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Lessard É, O'Brien N, Panaite AC, Leclaire M, Castonguay G, Rouly G, Boivin A. Can you be a peer if you don't share the same health or social conditions? A qualitative study on peer integration in a primary care setting. BMC PRIMARY CARE 2024; 25:298. [PMID: 39134944 PMCID: PMC11318225 DOI: 10.1186/s12875-024-02548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Peer support has been extensively studied in specific areas of community-based primary care such as mental health, substance use, HIV, homelessness, and Indigenous health. These programs are often built on the assumption that peers must share similar social identities or lived experiences of disease to be effective. However, it remains unclear how peers can be integrated in general primary care setting that serves people with a diversity of health conditions and social backgrounds. METHODS A participatory qualitative study was conducted between 2020 and 2022 to explore the feasibility, acceptability, and perceived effects of the integration of a peer support worker in a primary care setting in Montreal, Canada. A thematic analysis was performed based on semi-structured interviews (n = 18) with patients, relatives, clinicians, and a peer support worker. FINDINGS Findings show that peers connect with patients through sharing their own hardships and how they overcame them, rather than sharing similar health or social conditions. Peers provide social support and coaching beyond the care trajectory and link identified needs with available resources in the community, bridging the gap between health and social care. Primary care clinicians benefit from peer support work, as it helps overcome therapeutic impasses and facilitates communication of patient needs. However, integrating a peer into a primary care team can be challenging due to clinicians' understanding of the nature and limits of peer support work, financial compensation, and the absence of a formal status within healthcare system. CONCLUSION Our results show that to establish a relationship of trust, a peer does not need to share similar health or social conditions. Instead, they leverage their experiential knowledge, strengths, and abilities to create meaningful relationships and reliable connections that bridge the gap between health and social care. This, in turn, instills patients with hope for a better life, empowers them to take an active role in their own care, and helps them achieve life goals beyond healthcare. Finally, integrating peers in primary care contributes in overcoming obstacles to prevention and care, reduce distrust of institutions, prioritize needs, and help patients navigate the complexities of healthcare services.
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Affiliation(s)
- Émilie Lessard
- Canada Research Chair in Partnership with Patients and Communities, Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), 850 St-Denis Street, Montréal, Québec, H2X 0A9, Canada
| | - Nadia O'Brien
- Public Health Agency of Canada, 200 René-Lévesque West Blvd, #102, Montréal, Québec, H2Z 1X4, Canada
| | - Andreea-Catalina Panaite
- Canada Research Chair in Partnership with Patients and Communities, Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), 850 St-Denis Street, Montréal, Québec, H2X 0A9, Canada
| | - Marie Leclaire
- Faculty of Medicine, Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Montréal, Québec, H3T 1J4, Canada
| | - Geneviève Castonguay
- Canada Research Chair in Partnership with Patients and Communities, Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), 850 St-Denis Street, Montréal, Québec, H2X 0A9, Canada
| | - Ghislaine Rouly
- Canada Research Chair in Partnership with Patients and Communities, Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), 850 St-Denis Street, Montréal, Québec, H2X 0A9, Canada
| | - Antoine Boivin
- Canada Research Chair in Partnership with Patients and Communities, Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM), 850 St-Denis Street, Montréal, Québec, H2X 0A9, Canada.
- Faculty of Medicine, Department of Family Medicine and Emergency Medicine, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Montréal, Québec, H3T 1J4, Canada.
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Roy R, Raman KJ, Raj EA, Varambally S. Outcomes of psychosocial interventions for homeless individuals with mental illness: A systematic review. Int J Soc Psychiatry 2024; 70:841-849. [PMID: 38174711 DOI: 10.1177/00207640231217173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Homelessness creates a significant social and economic burden in the society. Homelessness and mental illness are two interconnected social issues that poses challenges to individuals and communities across the globe. This systematic review aims to synthesize the existing literature on interventions for the homeless persons with mental illness. OBJECTIVES To systematically review the existing literature on psychosocial interventions for homeless persons with mental illness. SEARCH METHODS Five databases including PubMed, ProQuest, Cochrane Library, OVID, and Google Scholar were searched using homelessness, psychosocial interventions, mental ill, residential mental health facility, and case management for experimental studies published from January 2000 to December 2022. STUDY SELECTION Abstract review was conducted for the screened studies, and full-text review was done for studies which met inclusion exclusion criteria. DATA EXTRACTION AND ANALYSIS Among the 6,387 studies screened 20 studies were selected which fulfilled inclusion criteria. The full text review yielded data of 12,174 homeless persons with mental illness who undergone intervention. RESULTS The major psychosocial interventions found including critical time intervention, case management, housing support intervention, assertive community treatment, and life skills training. These interventions were helpful in sustaining housing stability, preventing relapse, reducing hospitalizations, and improving quality of life of the homeless persons with mental illness. CONCLUSION Targeted and integrated interventions addressing homelessness and mental illness are required to tackle the social problems of homelessness and mental illness. Further research is required to explore the most effective strategies that address homelessness and mental illness.
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Affiliation(s)
- Roniyamol Roy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - K Janaki Raman
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - E Aravind Raj
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Shivarama Varambally
- Depatment of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Heetderks-Fong E, Bobb A. Community Mental Health Workers: Their Workplaces, Roles, and Impact. Community Ment Health J 2024:10.1007/s10597-024-01306-2. [PMID: 38896213 DOI: 10.1007/s10597-024-01306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
Mental health care in the U.S. is at a critical crisis, compounded with a severe shortage of providers. The cost burden is immense, with severe disparity seen in traditionally marginalized communities and rural populations. Community health workers have been used to increase access to physical health care in the U.S. for over seventy years-and have been used abroad for centuries. Their use in mental health care is more recent and can increase access, but raises policy, reimbursement, triage, and scopes-of-practice considerations. They are especially beneficial for many at-risk populations including communities of color, those with serious mental illness, rural communities, the elderly, and youth. This literature review searched PubMed, EMBASE, and Google Scholar and provides a broad review of the different types of community mental health workers (community health workers/promotores de salud, peer support, peer navigators, and lay counselors), how they increase access to care, skill sets, practice locations, and uses for specific at-risk populations. Increasing and expanding the use of community mental health workers expands much needed mental health care to those at risk by task-shifting the burden on the traditional professional workforce, offering a solution to both the workforce shortage and the lack of equity in mental health care.
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Affiliation(s)
| | - Anna Bobb
- Vreds Philanthropy, Washington, DC, USA
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Viswanathan M, Kennedy SM, Sathe N, Eder ML, Ng V, Kugley S, Lewis MA, Gottlieb LM. Evaluating Intensity, Complexity, and Potential for Causal Inference in Social Needs Interventions: A Review of a Scoping Review. JAMA Netw Open 2024; 7:e2417994. [PMID: 38904959 PMCID: PMC11193129 DOI: 10.1001/jamanetworkopen.2024.17994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/19/2024] [Indexed: 06/22/2024] Open
Abstract
Importance Interventions that address needs such as low income, housing instability, and safety are increasingly appearing in the health care sector as part of multifaceted efforts to improve health and health equity, but evidence relevant to scaling these social needs interventions is limited. Objective To summarize the intensity and complexity of social needs interventions included in randomized clinical trials (RCTs) and assess whether these RCTs were designed to measure the causal effects of intervention components on behavioral, health, or health care utilization outcomes. Evidence Review This review of a scoping review was based on a Patient-Centered Outcomes Research Institute-funded evidence map of English-language US-based RCTs of social needs interventions published between January 1, 1995, and April 6, 2023. Studies were assessed for features related to intensity (defined using modal values as providing as-needed interaction, 8 participant contacts or more, contacts occurring every 2 weeks or more often, encounters of 30 minutes or longer, contacts over 6 months or longer, or home visits), complexity (defined as addressing multiple social needs, having dedicated staff, involving multiple intervention components or practitioners, aiming to change multiple participant behaviors [knowledge, action, or practice], requiring or providing resources or active assistance with resources, and permitting tailoring), and the ability to assess causal inferences of components (assessing interventions, comparators, and context). Findings This review of a scoping review of social needs interventions identified 77 RCTs in 93 publications with a total of 135 690 participants. Most articles (68 RCTs [88%]) reported 1 or more features of high intensity. All studies reported 1 or more features indicative of high complexity. Because most studies compared usual care with multicomponent interventions that were moderately or highly dependent on context and individual factors, their designs permitted causal inferences about overall effectiveness but not about individual components. Conclusions and Relevance Social needs interventions are complex, intense, and include multiple components. Our findings suggest that RCTs of these interventions address overall intervention effectiveness but are rarely designed to distinguish the causal effects of specific components despite being resource intensive. Future studies with hybrid effectiveness-implementation and sequential designs, and more standardized reporting of intervention intensity and complexity could help stakeholders assess the return on investment of these interventions.
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Affiliation(s)
| | | | - Nila Sathe
- RTI International, Research Triangle Park, North Carolina
| | | | - Valerie Ng
- RTI International, Research Triangle Park, North Carolina
| | - Shannon Kugley
- RTI International, Research Triangle Park, North Carolina
| | - Megan A. Lewis
- RTI International, Research Triangle Park, North Carolina
| | - Laura M. Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco
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Oeltjen LK, Schulz M, Heuer I, Knigge G, Nixdorf R, Briel D, Hamer P, Brannath W, Utschakowski J, Mahlke C, Gerhardus A. Effectiveness of a peer-supported crisis intervention to reduce the proportion of compulsory admissions in acute psychiatric crisis interventions in an outreach and outpatient setting: study protocol for an exploratory cluster randomised trial combined with qualitative methods. BMJ Open 2024; 14:e083385. [PMID: 38816053 PMCID: PMC11138285 DOI: 10.1136/bmjopen-2023-083385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Compulsory admissions are associated with feelings of fear, humiliation and powerlessness. The number of compulsory admissions in Germany and other high-income countries has increased in recent years. Peer support has been shown to increase the self-efficacy of individuals with mental health conditions in acute crises and to reduce the use of coercive measures in clinical settings. The objective of this study is to reduce the number of compulsory admissions by involving peer support workers (PSWs) in acute mental health crises in outreach and outpatient settings. METHODS AND ANALYSIS This one-year intervention is an exploratory, cluster randomised study. Trained PSWs will join the public crisis intervention services (CIS) in two of five regions (the intervention regions) in the city of Bremen (Germany). PSWs will participate in crisis interventions and aspects of the mental health services. They will be involved in developing and conducting an antistigma training for police officers. The remaining three regions will serve as control regions. All individuals aged 18 and older who experience an acute mental health crisis during the operating hours of the regional CIS in the city of Bremen (around 2000 in previous years) will be included in the study. Semistructured interviews will be conducted with PSWs, 30 patients from control and intervention regions, as well as two focus group discussions with CIS staff. A descriptive comparison between all participants in the intervention and control regions will assess the proportion of compulsory admissions in crisis interventions during the baseline and intervention years, including an analysis of temporal changes. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the University of Bremen (file 2022-09) on 20 June 2022. The results will be presented via scientific conferences, scientific journals and communicated to policy-makers and practitioners. TRIAL REGISTRATION NUMBER DRKS00029377.
