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. We are currently awaiting IRB approval to conduct the feasibility trail at the GLA VA site, which start is projected for June 2006. 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, assistance 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.

STATUS: Project work is ongoing.

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. With the data collected from the focus groups and administrative interviews this study next plans to conduct a feasibility trial using veterans as consumer providers at the GLA VA site.

PUBLICATIONS:
Chinman M, Young AS, Hassell J, Davidson L. (2006) Toward the implementation of mental health consumer provider services. J Behav Health Serv Res. Apr;33(2):176-95

Principal Investigator:
Matthew J. Chinman, PhD; and Alexander S. Young, MD, MSHS.

Partners: The Connecticut Mental Health Center, and VA Healthcare Centers at Little Rock, Arkansas, San Diego, California, Long Beach, California, and Los Angeles, California.