Abstract: A Randomized Controlled Trial of the “Bridge” Peer Health Navigator Intervention (Society for Social Work and Research 21st Annual Conference - Ensure Healthy Development for all Youth)

Schedule:

Friday, January 13, 2017: 9:45 AM

Preservation Hall Studio 9 (New Orleans Marriott)

* noted as presenting author

Erin L. Kelly, PhD, Research Associate, University of Southern California, Los Angeles, CA

John S. Brekke, PhD, Frances Larson Professor of Social Work Research; Fellow, American Academy of Social Work and Social Welfare, University of Southern California, Los Angeles, CA

Lei Duan, PhD, Biostatistician, University of Southern California, Los Angeles, CA

Helen Kiger, RN, Adjunct Professor, University of California, Los Angeles, Los Angeles, CA

Heather Cohen, MA, Project Manager, University of Southern California, Los Angeles, CA

Laura Pancake, LCSW, Corporate Director of Employment Services, Pacific Clinics, Arcadia, CA

Background and Purpose. The physical health of individuals with serious mental illnesses is severely compromised. There is consistent evidence that individuals with a serious mental illness are dying on average over 15 years before their non-mentally ill peers. This early mortality is largely due to preventable and treatable physical health conditions in this population.

The “Bridge” is a comprehensive, healthcare engagement and self-management intervention which teaches participants the skills to improve healthcare access and use. The intervention lasts approximately 6 months and is delivered by trained mental health peers. It is manualized and uses motivational interviewing, behavioral strategies, and psychoeducation to activate and engage participants in their health and healthcare. The intervention is delivered largely in vivo in community settings where physical health services are received.

Methods. Participants were recruited from a large community mental health agency in southern California that did not provide on-site primary health care. 151 consumers with serious mental illness were randomized to receive either usual mental health care plus the Bridge intervention (n =76) or usual mental health care while on a 6 month waitlist (n = 75). The waitlist group received the intervention after the six month waitlist period. The mean age of the sample was 46.9 with gender being roughly equal (54% female). The race/ethnicity was Hispanic/Latino (60%), followed by Caucasian (25%), African American (8%) and other/mixed race (8%).

Data were collected in 3 waves with 6 month intervals between assessments. Change score comparisons were conducted for baseline (pre-treatment) to 6 months (post-treatment) for the treated versus usual care groups. Outcomes included the detection of chronic diseases, pain, use of routine health care, use of emergency services, preferred locus of health care, quality of the consumer-physician relationship, attitudes about healthcare self-management and self-management behaviors. 123 subjects participated in the six-month post-treatment assessment, an 18.5% attrition rate, which was less than expected.

Results. Fidelity assessments were done by trained raters using interview, role play, and electronic case records. Fidelity ratings indicated the intervention was delivered as designed. In terms of outcomes, change score comparisons (difference of differences) of the treatment vs the waitlist groups revealed that the treated group showed significantly greater improvement in access and use of primary care health services, higher quality of the consumer-physician relationship, decreased preference for emergency, urgent care, or avoiding health services and increased preference for primary care clinics, improved detection of chronic health conditions, reductions in pain, and increased confidence in consumer self-management of healthcare.

The gains from the intervention were maintained for six months post-intervention. There were two indicators of further improvement as the immediate intervention group reported significantly fewer emergency room/urgent care visits and significantly more behavioral self-management at the 6 month post-treatment assessment. When the intervention effects were combined for the two groups (immediate treatment and waitlist) there were statistically significant improvements on all of the main outcomes.

Conclusions. The “Bridge” intervention is a promising peer-delivered intervention to address the physical health and health care needs of individuals with serious mental illnesses.