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Affiliation(s)
- Lena Katharina Oeltjen
- Department of Health Services Research, Institute of Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Maike Schulz
- Department of Psychiatry and Psychotherapy, Hospital Bremen-Ost, Gesundheit Nord Klinikverbund Bremen gGmbH (GENO), Bremen, Germany
| | - Imke Heuer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Knigge
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Denis Briel
- Department of Psychiatry and Psychotherapy, Hospital Bremen-Ost, Gesundheit Nord Klinikverbund Bremen gGmbH (GENO), Bremen, Germany
| | | | - Werner Brannath
- Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Jörg Utschakowski
- Department of Mental Health and Addiction, Ministry of Health, Women and Consumer Protection, Bremen, Germany
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute of Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
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Corrigan PW, Nieweglowski K, Qin S, Sheehan L, Puhl R, Talluri SS. Weight Self-Efficacy and Recovery Among African-Americans With Serious Mental Illness and High Body Weight. J Nerv Ment Dis 2023; 211:735-741. [PMID: 37581454 PMCID: PMC10593089 DOI: 10.1097/nmd.0000000000001659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
ABSTRACT Many African-Americans with serious mental illness fail to engage in evidence-based programs that positively affect weight management. We examined how having a weight-related physical illness correlated with self-efficacy, recovery, and quality of life by contrasting illnesses with symptoms that are obviously perceived ( e.g. , sleep apnea and pain related to weight) versus those that are not ( e.g. , hypertension). African-Americans with serious mental illness who were overweight (body mass index ≥25) completed the Weight Efficacy Lifestyle Questionnaire, Recovery Assessment Scale, and Quality of Life Scale in this study assessing the impact of a program on weight and health. Silent weight-related physical disorders were not found to correlate with quality of life, recovery, or weight self-efficacy. Differences in recovery were found in people with versus without sleep apnea and weight-related pain. Findings suggest future directions for affirming approaches to promote engagement among African-Americans with serious mental illness in weight management programs.
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Affiliation(s)
- Patrick W Corrigan
- Illinois Institute of Technology, Department of Psychology, Chicago, Illinois
| | | | | | - Lindsay Sheehan
- Illinois Institute of Technology, Department of Psychology, Chicago, Illinois
| | - Rebecca Puhl
- University of Connecticut, Department of Human Development & Family Sciences, Storrs, Connecticut
| | - Sai Snigdha Talluri
- Illinois Institute of Technology, Department of Psychology, Chicago, Illinois
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Smit D, Miguel C, Vrijsen JN, Groeneweg B, Spijker J, Cuijpers P. The effectiveness of peer support for individuals with mental illness: systematic review and meta-analysis. Psychol Med 2023; 53:5332-5341. [PMID: 36066104 PMCID: PMC10476060 DOI: 10.1017/s0033291722002422] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The benefits of peer support interventions (PSIs) for individuals with mental illness are not well known. The aim of this systematic review and meta-analysis was to assess the effectiveness of PSIs for individuals with mental illness for clinical, personal, and functional recovery outcomes. METHODS Searches were conducted in PubMed, Embase, and PsycINFO (December 18, 2020). Included were randomized controlled trials (RCTs) comparing peer-delivered PSIs to control conditions. The quality of records was assessed using the Cochrane Collaboration Risk of Bias tool. Data were pooled for each outcome, using random-effects models. RESULTS After screening 3455 records, 30 RCTs were included in the systematic review and 28 were meta-analyzed (4152 individuals). Compared to control conditions, peer support was associated with small but significant post-test effect sizes for clinical recovery, g = 0.19, 95% CI (0.11-0.27), I2 = 10%, 95% CI (0-44), and personal recovery, g = 0.15, 95% CI (0.04-0.27), I2 = 43%, 95% CI (1-67), but not for functional recovery, g = 0.08, 95% CI (-0.02 to 0.18), I2 = 36%, 95% CI (0-61). Our findings should be considered with caution due to the modest quality of the included studies. CONCLUSIONS PSIs may be effective for the clinical and personal recovery of mental illness. Effects are modest, though consistent, suggesting potential efficacy for PSI across a wide range of mental disorders and intervention types.
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Affiliation(s)
- Dorien Smit
- Pro Persona Mental Health Care, Pro Persona Research, Depression Expertise Center, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Janna N. Vrijsen
- Pro Persona Mental Health Care, Pro Persona Research, Depression Expertise Center, Nijmegen, The Netherlands
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Groeneweg
- Dutch Depression (Patient) Association, Amersfoort, The Netherlands
| | - Jan Spijker
- Pro Persona Mental Health Care, Pro Persona Research, Depression Expertise Center, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Weightman AL, Kelson MJ, Thomas I, Mann MK, Searchfield L, Willis S, Hannigan B, Smith RJ, Cordiner R. Exploring the effect of case management in homelessness per components: A systematic review of effectiveness and implementation, with meta-analysis and thematic synthesis. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1329. [PMID: 37206622 PMCID: PMC10189499 DOI: 10.1002/cl2.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Adequate housing is a basic human right. The many millions of people experiencing homelessness (PEH) have a lower life expectancy and more physical and mental health problems. Practical and effective interventions to provide appropriate housing are a public health priority. Objectives To summarise the best available evidence relating to the components of case-management interventions for PEH via a mixed methods review that explored both the effectiveness of interventions and factors that may influence its impact. Search Methods We searched 10 bibliographic databases from 1990 to March 2021. We also included studies from Campbell Collaboration Evidence and Gap Maps and searched 28 web sites. Reference lists of included papers and systematic reviews were examined and experts contacted for additional studies. Selection Criteria We included all randomised and non-randomised study designs exploring case management interventions where a comparison group was used. The primary outcome of interest was homelessness. Secondary outcomes included health, wellbeing, employment and costs. We also included all studies where data were collected on views and experiences that may impact on implementation. Data Collection and Analysis We assessed risk of bias using tools developed by the Campbell Collaboration. We conducted meta-analyses of the intervention studies where possible and carried out a framework synthesis of a set of implementation studies identified by purposive sampling to represent the most 'rich' and 'thick' data. Main Results We included 64 intervention studies and 41 implementation studies. The evidence base was dominated by studies from the USA and Canada. Participants were largely (though not exclusively) people who were literally homeless, that is, living on the streets or in shelters, and who had additional support needs. Many studies were assessed as having a medium or high risk of bias. However, there was some consistency in outcomes across studies that improved confidence in the main findings. Case Management and Housing Outcomes Case management of any description was superior to usual care for homelessness outcomes (standardised mean difference [SMD] = -0.51 [95% confidence interval [CI]: -0.71, -0.30]; p < 0.01). For studies included in the meta-analyses, Housing First had the largest observed impact, followed by Assertive Community Treatment, Critical Time Intervention and Intensive Case Management. The only statistically significant difference was between Housing First and Intensive Case Management (SMD = -0.6 [-1.1, -0.1]; p = 0.03) at ≥12 months. There was not enough evidence to compare the above approaches with standard case management within the meta-analyses. A narrative comparison across all studies was inconclusive, though suggestive of a trend in favour of more intensive approaches. Case Management and Mental Health Outcomes The overall evidence suggested that case management of any description was not more or less effective compared to usual care for an individual's mental health (SMD = 0.02 [-0.15, 0.18]; p = 0.817). Case Management and Other Outcomes Based on meta-analyses, case management was superior to usual care for capability and wellbeing outcomes up to 1 year (an improvement of around one-third of an SMD; p < 0.01) but was not statistically significantly different for substance use outcomes, physical health, and employment. Case Management Components For homelessness outcomes, there was a non-significant trend for benefits to be greater in the medium term (≤3 years) compared to long term (>3 years) (SMD = -0.64 [-1.04, -0.24] vs. -0.27 [-0.53, 0]; p = 0.16) and for in-person meetings in comparison to mixed (in-person and remote) approaches (SMD = -0.73 [-1.25,-0.21]) versus -0.26 [-0.5,-0.02]; p = 0.13). There was no evidence from meta-analyses to suggest that an individual case manager led to better outcomes then a team, and interventions with no dedicated case manager may have better outcomes than those with a named case manager (SMD = -0.36 [-0.55, -0.18] vs. -1.00 [-2.00, 0.00]; p = 0.02). There was not enough evidence from meta-analysis to assess whether the case manager should have a professional qualification, or if frequency of contact, case manager availability or conditionality (barriers due to conditions attached to service provision) influenced outcomes. However, the main theme from implementation studies concerned barriers where conditions were attached to services. Characteristics of Persons Experiencing Homelessness No conclusions could be drawn from meta-analysis other than a trend for greater reductions in homelessness for persons with high complexity of need (two or more support needs in addition to homelessness) as compared to those with medium complexity of need (one additional support need); effect sizes were SMD = -0.61 [-0.91, -0.31] versus -0.36 [-0.68, -0.05]; p = 0.3. The Broader Context of Delivery of Case Management Programmes Other major themes from the implementation studies included the importance of interagency partnership; provision for non-housing support and training needs of PEH (such as independent living skills), intensive community support following the move to new housing; emotional support and training needs of case managers; and an emphasis on housing safety, security and choice. Cost Effectiveness The 12 studies with cost data provided contrasting results and no clear conclusions. Some case management costs may be largely off-set by reductions in the use of other services. Cost estimates from three North American studies were $45-52 for each additional day housed. Authors' Conclusions Case management interventions improve housing outcomes for PEH with one or more additional support needs, with more intense interventions leading to greater benefits. Those with greater support needs may gain greater benefit. There is also evidence for improvements to capabilities and wellbeing. Current approaches do not appear to lead to mental health benefits. In terms of case management components, there is evidence in support of a team approach and in-person meetings and, from the implementation evidence, that conditions associated with service provision should be minimised. The approach within Housing First could explain the finding that overall benefits may be greater than for other types of case management. Four of its principles were identified as key themes within the implementation studies: No conditionality, offer choice, provide an individualised approach and support community building. Recommendations for further research include an expansion of the research base outside North America and further exploration of case management components and intervention cost-effectiveness.
