EXPEERTs

Our societies are facing a growing number of citizens who are losing their autonomy, whether as a result of disability, illness or even ageing. The gradual emergence of what have become a public problem and the focus of media attention has revealed a significant deficit in the transmission of knowledge about autonomy in situations of dependency. At the same time, people with disabilities, chronic illness or mental health problems have accumulated knowledge from their experiences. This experiential knowledge (Borkman, 1976) is of major societal concern. Yet it is little known, let alone disseminated.
This booklet will report on the progress of the EXPEERTs research program on rare experiential knowledge and the contexts facilitating its creation, particularly peer support (Gardien, 2018). It will also disseminate information on publications and events related to this topic.
The EXPEERTs program is an ongoing research project, carried out by a multidisciplinary team (Sociology, Anthropology, STAPS (1), History, Psychology, Public Health). It has been certified by the Institute of the Social and Human Sciences of Brittany. This program is currently funded by IRESP (French Public Health Research Institute). This work is part of the activities of the ESO laboratory (UMR CNRS 6590) and its partners.
This booklet will be of interest to all those who wish to understand what the experience of disability, chronic illness or mental health disorders can contribute on its own and in a positive way.

(1) Sciences and Techniques of Physical and Sports Activities

Study day 2022

EXPEERTs – ORSPERE Samdarra

Does lived experience engender skills?

Mutual aid and peer support

On-line Study Day, January 21, 2022

Today, many people are convinced there is a direct causal link between lived experience and the skills required to support one’s peers. Experience should lead to knowledge and skills. However, nothing has been proven in this respect, no more than the opposite. It is clear that a wide variety of effects are produced by people declaring themselves as “peers”. Through their support, some of them enable others to regain footing in their lives; whereas others diminish support for the group solely by their presence.

What makes it possible to know how to act in an appropriate and useful way towards one’s peers? Is lived experience alone sufficient to bring out the abilities or not? Surveys have shown that some individuals who have experienced major challenges in life are especially competent at supporting their peers. It’s possible to be competent without being a professional, or even a volunteer. Some individuals have been able to develop their skills in supporting their peers because of training that has allowed them to build on their lived experience. It also happens, infrequently, that trained and qualified individuals are not competent at supporting their peers.

In other words, there is no direct causal link between lived experience and the ability to support peers, but lived experience is essential for establishing a peer-to-peer relationship. Two questions therefore arise:

  • How does lived experience contribute to forging an ability to support one’s peers?
  • Since life experience is not enough, what other qualities, skills and attitudes are needed to support one’s peers?

The gradual institutionalization of peer support practices and their scope of action does not in practice resolve this question of the link between lived experience and skills. Institutionalization through public action in France has indeed several facets. Many scenarios are adopted without this question of the link between competency to support one’s peers and lived experience being truly investigated, understood, or even scientifically proven. Some sectors and some institutions frankly prefer lived experience, while others favor brief training more, and still others value a university degree following training and a practical internship.

For example, since 2017, the roll-out of Housing First [1] promotes the recruitment of a peer in each intervention team. For the Housing First policy, the conditions for qualifying required by a 2016 decree are experience using mental health services and certification of at least level III, in other words a Baccalaureate degree + 2 years, and, failing that, validation of what has been acquired from experience (VAE) within 5 years of taking up the position. This second option of VAE is commonly used and therefore leads to recruiting based mainly on lived experience.

Following the work of a collaborative group coordinated by the Interministerial Disability Committee (CIH) during the 2019-20 period, a peer intervener training course is now being developed on a national level. Lasting 4 to 5 days and currently addressing people with disabilities, this training aims to identify and consolidate acquired experiential knowledge, to acquire a base of knowledge on the political and administrative organization of the field, and to integrate methods of peer intervention. In this case, priority is given to a very short training program that complements lived experience.

The implementation of the professional license for Health-Peer Mediator (MSP) [2] and the university diploma (DU) Peer supporter [3] mark the firm choice of some actors in the field of mental health to qualify through a training course of several weeks and a practical internship. The selection for entry into these courses is important because of the limited number of places for a large number of candidates. In addition, genuine theoretical and practical work and the creation of a professional attitude are expected. This option is clearly one of professionalization, well beyond lived experience alone.

