Testing the Effectiveness of a Brief, Peer Support Intervention to Facilitate Transition Form Psychiatric Hospitalization
Phase: NA
Conditions: Psychosis
Sponsor: Centre for Addiction and Mental Health

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Study Title: 
Testing the Effectiveness of a Brief, Peer Support Intervention to Facilitate Transition from 
Psychiatric Hospitalization 
 
Principal Investigator: 
Sean Kidd, Ph.D. 
 
NCT Number: 
NCT02946255 
 
Date: 
Aug 15, 2018 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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STUDY PROTOCOL 
(Original - 01 August 2016) 
(Version 2 – 11 January 2017) 
(Version 3 – 13 March 2017) 
(Version 4 – 26 April 2017) 
(Version 5 – 13 July 2017) 
(Version 6 – 04 August 2017) 
(Version 7 – 26 September 2017) 
(Version 8 – 15 August 2018) 
         
Study Title: 
Testing the Effectiveness of a Brief, Peer Support Intervention to 
Facilitate Transition from Psychiatric Hospitalization 
Principal Investigator: 
Sean Kidd, Ph.D. 
Institution: 
Centre for Addiction and Mental Health 
Co-Investigators: 
Tony George MD, April Collins MSW, Gursharan Virdee Psy.D., 
George Mihalakakos PSW 
Graduate Student:  
  Christina Mutschler, PhD Candidate 
 
 
Introduction 
 
Goal: 
The goal of this study is to generate an effective, readily implemented intervention to  
support individuals with schizophrenia in transition to communities after lengthy hospital 
stays. This is a topic of importance given that, in Canada, approximately 75% of people with 
schizophrenia have been hospitalized, 38% are readmitted within 1 year, and the average length 
of stay is 27 days1,2. This rate of readmission is considerably higher than other mental illnesses, 
with the first month post-discharge highlighted as the period of greatest risk for poor outcomes 
such as suicide, disengagement from care, and readmission1,3,4. Such outcomes reflect poorly 
aligned inpatient and outpatient sectors5, with few interventions articulated in the small and 
variable literature in this area6. 
 
Objective and outputs: 
Building upon evidence of the benefits of peer support in the transitional period7,8 and our 
previous success with developing and proving the feasibility of a brief peer transitional 
intervention9, the objective of the proposed study is to test the hypothesis that this 
intervention will improve the discharge-related outcomes of individuals with schizophrenia. 
The proposed approach is unique in its brief, critical time orientation, its provision of basic 
living supplies, its community engagement emphasis, and the application of evidence-based 
compensatory cognitive strategies. Effectively disseminated, the outputs would align with 
system priorities: the need to reduce rehospitalization rates, the need for resource-lean 
approaches, and the need to generate evidence for peer support. Peer supports are increasingly 
emphasized as an important resource in mental health care10 and this intervention plays well to 
the skill sets of peers. 
 

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Version #8:  15 August 2018 
 
 
 
Context and need: 
Of the major mental illnesses, which are responsible for 3.8% of hospital admissions in 
Canada2, schizophrenia is the most costly11. Generating effective services for this condition has 
been a persistent challenge hampered by its complexity – requiring, for most, combinations of 
 
psychosocial and pharmacological interventions that are difficult to access and have modest 
effectiveness12. In considering complex needs in resource challenged systems, leverage is 
important. Discharge from hospital is a point of systemic leverage, and the authors of the 
proposed study having designed a brief intervention for this period tailored to the unique needs 
of individuals with schizophrenia. This work is timely not only in that it addresses a clear gap in 
the practice literature, but also in its addressing priorities of the Mental Health Strategy for 
Canada10, including the need to create better means of bridging care from hospital to community 
and the use of peer supports. Peer support involves individuals with lived experience of mental 
illness engaging clients in relationships and activities to support recovery that are grounded in 
empathy and shared experience. 
 
Background: 
In a recent systematic review, Vigod and colleagues6 identified 15 studies in this area. 
Interventions varied markedly, with components including pre-discharge activities (e.g., 
psychoeducation), post-discharge activities (e.g., phone follow-up), and bridging activities (e.g., 
transition manager meets outpatient clinician). The authors concluded that these interventions, 
regardless of type, were associated with service process and outcome improvements, with 7 
studies demonstrating a positive effect on re-admission rates (13.6-37.0% reduction). Peer 
support is a promising approach in this area. Peers, to a greater extent than professionals, 
focus upon what clients perceive as the main challenges (marginalization, poverty, stigma) that 
attend discharge13. Integrating peer supports into the discharge process with up to a year of 
follow up has been associated with improvements in social aspects of quality of life and lower 
emergency service use7  and up to 3 months of a peer-facilitated group follow-up has been 
associated with a 50% reduction in readmission rates8. 
 