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Affiliation(s)
| | - Mark J. Kelson
- Department of Mathematics and Statistics, Faculty of Environment, Science and EconomyUniversity of ExeterExeterUK
| | - Ian Thomas
- Wales Institute of Social and Economic Research and Data (WISERD)Cardiff UniversityCardiffUK
| | - Mala K. Mann
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Lydia Searchfield
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Simone Willis
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Ben Hannigan
- Mental Health Nursing, School of Healthcare SciencesCardiff UniversityCardiffUK
| | | | - Rhiannon Cordiner
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
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Åkerblom KB, Ness O. Peer Workers in Co-production and Co-creation in Mental Health and Substance Use Services: A Scoping Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:296-316. [PMID: 36396756 PMCID: PMC9931804 DOI: 10.1007/s10488-022-01242-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
Abstract
People with lived experience of mental health challenges are extensively employed as peer workers within mental health and substance use services worldwide. Research shows that peer workers benefit individuals using such services and can have essential roles in developing recovery-oriented services. However, understanding how peer workers' contributions, by their role, functions, and input can be better used remains a critical challenge. Research on public sector innovation has focused on relevant actors collaborating to tackle complex demands. Co-production and co-creation are concepts used to describe this collaboration. Co-production refers to the collaboration between providers and users at the point of service delivery, whereas co-creation refers to collaboration starting in the early service cycle phases (e.g., in commissioning or design), including solution implementation. We overviewed research literature describing peer workers' involvement in mental health and substance use services. The research question is as follows: How are peer workers involved in co-production and co-creation in mental health and substance use services, and what are the described outcomes? A literature search was performed in 10 different databases, and 13,178 articles were screened, of which 172 research articles describing peer workers' roles or activities were included. The findings show that peer workers are involved in co-production and function as providers of pre-determined services or, most often, as providers of peer support. However, they are rarely engaged as partners in co-creation. We conclude that the identified peer worker roles have different potential to generate input and affect service delivery and development.
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Affiliation(s)
| | - Ottar Ness
- Department of Education and Lifelong Learning, Norwegian University of Science and Technology, Trondheim, Norway
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Høgh Egmose C, Heinsvig Poulsen C, Hjorthøj C, Skriver Mundy S, Hellström L, Nørgaard Nielsen M, Korsbek L, Serup Rasmussen K, Falgaard Eplov L. The Effectiveness of Peer Support in Personal and Clinical Recovery-Systematic Review and Meta-Analysis. Psychiatr Serv 2023:appips202100138. [PMID: 36751908 DOI: 10.1176/appi.ps.202100138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Peer support has been shown to support personal recovery from mental illness. It is unclear whether the effects of peer support across different mental illnesses depend on the organizational setting. The authors reviewed the effectiveness of peer support for both personal recovery and clinical recovery of adults with any mental illness and evaluated the effectiveness of peer support in different settings. METHODS A systematic review of randomized controlled trials (RCTs) was conducted in PubMed, PsycInfo, CINAHL, Cochrane Library, and Web of Science. A meta-analysis of outcomes of personal and clinical recoveries at the end of interventions was conducted. RESULTS In total, 49 RCTs with 12,477 participants with any mental illness were included. Most of the trials had a high risk for bias. Results of the meta-analysis indicated that peer support in general had a small positive effect on personal recovery (standard mean difference [SMD]=0.20; 95% CI=0.11-0.29) and decreased anxiety symptoms (SMD=-0.21; 95% CI=-0.40 to -0.02), with most trials evaluating peers added to mental health-related hospital services. No data for peers in established service roles were available for the meta-analysis. Peer-designed interventions developed to be provided independently of hospital services and delivered in community settings had a modest effect on self-advocacy. A small nonsignificant effect on personal recovery for peer support delivered online was also observed. CONCLUSIONS The effect on personal recovery from mental illness was most evident in peer support added to hospital services. High-quality RCTs with comparable cocreated interventions and clear descriptions of mechanisms of change are needed to further investigate peer support efficacy.
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Affiliation(s)
- Cecilie Høgh Egmose
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Chalotte Heinsvig Poulsen
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Sara Skriver Mundy
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Lone Hellström
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Mette Nørgaard Nielsen
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Lisa Korsbek
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Klavs Serup Rasmussen
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
| | - Lene Falgaard Eplov
- Copenhagen Research Center for Mental Health, University of Copenhagen, Copenhagen (Høgh Egmose, Heinsvig Poulsen, Hjorthøj, Skriver Mundy, Hellström, Nørgaard Nielsen, Falgaard Eplov); Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen (Hjorthøj); Mental Health Services, Region of Southern Denmark, Odense (Korsbek); Peer Partnership Association, Social Network Association, Copenhagen (Serup Rasmussen)
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11
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Schiffler T, Kapan A, Gansterer A, Pass T, Lehner L, Gil-Salmeron A, McDermott DT, Grabovac I. Characteristics and Effectiveness of Co-Designed Mental Health Interventions in Primary Care for People Experiencing Homelessness: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:892. [PMID: 36613214 PMCID: PMC9820061 DOI: 10.3390/ijerph20010892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
People experiencing homelessness (PEH) face a disproportionately high prevalence of adverse mental health outcomes compared with the non-homeless population and are known to utilize primary healthcare services less frequently while seeking help in emergency care facilities. Given that primary health services are more efficient and cost-saving, services with a focus on mental health that are co-designed with the participation of users can tackle this problem. Hence, we aimed to synthesize the current evidence of such interventions to assess and summarize the characteristics and effectiveness of co-designed primary mental healthcare services geared towards adult PEH. Out of a total of 10,428 identified records, four articles were found to be eligible to be included in this review. Our findings show that co-designed interventions positively impacted PEH's mental health and housing situation or reduced hospital and emergency department admissions and increased primary care utilization. Therefore, co-designed mental health interventions appear a promising way of providing PEH with continued access to primary mental healthcare. However, as co-designed mental health interventions for PEH can improve overall mental health, quality of life, housing, and acute service utilization, more research is needed.
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Affiliation(s)
- Tobias Schiffler
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Ali Kapan
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Alina Gansterer
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Thomas Pass
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Lisa Lehner
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
- Department of Science & Technology Studies, Cornell University, 303 Morrill Hall, Ithaca, NY 14853, USA
| | - Alejandro Gil-Salmeron
- International Foundation for Integrated Care, Wolfson College, Linton Rd., Oxford OX2 6UD, UK
| | - Daragh T. McDermott
- NTU Psychology, School of Social Sciences, Nottingham Trent University, Nottingham NG1 4FQ, UK
| | - Igor Grabovac
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
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12
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Mullen JN, Levitt A, Markoulakis R. Supporting Individuals with Mental Health and/or Addictions Issues Through Patient Navigation: A Scoping Review. Community Ment Health J 2023; 59:35-56. [PMID: 35648257 DOI: 10.1007/s10597-022-00982-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/01/2022] [Indexed: 01/07/2023]
Abstract
Pathways through the mental health care system can be complex and laden with barriers that prevent individuals from finding the most appropriate care. Navigation has been proposed as a solution for improving access to and transition through complex health care systems. While several MHA navigation programs have emerged in the past decade, no study has explored the core themes of MHA navigation, which was the goal of the current review. A scoping review was conducted; the search yielded 11,525 unique results, of which 26 were entered into extraction and subsequent descriptive and thematic analysis. Barrier reduction, client-centered support, and integrated care emerged as the distinct themes underlying MHA services, and overall, navigation significantly improved outcomes for individuals experiencing MHA issues. These findings may support evidence-based implementation of navigation services and point to a need for increased exploration and reporting of MHA navigation outcomes in the literature.
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Affiliation(s)
- Jennifer N Mullen
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Anthony Levitt
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roula Markoulakis
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada.
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
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13
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Tsai J, Kelton K. Service use and barriers to care among homeless veterans: Results from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:507-515. [PMID: 35748189 DOI: 10.1002/jcop.22912] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/22/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
The objective of this study was to examine type of services U.S. veterans seek when they experience homelessness, characteristics associated with service use, and reasons for not using services. Data from a 2021 nationally representative survey of 1004 low-income U.S. veterans were analyzed with descriptive and multivariable analyses. One-quarter of low-income U.S. veterans with experiences of homelessness reported using homeless services while they were homeless and about 27% reported using U.S. Department of Veterans Affairs (VA) healthcare or benefits while homeless. Black and Hispanic veterans were more likely to use both homeless services and VA services while homeless than veterans of other race/ethnic groups. The most common barriers to services were: veterans felt they did not need help, they did not have information about services, there was stigma and shame, and transportation barriers were encountered. These findings suggest veterans use various VA and community-based homeless and healthcare services, but they do experience barriers that may be improved with better public information and care coordination to improve service uptake among homeless veterans.