Finally, let us point out the case of the AQRP [4] in Quebec, which has been developing training for peers since 2006 along with training for employers and mental health teams. Peer training includes two weeks on site and a 42-hour internship. Even before selection, the person must meet a certain number of criteria, including: having lived or living with a mental health problem, being ready to reveal their lived experience in connection with their mental disorder and their recovery, having been invested in their recovery for at least two years, skills in helping relationships, relevant experience in work or involvement, good spoken and written French, a high school diploma or its equivalent. In this example, while the training and internship are brief, the pre-selection and selection are more demanding than is usual in France. In addition, the person and their employer are given support after starting the job. Lived experience is an important criterion, but remains one criterion among others.

While competency is the thorough and recognized knowledge of a field – conferring on the individual holder the right to judge or decide in certain matters – this competency is always limited and circumscribed. The attitudes and skills acquired in the course of experience do not confer omniscience. If people are holders of experiential knowledge, in which areas are they competent, since everyone is commonly the holder of experiential knowledge? Are there competencies that cut across different types of experience? Does the experience of supporting one’s peers enable the production of knowledge and skills? Under what conditions does the experience of supporting peers within a multi-professional team allow the development of peer-to-peer relationships?

This study day is not intended to evaluate or judge recruitment criteria, or the choices made by sectors, institutions or employers. This scientific event aims to understand, produce knowledge, and shed light on the link between lived experience and the ability to support one’s peers.

AVAILABLE DOWNLOADS
  1. Poster of Study Day 2022
  2. Presentation of the Study Day 2022
  3. Link to the Web site for the 2022 Study Day

[1] Public action carried out by the DIHAL

[2] Bachelor’s degree in health and social sciences, Health and Peer Mediators course, Sorbonne Paris Nord University

[3] Pair-Aidance University Diploma in Mental Health, Lyon 1 University

[4] AQRP : Quebec Association for Psychosocial Rehabilitation

EXPEERTs Conference 2019

Peer support : contemporary issues Health, Disability, Mental Health

Institute in Social Sciences in Britanny (MSHB), Rennes, November, 14th and 15th 2019

Since the 2010’s, this participatory orientation has taken a new turn with the introduction of peers into a set of public policies. The peer refers to a type of actor newly recognized and legitimized by the public authorities in the name of their experiential knowledge: experience of life on the street, experience of chronic disease, experience of addictions, experience of disability, etc. Some are peer advocates, others teachers or trainers, others peer supporters or peer counselors. It is the latter that are the focus of this conference.

Peers are recruited in the multi-professional teams of Housing First public policy for homeless people. Others are asked to participate in the Supported Response for All policy concerning people with disabilities, people living with chronic illness or mental health problems and their families. Still others are expected to break the loneliness and co-construct solidarity and reciprocal relationships within Mutual Aid Groups. Some are enrolled in health or even public health facilities to contribute to therapeutic education or health prevention programs, etc.

As a result of this obvious interest in contemporary French public policies for peers, the practices of peer support, their contexts and statutes are multiplying. While they are fundamental characteristics of peer relationships, symmetry and reciprocity are sometimes even lost sight of. This is not without questioning the issues underlying this participation.

  • Is it the development of the peer support function or the deployment of public policies that is privileged?
  • Is it a desire to democratize targeted sectors of activity and improve public policies, or, conversely, is it the ambition to encourage peers to support public policies through their participation?
  • Is it about recognizing the experiential knowledge of peers and their potential contribution to our society? Or is it a new form of citizen activation?
  • Is the purpose of this peer participation to expand the possibilities for support?
  • Is it a call to lay people to limit public spending?
  • Does peer participation aim to make the populations targeted by public policies more challenging?
  • Or is it standardization and inclusion of peer leaders through ad hoc training and professionalization?

