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2023 HSR&D/QUERI National Conference Abstract

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4060 — When does a Peer Specialist help? The effect of dose on psychosocial and psychiatric factors for dual diagnosed, recently housed Veterans

Lead/Presenter: Matthew Chinman,  COIN - Pittsburgh/Philadelphia
All Authors: Chinman MJ ((Center for Health Equity Research and Promotion, Pittsburgh)), McCarthy S (Center for Health Equity Research and Promotion, Pittsburgh) Bachrach R (Center for Health Equity Research and Promotion, Pittsburgh) Mitchell-Miland C (Center for Health Equity Research and Promotion, Pittsburgh) Schutt R (Center for Healthcare Organization and Implementation Research, Bedford, MA) Ellison M (Center for Healthcare Organization and Implementation Research, Bedford, MA)

Objectives:
Veterans who are homeless and have serious mental illness (SMI) remain a difficult population to engage and treat. Previous research on Peer Specialists (PSs)—individuals in recovery from SMI hired as clinical team members—suggests they can improve patient engagement and other outcomes among this Veteran population, but no definitive study has been conducted. Further, the use of random assignment in previous PS studies may have masked subgroups of Veterans who showed benefit from PSs. This is because the fit between a PS and Veteran—based on social comparison and modeling theories—is vital. Because this fit varies, it is possible that within samples of those receiving PS services across previous null-result trials, there are subgroups who did benefit from PSs. As part of a larger randomized trial comparing recently housed Veterans with SMI receiving usual care or usual care+PSs over one year, additional analyses were conducted assessing two questions: 1) Does better fit (operationalized as greater engagement in PS services) lead to improved outcomes? and 2) Which factors predict greater PS engagement?

Methods:
1)To assess the impact of fit, logistic regression analyses were conducted to predict positive change in two outcomes—psychiatric symptoms and hope—by level of PS engagement, controlling for relevant demographic factors, several baseline mental health and substance abuse measures, and service use. The Reliable Change Index was used to compute whether Veterans (N = 140) achieved reliable positive change on standardized baseline-to-posttest assessments of symptoms and hope. 2)To assess factors predicting PS engagement among Veterans assigned to PS (N = 71), investigators conducted a negative binomial regression to evaluate the association between PS service engagement and factors from the three domains of the Andersen model of health service utilization: predisposing (personal demographic and social variables); enabling (support variables), and need (perceived and evaluated health problems) factors. Demographic characteristics and behavioral health service use six months before baseline were also predictors.

Results:
Results: 1)Logistic regression models showed that Veterans with higher PS engagement were more likely than those in the control group to show reliable positive change in psychiatric symptoms but not in hope. Compared with the control group, those with lower peer specialist engagement did not show positive change on either measure. 2)Veteran engagement with PSs was significantly predicted by greater hope (predisposing), worse psychiatric symptoms (need), and greater service utilization.

Implications:
Results suggest that Veterans with higher levels of hope, more symptoms, and more service use may be most likely to engage with PSs, and that benefits (improved symptoms) can be expected for Veterans who have more engagement with a PS.

Impacts:
Adding PSs to teams that serve recently housed Veterans with SMI, and targeting certain Veteran subpopulations served by those teams, can provide added improvement for Veterans’ psychiatric symptoms. Where PS services are limited, it may be more effective for PSs to target patients who have demonstrated some willingness to use services and who are more hopeful. This approach could increase the effectiveness of PSs by reducing multiple efforts to engage those who have little likelihood of engagement.