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Affiliation(s)
- Jack Tsai
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, Florida, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Katherine Kelton
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, Florida, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
- South Central Mental Illness Research Education and Clinical Center (MIRECC), Houston, TX, USA
- South Texas Veterans Health Care System, San Antonio Geriatric Research Education and Clinical Center (GRECC), San Antonio, TX, USA
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14
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Shover CL, Rosen A, Mata J, Robie B, Alvarado J, Frederes A, Romero R, Beltran J, Bratcher A, Chang AH, Choi KR, Garcia C, Shoptaw S, Guha P, Richard L, Sixx G, Baez A, Coleman A, Harvell S, Jackson S, Lee C, Swan J, Torres K, Kantrim EU, McKeever M, Nguyen A, Rice A, Rosales M, Spoliansky J, Bromley E, Behforouz H, Gelberg L, Gorbach PM, Rimoin AW, Thomas EH. Engaging Same-Day Peer Ambassadors to Increase Coronavirus Disease 2019 Vaccination Among People Experiencing Unsheltered Homelessness in Los Angeles County: A Hybrid Feasibility-Evaluation Study. J Infect Dis 2022; 226:S346-S352. [PMID: 36208168 PMCID: PMC9989733 DOI: 10.1093/infdis/jiac291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the feasibility and acceptability of engaging unhoused peer ambassadors (PAs) in coronavirus disease 2019 (COVID-19) vaccination efforts to reach people experiencing unsheltered homelessness in Los Angeles County. METHODS From August to December 2021, vaccinated PAs aged ≥18 years who could provide informed consent were recruited during vaccination events for same-day participation. Events were held at encampments, service providers (eg, housing agencies, food lines, and mobile showers), and roving locations around Los Angeles. PAs were asked to join outreach alongside community health workers and shared their experience getting vaccinated, receiving a $25 gift card for each hour they participated. Postevent surveys evaluated how many PAs enrolled and how long they participated. In October 2021, we added a preliminary effectiveness evaluation of how many additional vaccinations were attributable to PAs. Staff who enrolled the PAs estimated the number of additional people vaccinated because of talking with the PA. RESULTS A total of 117 PAs were enrolled at 103 events, participating for an average of 2 hours. At events with the effectiveness evaluation, 197 additional people were vaccinated over 167 PA hours ($21.19 gift card cost per additional person vaccinated), accounting for >25% of all vaccines given at these events. DISCUSSION Recruiting same-day unhoused PAs is a feasible, acceptable, and preliminarily effective technique to increase COVID-19 vaccination in unsheltered settings. The findings can inform delivery of other health services for people experiencing homelessness.
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Affiliation(s)
- Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Allison Rosen
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - José Mata
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Brooke Robie
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Julissa Alvarado
- Department of Environmental Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Ashley Frederes
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Ruby Romero
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Jacqueline Beltran
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Anna Bratcher
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Alicia H Chang
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Kristen R Choi
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
- UCLA School of Nursing,, Los Angeles, California, USA
| | - Candelaria Garcia
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Steven Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Priyanka Guha
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Lindsey Richard
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Gunner Sixx
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Angel Baez
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Anthony Coleman
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Sarah Harvell
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Shirnae Jackson
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Caroline Lee
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Joanna Swan
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Kenny Torres
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Emily Uyeda Kantrim
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Maya McKeever
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Anh Nguyen
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Adam Rice
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Marisol Rosales
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Jordan Spoliansky
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Elizabeth Bromley
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Heidi Behforouz
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Lillian Gelberg
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Pamina M Gorbach
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Anne W Rimoin
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Emily H Thomas
- Los Angeles County Department of Health Services, Los Angeles, California, USA
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15
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Coles A, Maksyutynska K, Knezevic D, Agarwal SM, Strudwick G, Dunbar JA, Druss B, Selby P, Banfield M, Hahn MK, Castle D. Peer‐facilitated interventions for improving the physical health of people with schizophrenia spectrum disorders: systematic review and meta‐analysis. Med J Aust 2022; 217 Suppl 7:S22-S28. [DOI: 10.5694/mja2.51693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Alexandria Coles
- Centre for Complex Interventions, Centre for Addiction and Mental Health Toronto Canada
| | - Kateryna Maksyutynska
- Centre for Complex Interventions, Centre for Addiction and Mental Health Toronto Canada
- Institute of Medical Science University of Toronto Toronto Canada
| | - Dunja Knezevic
- Centre for Complex Interventions, Centre for Addiction and Mental Health Toronto Canada
| | - Sri Mahavir Agarwal
- Centre for Complex Interventions, Centre for Addiction and Mental Health Toronto Canada
- Institute of Medical Science University of Toronto Toronto Canada
| | - Gillian Strudwick
- Centre for Addiction and Mental Health Toronto Canada
- Institute of Health Policy, Management and Evaluation University of Toronto Toronto Canada
| | | | - Benjamin Druss
- Rollins School of Public Health Emory University Atlanta United States of America
| | - Peter Selby
- Centre for Addiction and Mental Health Toronto Canada
| | - Michelle Banfield
- Centre for Mental Health Research Australian National University Canberra ACT
| | - Margaret K Hahn
- Centre for Complex Interventions, Centre for Addiction and Mental Health Toronto Canada
- Institute of Medical Science University of Toronto Toronto Canada
| | - David Castle
- Centre for Complex Interventions, Centre for Addiction and Mental Health Toronto Canada
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16
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Julian McFarlane S, Occa A, Peng W, Awonuga O, Morgan SE. Community-Based Participatory Research (CBPR) to Enhance Participation of Racial/Ethnic Minorities in Clinical Trials: A 10-Year Systematic Review. HEALTH COMMUNICATION 2022; 37:1075-1092. [PMID: 34420460 DOI: 10.1080/10410236.2021.1943978] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There has not been a significant improvement in the rate of clinical trial accrual in more than 20 years. Worse, the challenge of inadequate representation among racial and ethnic minorities also persists, deepening disparities in health. Community-Based Participatory Research (CBPR) is a participatory communication method that centers on effective dialogue between researchers and community stakeholders with the goal of creating an equitable partnership for health and social change. The objective of the current study was to provide an update since a systematic review in 2012, on the current status of the empirical research, with a particular focus on the elements of CBPR methods used to improve the rate of accrual of members of racial and ethnic minority communities for clinical trials. Our systematic review found a large increase in the number of CBPR related studies and studies related to racial and ethnic representation in research. More than 85% of studies employing CBPR methods saw statistically positive outcomes. Specifically, the elements of CBPR that are associated with these positive outcomes include community partner participation in (1) a study advisory committee, (2) data collection, (3) the development of interventions, and (4) participant recruitment. However, the results of our study indicate that researchers need to be more transparent about the extent of community participation as well as more thoroughly and accurately describe the nature of the partnership with members of minority communities in order to build upon the scientific literature on community-engaged methods.
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Affiliation(s)
| | - Aurora Occa
- Department of Communication, University of Kentucky
| | - Wei Peng
- Murrow College of Communication, Washington State University
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17
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Shepherd-Banigan M, Drake C, Dietch JR, Shapiro A, Tabriz AA, Van Voorhees EE, Uthappa DM, Wang TW, Lusk JB, Rossitch SS, Fulton J, Gordon A, Ear B, Cantrell S, Gierisch JM, Williams JW, Goldstein KM. Primary Care Engagement Among Individuals with Experiences of Homelessness and Serious Mental Illness: an Evidence Map. J Gen Intern Med 2022; 37:1513-1523. [PMID: 35237885 PMCID: PMC9085989 DOI: 10.1007/s11606-021-07244-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Experiences of homelessness and serious mental illness (SMI) negatively impact health and receipt of healthcare. Interventions that promote the use of primary care services for people with both SMI and homelessness may improve health outcomes, but this literature has not been evaluated systematically. This evidence map examines the breadth of literature to describe what intervention strategies have been studied for this population, elements of primary care integration with other services used, and the level of intervention complexity to highlight gaps for future intervention research and program development. METHODS We followed an a priori protocol developed in collaboration with clinical stakeholders. We systematically searched the published literature to identify interventions for adults with homelessness who also had SMI. We excluded case reports, editorials, letters, and conference abstracts. Data abstraction methods followed standard practice. Data were categorized into intervention strategies and primary care integration strategies. Then we applied the Complexity Assessment Tool for Systematic Reviews (iCAT_SR) to characterize intervention complexity. RESULTS Twenty-two articles met our inclusion criteria evaluating 15 unique interventions to promote engagement in primary care for adults with experiences of homelessness and SMI. Study designs varied widely from randomized controlled trials and cohort studies to single-site program evaluations. Intervention strategies varied across studies but primarily targeted patients directly (e.g., health education, evidence-based interactions such as motivational interviewing) with fewer strategies employed at the clinic (e.g., employee training, multidisciplinary teams) or system levels (e.g., data sharing). We identified elements of primary care integration, including referral strategies, co-location, and interdisciplinary care planning. Interventions displayed notable complexity around the number of intervention components, interaction between intervention components, and extent to which interventions were tailored to specific patient populations. DISCUSSION We identified and categorized elements used in various combinations to address the primary care needs of individuals with experiences of homeless and SMI.
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Affiliation(s)
- Megan Shepherd-Banigan
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, NC, USA.
- Margolis Center for Health Policy, Duke University, Durham, NC, USA.
| | - Connor Drake
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| | - Abigail Shapiro
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Elizabeth E Van Voorhees
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Diya M Uthappa
- Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Tsai-Wei Wang
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Jay B Lusk
- Duke University School of Medicine, Durham, NC, USA
- Duke University Fuqua School of Business, Durham, NC, USA
| | | | - Jessica Fulton
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Adelaide Gordon
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Belinda Ear
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Sarah Cantrell
- Duke University School of Medicine, Durham, NC, USA
- Duke University Medical Center Library & Archives, Durham, USA
| | - Jennifer M Gierisch
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - John W Williams
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Karen M Goldstein
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
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18
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Flike K, Aronowitz T. Factors That Influence Quality of Life in People Experiencing Homelessness: A Systematic Mixed Studies Review. J Am Psychiatr Nurses Assoc 2022; 28:128-153. [PMID: 33478314 DOI: 10.1177/1078390320985286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND An emerging category of morbidity in research among people experiencing homelessness (PEH) is quality of life (QoL). The Commission on Social Determinants of Health (CSDH) framework was used to explain the relationship between the resulting factors and their impact on QoL among PEH. AIMS The purpose of this systematic mixed studies review was to explore the factors that are associated with QoL among homeless individuals. METHOD A systematic mixed studies review was conducted using CINAHL, Medline, PubMed, and SocIndex databases. Quantitative, qualitative, and mixed methods studies were included and synthesized employing results-based convergent synthesis design. RESULTS The initial search resulted in 757 studies with 55 studies meeting the inclusion criteria. Thematic analysis revealed themes influencing QoL among PEH categorized by the CSDH determinants of structural, social cohesion and social capital, and intermediary determinants. Among these themes, higher social status, strong relationships, better reported physical and mental health, and a positive life outlook were associated with increased QoL. Social isolation, substance use, poorer life outlook, increased years spent homeless, and perceived quality of housing were associated with decreased QoL. Age, sex, and housing programs revealed inconsistent results on QoL. CONCLUSIONS While the factors presented in this review indicate some consistent relationships with QoL in PEH, this review has shown QoL among this population is complex and multifactorial. Future research should focus on relationships between the CSDH determinants, particularly the psychosocial factors and the QoL priorities defined by PEH, and how they may influence QoL among PEH.