This conference aimed at examining the issues underlying these multiple practical forms of peer participation in the health, social and medico-social sectors as well as self-managed organizations. Its objective was to discern, define and qualify them, and to clarify their practical consequences

Plenary Session – Citizens in a changing society

Session Chair: Baptiste Brossard, Australian National University (Australia)

Joëlle Zask, philosopher, University of Provence – Elements for a culture of participation

Jean-Louis Genard, sociologist, University of Mons (Belgium) – The anthropological horizon of new social policies

En podcast

Plenary Session – From citizen participation to peer support

Session Chair: Robert Dingwall, Nottingham Trent University (United Kingdom)

Marcel Jaeger, sociologist, professor emeritus at the CNAM – The participation of people supported/cared for in France: expected effects, effects produced

Eve Gardien, Christian Laval, sociologists (for the EXPEERTs team), Rennes 2 University – Peer support: context effects, public policy effects

En podcast

Plenary Session – Peer support and accompaniment: the contemporary challenge of professionalization

Session Chair: Eve Gardien, Rennes 2 University

Lise Demailly, sociologist, professor emeritus of the University of Lille – Professionalization of peer support in mental health in France: objectives and challenges

Chyrell Bellamy, PhD, Associate Professor of Yale School of Medicine’s Department of Psychiatry, Yale University (USA) – Experiences of professionalizing peer support: Should human experience be professionalized? Build the link between lived experience and acquired experience

En podcast

DOWNLOADS AVAILABLE

  1. The programme of the EXPEERTs 2019 conference
  2. The poster of the EXPEERTs 2019 conference
  3. Proceedings of the workshops of the EXPEERTs 2019 Conference
  4. Slideshows of the workshops of the EXPEERTs 2019 Conference

HYPERTEXT LINKS

  1. to Aired’U: all the plenary podcasts
  2. to the dedicated MSHB page: presentation of the conference
  3. to the website of the EXPEERTs conference

PROCEEDINGS OF THE EXPAIRs 2019 CONFERENCE

A book will be published in the next few months, taking up the subject of the conference in greater depth. The information will be available on this page.

EXPEERTs Study day 2021

What can patients give to their peers and to health professionals?

Online conference, January 28, 2021

Patients are often seen as consumers of care, but they are more than that, just as they are not simply patients being cared for. The patient is an essential player in health care. Since the year 2000 in France, directions taken by public policies (Law 2002, HPST Law, Health Law), the activities of various institutional players (including HAS[1]), and dedicated professionals or patient associations have enhanced and facilitated patient involvement.

As part of a call for health democracy, the law of March 4, 2002 established new patient roles and responsibilities. This law promotes a two-fold involvement of the patient. At an individual level, each patient has the right to complete and accurate information on their state of health in order to be able to exercise – in an informed manner – their right to consent to or, on the contrary, to reject a medical examination or treatment. At the collective level, the 2002 law created the status of user representative. The latter is a member of a registered patient association and is mandated within this framework to bring a global perspective, developed collectively by patients at various levels in the health sector or in the region. The user representative can also function as an observer, gather information on practices and process, mediate, participate in defining health policies, prevent undesirable events or advocate for effective patient rights.

There is thus a broad scope of authorized action available to patients within the healthcare system. There are more and more groups devoted to consultation, information and co-construction: Patients’ Commission (CDU), Supervisory Board (CS), Medical Commission on Care Institutions (CME), Institutional Technical Committee (CTE), Sustainable Development Committee , Ethics Committee, Hospital-acquired Infections Control Committee (CLIN), Medicines and Medical Devices Committee (CMDMS), but also Local Health Councils (CLS), Local Mental Health Councils (CLSM), Patients’ Center, Regional Conference on Health and Autonomy (CRSA), City Health Workshops, Regional Health Contracts, Regional Health Project, Regional Mental Health Project, etc. This list is far from exhaustive.

In addition, other types of patient involvement are developing: the “patient-expert” participates in the Therapeutic Education of the Patient (HPST law[2]); “resource patients” supports various courses of action through their contributions, and help in organizing and implementing them; the “patient partner” gets involved following requests by professionals or institutions; the “peer helper” or “peer health mediator” gives support to other people going through mental health challenges and shares their own experiential knowledge; the “patient-teacher” or the “patient trainer” participates in providing content in medical and nursing schools (IFSI), in paramedical training, etc. Not to mention the recent development of participation – at the initiative of caregivers – in care within a collective framework in physical medicine and rehabilitation facilities and services, as well as an emphasis on informal support between patients.

