction for healthcare and prevention in China. In addition to those interested in diabetes, we are also developing links with leaders in mental health and in prevention, especially smoking cessation, both areas to which peer support may provide great benefit. We are pursuing collaboration with a number of those who attended the meeting and planning a follow-up meeting through the 2011 Symposium to be held in August in Nanjing.

Peers for Progress also extended our networking in 2010 through collaboration with the Johnson & Johnson Diabetes Institute, established in a number of countries around the world to provide training in diabetes patient education for nurses and other professionals. The Institute’s focus on training professionals is a natural complement to that of Peers for Progress on the role of peer support. Through the Institute, we presented a webinar on the role of peer support in diabetes care to over 100 participants this past December, and have begun planning with its leaders for a follow-up presentation in 2011 that will highlight applied examples of peer support programs and their adaptability to various populations, settings, cultures, and other contexts.

2010 also saw expansion of the Peers for Progress Global Advisory Board with its responsibility for help in strategic development. In addition to continuing representatives from the YMCAs of America (Lynne Vaughn, Senior Vice President, Chief Innovation Officer) and the American Association of Diabetes Educators (Lana Vukovljak, CEO, Amparo Gonzalez, former President), the Board has been joined by Bert van den Bergh from the Executive Board of Iroko Holdings and a retired Eli Lilly executive with extensive global experience, and Ronald Aubert, Ph.D., Vice President of Clinical Analytics and Outcomes Research at Medco Health Solutions Inc. and author of one of the first major research papers documenting the value of ongoing patient support in diabetes management. Additional new additions to the Peers for Progress family in 2010 included Mu Chieh “Maggy” Coufal who joined the Program Development Center at UNC-Chapel Hill as Program Manager. A native of Taiwan, Ms. Coufal has masters degrees in both public health and organizational management, and has been enormously helpful in expanding our ability to reach out to colleagues in China.

Turning to organizational growth and funding, in November Peers for Progress was pleased to be one of four projects initially funded by the Bristol-Myers Squibb Foundation as part of its new, $100 million initiative, Together on Diabetes. We received $5 million to support a project that will show the value of peer support as a strategy for reaching individuals and communities in need from the “patient-centered medical home.”

Especially exciting, this new project will entail collaboration with the National Council of La Raza, the nation’s largest Hispanic civil rights and advocacy organization. Focusing on delivering services to Latino communities, we will work with NCLR to show the value of “promotoras” as peer supporters in diabetes care. The award also includes funding to establish a national collaborative network of programs interested in peer support approaches. This will add to our networking and promotion working with NCLR and its 300 affiliates and constituents around the country. Also joining in this project is TransforMed, the subsidiary of the American Academy of Family Physicians that is dedicated to helping primary medical care groups develop their patient centered medical home programs and services.

The funding from Bristol-Myers Squibb Foundation and collaboration with the National Council of La Raza are great milestones for Peers for Progress as they signify that the program is gaining respect and recognition as a major force in peer support both in the United States and around the world. This grant also expands our funding base beyond the Eli Lilly and Company Foundation, further solidifying our ability grow and sustain Peers for Progress for many years to come.

With a growing set of leaders in peer support and health interested in working with us around the world, new partners in the National Council of La Raza, and expanded funding Peers for Progress is excited that 2011 will see great accomplishments in our mission, accelerating best practices in peer support around the world. We hope the year is a great one for you as well and the many fine causes we all serve, and look forward to being in contact with you as the year unfolds.

Sincerely,

Edwin B. Fisher, Ph.D.
Global Director, Peers for Progress,
Professor of Public Health and Psychology,University of North Carolina at Chapel Hill

Annual Letter

Dear Friend of Peers for Progress,

Happy New Year from Peers for Progress, the program of the American Academy of Family Physicians Foundation dedicated to promoting peer support in diabetes, health and health care. Solid research to strengthen the evidence for peer support, networking to promote knowledge sharing among thousands of peer support programs, and resources to facilitate quality improvement all contribute to our goal of increasing peer support programs and improving their quality around the world. In this letter, I would like to share some highlights of the past year with you – our collaborators, advisors, and leaders of peer support programs.