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Affiliation(s)
- Kimberlee Flike
- Kimberlee Flike, MSN, UMass Boston, College of Nursing & Health Sciences, Boston, MA, USA
| | - Teri Aronowitz
- Teri Aronowitz, PhD, APRN, FNP-BC, FAAN, UMass Boston, College of Nursing & Health Sciences, Boston, MA, USA
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Wiles LK, Kay D, Luker JA, Worley A, Austin J, Ball A, Bevan A, Cousins M, Dalton S, Hodges E, Horvat L, Kerrins E, Marker J, McKinnon M, McMillan P, Pinero de Plaza MA, Smith J, Yeung D, Hillier SL. Consumer engagement in health care policy, research and services: A systematic review and meta-analysis of methods and effects. PLoS One 2022; 17:e0261808. [PMID: 35085276 PMCID: PMC8794088 DOI: 10.1371/journal.pone.0261808] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/11/2021] [Indexed: 12/14/2022] Open
Abstract
To assess the effects of consumer engagement in health care policy, research and services. We updated a review published in 2006 and 2009 and revised the previous search strategies for key databases (The Cochrane Central Register of Controlled Trials; MEDLINE; EMBASE; PsycINFO; CINAHL; Web of Science) up to February 2020. Selection criteria included randomised controlled trials assessing consumer engagement in developing health care policy, research, or health services. The International Association for Public Participation, Spectrum of Public Participation was used to identify, describe, compare and analyse consumer engagement. Outcome measures were effects on people; effects on the policy/research/health care services; or process outcomes. We included 23 randomised controlled trials with a moderate or high risk of bias, involving 136,265 participants. Most consumer engagement strategies adopted a consultative approach during the development phase of interventions, targeted to health services. Based on four large cluster-randomised controlled trials, there is evidence that consumer engagement in the development and delivery of health services to enhance the care of pregnant women results in a reduction in neonatal, but not maternal, mortality. From other trials, there is evidence that involving consumers in developing patient information material results in material that is more relevant, readable and understandable for patients, and can improve knowledge. Mixed effects are reported of consumer-engagement on the development and/or implementation of health professional training. There is some evidence that using consumer interviewers instead of staff in satisfaction surveys can have a small influence on the results. There is some evidence that consumers may have a role in identifying a broader range of health care priorities that are complementary to those from professionals. There is some evidence that consumer engagement in monitoring and evaluating health services may impact perceptions of patient safety or quality of life. There is growing evidence from randomised controlled trials of the effects of consumer engagement on the relevance and positive outcomes of health policy, research and services. Health care consumers, providers, researchers and funders should continue to employ evidence-informed consumer engagement in their jurisdictions, with embedded evaluation. Systematic review registration: PROSPERO CRD42018102595.
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Affiliation(s)
- Louise K. Wiles
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Debra Kay
- Health Consumer Advocate/Representative, Adelaide, South Australia, Australia
| | - Julie A. Luker
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Anthea Worley
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Jane Austin
- Health Performance Council, Adelaide, South Australia, Australia
| | - Allan Ball
- National Disability Insurance Agency, Adelaide, South Australia, Australia
| | - Alan Bevan
- Health Consumer Advocate/Representative, Adelaide, South Australia, Australia
| | | | - Sarah Dalton
- The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Ellie Hodges
- Lived Experience Representative, Adelaide, South Australia, Australia
| | - Lidia Horvat
- Safer Care Victoria, Melbourne, Victoria, Australia
| | - Ellen Kerrins
- SAHMRI Community Advisory Group, Adelaide, South Australia, Australia
| | - Julie Marker
- Health Consumer Advocate/Representative, Adelaide, South Australia, Australia
| | | | - Penelope McMillan
- Health Consumer Advocate/Representative, Adelaide, South Australia, Australia
| | - Maria Alejandra Pinero de Plaza
- Health Consumer Advocate/Representative, Adelaide, South Australia, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia
| | - Judy Smith
- Royal District Nursing Service, Keswick, South Australia, Australia
| | - David Yeung
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- SA Pathology, Adelaide, South Australia, Australia
| | - Susan L. Hillier
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- * E-mail:
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Providing peer navigation services to women with a history of opioid misuse pre- and post-release from jail: A program description. J Clin Transl Sci 2022; 6:e106. [PMID: 36128341 PMCID: PMC9453575 DOI: 10.1017/cts.2022.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/10/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Justice system-involved women with opioid use disorder (OUD) experience layered health risks and stigma, yet peer navigation services during reentry may support positive outcomes. This manuscript offers a program description of a women’s peer navigation intervention delivered pre- and post-release from jail to remove barriers to women’s access to OUD treatment, including medications for opioid use disorder (MOUD). Methods: All data were collected as part of a NIH/NIDA-funded national cooperative, the Justice Community Opioid Innovation Network (JCOIN) project. Through the larger study’s intervention, women in jail with OUD are connected via videoconference to a peer navigator, who provides an initial reentry recovery assessment and 12+ weeks of recovery support sessions post-release. Qualitative analyses examined peers’ notes from initial sessions with women (N = 50) and in-depth interviews with peers (N = 3). Results: Peers’ notes from initial sessions suggest that women anticipate challenges to successful recovery and community reentry. More than half of women (51.9%) chose OUD treatment as their primary goal, while others selected more basic needs (e.g. housing, transportation). In qualitative interviews, peers described women’s transitions to the community as unpredictable, creating difficulties for reentry planning, particularly for rural women. Peers also described challenges with stigma against MOUD and establishing relationships via telehealth, but ultimately believed their role was valuable in providing resource referrals, support, and hope for recovery. Conclusions: For women with OUD, peer navigation can offer critical linkages to services at release from jail, in addition to hope, encouragement, and solidarity. Findings provide important insights for future peer-based interventions.
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Lowe D, Ryan R, Schonfeld L, Merner B, Walsh L, Graham-Wisener L, Hill S. Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. Cochrane Database Syst Rev 2021; 9:CD013373. [PMID: 34523117 PMCID: PMC8440158 DOI: 10.1002/14651858.cd013373.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health services have traditionally been developed to focus on specific diseases or medical specialties. Involving consumers as partners in planning, delivering and evaluating health services may lead to services that are person-centred and so better able to meet the needs of and provide care for individuals. Globally, governments recommend consumer involvement in healthcare decision-making at the systems level, as a strategy for promoting person-centred health services. However, the effects of this 'working in partnership' approach to healthcare decision-making are unclear. Working in partnership is defined here as collaborative relationships between at least one consumer and health provider, meeting jointly and regularly in formal group formats, to equally contribute to and collaborate on health service-related decision-making in real time. In this review, the terms 'consumer' and 'health provider' refer to partnership participants, and 'health service user' and 'health service provider' refer to trial participants. This review of effects of partnership interventions was undertaken concurrently with a Cochrane Qualitative Evidence Synthesis (QES) entitled Consumers and health providers working in partnership for the promotion of person-centred health services: a co-produced qualitative evidence synthesis. OBJECTIVES To assess the effects of consumers and health providers working in partnership, as an intervention to promote person-centred health services. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2000 to April 2019; PROQUEST Dissertations and Theses Global from 2016 to April 2019; and grey literature and online trial registries from 2000 until September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs of 'working in partnership' interventions meeting these three criteria: both consumer and provider participants meet; they meet jointly and regularly in formal group formats; and they make actual decisions that relate to the person-centredness of health service(s). DATA COLLECTION AND ANALYSIS Two review authors independently screened most titles and abstracts. One review author screened a subset of titles and abstracts (i.e. those identified through clinical trials registries searches, those classified by the Cochrane RCT Classifier as unlikely to be an RCT, and those identified through other sources). Two review authors independently screened all full texts of potentially eligible articles for inclusion. In case of disagreement, they consulted a third review author to reach consensus. One review author extracted data and assessed risk of bias for all included studies and a second review author independently cross-checked all data and assessments. Any discrepancies were resolved by discussion, or by consulting a third review author to reach consensus. Meta-analysis was not possible due to the small number of included trials and their heterogeneity; we synthesised results descriptively by comparison and outcome. We reported the following outcomes in GRADE 'Summary of findings' tables: health service alterations; the degree to which changed service reflects health service user priorities; health service users' ratings of health service performance; health service users' health service utilisation patterns; resources associated with the decision-making process; resources associated with implementing decisions; and adverse events. MAIN RESULTS We included five trials (one RCT and four cluster-RCTs), with 16,257 health service users and more than 469 health service providers as trial participants. For two trials, the aims of the partnerships were to directly improve the person-centredness of health services (via health service planning, and discharge co-ordination). In the remaining trials, the aims were indirect (training first-year medical doctors on patient safety) or broader in focus (which could include person-centredness of health services that targeted the public/community, households or health service delivery to improve maternal and neonatal mortality). Three trials were conducted in high income-countries, one was in a middle-income country and one was in a low-income country. Two studies evaluated working in partnership interventions, compared to usual practice without partnership (Comparison 1); and three studies evaluated working in partnership as part of a multi-component intervention, compared to the same intervention without partnership (Comparison 2). No studies evaluated one form of working in partnership compared to another (Comparison 3). The effects of consumers and health providers working in partnership compared to usual practice without partnership are uncertain: only one of the two studies that assessed this comparison measured health service alteration outcomes, and data were not usable, as only intervention group data were reported. Additionally, none of the included studies evaluating this comparison measured the other primary or secondary outcomes we sought for the 'Summary of findings' table. We are also unsure about the effects of consumers and health providers working in partnership as part of a multi-component intervention compared to the same intervention without partnership. Very low-certainty evidence indicated there may be little or no difference on health service alterations or health service user health service performance ratings (two studies); or on health service user health service utilisation patterns and adverse events (one study each). No studies evaluating this comparison reported the degree to which health service alterations reflect health service user priorities, or resource use. Overall, our confidence in the findings about the effects of working in partnership interventions was very low due to indirectness, imprecision and publication bias, and serious concerns about risk of selection bias; performance bias, detection bias and reporting bias in most studies. AUTHORS' CONCLUSIONS The effects of consumers and providers working in partnership as an intervention, or as part of a multi-component intervention, are uncertain, due to a lack of high-quality evidence and/or due to a lack of studies. Further well-designed RCTs with a clear focus on assessing outcomes directly related to partnerships for patient-centred health services are needed in this area, which may also benefit from mixed-methods and qualitative research to build the evidence base.