Preliminary work: 
This proposal builds upon the emerging evidence in this area. The authors have already 
demonstrated the feasibility of a brief peer-facilitated transitional intervention that uniquely 
targets the most critical period post-discharge. Initial study of the intervention demonstrated 
its ready uptake in clinical service, associations with improved community functioning, 
engagement, and quality of life, and a trend towards lower readmission at 6 months post- 
discharge9. The authors have also developed a training model for building capacity in the use of 
this approach. 
 
Anticipated contributions: 
A critical next step in this line of investigation is to prove effectiveness and optimize 
efficiency. The proposed research would accomplish this objective and, if successful, make a 
compelling case for services to adopt this approach. The deliverable would be a manualized, 
clearly articulated peer intervention and clear guidance for implementation. It would be 
disseminated internationally through the established networks of the investigators and help 
address the critical, systemic disruption of service that attends discharge from hospital and its 

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substantial impacts from individual to economic levels.  
 
Methods 
 
1. What is the proposed trial design? 
This study will focus on two objectives. First, it will provide data about the effectiveness of the 
Welcome Basket (WB) intervention, which has demonstrated feasibility and is associated with 
positive outcomes9. In the proposed trial, we hypothesize that the WB will be proven effective as 
compared with treatment as usual (TAU) in service use and clinical domains. Baseline measures 
will be completed in the week prior to discharge, at 4 weeks post discharge to assess short-term 
impact, and at 6 months post-discharge to assess sustainment of gains. Assignment for this single 
blind trial will be random. 
 
Figure 1 – Trial Diagram, Measure Summary, Study Timeframe 
 
 
 
 
 
 
 
 
 
 
 
 
 
Measures: 
 
Community Functioning (primary)  
 
 
 
Hospitalization 
 
 
 
 
Quality of Life  
 
 
 
Community Involvement 
Symptomatology 
Recovery Process Engagement 
 
Along with the intended outputs of the Welcome Basket (WB) Trial were a clinical outcome 
paper and a process paper on WB implementation. During initial meetings for the process paper, 
we have discussed that it is necessary to interview the peer support workers on the trial in order 
to get an in depth understanding of how peer support is implemented. The process paper will 
illustrate how peer support workers implement peer support at an individual level as well as the 
successes and barriers that occur for peer workers at both the individual and system levels. This 
understanding will allow for recommendations to be made as to how peer support work can be 
done successfully and how to best troubleshoot challenges that may arise during 
WBbrief 
N = 25 
TAU 
 
Recruit 
                           
  Baseline                  Post                                     6mos Follow Up 
TAU 
N = 50 
TAU 
 
WB 
N = 50 
TAU 
 

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implementation. 
 
Study Timeframe 
 
 
 
Activity                                Months:  
0             6  
12  
18  
24  
30  
36  
Staffing/Setup  
>>  
Recruitment (6/month)  
    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 
Intervention 
 
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
>>  
Measures  
     >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>  
 
