Implementing Peers in Newly Integrated Health Settings

Background: Many studies support that peer providers are equally or more effective than non-peers in providing mental health services.  Peers also play critical roles in the implementation of integrated health care teams under health care reform, including health navigation, wellness coaching, and facilitating chronic disease self management groups. While evidence is accumulating that peers are critical members of integrated teams, little is known about their specific roles or the factors that facilitate their successful implementation.   The purpose of this presentation is to describe the roles of peers within newly implemented integrated health care programs designed to serve the physical health care needs of adults with mental health and co-occurring physical heath conditions.  These programs have been implemented within the Los Angeles Department of Mental Health as the final project of the Mental Health Services Act.

Methods: Full day on-site program visits were conducted at 24 integrated pilot programs by teams of implementation monitors during the summer of 2013.  Implementation of newly integrated care programs was evaluated using the Integrated Treatment (IT) Tool.   Data for this presentation were derived from IT Tool questions specifically addressing the role of peers.  Data sources included in-depth semi-structured interviews with program staff, clinic observation, and chart review. Following site visits, evaluators independently scored and provided rationale for each of the 30 items contained within the IT-Tool. A final program report reflected group consensus.

Results: Programs that implemented peers fit within 1 of 3 possible models that include: Integrated clinic model (n=3); Integrated Assertive Community Treatment (n=5); and models designed to build on the specific strengths of underserved ethnic communities (n=7). Integrated programs utilized different criteria that individuals must meet to be eligible for the role of peer, and the roles of peers varied substantially by program type. Peers on ACT teams played central roles in treatment planning and benefits coordination in collaboration with other team members.  Peers in co-located settings had received training in evidence-based practices such as Wellness Recovery Action Planning.  Culturally specific programs had varying definitions of what constituted a peer, and included individuals who shared a cultural and linguistic background with their clients, independent of a psychiatric diagnosis.  Nine of 24 integrated programs had not implemented peers at the time of evaluation.  Many non-implementing sites shared the sentiment that peers would not be appropriate additions for their staff given the high co-occurrence of addictions in their consumer population, though many also aspired to include peer support in the future. 

Discussion: Peers can provide valuable supports to clients receiving health care in integrated settings.  Questions emerged from this analysis regarding the definition of peer and the precise nature of their roles within newly integrated programs.  Additional research is needed to understand the depth of peer involvement in interdisciplinary health care teams.