Peer Navigation for Psychiatric Disabilities

(DRRRP-PHN Trial)

Recruiting at 1 trial location

Overseen By Carla D Kundert, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Illinois Institute of Technology

Disqualifiers: Peer support, ACT services, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 8 months

354 Participants Needed

Trial Summary

What is the purpose of this trial?

Adults with psychiatric disabilities get sick and die 20 to 30 years younger than same-age peers, with even greater disparities occurring when the person is from a low SES or of color. Factors explaining this difference are complex and include genetic comorbidity, iatrogenic effects of medication, life choices, and life consequences. These factors are worsened by service disparities which are often fragmented in the public health system. Peer navigators are part of a program in which providers escort people with psychiatric disabilities around the fragmented system to meet their health and wellness goals, often a demanding task for the person who has needs addressed at clinics, labs, and pharmacies spread across an urban area. Navigators are peers because they have lived experience of recovery and are often from similar ethnic groups. A community-based participatory research program supported by NIMHD and PCORI developed a peer navigator program specific to the needs of people with psychiatric disabilities. Results of two small pilots funded by NIMHD and PCORI showed the Peer Navigator Program (PNP) led to significant improved service engagement which corresponded with better health, recovery, and quality of life. The studies included fidelity measurement which showed peer navigators conducting the intervention at high levels of fidelity. The current research is an efficacy study with a more fully powered test of PNP versus treatment as usual, which is integrated care (TAU-IC). The investigators aim to recruit 300 adults with psychiatric disability who wish to improve physical health/wellness through peer health navigation randomized to TAU-IC or TAU-IC plus PNP. Individuals will participate in assigned interventions as part of 8-month cohorts with data being obtained at baseline, 4, 8, and 12 months. Data will include personal descriptors (demographics, diagnosis, life consequences report), outcomes (service engagement, physical symptoms, blood pressure, recovery, and quality of life), mediators (personal empowerment, self-determination, and perceived relationship for recovery), and process measures (fidelity, feasibility, and acceptability). Investigators hypothesize that those in PNP intervention will have improved outcomes over the integrated care as usual. A cost-benefit analysis will seek to model impact based on quality-adjusted life years. Larger effect sizes will permit post hoc identification of how PNP effects vary by participant characteristics such as ethnicity and gender.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on peer support and navigation rather than medication changes.

What data supports the effectiveness of the treatment Peer Navigation for Psychiatric Disabilities?

Research shows that peer navigation, where individuals with similar experiences help others navigate healthcare, can improve healthcare appointment attendance and health outcomes for people with serious mental illness, especially those who are homeless or from minority groups. This suggests that peer navigation may help overcome barriers to healthcare access and improve health management. ^{1 2 3 4 5}

Is Peer Navigation safe for people with psychiatric disabilities?

Research on Peer Navigation, including studies on individuals with serious mental illness, suggests it is generally safe and can improve health outcomes by helping people manage their healthcare better. ^{3 4 5 6 7}

How is Peer Navigation treatment different from other treatments for psychiatric disabilities?

Peer Navigation is unique because it involves trained individuals with similar experiences (peers) helping others navigate healthcare systems, focusing on building trust and accessibility, rather than using medication or traditional therapy methods. ^{5 6 8 9 10}

Research Team

Patrick W Corrigan, PsyD

Principal Investigator

Illinois Institute of Technology

Eligibility Criteria

This trial is for adults over 18 with serious mental illness who want to improve their physical health and wellness. They must be active members of Thresholds in the Chicago South Side area, willing to attend sessions but not already receiving peer support or Assertive Community Treatment services.

Inclusion Criteria

I want to better my health and prevent illness with the help of a health guide.

Serious mental illness (as indicated by disability)

Willing to attend

Exclusion Criteria

I am currently getting support from a community mental health team.

