COSP Evidence-Based Practices

COSP Definition

Consumer-Operated Service Programs (COSPs) is an umbrella term for programs that are administratively controlled and operated by persons with mental illness and emphasize self-help as their operational approach in delivering peer support services.

Introduction:Development of COSPs

• In the early 1970’s, large numbers of psychiatric patients were discharged from psychiatric hospitals to find themselves adrift in uncaring communities.

• In response, they began to organized small groups for mutual support through self-help approaches and to advocate for social justice.

Development of COSPs

• By the 1990’s persons with mental illness began to more formally organize on a national level championing the South African disability motto “Nothing About Us, Without Us.”

• Many self-help groups were bundled together as consumer-operated service programs (COSPs).

Development of COSPs

• By the turn of the 21st century, the push for recovery and the use of peer support services accelerated across the United States as COSPs matured, diversified and increased in numbers.

Primary COSP Models

• Today, a wide range of peer support services are available through six primary COSP service delivery models:– Self help groups– Drop-in centers– Specialized peer services (crisis, unemployment,

homelessness)– Multi-service agencies– Peer educator and advocacy programs– Peer phone services (warmlines)

COSPs and Positive Outcomes

• Until recently, mental health services research focused primarily on the effectiveness of traditional mental health modalities and programs to treat mental illness, and neglected to consider COSPs as valued service partners that could produce positive outcomes for persons with mental illness leading to recovery.

COSP Multi-Site Study

• Largest and most rigorous study of COSPs to date

• A decade of research was funded by SAMHSA and led by the MIMH Coordinating Center on eight COSPs located across the United States

• Randomized, controlled trial study design• Fidelity tool• Analyses: As-Treated and Intent-to-Treat• Over 1800 study participants (adults with severe

and persistent mental illness)

COSP Study Results

• Participants offered consumer-operated services as an adjunct to their traditional mental health services showed significant gains in positive subjective wellbeing (CWB) – hope, self-efficacy, empowerment, goal

attainment and meaning of life

in comparison to those who were offered traditional mental health services only.

Change in Well-Being Over TimeCOSP+TMHS vs. TMHS Only

-.2

-.1

.0

.1

.2

.3

Base(N=1600)

4mo(N=1441)

8mo(N=1357)

12mo(N=1272)

TMHS, 797

COS+, 803

COSP Study Results

• The greatest gains in CWB were found for the participants who used the peer support services the most.

• Variations in CWB effects across sites were unrelated to formal COSP models of peer support service delivery.

• Most important, analyses of COSP practices and outcome results established evidence of a strong relationship between key peer practices and CWB outcomes.

Well-Being by Intensity of COSP Use

-.2

-.1

.0

.1

.2

.3

Base(N=516)

4mo(N=479)

8mo(N=449)

12mo(N=404)

High, 77

Low, 79

None, 360

COSPs Are EBPs

• COSP study results confirmed that COSPs are evidence-based:– Using the EBP protocol of the Agency for Healthcare

Research and Quality (AHRQ, previously the Agency for Health Care Policy and Research [AHCPR]), two additional randomized controlled trials were identified that supported the CWB hypothesis.

– SAMHSA recognized COSPs as EBPs and funded the publication of the COSP EBP Toolkit

COSP Study Roll Out

• Fidelity Tool based on COSP study developed, field-tested and implemented in selected states

• Website developed with public domain data base, data dictionary, final report, fidelity tool, links

• Coordination between SAMHSA and UM-STL Communications

• Press Release

Policy Efforts to Expand COSPs as an EBP

• As the nation’s mental health system adopts an integrated, recovery-based approach to providing mental health services and supports, evidence of the effectiveness of COSPs will encourage policy efforts to expand peer support services within the continuum of community care.

VISION OF THE FUTURE

• COSPs will become a vital force for promoting the wellbeing of persons with mental illness carrying a message of recovery across the globe.