Data Analysis  
  >>>>  
           >>>>  
Knowledge Exchange  
>>>>>>>>>  
 
 
2. What are the planned trial interventions 
 
Experimental Interventions 
 
1. Welcome Basket Intervention: The Welcome Basket (WB) intervention is based in part upon 
the original model established in New Haven, Connecticut in 19968. However, this version of the 
WB differs from the original in its brevity (original involved several months of follow up), use of 
1-1 outreach (as opposed to group meetings), and employment of compensatory interventions. In 
the proposed study, Peer Support Workers (PSWs) hold 1-2 initial meetings with clients 
(typically 30-60 minutes) in the 2-week period before they are discharged from hospital. In these 
meetings they will describe the program and undertake an assessment of the individual’s needs 
and interests as they pertain to their transition to the community. From this assessment the two 
core components of the intervention are initiated. First, a “welcome basket” is created based 
upon the assessment, containing staple supplies, plants, coupons for stores nearby the client’s 
residence, and comfort items within a modest budget (for the purposes of this study the budget 
will be up to $40/basket). The PSW also forms a plan with the client about tours of their 
neighbourhood to familiarize them with the local resources (e.g., low cost entertainment venues; 
libraries; parks; inclusive spaces) and support them as needed in building confidence in accessing 
their local communities. These activities will take place through weekly visits 
(typically 2 hours/visit) in the 4 weeks immediately following discharge. WB will be provided in 
combination with core Cognitive Adaptation Training (CAT) compensatory interventions14. 
These include the setting up and placement of a calendar, lists of daily activities, signs that 
prompt recall of tasks, basic organization of living space, and the use of alarms and reminders 
(CAT supply budget of $25). These supports are important (and often overlooked) in many 
clients’ efforts to establish self-sufficiency after many weeks and months in hospital where staff 
typically initiate and structure the majority of activities.  
  
In our recently completed mixed methods study of process and outcome indicators for 23 

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participants who received the WB, we observed staff and client qualitative reports of successful 
implementation and outcome. We also observed significant quantitative changes in community 
functioning (ES = 0.64), domains of quality of life (ES = .38 – 1.28), psychological community 
integration (ES = .51) and a trend of lower rehospitalization at 6 months post-discharge as 
compared with average readmission rates on referring units. 
2. Welcome Basket (Brief) Intervention: The brief version of the Welcome Basket (WBbr) was 
developed based upon the observation in feasibility testing that for some participants much of the 
benefit of this approach appeared to be centred upon the visits immediately prior and subsequent 
to discharge. In the WBbr the same core components will be present, albeit in an abbreviated form 
with one 30-60 minute visit in the week prior to discharge and a single, 3-hour visit in the week 
subsequent to discharge in which the welcome basket would be delivered, core CAT strategies 
discussed and implemented, and some basic orientation to community resources undertaken. This 
brief version of the intervention has not to date been studied. 
 
Treatment As Usual 
 
Treatment as usual (TAU) involves the typical discharge procedures for clients from Unit 2, 
Forensic and EPU wards at CAMH. It includes referral to outpatient psychiatric services and 
relevant community supports with the transition facilitated by inpatient social work staff. 
 
Controlling for Case Management 
 
It will be a requirement that all clients enrolled in the study are engaged in some form of 
community-based case management along with medical follow-up. This strategy will assist in 
controlling for outcome variance impacted by conditions other than the intervention being 
studied. 
 
Peer Support Worker Training and Clinical Context 
 
Inpatient and outpatient clinicians and administrators are familiar with the intervention and 
regarded it positively from feasibility testing through to its current, ongoing delivery. There are 
currently 5 Peer Support Workers on staff who are extensively trained in the WB intervention. 
They were initially trained by Mr. Richard Weingarten who developed the original WB 
intervention in New Haven and were trained in compensatory intervention by CAT specialists in 
collaboration with Drs. Velligan and Maples. 
 
Participant Allocation and Blinding 
 
For the trial, blocked randomization at a 2:2:1 ratio (TAU:WB:WBbr) will be employed to ensure 
balance in sample size between treatment and control groups. Stratification will not be employed 
as feasibility study findings did not suggest significant variance attributable to demographic or 
treatment history factors. Study measures will be collected by research assistants blinded to the 
treatment condition. 
 
3. What are the planned inclusion/exclusion criteria? 
 
1.   Participants will be adults, 18 years of age or older, with a chart diagnosis of a 
schizophrenia spectrum mental illness or bipolar disorder with psychotic features confirmed 
by Module B (psychotic symptoms) of the Structured Clinical Interview for DSM-5 (SCID-

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5)15. All participants will be on CAMH inpatient units at the time of recruitment and will 
have been in inpatient care for close to or more than 2 weeks. This timeframe is guided by 
the rationale and experience indicating that an overly brief period of hospitalization 
circumscribes the relevance of the intervention.  
2.   Participants will be returning to places of residence in the Greater Toronto Area (catchment 
of CAMH). 
3.   Participants must have been referred to outpatient case management. 
4.   Proposed housing arrangements must be stable and conducive to the intervention. If 
homelessness or emergency shelter residence appears likely, or boarding home policy 
precludes any external staff from entering the premises, such individuals will be excluded. 
5.   Proficiency in English. 
 
