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IIR 02-009 – HSR&D Study

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IIR 02-009
Improving Care of Veterans by Using Consumers as Mental Health Providers
Matthew J. Chinman PhD
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: October 2003 - June 2007

BACKGROUND/RATIONALE:
Providing treatment to those with serious mental illnesses (SMI) is challenging and the second most costly illness treated in the VHA. While the treatment is expensive, a typical clinics care is often not efficiently targeted on those most in need, and patient outcomes are substantially worse than expected. This is perhaps because traditional services are often fragmented, overburdened, lack an emphasis on recovery, and thus may not be a good "fit" for all clients. Studies have shown that use of "consumer providers (CPs)" often improves public care, specifically because CP's can provide more flexible services aimed at meeting the diverse needs of patient's with SMI.

OBJECTIVE(S):
Despite the potential benefit of CP services, the use of mentally ill veterans to provide mental health services appears not to be common. Therefore, we propose this three year collaboration between the VISN 16 and 22 Mental Illness Research, Education, and Clinical Centers (MIRECC) to examine how to tailor this model for the VHA in order to improve SMI services for veterans. The proposed project has three objectives: (1) Assess VHA leadership, providers, and patients regarding how to tailor the CP model to be useful in the VHA as well as identify potential barriers and facilitators to its implementation; (2) Assess leading non-VHA CP programs and staff to understand the barriers and facilitators they faced in order to inform VHA consumer provider service development; (3) Conduct a small feasibility trial implementing CP services in order to assess the CP hiring process, develop training, evaluate patient response, deal with staff resistance, and conduct performance monitoring.

METHODS:
In order to examine how to tailor this model for the VHA to improve SMI services for veterans, a series of interviews and focus groups will be conducted with patients, providers, and administrators across six VHA clinics in two VISNs: VISN 16 and 22. At each VHA clinic site, two patient and two provider focus groups, and three key administrator interviews will be conducted. Each patient and provider focus group will include six to ten persons, all of whom will be purposefully recruited in order to represent a range of racial/ethnic groups, both genders, ages, and diagnoses. Also at all the sites, key administrators will be asked to participate in an individual interview based on their responsibility for overseeing clinical services. In addition, interviews and focus groups will be conducted with patients, providers, and administrators at a non-VHA site, the Connecticut Mental Health Center (CMHC) in New Haven, CT. CMHC is a public sector setting in which managers, providers, and patients have experiences with CPs that would enrich the findings. Then, a CP will work 30 hours a week at the GLA MHICM team. MHICM stands for Mental Health Intensive Case Management and provides community-based care for those with serious mental illness who utitilize a great deal of inpatient services. The study will track the impact of implementing CP services on the level of recovery experienced at two levels: a) the individual patient and b) the mental health system (i.e., clinic or treatment team). It is also a goal of the study to assess patient outcomes such as substance use, depression and psychosis symptoms, and functioning at the individual level.

FINDINGS/RESULTS:
We have completed data collection at all sites including the Los Angeles, Long Beach, San Diego, and Little Rock VA's, and the CMHC. Thus far we have analyzed the data collected for the Southern California groups which included data from 38 patients, 63 mental health providers, and 9 administrators. In analyzing the survey data for all three stakeholder groups they similarly and strongly agreed with both the positive and negative attitudes toward CPs. There were no significant differences comparing patients' and providers' attitudes toward CPs. In analyzing the qualitative data across all three groups, there was a range of responses that both supported and raised concerns about starting a CP service in the VHA. However, the majority of patients, administrators, and providers were in agreement that CPs could be helpful to veteran patients over and above currently available services by providing: support, role modeling, hope for recovery, assitance with community integration, and a link between patients and the mental health system. The key differences of the stakeholders lie in the best job structures through which to apply these roles, concerns about CPs, and ways to overcome barriers to implementing a CP service within VHA. We are currently conducting the feasibility trail at the GLA VA site.

IMPACT:
Using CPs has the potential to reduce costly inpatient hospitalizations, improve care quality, and as a result lead to greater satisfaction with care among veteran patients. Our study of VHA stakeholders has provided the data needed to tailor the consumer provider model to veterans within the VHA. We have disseminated this information through publications and presentations, listed below. In addition, the grant has provided information useful to several VA planning committees in which Dr. Chinman has played a key service role.

PUBLICATIONS:

Journal Articles

  1. Chinman M, Hassell J, Magnabosco J, Nowlin-Finch N, Marusak S, Young AS. The feasibility of computerized patient self-assessment at mental health clinics. Administration and policy in mental health. 2007 Jul 1; 34(4):401-9.
  2. Fremont AM, Young AS, Chinman M, Pantoja P, Morton S, Koegel P, Sullivan G, Kanouse D. Differences in HIV care between patients with and without severe mental illness. Psychiatric services (Washington, D.C.). 2007 May 1; 58(5):681-8.
  3. Davidson L, Chinman M, Sells D, Rowe M. Peer support among adults with serious mental illness: a report from the field. Schizophrenia Bulletin. 2006 Jul 1; 32(3):443-50.
  4. Chinman M, Young AS, Hassell J, Davidson L. Toward the implementation of mental health consumer provider services. The journal of behavioral health services & research. 2006 Apr 1; 33(2):176-95.
  5. Young AS, Chinman M, Forquer SL, Knight EL, Vogel H, Miller A, Rowe M, Mintz J. Use of a consumer-led intervention to improve provider competencies. Psychiatric services (Washington, D.C.). 2005 Aug 1; 56(8):967-75.
  6. Chinman M, Hannah G, Wandersman A, Ebener P, Hunter SB, Imm P, Sheldon J. Developing a community science research agenda for building community capacity for effective preventive interventions. American journal of community psychology. 2005 Jun 1; 35(3-4):143-57.
  7. Young AS, Chinman MJ, Cradock-O'Leary JA, Sullivan G, Murata D, Mintz J, Koegel P. Characteristics of individuals with severe mental illness who use emergency services. Community mental health journal. 2005 Apr 1; 41(2):159-68.
  8. Young AS, Sullivan G, Bogart LM, Koegel P, Kanouse DE. Needs for services reported by adults with severe mental illness and HIV. Psychiatric services (Washington, D.C.). 2005 Jan 1; 56(1):99-101.
  9. Chinman M, Young AS, Schell T, Hassell J, Mintz J. Computer-assisted self-assessment in persons with severe mental illness. The Journal of clinical psychiatry. 2004 Oct 1; 65(10):1343-51.
  10. Davidson L, Shahar G, Stayner DA, Chinman MJ, Rakfeldt J, Tebes JK. Supported socialization for people with psychiatric disabilities: lessons from a randomized controlled trial. Journal of Community Psychology. 2004 Jul 1; 32(4):453-477.
Conference Presentations

  1. Cohen AN, Hamilton A, Chinman M, Ebener P, Oberman R, Young AS. Implementation of consumer providers in mental health settings. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 23; Baltimore, MD.
  2. Chinman MJ. Transforming the system. Paper presented at: VA Employee Education System The Evolving Roles of Peers in VA Mental Health Conference; 2007 Aug 3; Chicago, IL.
  3. Chinman M, Young AS, Hassell J, Davidson L. Toward the Implementation of Mental Health Consumer Providers Services in the VA. Paper presented at: VA Transforming Mental Health Care Conference; 2007 Jul 18; Alexandria, VA.
  4. Chinman MJ, Young AS, Hassell J, Magnabosco JL. Feasibility of implementing computerized self-assessment in routine care settings serving patients with severe mental illness. Paper presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA.
  5. Chinman M, Young AS, Hassell J, Davidson L. Toward the implementation of mental health consumer provider services in the VA. Paper presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2006 Sep 1; Portland, OR.
  6. Chinman MJ. What is "Recovery" and how do we measure it? Paper presented at: VA MIRECC Annual Retreat; 2006 Jan 13; Little Rock, AR.
  7. Resnick SG, Goodale L, Chinman MJ, Pazienza N, Cadoret G. Program structure: Where do peer services fit in the VA System? Independent programs or integrated services? Paper presented at: VA Mutual Learning: A VA Peer Support & Education Conference; 2005 Nov 1; Memphis, TN.
  8. Chinman MJ. Peer support among those with serious mental illnesses: Empirical evidence and program implications. Paper presented at: University of California Los Angeles / RAND / National Institute of Mental Health Center for Research on Quality in Managed Care Quality Forum; 2005 Sep 12; Los Angeles, CA.
  9. Young AS, Chinman M, Mintz J, Hassell J, Magnabosco J, Cohen AN. Implementing routine outcome assessment at public clinics. Paper presented at: National Institute of Mental Health Mental Health Services Research Annual Conference; 2005 Jul 1; Bethesda, MD.
  10. Young AS, Chinman M, Mintz J, Hassell J, Magnabosco J. Implementing routine outcome assessment to improve care for mental illness. Paper presented at: AcademyHealth Annual Research Meeting; 2005 Jun 1; Boston, MA.
  11. Young AS, Cohen AN, Mintz J. Information systems and improving care for schizophrenia. Paper presented at: AcademyHealth Annual Research Meeting; 2005 Jun 1; Boston, MA.
  12. Chinman MJ, Young AS, Mintz J, Shih S, Hassell J. Evaluating Computer Self-Assessments In Patients With Severe Mental Illness. Paper presented at: VA HSR&D National Meeting; 2005 Feb 1; Baltimore, MD.
  13. Young AS, Chinman MJ, Magnabosco J, Hassell J, Cohen AN, Mintz J. Implementing Routine Outcome Assessment to Improve Care for Chronic Mental Illness. Paper presented at: VA HSR&D National Meeting; 2005 Feb 1; Baltimore, MD.
  14. Chinman MJ. Peer support programs. Recovery and Rehabilitation of the Client with Psychosis: Evidence-Based Practices. Paper presented at: VA MIRECC Annual Conference; 2004 Oct 29; Huntington Beach, CA.


DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Treatment - Observational
Keywords: Complementary & alternative therapy, Depression, Schizophrenia
MeSH Terms: none

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