JMIR Publications

ABSTRACT

Background:

Family Peers have lived experience of parenting a child with mental health needs and specialized training to support other caregivers in navigating their child’s mental health needs and services. Family Peers promote caregiver skill building, empower families to self-advocate, and provide caregivers with informational, emotional, affirmational, and instrumental support. Family Peer services are widely used and are Medicaid-reimbursable in many states. While there are positive findings from randomized trials related to Family Peer services for a range of caregiver and child outcomes, there is little understanding of the mechanisms through which Family Peer support improves these outcomes. While observational coding of audio or video is considered the gold standard for measuring psychosocial interventions, Family Peers have described it as inappropriate due to invasiveness of these procedures. This makes it necessary to explore other strategies for measuring intervention delivery.

Objective:

This study will (1) identify common Family Peer intervention components across a range of Family Peer programs and models, (2) delineate potential causal mechanisms for Family Peer success related to child and caregiver outcomes, and (3) develop a pragmatic measure to capture use of these Family Peer common intervention components to support larger-scale testing.

Methods:

This study will examine one-to-one Family Peer support for caregivers of children ages 5-17 in outpatient settings including clinic, community and home-based. We will use Intervention Mapping to identify common components of Family Peer support and associated target mechanisms across Family Peer models through surveys with 50 Family Peers and 50 caregivers, and qualitative interviews with 32 Family Peers (including trainers and supervisors) and 16 caregivers (Aim 1). We will then refine a logic model that maps common Family Peer intervention components and mechanisms of change, and create a corresponding pragmatic tool to capture use of these components (Aim 2). Finally, we will validate in a sample of 200 Family Peers. A subset of forty Family Peers from this 200 will complete the tool in one or two role plays of a Family Peer encounter, which we will compare to observational coding. Another subset of 40 Family Peers and caregivers will be asked to complete a parallel self-report tool to report on the content of a selected session.

Results:

The study received National Institute of Mental Health funding in September 2025. At the time of manuscript submission, participant recruitment has not yet begun. Recruitment for Aim 1 is anticipated to start in August 2026. We anticipate Aim 1 will be completed in November 2026 at which point we will prepare for study activities in Aim 2. We aim to have all study data collected inclusive of Aims 1, 2, and 3 by August 2029. Per the terms of our grant award, we will submit de-identified study data collected in Aims 1 and 3 to the NIMH Data Archive for participants who consent to data sharing.

Conclusions:

Findings from this study will advance our understanding of the best ways to measure Family Peer support, and mechanisms by which it impacts caregivers and children. In addition, this study will result in a tool to measure common Family Peer intervention components across a range of outpatient programs and models. Results will inform a larger experimental trial to test the identified mechanisms of effective Family Peer support on child and caregiver outcomes. Clinical Trial: N/A, not a clinical trial