 
4. What are the proposed primary and secondary outcome measures and qualitative 
feedback? 
 
Primary Measure: Community Functioning will be assessed with the Multnomah 
Community Ability Scale (MCAS)16, a 17-item scale assessing domains of functionality 
including health, adjustment to living, social competence, and behavioral problems 
(completed at all time points). This measure best reflects the primary aim of this 
intervention: to support a greater degree of illness self-management, independence, and 
level of community activity. The MCAS will be scored based upon interviews with 
participants primary clinician (inpatient for baseline and case managers for post and 
follow up measures). 
 
Secondary Measures (All inventories have established psychometrics with this 
population.) 
 
1.   Hospitalization as assessed at 4 weeks and 6 months post-discharge (number of 
rehospitalizations and lengths of stay captured through case manager report and 
verified through hospital electronic database if a CAMH hospitalization). 
2.   Quality of Life (QoL) will be assessed with the Satisfaction With Life scale 
(SWLS)17, an 18- item scale that has subscales assessing living situation, social 
relationships, work, self and present life. SWLS will be assessed post intervention and 
at follow up (would not be valid during inpatient stay due to contextual confounds 
with items). QoL will also be assessed using the Social Support Survey18, a 19 item 
scale that measures emotional/information support, tangible support, affectionate 
support and positive social interaction (all time points)  
3.   Symptomatology will be measured using the 53 item Brief Symptom Inventory19 (all 
time points) and the 23 item GAIN Short Screener (GAIN-SS)20 (all time points). 
4.   Recovery Process Engagement will be measured with the brief, 10-item version of the 
Personal Recovery Outcome Measure21 (all time points). 
5.   Community Involvement will be assessed with the 11 item Community Integration 
Scale which was developed for the At Home study with a comparable population to 
assesses psychological and behavioural community engagement22.  Community 
Involvement will also be assessed with the Social Functioning Scale23. Community 
Involvement will be assessed post intervention and at follow up (would not be valid 

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during inpatient stay due to contextual confounds with items).  
6.   Descriptive Measures include core demographics (gender, ethnicity, sexual 
orientation, age, education, etc.; assessed at time 1) and service use history (history of 
hospitalization, physical and mental health service use, community services; assessed 
at baseline and updated at each contact). Amount of contact in hours/month with a 
person or persons (other than providers; e.g., family) regarded as an important 
supports by participants will be captured. This will help in determining if non-service 
supports are a relevant covariate in considering outcomes. 
 
Qualitative interviews: The current peer support workers involved with the Welcome 
Basket study will be asked to participate in an open-ended interview that will ask how 
they engage in peer support work with clients as well as successes and challenges that 
occur at both the individual and system level. After obtaining consent, the graduate 
research assistant will conduct a 1-hour interview with the peer worker (see Appendix 
2).  
 
5. What is the proposed sample size and analysis strategy? 
 
The primary objective of this trial is to test a difference between the full WB intervention and the 
control condition with an alpha level of 0.05 and a power of 80%. An additional pilot study of 
the WB brief intervention is proposed with an approximate 0.05 alpha level, at 50% power. While 
multiple testing has not been corrected for, the intention is not to power this trial to detect these 
differences but rather to gather the necessary preliminary data on the average effect and variance 
of response in the brief intervention group to determine whether further testing is indicated and 
sufficient data to allow for power calculations for a follow-up trial. The target sample is thus 125 
participants with a 2:2:1 randomization ratio of TAU to full WB to WB brief. Accounting for an 
estimated 13% attrition rate (observed in the feasibility study) this sample size would result in 44 
completers/group for the main intervention and control groups and 22 completers in the brief 
intervention group. Based on MCAS means and the pooled standard deviation observed in the 
feasibility study (assuming no beneficial change in MCAS in the control group), and using a 
superiority trial power calculation24, this sample size will allow for the detection of medium effect 
sizes at 80% power. 
 