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Affiliation(s)
- Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Crone B, Metraux S, Sbrocco T. Health Service Access Among Homeless Veterans: Health Access Challenges Faced by Homeless African American Veterans. J Racial Ethn Health Disparities 2021; 9:1828-1844. [PMID: 34402040 PMCID: PMC8367031 DOI: 10.1007/s40615-021-01119-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022]
Abstract
Veteran homelessness is a public health crisis, especially among the disproportionate number of minority veterans in the homeless veteran population. African American homeless veterans in particular face unique challenges accessing appropriate health care services to meet their medical needs. Their needs are often underrepresented in the literature on veteran homelessness. Drawing together over 80 studies and government reports from the last two decades, this review provides a timely synopsis of homeless veterans' health care access, with a particular focus on the barriers faced by African American veterans. This review employs Penchansky and Thomas' Access Model to frame health access barriers faced by homeless veterans, dialing in on what is known about the experience of African American veterans, within the five dimensions of access: Availability, Accessibility, Accommodation, Affordability, and Acceptability. Actionable guidance and targeted interventions to address health access barriers for all veterans are delineated with a focus on the need to gather further data for African American homeless veterans and to consider tailoring interventions for this important and underserved group.
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Affiliation(s)
- Baylee Crone
- Uniformed Service University of the Health Sciences, Bethesda, MD, USA.
| | | | - Tracy Sbrocco
- Uniformed Service University of the Health Sciences, Bethesda, MD, USA
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Rinehart DJ, Stowell M, Collings A, Durfee MJ, Thomas-Gale T, Jones HE, Binswanger I. Increasing access to family planning services among women receiving medications for opioid use disorder: A pilot randomized trial examining a peer-led navigation intervention. J Subst Abuse Treat 2021; 126:108318. [PMID: 34116817 PMCID: PMC8197777 DOI: 10.1016/j.jsat.2021.108318] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/05/2020] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE High rates of unintended pregnancy occur among women with opioid use disorder (OUD). OUD treatment settings may provide an ideal opportunity to address the family planning needs of patients. However, few studies have rigorously evaluated interventions designed to address family planning needs in the OUD treatment setting. This study assessed the feasibility, acceptability, and preliminary efficacy of a peer-led navigation intervention designed to educate and link women receiving medications for OUD to family planning services. METHODS The study recruited women from four OUD treatment programs in Denver, Colorado, to participate in a pilot randomized controlled trial from March 2018 to February 2019. Eligible participants were English-speaking adult females who were neither pregnant nor desiring a pregnancy and who were not using a long-acting reversible contraceptive (LARC) method. Participants completed a baseline survey, and the study randomized them to receive a two-session, peer-led family planning navigation intervention or usual care. The study assessed feasibility by participant engagement in the intervention. The study used follow-up self-report surveys and electronic health record data to assess intervention acceptability and intervention efficacy for the primary outcomes of a family planning visit and use of a LARC method. RESULTS The study enrolled 119 women who were randomized to the Sexual Health Initiative for Navigation and Empowerment (SHINE) peer-led navigation intervention (n = 56) or usual care (n = 63). The average age was 32 (SD = 6.4); 76% were receiving methadone, 24% were receiving buprenorphine and 19% reported a treatment provider had ever discussed family planning with them. Most had a previous pregnancy (82%) and of these, 93% reported an unplanned pregnancy. Among intervention participants, 93% completed the first navigation session, 90% felt that intervention topics were important, 76% indicated that the information was new, and 82% found working with a peer helpful. At six months postbaseline, significantly more (p = 0.01) intervention participants (36%) received a family planning visit compared to control participants (14%). There was no between-group difference on use of LARC methods. CONCLUSIONS A peer-led family planning navigation intervention was feasible to implement, acceptable to participants, and showed evidence of preliminary efficacy. This model may be an effective and potentially sustainable approach to support the family planning needs of women in treatment for OUD.
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Affiliation(s)
- Deborah J Rinehart
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, 777 Bannock St., M.C. 6551, Denver, CO 80204, USA; Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17(th) Ave., Aurora, CO 80045, USA.
| | - Melanie Stowell
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, 777 Bannock St., M.C. 6551, Denver, CO 80204, USA.
| | - Adriana Collings
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, 777 Bannock St., M.C. 6551, Denver, CO 80204, USA.
| | - M Joshua Durfee
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, 777 Bannock St., M.C. 6551, Denver, CO 80204, USA.
| | - Tara Thomas-Gale
- Ambulatory Care Services, Denver Health and Hospital Authority, 777 Bannock St., M.C. 1916, Denver, CO 80204, USA.
| | - Hendrée E Jones
- UNC Horizons and Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 410 North Greensboro St., NC 27510, USA.
| | - Ingrid Binswanger
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17(th) Ave., Aurora, CO 80045, USA; Institute for Health Research, Kaiser Permanente Colorado, PO Box 378066, Aurora, CO 80014, USA; Colorado Permanente Medical Group, 10350 E. Dakota Ave., Denver, CO 80247, USA.
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Moledina A, Magwood O, Agbata E, Hung J, Saad A, Thavorn K, Pottie K. A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1154. [PMID: 37131928 PMCID: PMC8356292 DOI: 10.1002/cl2.1154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Homelessness has emerged as a public health priority, with growing numbers of vulnerable populations despite advances in social welfare. In February 2020, the United Nations passed a historic resolution, identifying the need to adopt social-protection systems and ensure access to safe and affordable housing for all. The establishment of housing stability is a critical outcome that intersects with other social inequities. Prior research has shown that in comparison to the general population, people experiencing homelessness have higher rates of infectious diseases, chronic illnesses, and mental-health disorders, along with disproportionately poorer outcomes. Hence, there is an urgent need to identify effective interventions to improve the lives of people living with homelessness. Objectives The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness. Search Methods In consultation with an information scientist, we searched nine bibliographic databases, including Medline, EMBASE, and Cochrane CENTRAL, from database inception to February 10, 2020 using keywords and MeSH terms. We conducted a focused grey literature search and consulted experts for additional studies. Selection Criteria Teams of two reviewers independently screened studies against our inclusion criteria. We included randomised control trials (RCTs) and quasi-experimental studies conducted among populations experiencing homelessness in high-income countries. Eligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income. Data Collection and Analysis Teams of two reviewers extracted data in duplicate and independently. We assessed risk of bias using the Cochrane Risk of Bias tool. We performed our statistical analyses using RevMan 5.3. For dichotomous data, we used odds ratios and risk ratios with 95% confidence intervals. For continuous data, we used the mean difference (MD) with a 95% CI if the outcomes were measured in the same way between trials. We used the standardised mean difference with a 95% CI to combine trials that measured the same outcome but used different methods of measurement. Whenever possible, we pooled effect estimates using a random-effects model. Main Results The search resulted in 15,889 citations. We included 86 studies (128 citations) that examined the effectiveness and/or cost-effectiveness of interventions for people with lived experience of homelessness. Studies were conducted in the United States (73), Canada (8), United Kingdom (2), the Netherlands (2) and Australia (1). The studies were of low to moderate certainty, with several concerns regarding the risk of bias. PSH was found to have significant benefits on housing stability as compared to usual care. These benefits impacted both high- and moderate-needs populations with significant cimorbid mental illness and substance-use disorders. PSH may also reduce emergency department visits and days spent hospitalised. Most studies found no significant benefit of PSH on mental-health or substance-use outcomes. The effect on quality of life was also mixed and unclear. In one study, PSH resulted in lower odds of obtaining employment. The effect on income showed no significant differences. Income assistance appeared to have some benefits in improving housing stability, particularly in the form of rental subsidies. Although short-term improvement in depression and perceived stress levels were reported, no evidence of the long-term effect on mental health measures was found. No consistent impact on the outcomes of quality of life, substance use, hospitalisations, employment status, or earned income could be detected when compared with usual services. SCM interventions may have a small beneficial effect on housing stability, though results were mixed. Results for peer support interventions were also mixed, though no benefit was noted in housing stability specifically. Mental health interventions (ICM, ACT, CTI) appeared to reduce the number of days homeless and had varied effects on psychiatric symptoms, quality of life, and substance use over time. Cost analyses of PSH interventions reported mixed results. Seven studies showed that PSH interventions were associated with increased cost to payers and that the cost of the interventions were only partially offset by savings in medical- and social-services costs. Six studies revealed that PSH interventions saved the payers money. Two studies focused on the cost-effectiveness of income-assistance interventions. For each additional day housed, clients who received income assistance incurred additional costs of US$45 (95% CI, -$19, -$108) from the societal perspective. In addition, the benefits gained from temporary financial assistance were found to outweigh the costs, with a net savings of US$20,548. The economic implications of case management interventions (SCM, ICM, ACT, CTI) was highly uncertain. SCM clients were found to incur higher costs than those receiving the usual care. For ICM, all included studies suggested that the intervention may be cost-offset or cost-effective. Regarding ACT, included studies consistently revealed that ACT saved payers money and improved health outcomes than usual care. Despite having comparable costs (US$52,574 vs. US$51,749), CTI led to greater nonhomeless nights (508 vs. 450 nights) compared to usual services. Authors' Conclusions PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness.
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Affiliation(s)
| | - Olivia Magwood
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Eric Agbata
- Bruyere Research Institute, School of EpidemiologyPublic Health and Preventive MedicineOttawaCanada
| | - Jui‐Hsia Hung
- Faculty of Medicine, School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Ammar Saad
- Department of Epidemiology, C.T. Lamont Primary Care Research Centre, Bruyere Research InstituteUniversity of OttawaOttawaCanada
| | - Kednapa Thavorn
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
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Taweh N, Schlossberg E, Frank C, Nijhawan A, Kuo I, Knight K, Springer SA. Linking criminal justice-involved individuals to HIV, Hepatitis C, and opioid use disorder prevention and treatment services upon release to the community: Progress, gaps, and future directions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103283. [PMID: 34020864 DOI: 10.1016/j.drugpo.2021.103283] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/17/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
Improving HIV and Hepatitis C Virus (HCV) management among people involved in the criminal justice (CJ) system who use drugs, in particular those with opioid use disorder (OUD), requires effective approaches to screening, linkage, and adherence to integrated prevention and treatment services across correctional and community agencies and providers. This manuscript reviews the literature to explore gaps in HIV, Hepatitis C, and OUD prevention, treatment, and delivery cascades of care for persons involved in the CJ system. Specifically, we compare two models of linkage to prevention and treatment services: Peer/Patient Navigation (PN) wherein the PN links CJ-involved individuals to community-based infectious disease (ID) and substance use prevention and treatment services, and Mobile Health Units (MHU) wherein individuals are linked to a MHU within their community that provides integrated ID and substance use prevention and treatment services. The most notable finding is a gap in the literature, with few to no comparisons of models linking individuals recently released from the CJ system to integrated HIV, Hepatitis C, and OUD prevention and treatment and other harm reduction services. Further, few published studies address the geographical distinctions that affect service implementation and their effects on these substance use, ID and harm reduction care cascades. This manuscript makes specific recommendations to fill this gap through a detailed evaluation of PN and MHU linkage models to co-located and integrated HIV, Hepatitis C, and OUD prevention and treatment services across different communities within the U.S.