Research
All our activities were energized in February when, with the support provided by the Eli Lilly and Company Foundation, we announced fourteen grants totaling $7 million. This funded programs in nine countries on six continents.

Their locations are depicted on the map. These programs will expand the evidence base for peer support in healthcare. Just as important, they will also provide models for how to integrate peer support into health care in settings around the world.
One of the exciting things about our grantees’ projects is the variety of approaches they take to peer support. Space does not allow describing them all but, reflecting the strengths and traditions of their settings – and the ingenuity of their leaders –a sampling includes:
• Making the peer supporter part of the nurse and doctor treatment team in San Francisco
• Training peer supporters to work with village health workers in Thailand
• Pairing individuals with each other to provide mutual support as part of programs in Cameroon, Uganda and South Africa
• Comparing group based and individually provided peer support in Cambridgeshire, England

Resources for Program Development
Across all our activities, the Peers for Progress Program Development Center at the University of North Carolina at Chapel Hill has provided leadership on a number of key endeavors, with the Peers for Progress website (peersforprogress.org) serving as the hub for this work. Practitioners, program leaders and researchers can use this resource to find out what would be entailed in developing a peer support program and to find models for the details of program development, such as in the recruitment and training of peer supporters or in planning the content and delivery of services. The site offers a number of advanced tools for quality improvement as well as evaluating programs. There are also options for sharing observations and knowledge – “lessons learned” – across the field and around the world. We will continue to add resources to assist programs in building their evidence bases and business cases for their work, and to join with physicians and health care organizations in integrating peer support into health care.

Global Networking
Peer support is probably as old as humankind and, so, is nothing we can claim to have discovered, nothing we can patent, package, or put in a box. But this age old, ubiquitous quality of peer support is also our good news. We do not need to worry about whether we may be dedicating resources to a fad that will go out of style! At the same time, most of the thousands of peer support programs around the world go unevaluated, unpublished, and unshared beyond the organizations in which they operate. With this recognition, a major goal of Peers for Progress has been to bring together the knowledge and lessons learned of all those in the field. We do this by identifying the best knowledge in the field, providing the tools to help groups develop and manage their peer support programs, and then providing the vehicles – through our webpage and international networking – to share observations and approaches, all to improve the quality of peer support programs and increase the numbers they reach. As put well by a friend who was among a group of St. Louis leaders advising us last Fall: our mission is to “accelerate best practices in peer support around the world."


A key perspective that we have learned is the importance of working through regional collaborations. In October, for example, we co-sponsored a meeting initiated by Dr. Juliana Chan, the director of our grant project in Hong Kong, that brought together members of the Western Pacific Declaration on Diabetes, the Western Pacific Region office of the World Health Organization, and about 25 leaders in diabetes and peer support from the region. In addition to rich exchange among wonderful peer support programs, the meeting ended with plans for collaborative efforts to promote comprehensive diabetes programs that include peer support. Working with groups like this is an important model for our role in promoting high quality peer support, adding to their efforts the strength of being part of a global initiative, and actively promoting peer support while collaborating with regional direction of regional programs.

With research and an expanded knowledge base, growing collaborations all over the world, and resources that assist program development and promote quality improvement, Peers for Progress is indeed achieving its mission to “accelerate best practices in peer support around the world.” We want especially to thank you – our collaborators, advisors, and leaders of peer support programs – for your tremendous help in this growth.

In coming months, we will continue to inform you about further developments in Peers for Progress but would welcome your thoughts or suggestions throughout the year. Please feel free to contact me at edfisher@unc.edu or our group through our website, peersforprogress.org (“contact us” in upper right corner of homepage). We will look forward to hearing from you!