The data analysis strategy is as follows: (1) We will examine treatment and control groups at 
baseline on demographic variables and flag any clinically significant differences that might 
confound outcomes. (2) We will develop a descriptive profile of session attendance. We will 
consider the participant as having been exposed to the intervention if they have attended at least 
50% of sessions. (3) We will compare the full WB intervention group and the control group on 
changes in hospitalization, community involvement, community functioning, quality of life, and 
symptomatology from baseline to week 4 post discharge. Analysis of variance (ANCOVA) will 
be used for this comparison with the above variables being the dependent measures and treatment 
group being the independent variable controlling for MCAS scores at baseline. (4) Differences 
over time in these variables from baseline, to 4 week and 6 month follow up measures will be 

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analyzed using mixed-effects linear modeling. For these analyses, a time effect will reflect 
changes across groups over time, and the group-by-time interaction will reflect changes over 
time between the groups. For all analyses  p < .05 will be used as the level of 
significance with Cohen's d effect sizes reported. A blinded interim analysis will be conducted to 
determine if the sampling estimation needs to be revised. Plotting, mean and variance estimates 
will be calculated using the data from the WB brief treatment arm and compared with the control 
and full treatment. 
 
All interviews will be recorded and transcribed by the graduate research assistant and 
undergraduate volunteers. Two independent researchers will code the transcripts using thematic 
content analysis25, in order to analyze common themes that occur within the data. The PI will 
resolve any discrepancies that occur within the qualitative analysis. The themes will be brought 
back and discussed with the peer workers and WB team. Any other comments or themes that 
arise from this discussion will be documented using field notes26. 
6. Data Management and Integrity 
 
The basic protection against risk in this study will be provided by Dr. Sean Kidd (study PI). The 
PI will have primary responsibility for monitoring of participants during the entire time they 
participate in the study. The PI will meet regularly with study personnel to review accrued data, 
data confidentiality, and adherence to protocol design, recruitment, and participant complaints. 
During meetings the Study PI will also review the enrollment data, the accrual and integrity of 
clinical data, and any adverse event associated with the various components of the study. If a 
serious adverse event occurs during the study, it will be reported to REB. 
 
All data pertaining to a participant’s involvement in this study will be coded and stored in locked 
offices. This information will only be accessible to the research team. In unusual cases, a 
participant’s research records may be released in response to a court order. If the research team 
learns that a participant or someone with whom the participant is involved with is in serious 
danger or harm, an investigator will inform the appropriate agencies as per legal or regulatory 
requirements. 
 
The hard data are stored in a locked filing cabinet stored in a locked office to further protect 
participant anonymity. Data auditing, entry and quality control will be carried out at regularly. 
Regularly scheduled, and as needed, communications between the study team and the Study PI 
will clarify any inconsistencies and ambiguities in the data. 
 
Study data will be entered in a secure database (REDCap). At point-of-entry, data values will 
undergo consistency edits (e.g., ID validation, range verification, duplicate detection) and 
personnel will be required to correct errors. Data management staff will run logic error programs 
to check for accuracy and irregularities within and across data structures and within and across 
sites. Quality assurance checks will be conducted daily and weekly by site personnel, as well as 

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by data management staff. 
 
7. Recruitment, Consent, Risk and Risk Mitigation 
 
The estimated rate of 5-6 individuals screened into the study per month is feasible based upon the 
previous study and is readily accommodated in a large service of over 150 beds relevant to study 
recruitment. Participants would be referred to the study by inpatient unit staff – primarily Social 
Workers engaged in discharge planning who will be oriented to the study. Specifically, inpatient 
clients meeting eligibility criteria who are expected to be discharged in 1-2 weeks and deemed 
capable of providing consent or have a substitute decision maker (SDM)who can provide consent 
to participate in the study will be approached by inpatient staff, the project briefly described to 
them, and their permission sought to be approached by research staff (see script). The treating 
physician/clinical care team will not obtain consent. 
 
A physician investigator or trained research personnel will obtain informed consent from the 
participant or SDM. Participants and SDMs will be provided with a clear explanation of the 
objectives, procedures, risks and benefits of the study and all questions will be answered. 
Questions will be asked of subjects to ensure that they understand the nature of the research, the 
risks and potential benefits of study participation, and their rights as research subjects prior to 
obtaining their signature on the informed consent document. Because we believe that consent is an 
ongoing process in any study, we will continue to educate subjects about the nature of the 
research and address any questions that may arise throughout the course of the study. In cases 
where SDM consent is required, as a first step the principal investigator will liaise with the 
Medically Responsible Person (MRP) and Case Manager (CM) to assess mental status and benefit 
of participation. 
 