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Affiliation(s)
- Noor Taweh
- Yale School of Medicine, Section of Infectious Disease, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510, United States; University of Connecticut, Storrs, CT, United States
| | - Esther Schlossberg
- Yale School of Medicine, Section of Infectious Disease, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510, United States
| | - Cynthia Frank
- Yale School of Medicine, Section of Infectious Disease, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510, United States
| | - Ank Nijhawan
- University of Texas Southwestern, Division of Infectious Diseases and Geographic Medicine, TX, United States
| | - Irene Kuo
- George Washington University, DC, United States
| | - Kevin Knight
- Texas Christian University, Institute of Behavioral Research, TX, United States
| | - Sandra A Springer
- Yale School of Medicine, Section of Infectious Disease, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510, United States.
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Ojeda VD, Munson MR, Jones N, Berliant E, Gilmer TP. The Availability of Peer Support and Disparities in Outpatient Mental Health Service Use Among Minority Youth with Serious Mental Illness. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:290-298. [PMID: 32728991 PMCID: PMC7870605 DOI: 10.1007/s10488-020-01073-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We examine whether the availability of peer support reduces disparities in service use among minority youth ages 16-24 with serious mental illness in Los Angeles and San Diego Counties. Administrative data from 2015-2018 was used to summarize service use among 13,363 transition age youth age 16-24 with serious mental illness who received services from 183 outpatient public mental health programs; 17.2% were Black, 67.4% were Latinx, and 15.4% were non-Latinx white. The availability of peer support was assessed via a program survey. Generalized linear models were used to assess the relationship between availability of peer support, defined as having a peer specialist on staff, and the annual number of outpatient mental health visits. We also examined the relationship between racial/ethnic concordance of youth and peer specialists and use of outpatient services. Forty-six percent of youth received services from programs that employed peer specialists. Among youth in both counties, the availability of peer support was associated with an increase in annual outpatient visits (P ≤ .05 each). Peer support was associated with reductions in service use disparities among Black and Latinx youth in Los Angeles County (P < .001 each). Peer concordance was associated with an increase in outpatient service use among Latinx youth in both counties (P < .05 each). Peer support was associated with increases in use of outpatient mental health services. Detailed examination of the context for youth peer support implementation is merited to identify the specific pathways that improve outcomes.
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Affiliation(s)
- Victoria D. Ojeda
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | | | - Nev Jones
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Emily Berliant
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - Todd P. Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, USA
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Peer navigation for individuals with serious mental illness leaving jail: a pilot randomized trial study protocol. Pilot Feasibility Stud 2020; 6:114. [PMID: 32821420 PMCID: PMC7429745 DOI: 10.1186/s40814-020-00659-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Serious mental illness (SMI) is a prevalent public health problem affecting 25% of individuals in jail. Re-entry to the community following incarceration is a vulnerable time for justice-involved individuals with SMI. SMI requires prompt and ongoing access to mental health and other healthcare services. Methods The study will (1) develop a Mentoring And Peer Support (MAPS) intervention for post-release mental health and other service connection among jailed individuals with SMI and (2) pilot test the MAPS intervention to determine its feasibility and acceptability. The primary outcomes will be to evaluate the feasibility and acceptability of the proposed recruitment methods and research design, of the intervention training methods, and of delivering the enhanced peer-navigator and control interventions. Study samples include focus groups (n=36), open trial (n=15), and a randomized pilot trial in a sample of 40 individuals with SMI re-entering the community after jail release. Secondary outcomes will include post-release enrollment in mental health, medical care, and substance use services. We will also evaluate reduction in psychiatric symptoms, improvements in functioning, adherence to psychiatric medications, fewer substance using days, fewer hospitalizations and suicide attempts, nights unstably housed, and time until rearrest. Discussion This pilot study will evaluate the feasibility and acceptability of a peer navigation intervention for individuals with serious mental illness leaving jails. The study will serve as a formative work for a larger randomized controlled trial assessing the effectiveness of peer navigator intervention for (include the primary outcome) in this population.
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Bochicchio L, Stefancic A, Gurdak K, Swarbrick M, Cabassa LJ. "We're All in this Together": Peer-specialist Contributions to a Healthy Lifestyle Intervention for People with Serious Mental Illness. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:298-310. [PMID: 30565004 DOI: 10.1007/s10488-018-0914-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This qualitative study explored peer specialists' contributions to a healthy lifestyle intervention for obese/overweight individuals with serious mental illness (SMI) living in supportive housing. Intervention participants, peer specialists, and supervisors were interviewed and a grounded model emerged from the data identifying essential interpersonal attributes of the peer specialist-participant relationship. Peer specialists' disclosure of their own experiences making health behaviors changes was critical for building participants' motivation and ability to try lifestyle changes. Findings can inform peer specialist training and practice standards and facilitate the expansion of peer-delivered interventions to improve the physical health of people with SMI.
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Affiliation(s)
- Lauren Bochicchio
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Ana Stefancic
- Department of Psychiatry, Columbia University, 1051 Riverside Dr., Rm 6203, New York, NY, 10031, USA
| | - Kristen Gurdak
- Department of Psychiatry, Columbia University, 1051 Riverside Dr., Rm 6203, New York, NY, 10031, USA
| | - Margaret Swarbrick
- Collaborative Support Programs of New Jersey, Rutgers Behavioral Health Care, 11 Spring Street, Freehold, NJ, 07728, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
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Eddie D, Hoffman L, Vilsaint C, Abry A, Bergman B, Hoeppner B, Weinstein C, Kelly JF. Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching. Front Psychol 2019; 10:1052. [PMID: 31263434 PMCID: PMC6585590 DOI: 10.3389/fpsyg.2019.01052] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/24/2019] [Indexed: 12/05/2022] Open
Abstract
Peer recovery support services (PRSS) are increasingly being employed in a range of clinical settings to assist individuals with substance use disorder (SUD) and co-occurring psychological disorders. PRSS are peer-driven mentoring, education, and support ministrations delivered by individuals who, because of their own experience with SUD and SUD recovery, are experientially qualified to support peers currently experiencing SUD and associated problems. This systematic review characterizes the existing experimental, quasi-experimental, single- and multi-group prospective and retrospective, and cross-sectional research on PRSS. Findings to date tentatively speak to the potential of peer supports across a number of SUD treatment settings, as evidenced by positive findings on measures including reduced substance use and SUD relapse rates, improved relationships with treatment providers and social supports, increased treatment retention, and greater treatment satisfaction. These findings, however, should be viewed in light of many null findings to date, as well as significant methodological limitations of the existing literature, including inability to distinguish the effects of peer recovery support from other recovery support activities, heterogeneous populations, inconsistency in the definitions of peer workers and recovery coaches, and lack of any, or appropriate comparison groups. Further, role definitions for PRSS and the complexity of clinical boundaries for peers working in the field represent important implementation challenges presented by this novel class of approaches for SUD management. There remains a need for further rigorous investigation to establish the efficacy, effectiveness, and cost-benefits of PRSS. Ultimately, such research may also help solidify PRSS role definitions, identify optimal training guidelines for peers, and establish for whom and under what conditions PRSS are most effective.
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Affiliation(s)
- David Eddie
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lauren Hoffman
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Corrie Vilsaint
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Alexandra Abry
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Brandon Bergman
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Bettina Hoeppner
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Charles Weinstein
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - John F. Kelly
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Sheehan L, Torres A, Lara JL, Paniagua D, Larson JE, Mayes J, Doig S, Corrigan PW. Qualitative Evaluation of a Peer Navigator Program for Latinos with Serious Mental Illness. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:495-504. [PMID: 29168016 PMCID: PMC5997452 DOI: 10.1007/s10488-017-0839-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Peer navigator programs (PNP) may help reduce physical health disparities for ethnic minorities with serious mental illness (SMI). However, specific aspects of PNP that are important to peer navigators and their clients are under-researched. A qualitative study explored the perspectives of service users (n = 15) and peer navigators (n = 5) participating in a randomized controlled trial of a PNP for Latinos with SMI. Results show PN engagement with service users spans diverse areas and that interactions with peers, trust, and accessibility are important from a service user perspective. PNs discussed needs for high-quality supervision, organizational support, and additional resources for undocumented Latinos.
