SC CTSI-Supported Investigator Receives $1.24 Million PCORI Grant for RCT of Peer Health Navigation

Peer navigators may help mentally ill take charge of their health.

September 24, 2013

Note: This new grant is the result of a long-term partnership between the SC CTSI and USC's John Brekke, PhD, that began in 2008 with the award of a grant from the UniHealth Foundation which provided seed money for the original pilot study.  The SC CTSI Community Engagement team has continued to  provide in-kind staffing support for the training and supervision of new Health Navigators and will be part of the research team for the PCORI funded RTC.   

Not only do individuals with serious mental illness die an average of 25 years earlier than the general population, but those deaths are also often attributed to preventable medical conditions.

Improving how those individuals interact with the complex and often uncoordinated health care system is a key component of a new intervention being tested by John Brekke, the Frances G. Larson Professor of Social Work Research at the USC School of Social Work.

Backed by a $1.2 million award from the Patient-Centered Outcomes Research Institute (PCORI), he is exploring the effectiveness of peer navigators, or those who have personal experience with mental illness and the treatment system.

“They help individuals with serious mental illness gain access to primary preventive and specialty health care services,” Brekke said. “They do everything from help them find and engage with doctors, make appointments and get follow-up care. It helps them maintain these health care relationships over time on their own.”

A disconnection between mental and physical health care providers is considered a critical factor that leads to health disparities among people with serious mental illness, he said. An intervention known as the Bridge employs peer navigators to help current health care consumers improve their health status and satisfaction with care.

A recently completed pilot project revealed promising results, Brekke said, including a significant reduction in overall health problems and physical pain among participants.

“We found improvements in the use of medication related to physical health conditions and really importantly, we found a dramatic shift away from the emergency room, away from urgent care, and toward outpatient primary care,” he said.

The Bridge intervention is based on a behavioral model of health service use for vulnerable populations that Brekke and his research team adapted for people with serious mental illness. It features a three-pronged approach focused on integrating different systems of care, educating patients about health and self-care, and building cognitive and behavioral skills.

The two-year, PCORI-funded study will randomly assign approximately 150 participants with serious mental illness to one of two groups. One group will receive treatment as usual, and the other will participate in the Bridge peer navigator program.

Brekke’s team will track health outcomes across three time points—at the onset of the study, 6 months and 1 year—to determine the intervention’s effectiveness in terms of health care service use, health knowledge, satisfaction with care, health status, quality of life and self-efficacy. In addition to surveying study participants, Brekke will rely on medical records and insurance claims information to objectively examine health status.

He said peer navigators have proven effective at building a strong connection with clients and empowering them to take charge of their health.

“The clients really appreciate and engage with learning these skills, and the peer providers take tremendous reinforcement from being the ones providing the training,” Brekke said, noting that there was some initial concern that it may be challenging for peer navigators to administer the Bridge program.

Read the full story on the USC Social Work website

Related post:

• Helping People With Mental Illness Get Medical Care

NIH Funding Acknowledgment: Important - All publications resulting from the utilization of SC CTSI resources are required to credit the SC CTSI grant by including the NIH funding acknowledgment and must comply with the NIH Public Access Policy.