Three conditions will be necessary for enrollment: 
1. At least one clinician (MRP and/or CM) provide documented agreement regarding the 
appropriateness of involvement in this study 
2. Documented participant assent 
3. Documented SDM consent 
 
If a participant does not assent and the substitute decision maker consents the participant will not 
be enrolled.  
Participants who are referred from the inpatient units to the Slaight Centre for Youth in Transition 
(SCFYT), will be recruited and pre-screened with the REB approved “pre-screen form” that is 
implemented across all Slaight studies. At SFCYT, case review meetings are conducted twice a 
week to review recruitment and to identify new patients who may be eligible for research studies. 
With their assent, research staff will then meet with potential participants, describe the study in 
detail, and obtain consent. With 60-70 discharges taking place across relevant wards every month, 

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we have a large pool of potential participants from whom to draw. 
 
Following provision of written informed consent, all participants will be assessed for suitability for 
inclusion in the study based on the inclusion and exclusion criteria. If it is deemed necessary, 
research staff may review participants’ CAMH medical charts to obtain additional information to 
confirm their eligibility or to obtain clinically relevant information for research purposes and the 
contact information of their case manager. The study team will also have access to the participant’s 
health records in order to document their participation in this study into their CAMH health record. 
The investigator or research staff may also request information from the participant’s physician 
and/or a member of their case management team after obtaining consent for release of personal 
health information to determine eligibility. 
 

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Ongoing experience with the delivery of this intervention over the past 3 years has resulted in both 
confidence that this study will not run into substantive challenges as well as knowledge of an array 
of problem mitigating strategies. Recruitment has at times slowed, though this has 
historically been addressed readily through meeting with managers who in turn encourage teams, 
engagement of the Social Work practice group, and presenting at team meetings. In this period 
there have been no adverse events in the delivery of this intervention, it has proven feasible, and 
outcomes associated with its delivery have been positive. 
Additionally,  as  part  of  the  CLEARR  (Clinical  Engagement  and  Research  Recruitment) 
initiative, a delegated Research Coordinator under the supervision of a CLEARR team recruiting 
clinician and accountable to the Research Manager will identify potential participants and notify the 
research team and the participant’s clinician about their eligibility to participate in the study. The 
clinician will then ask their client if they would be willing to meet with a study team member 
about participating. Only with clients’ agreement will they be approached. 
 
The delegated Research Coordinator will access personal health information (PHI) in I-CARE in 
order to determine eligibility of CAMH clients to participate in the research study. No PHI 
except MRN will be collected for this purpose and this information will be kept in a secure 
locked location per Research Standard Operating Procedures SOP# CR501. 
 
All clients will be given the option to participate. Participation in the study is voluntary. The 
decision to participate will not affect patients’ receipt of treatment or clinical services. Participants 
will be informed that they have the option of terminating their participation at any time, without 
consequence and that no new data will be collected on them. Any existing data will 
be anonymized. 
 
Recruitment of Peer Support Workers 
There are currently three peer support workers involved with the Welcome Basket study. All three 
workers will be asked to participate in the interview in order to best understand how peer support is 
employed within the WB study. Each peer support worker will need to provide fully informed 
consent.  
 
Termination of Study: 
Reasons for withdrawing individual participants from the study may include one or more of the 
following: 
 
a) Major protocol violation 
 
b) Participant lost to follow-up c) Withdrawal of consent 
Any participant may be discontinued from the study at the discretion of the investigators if this is 

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deemed to be in the best interest of the participant. The decision may be made either to protect 
the participant’s health and safety, or because it is part of the research plan that people who 
develop certain conditions may not continue to participate. 
 
Confidentiality 
 
There is a potential risk of breach of confidentiality that is inherent in all research protocols. Breach 
of confidentiality will be minimized by the staff who will maintain research data (identified only by 
participant code number not related to name, or date of birth) in separate charts and a dedicated 
password protected electronic database. A list of participant names, their ID numbers, and 
information about how they can be reached will be kept in a separate locked cabinet with access 
only to study personnel authorized by the PI. Procedures have been established, and will be 
followed, to minimize the risk of breach of confidentiality. Procedures to maintain confidentially 
include: (1) formal training sessions for all research staff emphasizing 
the importance of confidentiality; (2) specific procedures developed to protect participants’ 
confidentiality, and (3) formal mechanisms limiting access to information that can link data to 
individual participants. All information obtained from participants will be kept as confidential as 
possible. Computer based files/data will be entered into password-secured databases and paper- 
based files will be stored in a secure location. These data will only be accessible to personnel 
involved in the study and they will abide by confidentiality regulations of the REB. The ethics 
committee will be granted direct access to the study participants’ original medical records for 
verification of clinical trial procedures and/or data, without violating the confidentiality of the 
participants, to the extent permitted by the law and regulations. 
 
