Society for Social Work and Research

Sixteenth Annual Conference Research That Makes A Difference: Advancing Practice and Shaping Public Policy
11-15 January 2012 I Grand Hyatt Washington I Washington, DC

17024 A Bridge That Needed to Be Built; Examining the Benefits of An Intervention for Improving the Health of Individuals with Serious Mental Illness

Thursday, January 12, 2012: 4:30 PM
Latrobe (Grand Hyatt Washington)
* noted as presenting author
Rohini Pahwa, MA, MSW, PhD Candidate, Ph.D. Candidate, University of Southern California, Los Angeles, CA
Anthony Fulginiti, MSW, Ph.D. Student, University of Southern California, Los Angeles, CA
Louise Tallen, PhD, Project Manager, University of Southern California, Los Angeles, CA
Melvin Jones, Health Navigator, Pacific Clinics, Los Angeles, CA
John S. Brekke, PhD, Frances Larson Professor of Social Work Research, Associate Dean of Research, University of Southern California, Los Angeles, CA
Background: There is increasing evidence that the physical health of the severely mentally ill (SMI) in the United States is seriously compromised. Recent reports have found that individuals with SMI die, on average, 25 years earlier than the general population, predominantly due to treatable medical conditions. Despite the obvious need to integrate health and mental health services, few programs are pursuing integration. A promising service option is the use of peer providers to facilitate linkage between health and mental health services.

Purpose: The study aimed to pilot test the effectiveness of a peer health navigator intervention, the Bridge, designed for individuals with severe mental illness. The Bridge is a peer-staffed linkage model situated in a mental health clinic. It combines three approaches: integrated care, patient education, and skill building. Specifically, components of the intervention include assessment and planning (i.e. developing wellness goals), coordinated linkages (i.e. navigating consumers through healthcare system), consumer education (i.e. health and wellness issues) and the use of cognitive-behavioral strategies (i.e. modeling, successive approximation) to support health care utilization behavior change and behavior maintenance. Bridge aims to improve consumer health care utilization, health status, and efficacy related to accessing and utilizing health care services.

Methods: The study consisted of a small, randomized pilot test of the effectiveness of the Bridge health navigator intervention. Twenty-four consumers diagnosed with severe mental illness who were receiving mental health services at a mental health agency were randomized to either immediate navigation or to a wait-list condition with navigation beginning after 6 months. Within and between group analyses were conducted.

Proximal outcomes included self-reported measures of health status, satisfaction with health care, service utilization, and health care efficacy. Distal outcomes included measures of functional level, satisfaction with life, internal and external stigma.

Results: Significant differences in favor of the treatment group were found on several indicators of reported health status. Number of currently reported health problems was significantly lower in the treated compared to the untreated group (4.3 vs. 9.7; p < .005). Self-rated general health condition (from poor to excellent) was significantly higher in the treated group (p < .015). Self-reported health status on a scale from 0 (worst) to 100 (best) using the Euroqual scale was higher at a trend level in the treated group (X = 42 vs. 59). There were also significant differences in the amount of overall bodily pain (p<.05), and the pain that interfered with productive activity (p<.05) favoring the treated group.

Conclusions: Findings indicate the effectiveness of the Bridge intervention in reducing health problems, improving self-rated general health, and particularly reducing pain and impact of pain on activity. The Bridge successfully improved health behavior and outcomes in the context of a novel, peer navigation program that integrated health and mental health services. The Bridge intervention holds tremendous promise in terms of addressing and resolving the issue of health-related premature mortality, which disproportionately plagues individuals with serious mental illness. The bridge, in connecting the mental health and health care sectors, facilitates a fuller and healthier life.

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