Patient participation in the health system is therefore not a marginal trend but a significant development (Bousquet, Ghadi, 2017; Routelous, 2008). Ma santé 2022, the new certification procedures for health facilities, the HAS recommendations on user involvement in the health, social and medico-social sectors of activity, all these will doubtless profoundly change the French health care system. Through the analysis of concrete situations, the goal of this one-day conference is to understand the challenges of these new practices, their impact, their advantages and disadvantages. This day will focus particularly, but not exclusively, on formal or informal activities of patients in relation to other patients as part of the care and management of daily life with illness.

  1. Poster of the 2021 EXPEERTs study day
  2. Website of the 2021 EXPEERTs study day
  3. The recordings of the 2021 EXPEERTs study day

[1] High Authority of Health

[2] Hospital, Patient, Health, Territory Law

EXPEERTs Study Day 2018

Peer support: a cross-cutting approach to the fields of health, mental health and disability

Maison des Sciences de l’Homme de Bretagne (MSHB), Rennes, November, 7th 2018

Peer support in health, disability and mental health fields has been practiced for centuries and covers the entire globe. Let’s think for example of the Popular Health movement born in the 19th century in the USA, the very numerous clubs for war-disabled at the beginning of the 20th century in France, and self-help groups such as Alcoholics Anonymous that spread throughout the world, etc.

In the Western context, initiatives carried out by and for peers have been widely diversified since the end of the 19th century, mainly due to improvements in living conditions (the struggle for survival is no longer the primary objective of support) and an increase in life expectancy (with new situations being provided for). Gradually, new causes, identities and affiliations are emerging in a context of growing concern for the individual, his rights and freedoms. Peer support has been deployed in particular in several social movements in favour of the individual: civil rights, freedom of sexual orientation, enlightened consumer behaviour, demedicalisation, deinstitutionalisation, etc.

With or without a programme of mobilization, peer support is characterized by a common inspiration found in the self-help philosophy, a specific relational attitude, the will to improve everyday life, the recognition of the importance of experiential knowledge, self-determination and empowerment. Today, peer support is experiencing renewed interest due to its promotion by contemporary public policies (RAPT, Housing First, etc.). These recent implementations raise and pose new questions about identities, peer-to-peer relationships, practices, ethics and organizational frameworks. The effects of institutionalisation through public policy are not yet truly understood.

Transversality: what we have in common

The morning was devoted to understanding how it is that – beyond the boundaries drawn between these areas of disability, chronic illness or mental health – individuals are able to recognize their   peers and share relationships with similar effects; how it is that peer groups that do not know each other,  can share common values and objectives. How it is that peer groups that do not know each other,  can share common values and objectives.

This transversality, which creates common ground in the fields of disability, chronic illness and mental health, raises questions:

  • On what basis do we recognize ourselves as peers today?
  • What problems are we becoming aware of? What solutions are sought and found?

Plenary “Peer support: what are we talking about?

Podcast (french)

Round table “Peer support: mobilizing to cope, relying on your peers”

Podcast (french)

Transversality: what makes a distinction

The afternoon was devoted to a better understanding of what makes for difference and diversity, despite their common foundations. A major finding of the current survey is that practices, statutes and organisations are different. The training and professionalization of peer-supporters were the subject of lively debate. Work with institutions and professionals was discussed. Indeed, the different statutes, protocols and methodologies, the diversity of commitments of institutions, associations and federations, the variety of ways of welcoming within multi-professional teams, etc., have an influence on peer-support practices.

Plenary session “Peer support: what effects do statutes and practice contexts have? »

Podcast (french)

Round table “Peer support: effects of different statuses on actual practices”.

Podcast (french)

Downloads available
  1. The program for the EXPEERTs study day 2018
  2. The Acts of the EXPEERTs study day 2018
SOMe links
  1. to the Aire d’U
  2. to the MSHB page of the project