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*232. Peer Assisted Case Management: A Randomized Controlled Study

Mara Kushner CSW, Veterans Health Administration; Susan Essock PhD, Mount Sinai Medical Center

Objectives: This study uses a controlled design to compare the effectiveness of standard professional case management to a peer-assisted model. Measuring the patientís community tenure, quality of life and patient satisfaction during a follow up period will assess the outcome of the study.

Methods: Subjects have been randomly assigned to an experimental and control group. Subjects in both groups have been discharged from institutional settings with appropriate follow up care within VA mental health settings. Subjects in the experimental group however, have also been assigned to a peer counselor to assist with their transition to independent living. Contact with the Peer Counselor occurs minimally once a week and is focussed on activities of daily living, socialization and compliance with treatment. Outcome data is collected at four intervals throughout a one year period of the study.

Three Peer Counselors are supervised by one social worker. Each Peer Counselor will have a caseload of 7 clients once recruitment is completed for a total of 21 patients in study and 21 patients in the control group. Caseloads are organized geographically to promote socialization of clients and to increase ability for PCs to manage their caseloads. PCs have daily contact with the social worker who has overall clinical responsibility for the initiative and provides all P.C. supervision.

Subject Selection Criteria

1. Recruited from any New York Harbor Health Care System Homeless program

2. Must have major axis one psychiatric disorder

3. Will be enrolled within one month prior to transitioning to independent living

4. Must be willing to participate in the study

5. Must be willing to work with both case manager and peer counselor

6. Subjects may have dual disorders

Exclusionary Criteria

1. Subjects who are entering intensive supportive residences.

2. Subjects who have other case managers will be excluded.

Peer Counselor Selection

1. Graduate of any New York Harbor Health Care System Homeless program

2. Living independently for minimum of six month

3. Engaged in ongoing out patient treatment defined as contact with primary mental health provider at minimum once a month but not to exceed once a week

4. Abstinent from illicit substances for minimum of one year


Peer counselors must be veterans and formerly homeless.

Peers should have a strong knowledge base of substance abuse treatment and understanding of the recovery process.

Peers should have a working knowledge of community resources.

Peers should have prior experience facilitating groups.

Peers must have demonstrated solid people skills.

Results: Hypotheses Subjects in peer assisted case management will report quality of life that will be superior than that reported by subjects in the control group. Subjects in peer assisted case management will report satisfaction to treatment that is superior than that reported by the subjects in the control group. Subjects in peer assisted case management will have longer community tenure than that of the subjects in the control group. I will be presenting early results of baseline analysis in addition to 1. Implementation hurdles 2. Issues around training and maintaining peer counselors 3. Working through professional staff resistance

Conclusions: This is an effective method of treatment for the seriously mentally ill population. This can be implemented with previously homeless individuals, the service system can accept it and it can extend and enhance the range of case management services.

Impact: This is an efficient and effective treatment modality that improves patient outcome in transitioning to independent living. Patients can be maintained in the community, with improved quality of life and reduce hospitalizations.