Research data gathered as part of this study may be shared and provided to other investigators 
affiliated with the Slaight Family Centre for Youth in Transition (SFCYT) at CAMH for the 
purpose of data sharing. If participants are enrolled in multiple studies, their research data will be 
shared across studies to reduce participant burden and avoid duplication of procedures. Only 
investigators/research team affiliated with SFCYT Centre will have access to secured files and/or 
research data and will be well-informed regarding the protection of participants’ rights to 
confidentiality. 
 
Furthermore, investigators collaborating with SFCYT Centre (or other secondary investigators) 
will have access to the research data collected during the study for the purposes conducting 
secondary analyses about mental illnesses, such as autism spectrum disorder, depressive disorders, 
psychotic disorders, bipolar disorders, anxiety disorders, sleep disorders, substance use disorders or 
dementia (e.g. Alzheimer’s disease). This data will be anonymized and not contain 
any PHI. 
 
Participants will not be identified by name in any publication of research results. Results will be 

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published as group data without the use of characteristics that would identify individual 
participants. 
 
8.  Knowledge Translation: An array of knowledge exchange activities will occur following the 
successful completion of this trial. They will include: (i) publication in a relevant academic journal 
of good impact, (ii) presentation in at least one national or international conference with a focus 
upon practitioner and administrator audiences, (iii) a webinar advertised internationally through 
research, practice and administration networks, (iv) over the course of the study delivering 1-2 full 
day trainings in the intervention for peers and administrators which itself will be evaluated and 
enhanced, becoming a core CAMH training offered in the future, (v) manualizing the intervention 
and making it freely available on a website dedicated to the intervention on the CAMH Portico site, 
and (vi) cultivating an online community of practice on the website. 
 
Data generated from qualitative interviews will be used to create a case study of the WB 
intervention that will address how peer support is implemented within a hospital setting, from the 
perspective of the key stakeholders. The information will highlight the successes and challenges 
that occur for peers as they engage in peer support work, addressing a substantial gap in the present 
literature. This case study will be submitted to an academic conference for a poster session as well 
as a manuscript for publication.

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References 
 
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Appendix 1 – Clinician Script 
 
I would like to tell you about a project that his happening called the welcome basket. Some 
researchers at CAMH are trying to figure out ways that people could transition or move from 
hospital to their home in the community with more success – in other words, trying to make it a 
smoother process and provide some resources. Getting involved would mean that you’d 
randomly receive one of three things – like in a coin toss. You would either receive: 
 
-A service led by a Peer Support Worker. A Peer Support Worker is a CAMH staff member who 
has experienced mental illness and works to support CAMH clients. They would provide you 
with basic supplies you might need when you get home in a “welcome basket”, and they would 
then meet with you once before you leave hospital and once week for a month after you leave. In 
that time they would get you supplies that you might need to help keep your home organized and 
help with things like calendars and reminders that could help you with getting started with your 
goals. They would also, if you were interested, take you out to places in your community such as 
events, coffee shops, and restaurants to help you connect or reconnect with your neighborhood. 
 
-A service that would be the same as the one that I just described, except it would involve just 
two visits – once before you leave hospital and once shortly after you are discharged from 
hospital. 
 
-Or, you’d leave hospital as you normally would without these supports – the same as originally 
planned. 
 
The overall point of the project is to see if we can help people transition to the community more 
smoothly – becoming connected with community, making sure they have some basic necessities 
for the move, and being given tools to help address the impacts that psychosis can have in areas 
such as attention and memory. 
 
This is being researched. That would mean before it started and at the end you would complete 
some surveys about how you are doing. You’d get paid for those meetings. 
 
You don’t need to take part in this. Saying ‘no’ is fine – it won’t affect any of the services you 
get here. If you are interested, though, I would put you in touch with a project coordinator who 
would tell you more about it. What do you think? 