Does not reside in the catchment area (Chicago South Side)

Not an active Thresholds member

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants are randomized to either Treatment as Usual-Integrated Care (TAU-IC) or Peer Navigator Program (PNP) plus TAU-IC for 8 months

8 months

Visits as needed for healthcare appointments and goal-setting

Maintenance

Participants in the PNP intervention continue with a 4-month maintenance phase

4 months

Follow-up

Participants are monitored for outcomes such as service engagement, physical symptoms, and quality of life at 4, 8, and 12 months

4 months

Data collection at 4, 8, and 12 months

Treatment Details

Interventions

• Integrated Care
• Peer Navigation

Trial Overview The study tests a Peer Navigator Program (PNP) against usual integrated care. PNP uses peers with similar backgrounds and recovery experiences to help participants navigate healthcare services. The goal is better engagement, health, recovery, and quality of life.

Participant Groups

Group I: Peer Navigator Program (PNP) Experimental Treatment 1 Intervention

Peer navigators will meet individually and face-to-face with research participants in time and places convenient to the person as needed. Specific practices are determined by the research participant with the peer navigator and may include: * scheduling and attending healthcare appointments; * partnering with participant on tasks that arise from appointments; * health-related goal setting; and * taking action-steps toward health-related goals.

Group II: Treatment as Usual-Integrated Care (TAU-IC) Active Control 1 Intervention

Participants in this arm will receive integrated care from their usual provider, which is treatment as usual. Integrated care is mental health specialty and general medical care providers working together to address the physical and behavioral health care needs of patients. One-half of research participants will be randomized to integrated care alone.

Who Is Running the Clinical Trial?

Illinois Institute of Technology

Lead Sponsor

Trials

26

Recruited

15,300+

Arizona State University

Collaborator

Trials

311

Recruited

109,000+

Thresholds Inc.

Industry Sponsor

Trials

4

Recruited

810+

Findings from Research

The Bridge intervention, a peer-led health navigator program, significantly reduced emergency room visits among 144 individuals with serious mental illnesses, showing its effectiveness in improving healthcare access.

While the intervention did not affect overall inpatient or outpatient service use, the reduction in emergency room visits suggests that it may help individuals manage their health more effectively and avoid crisis situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Service Use by Medicaid Recipients With Serious Mental Illness During an RCT of the Bridge Peer Health Navigator Intervention. Kelly, EL., Hong, B., Duan, L., et al.[2021]

The Peer Navigator Program (PNP) significantly improved the scheduling and achievement of healthcare appointments for homeless African Americans with serious mental illness compared to treatment as usual (TAU) over a 12-month period.

Improvements in healthcare appointment utilization were particularly notable during the middle six months of the study, with benefits maintained in the final three months, highlighting the effectiveness of peer support in overcoming healthcare access barriers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer navigators to promote engagement of homeless African Americans with serious mental illness in primary care. Corrigan, PW., Pickett, S., Schmidt, A., et al.[2022]

The Bridge intervention, which involved peer health navigation for individuals with serious mental illness, led to significant improvements in health outcomes, including fewer pain and health symptoms after 6 months.

Participants in the Bridge group showed a marked shift in healthcare utilization, with a greater preference for primary care providers over emergency rooms, indicating a positive change in their approach to seeking medical care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A pilot test of a peer navigator intervention for improving the health of individuals with serious mental illness. Kelly, E., Fulginiti, A., Pahwa, R., et al.[2022]

The pilot study tested a modified peer-health navigator intervention for individuals with serious mental illnesses, focusing on the use of an electronic personal health record, and involved 20 participants.

Results showed that using health navigators and personal health records led to improvements in health care access and self-management, indicating the intervention's feasibility and potential effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using Electronic Health Records to Enhance a Peer Health Navigator Intervention: A Randomized Pilot Test for Individuals with Serious Mental Illness and Housing Instability. Kelly, EL., Braslow, JT., Brekke, JS.[2023]

The Our Peers-Empowerment and Navigational Supports (OP-ENS) program is a 12-month peer health navigator intervention designed specifically for Medicaid beneficiaries with physical disabilities in Chicago, aiming to improve access to healthcare services.

