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2023 HSR&D/QUERI National Conference Abstract

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1176 — PARTNER-MH: Peer-led navigation for minoritized Veterans receiving mental health services: A pilot study

Lead/Presenter: Johanne Eliacin,  COIN - Indianapolis
All Authors: Eliacin J (Richard L. Roudebush VA Medical Center, Women's Health Division, NCPTSD, Regenstrief Institute, Indiana University School of Medicine), Burgess, DJ (Minneapolis VA Healthcare System, University of Minnesota) Rollins, AL (Richard L. Roudebush VA Medical Center, Regenstrief Institute, Indiana University-Purdue University at Indianapolis) Patterson, S (Richard L. Roudebush VA Medical Center, Indiana University School of Medicine) Damush, T (Richard L. Roudebush VA Medical Center, Regenstrief Institute, Indiana University School of Medicine) Bair, MJ (Richard L. Roudebush VA Medical Center, Regenstrief Institute, Indiana University School of Medicine) O’Connor, C (Richard L. Roudebush VA Medical Center) Chinman, M (Center for Health Equity Research and Promotion, RAND) Slaven, JE (Indiana University School of Medicine) Matthias, MS (Richard L. Roudebush VA Medical Center, Regenstrief Institute, Indiana University School of Medicine)

Objectives:
Disparities in mental health treatment and outcomes are well-documented, with minoritized patients having less access to mental health services, lower satisfaction with treatment, and poorer outcomes compared to their White counterparts. This study’s goal was to test the feasibility and acceptability of PARTNER-MH, a mental health disparity intervention for minoritized Veterans in VHA outpatient mental health clinics. PARTNER-MH is a manualized, 6-month, peer-led intervention to engage racially and ethnically minoritized Veterans in mental health services, facilitate active engagement in care, and improve participation in shared decision-making with providers.

Methods:
Pilot randomized trial with waitlist-control. Participants were minoritized Veterans receiving VHA outpatient mental health services. Veterans were randomized to the intervention (n = 30) or control group (n = 20). Two peer specialists, employed by and embedded in the mental health clinic, delivered the intervention. Primary outcomes were feasibility of recruitment and study procedures and intervention acceptability. Secondarily, we assessed preliminary effects of PARTNER-MH on patient engagement, patient activation, shared decision-making (SDM), and health related-outcomes at baseline, 3, 6, and 9-months. We also conducted qualitative interviews with program completers to evaluate their experience with PARTNER-MH. Interviews were analyzed using thematic analysis.

Results:
Recruitment rate was 68%, enrollment rate was 91%, study retention rate was 72%, and intervention satisfaction was 89%. At the 6-month endpoint, patients in the PARTNER-MH arm showed statistically and clinically significant improvement relative to the control group on depression scores (-3.6 vs. 0.1, p = .0383) and patient self-reported mental health function (8.3 vs. -2.8, p = .0007). Improvements persisted at 9 months. There were no statistically significant differences between study arms on patient engagement, patient activation, or SDM. Patients’ qualitative interviews corroborate the quantitative findings, indicating high satisfaction with PARTNER-MH. To describe the impact of PARTNER-MH one participant explained: Around the time I started going, navigating through the mental health system at the VA, I was so angry. It was at the point where I wanted to hurt other people. In the last almost year, I’ve learned so much. I feel so much better. I give a lot of that credit to [peer] because he was that lifeline I needed in that moment. (Black female) Another participant described how PARTNER-MH supported his engagement in mental health treatment. You got to be engaged. I would say that’s probably the biggest thing I’ve learned …Before [PARTNER-MH], I was doing nothing. I didn’t make any kind of effort at all. After speaking with [peer], just knowing, it is my mental health, and I am responsible for it as well. (Black male)

Implications:
Overall, the PARTNER-MH intervention was feasible and acceptable. Immediate and sustained effects of PARTNER-MH on mental health highlight the promise of this intervention and the need for a full-scale evaluation.

Impacts:
Mental health conditions are common among Veterans and represent a significant social, economic, and public health burden, with wide-ranging impacts. Compared to non-minoritized Veterans, minoritized Veterans experience disproportionate unmet mental health needs. PARTNER-MH is an innovative intervention that could help address minoritized Veterans’ mental health needs and increase health equity in the VA.