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June 2, 2017 by Laysha Ostrow, PhD

Wealth of resources on peer respite at

Self-Evaluation Guidebook Just Released is a comprehensive online resource dedicated to dissemination and implementation efforts to help communities create effective, sustainable crisis alternatives through independent peer-run programs. Live & Learn, Inc created to provide a comprehensive online resource dedicated to dissemination and implementation efforts about peer respites, providing public access to information about research, technical assistance, and a program directory.

In May 2017, we launched the Guidebook for Peer Respite Self-Evaluation: Practical Steps and Tools to assist in building the evidence for peer respites.

Peer respites are safe alternatives to emergency services
Peer respites are voluntary, short-term, overnight programs that provide community-based, trauma-informed, and person-centered crisis support and prevention 24 hours per day in a homelike environment.1 For many individuals, hospital-based psychiatric emergency services are undesirable; forced medication, seclusion, restraint, and extended emergency department wait times, all of which can be traumatizing and counter-therapeutic, have been well documented.2-4 Crisis alternatives such as crisis stabilization and acute crisis residential programs have a well-documented evidence base for providing a safe alternative that can decrease the use of psychiatric emergency services.5

Peer respites are one such crisis alternative that is designed, managed, and staffed by people who have experienced extreme states or received behavioral health services, in order to build a resilient, supportive community going forward. This kind of managerial involvement and control in peer-run organizations is potentially influential in how an organization or program operates.6,7 To-date, a modest literature documents peer respites’ impact on quality of life, social connectedness, and reducing psychiatric emergency service use.8,9

Live & Learn, Inc’s best practice resources
Our 2016 Peer Respite Essential Features (PREF) survey of 22 U.S. peer respites showed that all but four programs conducted some type of evaluation. Through our consulting and research, we have found that programs, governments, and advocates would benefit from guidance on concrete, actionable recommendations on “best practices” in self-evaluation or other low-cost/low-resource approaches.

The Guidebook for Peer Respite Self-Evaluation can be used by peer respite program staff, managers, and administrators to document program operations and outcomes. The Guidebook includes recommendations on best practices in self-evaluation and data monitoring based on techniques used by other peer respites and in the world of program evaluation. It provides basic, practical guidance on developing a logic model, identifying outcomes, selecting measures/ indicators, collecting and analyzing data, and reporting findings.

The Guidebook was designed to be flexible to changes in the field and in the programs. We advocate for a shared framework because consistency in measurement across peer respites helps build stronger evidence for their real-world effectiveness. The rapid evolution of this innovative model suggests a need for more research on fidelity and effectiveness in promoting stronger communities while reducing psychiatric emergency service use. As peer respites continue to grow, it is important to document organizational policies and structures.

Within the first week of going live, the Guidebook for Peer Respite Self-Evaluation garnered 500 unique users from 20 countries, with average visits of more than 3 minutes, mirroring the initial launch of in January 2016, when the online resource had more than 2,000 unique visitors in its first 2 months. There is demonstrated need for information about peer respites – and other forms of peer supported crisis diversion – in the U.S. and beyond. It is important to note that many of the guidance provided in the Guidebook can be used for other peer support program evaluations beyond peer respites.

As the site is as of yet unfunded, visitor donations to support basic maintenance and updates to this valuable community service. Our hope is that providing access to organized, reliable, cutting-edge resources via could lead to improved implementation in local areas, and impact the ability of communities to innovate their service array and use research evidence in health system design. Long-term, we hope that will contribute to reduced psychiatric emergency services use, improved recovery outcomes, and community dialogue about prevention and psychiatric intervention.

Contact for more information: Laysha Ostrow, PhD CEO of Live & Learn, Inc. at



  1. Ostrow L, Croft B. Peer respites: a research and practice agenda. Psychiatr Serv. 2015;66(6):638-340.

  2. Madan A, Borckardt JJ, Grubaugh AL, et al. Efforts to reduce seclusion and restraint use in a state psychiatric hospital: a ten-year perspective. Psychiatr Serv. 2014;65(10):1273-1276.

  3. Frueh BC, Knapp RG, Cusack KJ, et al. Special section on seclusion and restraint: patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatr Serv. 2005;56(9):1123-1133.
  4. Donat DC. Special section on seclusion and restraint: encouraging alternatives to seclusion, restraint, and reliance on PRN drugs in a public psychiatric hospital. Psychiatr Serv. 2005;56(9):1105-1108.
  5. Thomas KA, Rickwood D. Clinical and cost-effectiveness of acute and subacute residential mental health services: a systematic review. Psychiatr Serv. 2013;64(11):1140-1149

  6. Ostrow L, Hayes SL. Leadership and characteristics of nonprofit mental health peer-run organizations nationwide. Psychiatr Serv. 2015;66(4):421-425.

  7. Segal SP, Silverman C, Temkin TL. Are all consumer-operated programs empowering self-help agencies? Soc Work Ment Health. 2013;11(1):1-15.
  8. Croft, B., & İsvan, N. (2015). Impact of the 2nd Story Peer Respite Program on Use of Inpatient and Emergency Services. Psychiatric Services, 66(6), 632-637. doi: doi:10.1176/

  9. Greenfield TK, Stoneking BC, Humphreys K, Sundby E, Bond J. A randomized trial of a mental health consumer-managed alternative to civil commitment for acute psychiatric crisis. Am J Community Psychol. 2008;42(1):135-144.


Founder & CEO of Live & Learn, Inc.

My research addresses how behavioral health systems implement effective policies, financing mechanisms, and service delivery practices that integrate the perspective of people who use or have used mental health services. I have particular expertise in the role of peer support in social service systems.

I hold a PhD from the Johns Hopkins School of Public Health and a Master of Public Policy from the Heller School for Social Policy and Management at Brandeis University. I completed a Postdoctoral Research Fellowship in the Department of Psychiatry at UCSF. I maintain a position as a Visiting Professional at UCLA’s Luskin School of Public Affairs.

In addition to community forums, I have been an invited speaker at events such as the Carter Center Symposium, the Kennedy Forum on Mental Health, the U.S. Senate HELP Committee’s roundtable to reauthorize the Higher Education Act, and the California Health Facilities Financing Authority. In 2016, I was the recipient of the 2016 Carol T. Mowbray Early Career Research Award from the Psychiatric Rehabilitation Association.

As a person who experienced mental health systems that are often ineffective at promoting recovery and community inclusion, I am passionate about improving these systems through research that advances the use of evidence-based practices in real-world settings.


2 thoughts on “Wealth of resources on peer respite at

  1. I value non-hospital alternatives; still I find the way the word “peer” is used in the US problematic. A “peer” is defined as someone who is “other” — a person with the kind of problem that requires lifetime meds dependency, deserves employment discrimination, is appropriately called out when renewing auto registration, and so forth. I appreciate the model pioneered in London’s Maytree Centre, where respite volunteers are generally “normals” and help to normalize the experience of emotional distress in the face of traumatic circumstance.

    1. Laysha Ostrow says:

      Thanks for your comment Carlene.

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