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2023 HSR&D/QUERI National Conference Abstract

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4145 — How did VHA Peer Support Programs Adapt to Meet Veterans’ Needs During the COVID-19 Pandemic? A Qualitative Investigation

Lead/Presenter: Johanne Eliacin,  COIN - Indianapolis
All Authors: Eliacin J (Richard L. Roudebush VA Medical Center, Regenstrief Institute, Indiana University School of Medicine), Burgess, DJ (Minneapolis VA Healthcare System, University of Minnesota) Rollins, AL (Richard L. Roudebush VA Medical Center, Regenstrief Institute, Indiana University-Purdue University at Indianapolis) Patterson, S. (Richard L. Roudebush VA Medical Center, Indiana University School of Medicine) O’Connor, C (Richard L. Roudebush VA Medical Center) Matthias, MS (Richard L. Roudebush VA Medical Center, Regenstrief Institute, Indiana University School of Medicine)

Objectives:
The COVID-19 pandemic and its sequelae have contributed to increased mental health concerns and created new barriers to care for people already suffering from mental illness and substance use disorders. VA peer specialists (peers) are particularly well-suited to support Veterans during times of crisis and could help increase the VA’s mental health workforce capacity to meet Veterans’ increasing mental healthcare needs. Peers are Veterans who are VA employees in recovery from mental illness or substance abuse disorders. However, prior to the COVID-19 pandemic, peer support services were delivered primarily in-person and were particularly vulnerable to significant disruptions in services delivery. Therefore, in this study, we sought to characterize the impacts of the COVID-19 pandemic on peer support programs and documented how these programs adapted to maintain peer services delivery.

Methods:
We conducted qualitative semi-structured interviews with peers and peer supervisors from VISN-10 (Ohio, Indiana, and Michigan), guided by the Consolidated Framework for Implementation Research (CFIR). Participants were asked to describe adaptations made to maintain or improve peer services delivery and to identify motivators and facilitators for these adaptations. We used an inductive and deductive approach to analyze the interviews.

Results:
Participants were 18 peers and 10 supervisors from 11 sites across VISN-10. Participants described significant disruptions in peer services delivery during the COVID-19 pandemic that amplified existing problems and created new ones. These disruptions were caused by both peers and Veterans’ technology barriers, interruptions in inter-agency collaborations, telework challenges, and communication barriers. These challenges led to several adaptations that improved peer services. Examples included development of new programs to meet Veterans’ unmet social needs, educating Veterans about COVID-19 safety guidelines, and facilitating access to telehealth mental health services by addressing Veterans’ technology needs and other barriers to care. CFIR domains, “patient needs” and “available resources,” were the most cited motivators and facilitators for these adaptations, followed by “external policies,” and “tension for change.” To illustrate, participants described how they increased the number of group offerings but reduced group duration and decreased the number of participants to maintain services delivery to all Veterans while following social distancing guidelines. Moreover, we identified several key strategies that facilitated programs’ adaptations. They include use of resources, network, and collaboration within and across VA facilities, fostering of peers’ self-efficacy and autonomy, and effective communication.

Implications:
Peer programs experienced significant challenges and disruptions in peer services delivery during the COVID-19 pandemic. However, they also demonstrated significant resilience, flexibility, and innovation as they adapted to meet Veterans’ increasing social and mental health needs.

Impacts:
The mental health impacts of the COVID-19 pandemic will be long-lasting. Supporting and using peer programs to their full capacity could be an effective strategy to expand VA’s mental health workforce capacity and to meet Veterans’ mental healthcare needs.