Warm regards,

Edwin B. Fisher, Ph.D.
Global Director, Peers for Progress

Peers for Progress edited update

The Peers for Progress was formally introduced to the world at the WHO consultative conferene held in Geneva, Switzerland on November 5-7 with an overview of the evidence as it exists n the world today. The nearly 50 invited guests participated in three very interactive days discussing the knowledge as it exists from various peer support programs around the world.
We are very grateful to Dr. SEge Resnikoff adn Dr Gojka Roglic for their support as WHO hosts for this significant, event. A thank you as well goes to the co chairs ( Linda Siminerio, Marty Funnell), the speakers ( Leoski, Lorig, Simmons, Less, Soegondo, Baksi) and the discussion group chairs ( Ed Fisher, David Marrero, Marty Funnell, Frank Snoek/ Simmons). They have a good handle on what is effecting change in their communities.
The six regions of the WHO world were represented: the attendees represente a corss section of health professionals, organizations and individuals with diabetes. This led to some high level and emotional discussions trying to determine the "right" next steps for the peer supporters in trying to answer the questions: Who can be a peer supporter? Who needs the support? What can peers do and how will they be trained and monitored? How will the peers sustain their viability in the community in which they work?
There were several important consensus conclusions at teh end of the meeting. It was concluded that peer supporters should have diabetes or a close relationship to someone with diabetes. They need to be recognized in some way for what they do. The community should define the role of teh peers. The role of the peer supporter could evolve in the health service system or community based system of care. There needs to be more evidence provided to further clarigy the value of the peer in the health care system and community which may mean more clinical study adn / or demonstration projects. The programs need to be global as the exploding demand for resources are needed in teh low resource communitities.
The central hypothesis of the Peers for Progress (PfP or P4P) program is that "sustainable indiviual behavioral changes are nedessary to improve long-term outcomes that will occur through peer to peer interactions mentoring and role modeling. PfP will devleop international programs to identify and train lay volunteers with diabetes to become "Peer Supporters". A Per Supporter will have the cognitive, behavioral, and interpersonal skills to assist another person with diabetes in adating to the consideralbe emotional, social and daily self-care demands of diabetes. It is belived that one percent of teh people with diabetes have teh capacity and desire to become Peer Supporters. LKE

Peers for Progress kicks off in Geneva

The Peers for Porgress formal introduction to the world happened at the WHO Consultative Conference held in Geneva, NOvember 5-7 with an overview of the evidence asof peer support programs in the world to date. The nearly 50 invited guests participated in a very interactive discussion groups talking about the knowledge that exists from teh arious peer support programs in the six WHO regions around the world.

We are very grateful to Dr. Serge Resnikoff and Dr. Gojka Roglic of the WHO for their suppor in hosting this fine event. A thank you as well to the co-chairs ( Siminerio and Funnell), speakers ( Leonski, Lorig, Simmons, Less, Soegondo, Baksi) and Chairs of the discussion groups( Fisher, Marerro, Funnell, Snoek). They have a good experience in these activies and the impact the programs could have in the communities around the world. The six regions of the WHO world were represented by their leadership as well as leaders from the health professional groups, organizations with interests in diabets and patients themselves. This led to some hight level and emotional discussions trying to answer the sqsuestions: WHo can be a peer supporter? WHo needs the support? What can peers do and how will they trained and monitored? HOw will the peers sustain their viability in th ecommunities in which they live and serve?

It was determined that peer supporters should have diabetes or a close relationship to diabetes. They need to be recognized in some way for what they do. The community should define the role of the peer supporter. The Role of the peer supporter could evolve in the health service system or community based system of care. There needs to be more evidence generated to further clarify the value of the peer in the health care system and community which means more clinical studies and / or demonstration projects. The programs needs to be global as the exploding demand for resouces are needed in the lor resource communities.

The Central hypothesis of the Peers for Progress program is that
sustainable individual behavioral chagnes are necessary to improve lon-term outcomes and will occur through peer to peer interactions, mentoring and role-modeling. Peers ror Progress will develop nationwide programs to identify, train lay volunteers with diabetes to become "peer supporters". A Peer Supporter will have the cognitive, behavioral, and interpersonal skills to assist another person with diabetes in adapting to the considerable emotional, social and daily self-care demands of diabetes. It is believed that one percent of teh peole with diabetes have the phenotype and desire to become a Peer Supporter.