Developed through collaboration with disability rights leaders and healthcare researchers, OP-ENS utilizes a structured approach to identify barriers and set goals, demonstrating a community-directed method to address health disparities faced by people with disabilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Our Peers-Empowerment and Navigational Support (OP-ENS): Development of a Peer Health Navigator Intervention to Support Medicaid Beneficiaries With Physical Disabilities. Magasi, S., Papadimitriou, C., Panko Reis, J., et al.[2021]

Peer navigator programs (PNP) can play a crucial role in reducing health disparities for ethnic minorities with serious mental illness, as highlighted by the perspectives of 15 service users and 5 peer navigators in a qualitative study.

Key factors for successful PNP include building trust and accessibility for service users, while peer navigators emphasized the need for quality supervision and support, particularly for undocumented Latinos.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Qualitative Evaluation of a Peer Navigator Program for Latinos with Serious Mental Illness. Sheehan, L., Torres, A., Lara, JL., et al.[2023]

Latinos with serious mental illness face significant health disparities, experiencing illness and mortality at younger ages compared to other adults, highlighting urgent healthcare needs.

Community-based research identified key barriers such as insurance issues, language, and immigration concerns, and emphasized the potential of peer navigators to improve access to care and support for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Healthcare Needs of Latinos with Serious Mental Illness and the Potential of Peer Navigators. Corrigan, PW., Torres, A., Lara, JL., et al.[2023]

The peer navigator program (PNP) significantly improved general health, psychological experience of physical health, recovery, and quality of life among 67 African American participants with serious mental illness compared to standard treatment over one year.

Participants in the PNP showed small to moderate effect sizes in health outcomes, indicating that peer support may enhance recovery and well-being, even as both groups experienced reductions in homelessness and increased insurance coverage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using Peer Navigators to Address the Integrated Health Care Needs of Homeless African Americans With Serious Mental Illness. Corrigan, PW., Kraus, DJ., Pickett, SA., et al.[2022]

The OP-ENS study demonstrated that peer navigators, who are trained individuals with disabilities, effectively improved health access for Medicaid beneficiaries by building trust and addressing social health concerns like poverty and discrimination.

The community-based participatory approach allowed peer navigators to refine the intervention based on their experiences, leading to a focus on social determinants of health and enhanced support for peers with mental health needs, highlighting the importance of consumer input in healthcare interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Relationships at Work: Integrating the Perspectives of Disability Partners to Enhance a Peer Navigation Intervention. Herrman, D., Papadimitriou, C., Green, B., et al.[2022]

People with serious mental illness have a significantly shorter life expectancy, dying up to 20 years younger than their peers, with people of color facing even greater disparities.

Peer health navigators (PHNs), who share similar backgrounds and experiences with patients, play a crucial role in helping individuals with serious mental illness navigate complex health systems, potentially improving their access to care and overall health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peer Navigators for the Health Needs of People of Color With Serious Mental Illness. Corrigan, PW., Razzano, L., Pashka, N., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Service Use by Medicaid Recipients With Serious Mental Illness During an RCT of the Bridge Peer Health Navigator Intervention. [2021]

2. Ireland pubmed.ncbi.nlm.nih.gov

Peer navigators to promote engagement of homeless African Americans with serious mental illness in primary care. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

A pilot test of a peer navigator intervention for improving the health of individuals with serious mental illness. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Using Electronic Health Records to Enhance a Peer Health Navigator Intervention: A Randomized Pilot Test for Individuals with Serious Mental Illness and Housing Instability. [2023]

5. England pubmed.ncbi.nlm.nih.gov

Our Peers-Empowerment and Navigational Support (OP-ENS): Development of a Peer Health Navigator Intervention to Support Medicaid Beneficiaries With Physical Disabilities. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Qualitative Evaluation of a Peer Navigator Program for Latinos with Serious Mental Illness. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

The Healthcare Needs of Latinos with Serious Mental Illness and the Potential of Peer Navigators. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Using Peer Navigators to Address the Integrated Health Care Needs of Homeless African Americans With Serious Mental Illness. [2022]

9. Switzerland pubmed.ncbi.nlm.nih.gov

Relationships at Work: Integrating the Perspectives of Disability Partners to Enhance a Peer Navigation Intervention. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Peer Navigators for the Health Needs of People of Color With Serious Mental Illness. [2022]