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2009 HSR&D National Meeting Abstract

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National Meeting 2009

1013 — Using Stakeholder Assessments to Improve Implementation of the VA Uniform Service Package

Chinman MJ (VISN 4 MIRECC), Lucksted A (VISN 5 MIRECC), Gresen R (VA Office of Mental Health Services), Davis M (Mental Health Care Line, VISN 3), Losonczy M (New Jersey Health Care System), Sussner B (New Jersey Health Care System), Martone L (Central Arkansas Veterans Healthcare System), Young A (VISN 22 MIRECC)

Objectives:
The new “Uniform Services Package (USP) for VA Mental Health Services” specifies best practices all facilities must provide. For example, now veterans must have access to Peer Support Technicians (PSTs): individuals in recovery from serious mental illness hired as clinical team members. Non-VA research (VA PSTs are new) shows that PSTs improve outcomes by role modeling community living, enhancing social networks, and improving patients’ adherence to, and participation in, treatment. These studies also revealed the existence of significant barriers to implementation (staff resistance, unclear roles). Stakeholder assessment can yield guidance VA managers need to address implementation barriers for PSTs and other practices in the USP. Accordingly, we assessed the barriers to PST implementation among VA stakeholders at two timepoints (BEFORE, and 6 months AFTER, the start of the PST initiative) and made recommendations.

Methods:
BEFORE: Two provider and two patient focus groups and three administrator interviews were conducted at three southern California VA clinics (N = 110: 38 patients, 63 providers, nine administrators) about the potential benefits and drawbacks to PSTs. Participants completed surveys about their perceived acceptability of PSTs (ratings were compared with MANCOVAs). AFTER: Five focus groups were conducted with 59 VA PSTs and 34 VA supervisors from across the US about barriers and facilitators of employing new PSTs. For all groups and interviews, two staff coded transcripts using a modified grounded theory approach to generate themes.

Results:
BEFORE: Qualitative data suggests that all stakeholders believe PSTs would be helpful (e.g., improving community integration, patient-provider communication). However, providers believed PSTs as full-time team members would be unfeasible, harmful to patients, and a burden to staff. On the surveys, stakeholders had similar positive and negative endorsements. AFTER: Focus group data showed that VA PSTs were in fact feasible, accepted by some teammates, but experienced significant role confusion and provider resistance.

Implications:
Although many of the initial concerns were not realized, resistance to PSTs exists and can undermine their potential to promote recovery.

Impacts:
Our recommendations—standardize training for PSTs and also train staff—have informed new VA guidelines for PST implementation. Stakeholder assessment can be a model for instituting other practices specified in the USP.


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