Version #8:  15 August 2018 
 
 
 
Appendix 2 
Welcome Basket Peer Support 
1. 
During your first meetings with a WB client, what do you typically focus on? 
2. 
What is the usual progression of the content throughout the WB intervention? (i.e., from 
session 1-4)  
3. 
What do you perceive is your role in the intervention? 
4. 
What do you perceive is the client’s role in the intervention? 
5. 
What do you hope to achieve when you are working with WB clients?  
6. 
How does the WB intervention create or sustain changes in clients? Probe: challenges, 
barriers. 
7. 
What is the role of the person’s context in the intervention and how does that affect the 
effectiveness of the intervention? (e.g., gender, ethnicity, housing, etc.) 
8. 
What are some challenges that occur when you are working with WB clients? 
9. 
How have you resolved these challenges? 
 
Role as a Peer Support Worker in WB 
10. 
How has being in the WB program affected your position as a peer support worker? 
11. 
What are the strengths/challenges of working within a research and RCT format? 
12. 
How is the WB different from other peer support interventions you have been involved 
with?  
13. 
What are the strengths/ weaknesses of the WB? 
14. 
What system level barriers have you run into as a peer worker while working on the WB 
project? 
15. 
How have you resolved these challenges? 
 
Implementation of WB 
16. 
How do you carry out the logistics of the WB (e.g., money, travel, etc.) 
17. 
How do you create connections with inpatient/outpatient teams in order to carry out the 
intervention successfully? 
18. 
How have issues with power within the team/hospital been handled? 
19. 
How is peer support within the hospital context different than community? 
20. 
What implementation barriers have you run into while working on the WB project? 
21. 
How have you resolved these challenges? 
22. 
Where do you think peer support is going?  
23. 
Are there any other considerations that need to happen? How would you do this differently? 
 
 
 
 
 
 
 
 
 

Version #8:  15 August 2018 
 
 
 
 
Budget 
 
Budget Justification (Total $259,598 – 3 years) 
Personnel (Subtotal: 226,229) 
Staff will include (i) one 1.0 FTE research assistant who will manage data, communications, and 
collect data (135,581; 3 years – includes 30% benefits), (ii) two 0.5 FTE Peer Support Workers to 
deliver the intervention, with both providing 50% of both brief and full versions of the WB to 
offset clinician effects(one at 69,167 in grant and one at 69,167 in-kind (core funded, CAMH), 2 
years to allow for preparation, delivery, and wind down along with capacity building/KTE), and 
(iii) 4k for 35 hours of statistical consulting at $120/hour (Biostatistician). Peer Supports will 
carry caseloads of 4-6 participants each. Along with outreach travel, supply purchase, 
documentation, and assistance with recruitment (e.g., orienting teams, connecting with social 
workers) this workload aligns with our past experience with the intervention. 
 
(Research Analyst 2, step 2, (Y1 29.27 + 30% bens 8.78 = 38.05 (.8fte, 10mos 45,660); Y2 29.71 
+ 30% bens 8.91  = 38.62 (.8fte 55,613); Y3 30.16 + 30% bens 9.05 = 39.21 (.8fte – minus 1 
month, 51,789) 
Peer Support Worker (Y1 27.08 + 30% bens 8.12 = 35.20, total 68,640; Y2 27.49 + 30% bens 
8.25 = 35.74, total 69,693) 
 
Trainees (Subtotal: 18,604) 
One graduate student trainee will be engaged for 2.5 years of the project (7 hours/week; 
19.38/hour – includes 13% benefits; 18,604 total) who will assist with data entry and 
management, data collection, and work closely with the PI and the Research Assistant. 
Deliverables for the graduate student will be 1 poster for which they will be first author and 
authorship on the core peer-reviewed publication. 
 
Consumables (Subtotal: 10,265) 
At $65/participant for WB intervention supplies, the total cost will be $8,625. Participants will 
be reimbursed $25/assessment (3 assessments/participant, 110 completers and 15 drop outs, total 
is $4,250). A total of $500 requested for general materials (printing, files, encrypted memory 
stick). A total of $1,140 is requested for transit tokens for outreach by Peers (estimated 350 
trips/$3.25/trip). 
 
Knowledge Translation (Subtotal: 4,500) 
We are requesting $2500 to fund the open access publication of the main paper to come out of 
the study. We are requesting $2000 to cover the costs of the PI presenting the findings at an 
appropriate national or international meeting (estimated $500 flight, $50 per diem for 3 days, 
$250/night hotel, $200 taxi, $500 meeting registration).