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Maintaining the Balance: Lessons from Peer Evaluators

Since the earliest days of the AIDS epidemic, peers have played critical roles in providing care for people affected by HIV, advocating for policy change to improve services, and helping people at high risk for the disease to develop life-saving risk-reduction skills. The Open Door, Inc. is a harm reduction housing first program in Pittsburgh, PA that is similarly built on the foundation of peer interventionists. We created the program to reduce deaths and improve the quality of life for homeless people living with HIV/AIDS in our region. We like to say that if housing is the most important thing we can offer our clients, the support of our peer staff members is a very close second. Like many AIDS service organizations across the country, we rely on the wisdom and strength of our peer staff members to develop rapport with our clients, help problem-solve adherence issues, and model how to create decision-making partnerships with clinical care providers.

AIDS United and M·A·C AIDS Fund’s Retention in Care (RiC) grant provided us with an incredible opportunity to expand our services and to increase our evaluation capacity. The level of data we collected for the national evaluation measures was a very big change for us. Knowing that our peer staff members had the best rapport with our clients, we believed that they were the best people to ensure client comfort while obtaining accurate data. Our peer staff members were part of the evaluation planning team from the very start. We worked proactively to provide out peer staff members with training and support in scheduling client assessments, follow-ups, and tracking assessment deadlines.

We weren’t very far into this process when we realized that we were a bit lopsided in our approach in thinking of evaluation as “other duties as assigned.” We built our peers into our program because they are critical interventionists, but then we committed a lot of their time to data collection – taking away time from the reason they were hired. Data collection is hugely important to our work and yet we did not carve out specific positions or time for this work to occur. In talking with staff from AIDS United, Dr. Cathy Maulsby from Johns Hopkins School of Bloomberg Health, and other RiC grantees, we realized that we weren’t alone in these struggles. I pitched to AIDS United the idea of conducting qualitative research with all of the RiC grantees to explore how peers are involved in evaluation activities, what challenges they experience, and the strategies they use to overcome those challenges.

In the summer of 2015, I visited all five of the RiC grantees who used peers to conduct evaluation activities and conducted 20 qualitative interviews with peers and their program managers. While our findings from this study will be shared soon in the webinar “Meaningful Involvement of Peers in Evaluation and Data Collection” and in peer-reviewed journals, here are some highlights from the interviews.

The first thing I need to acknowledge is that it was crazy exciting for me to get to meet so many people engaged in this work, especially on their home turfs! As someone who started her career as an HIV case manager but has been more removed from direct practice over the past 10 years, it was incredibly invigorating for me to reconnect with the frontline work. Again and again I was impressed by the unbelievably compassionate, high-level, mission-driven work that is being done by peer interventionists across all of the RiC grantee sites. Simply amazing, and I was moved to tears more than once.

I also learned that peers are involved with many different evaluation activities, including client assessments, data entry, and everything in between. While many peers and managers confirmed our belief that when peers conduct client assessments there is an easier rapport and sense of comfort for the client, this work does not come without a cost. The peers were very knowledgeable about the need to collect data with a high degree of rigor, but sometimes struggled with knowing how to follow evaluation protocol without causing negative consequences for the client or the program.

Perhaps the most important finding from this study is that it confirms what many of us already know: that peer workers are already working really hard to improve the lives of their community members, and adding evaluation responsibilities may challenge their self-care and well-being. One peer shared this very moving quote, which speaks to this issue:
I think about all the Retention in Care grantees out there that where we’re collecting this data as a group, but we don’t see each other. But we’re all pulling at the same place and it will improve the field overall…there’s an image [in my head] of peers with a beautiful silver tray, and on that tray they’re carrying all of the roles that they give to people…except it’s reversed. So they’re not giving things off their tray, they’re taking things on their tray. So you’re supporting people in crisis and you’re helping them adapt emotionally and you’re helping them get to their appointments and then at the very top of the tray now you’re collecting data. And I don’t want the tray to tip.
I wish I could give credit to the wonderful peer who spoke those insightful, poetic words; however, all of the interviews were conducted confidentially so people could feel free to say whatever they want without identifying who said what. But you know who you are, and we all thank you for your endless compassion.

I’m looking forward to sharing more about this experience during the webinar on October 25, including some of the great strategies that peers and their managers used to help the evaluation process run smoothly. Until then, keep up the incredible work that you do, and don’t forget to take care of yourself, too!

The Meaningful Involvement of Peers in Evaluation and Data Collection webinar explores strategies for involving Peers in a meaningful way in all aspects of the evaluation process. Access the recording and slides here!

Posted By: Mary Hawk, DrPH, LSW, University of Pittsburgh Graduate School of Public Health - Monday, October 10, 2016

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