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Affiliation(s)
- Lindsay Sheehan
- Illinois Institute of Technology, Chicago, USA. .,Department of Psychology, Illinois Institute of Technology, 3424 S. State Street, Chicago, IL, 60616, USA.
| | | | | | | | | | - John Mayes
- Trilogy Behavioral Healthcare, Chicago, USA
| | - Susan Doig
- Trilogy Behavioral Healthcare, Chicago, USA
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Parkes T, Matheson C, Carver H, Budd J, Liddell D, Wallace J, Pauly B, Fotopoulou M, Burley A, Anderson I, MacLennan G, Foster R. Supporting Harm Reduction through Peer Support (SHARPS): testing the feasibility and acceptability of a peer-delivered, relational intervention for people with problem substance use who are homeless, to improve health outcomes, quality of life and social functioning and reduce harms: study protocol. Pilot Feasibility Stud 2019; 5:64. [PMID: 31164989 PMCID: PMC6489271 DOI: 10.1186/s40814-019-0447-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/09/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While people who are homeless often experience poor mental and physical health and problem substance use, getting access to appropriate services can be challenging. The development of trusting relationships with non-judgemental staff can facilitate initial and sustained engagement with health and wider support services. Peer-delivered approaches seem to have particular promise, but there is limited evidence regarding peer interventions that are both acceptable to, and effective for, people who are homeless and using drugs and/or alcohol. In the proposed study, we will develop and test the use of a peer-to-peer relational intervention with people experiencing homelessness. Drawing on the concept of psychologically informed environments, it will focus on building trusting and supportive relationships and providing practical elements of support such as access to primary care, treatment and housing options. METHODS A mixed-method feasibility study with concurrent process evaluation will be conducted to explore the feasibility and acceptability of a peer-delivered, relational intervention for people with problem substance use who are homeless. Peer Navigators will be based in homelessness outreach and residential services in Scotland and England. Peer Navigators will work with a small number of participants for up to 12 months providing both practical and emotional support. The sample size for the intervention is 60. Those receiving the intervention must be currently homeless or at risk of homelessness, over the age of 18 years and self-report alcohol/drug problems. A holistic health check will be conducted in the first few months of the intervention and repeated towards the end. Health checks will be conducted by a researcher in the service where the Peer Navigator is based. Semi-structured qualitative interviews with intervention participants and staff in both intervention and standard care settings, and all Peer Navigators, will be conducted to explore their experiences with the intervention. Non-participant observation will be conducted in intervention and standard care sites to document similarities and differences between care pathways. DISCUSSION The SHARPS study will provide evidence regarding whether a peer-delivered harm reduction intervention is feasible and acceptable to people experiencing homelessness and problem substance use in order to develop a definitive trial. TRIAL REGISTRATION SRCTN registry ISRCTN15900054, protocol version 1.3, March 12, 2018.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - John Budd
- Edinburgh Access Practice, NHS Lothian, 22-24 Spittal Street, Edinburgh, EH3 9DU UK
| | - Dave Liddell
- Scottish Drugs Forum, 91 Mitchell Street, Glasgow, G1 3LN UK
| | - Jason Wallace
- Scottish Drugs Forum, 91 Mitchell Street, Glasgow, G1 3LN UK
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, Technology Enterprise Facility, University of Victoria, Room 273, Victoria, British Columbia V8P 5C2 Canada
| | - Maria Fotopoulou
- Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Adam Burley
- The Access Point, 17/23 Leith Street, Edinburgh, EH1 3AT UK
| | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
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Chien WT, Clifton AV, Zhao S, Lui S. Peer support for people with schizophrenia or other serious mental illness. Cochrane Database Syst Rev 2019; 4:CD010880. [PMID: 30946482 PMCID: PMC6448529 DOI: 10.1002/14651858.cd010880.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peer support provides the opportunity for peers with experiential knowledge of a mental illness to give emotional, appraisal and informational assistance to current service users, and is becoming an important recovery-oriented approach in healthcare for people with mental illness. OBJECTIVES To assess the effects of peer-support interventions for people with schizophrenia or other serious mental disorders, compared to standard care or other supportive or psychosocial interventions not from peers. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials on 27 July 2016 and 4 July 2017. There were no limitations regarding language, date, document type or publication status. SELECTION CRITERIA We selected all randomised controlled clinical studies involving people diagnosed with schizophrenia or other related serious mental illness that compared peer support to standard care or other psychosocial interventions and that did not involve 'peer' individual/group(s). We included studies that met our inclusion criteria and reported useable data. Our primary outcomes were service use and global state (relapse). DATA COLLECTION AND ANALYSIS The authors of this review complied with the Cochrane recommended standard of conduct for data screening and collection. Two review authors independently screened the studies, extracted data and assessed the risk of bias of the included studies. Any disagreement was resolved by discussion until the authors reached a consensus. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary data, and the mean difference and its 95% CI for continuous data. We used a random-effects model for analyses. We assessed the quality of evidence and created a 'Summary of findings' table using the GRADE approach. MAIN RESULTS This review included 13 studies with 2479 participants. All included studies compared peer support in addition to standard care with standard care alone. We had significant concern regarding risk of bias of included studies as over half had an unclear risk of bias for the majority of the risk domains (i.e. random sequence generation, allocation concealment, blinding, attrition and selective reporting). Additional concerns regarding blinding of participants and outcome assessment, attrition and selective reporting were especially serious, as about a quarter of the included studies were at high risk of bias for these domains.All included studies provided useable data for analyses but only two trials provided useable data for two of our main outcomes of interest, and there were no data for one of our primary outcomes, relapse. Peer support appeared to have little or no effect on hospital admission at medium term (RR 0.44, 95% CI 0.11 to 1.75; participants = 19; studies = 1, very low-quality evidence) or all-cause death in the long term (RR 1.52, 95% CI 0.43 to 5.31; participants = 555; studies = 1, very low-quality evidence). There were no useable data for our other prespecified important outcomes: days in hospital, clinically important change in global state (improvement), clinically important change in quality of life for peer supporter and service user, or increased cost to society.One trial compared peer support with clinician-led support but did not report any useable data for the above main outcomes. AUTHORS' CONCLUSIONS Currently, very limited data are available for the effects of peer support for people with schizophrenia. The risk of bias within trials is of concern and we were unable to use the majority of data reported in the included trials. In addition, the few that were available, were of very low quality. The current body of evidence is insufficient to either refute or support the use of peer-support interventions for people with schizophrenia and other mental illness.
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Affiliation(s)
- Wai Tong Chien
- The Chinese University of Hong KongNethersole School of Nursing8/F., Esther Lee Building, Chung Chi CampusThe Chinese University of Hong KongShatinNew TerritoriesHong Kong
| | - Andrew V Clifton
- De Montfort UniversityFaculty of Health and Life Sciences3.10 Edith Murphy HouseThe GatewayLeicesterUKLE1 9BH
| | - Sai Zhao
- The Ingenuity Centre, The University of NottinghamSystematic Review Solutions LtdTriumph RoadNottinghamUKNG7 2TU
| | - Steve Lui
- University of HuddersfieldSchool of Human and Health SciencesHarold Wilson BuildingQueensgateHuddersfieldUKHD1 3DH
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Godoy L, Hodgkinson S, Robertson HA, Sham E, Druskin L, Wambach CG, Beers LS, Long M. Increasing Mental Health Engagement From Primary Care: The Potential Role of Family Navigation. Pediatrics 2019; 143:peds.2018-2418. [PMID: 30877145 DOI: 10.1542/peds.2018-2418] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/24/2022] Open
Abstract
Early engagement in mental health intervention is critical, yet the vast majority of children who are experiencing mental health concerns are not receiving needed services. Pediatric primary care clinics have been recognized as an ideal setting in which to identify and address mental health problems early, although engagement in mental health services within primary care and in community-based settings remains low. Navigators, or individuals with experience in navigating the mental health system, have been highlighted as promising partners in efforts to improve engagement in mental health services. Navigation has a growing body of research support among adults and in targeting medical concerns, but there has been limited research on integrating family navigators into pediatric primary care settings to address mental health concerns. Despite this gap in the evidence base, we believe there is significant promise for the use of this model in addressing children's mental health needs. In this report, we discuss factors contributing to high levels of unmet mental health needs and low levels of engagement in mental health services, the role that navigators can play in increasing engagement in mental health care, and implications and recommendations related to integrating mental health-focused family navigators into pediatric primary care settings.
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Affiliation(s)
- Leandra Godoy
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia; .,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Stacy Hodgkinson
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | | | - Elyssa Sham
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Lindsay Druskin
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | | | - Lee Savio Beers
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Melissa Long
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
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Aschbrenner KA, Naslund JA, Grinley T, Bienvenida JCM, Bartels SJ, Brunette M. A Survey of Online and Mobile Technology Use at Peer Support Agencies. Psychiatr Q 2018; 89:539-548. [PMID: 29302771 PMCID: PMC6217798 DOI: 10.1007/s11126-017-9561-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Understanding how individuals with mental illness who receive services at peer support agencies use technology can inform the development of online and mobile health interventions tailored for users in these non-traditional mental health settings. The purpose of this study was to assess the use of technology among individuals with mental illness at peer support agencies. A survey delivered within peer support agencies (PSAs) in one state assessed technology use among individuals ages 18 and over with a self-identified mental illness receiving services at these agencies. In total, 195 individuals from 10 PSAs completed the survey. Eighty-two percent of respondents used the internet, with 63% of respondents connected to the internet at the PSAs. Eighty one percent of respondents owned a cell phone, 70% used text messaging, 58% owned smartphones, 61% used mobile applications, and 72% used social media. PSA users under age 55 were significantly more likely to own a smartphone than PSA users age 55 and older. Among internet users, 71% had searched for health information online and 57% had searched for mental health information online. Many individuals who receive services at PSAs have access to online and mobile technologies. These technologies may be leveraged to expand the reach of evidence-based health and mental health programs to individuals in these non-traditional mental health settings. Future research should explore the feasibility of intervention strategies that involve PSAs as a resource for linking people with mental illness to online and mobile support for their health and wellness goals.
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Affiliation(s)
- Kelly A Aschbrenner
- Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- Dartmouth-Hitchcock Health System, 294 Daniel Webster Highway, Merrimack, NH, 03054, USA.
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Thomas Grinley
- New Hampshire Department of Health and Human Services, Concord, NH, USA
| | - John Carlo M Bienvenida
- Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Stephen J Bartels
- Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Mary Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- New Hampshire Department of Health and Human Services, Concord, NH, USA
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Corrigan PW, Pickett S, Schmidt A, Stellon E, Hantke E, Kraus D, Dubke R. Peer navigators to promote engagement of homeless African Americans with serious mental illness in primary care. Psychiatry Res 2017; 255:101-103. [PMID: 28535474 PMCID: PMC5545154 DOI: 10.1016/j.psychres.2017.05.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 05/12/2017] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Abstract
Homeless African Americans with serious mental illness experience higher rates of morbidity and mortality than adults with severe mental illness alone. Peer navigators, individuals with similar lived experiences, may help these individuals navigate the healthcare system to improve healthcare utilization. This study examined whether the Peer Navigator Program (PNP) improved scheduling and achieving healthcare appointments compared to treatment as usual (TAU) over the course of 12 months, including three periods within that timeframe: engagement (first three months), impact (middle six months), and maintenance (final six months). Results indicated no change during the first three months of the study, a significantly greater improvement in scheduled and achieved appointments for PNP compared to TAU during the middle six months, and maintenance of appointment change improvements over the final three months of the study. This research suggests peer navigators may offer a promising solution to barriers in utilizing the healthcare system for people with severe mental illness, especially those who may be homeless or from minority racial groups.
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Affiliation(s)
| | | | - Annie Schmidt
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Dana Kraus
- Departmentof Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Rachel Dubke
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA.
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