INDIANAPOLIS – Research scientists led by Johanne Eliacin, PhD, of the U.S. Department of Veterans' Affairs (VA) and Regenstrief Institute, have developed PARTNER-MH, an innovative, peer-led patient navigation program to support racially and ethnically minoritized veterans seeking mental healthcare, regardless of the types of mental health services needed or their mental health diagnoses.
In two peer-reviewed published papers they report significant improvements in mental health outcomes and high participant satisfaction with the program.
PARTNER-MH, developed for VA mental health outpatient clinics, is delivered by peer support specialists to help patients more productively engage with mental health services. It supports patients in identifying their own health and healthcare priorities, communicating more effectively with clinicians and more actively participating in treatment decision-making so patients' voices are heard and outcomes improved.
"PARTNER-MH holds promise to be applicable to patients seen in many healthcare systems. Minoritized veterans share many experiences with civilians of minoritized backgrounds. Their experiences with mental health services are not that different in terms of some of the struggles they experience in communicating with their clinicians, accessing services and engaging in treatment," said Dr. Eliacin. "There are a lot of contributions that the PARTNER-MH program could potentially provide to similar populations or groups outside of the VA."
Pilot study of PARTNER-MH
In the pilot study of PARTNER-MH, 50 racially and ethnically minoritized veterans seeking mental health services in the VA were randomized to a control group or to peer navigation. Peer facilitators are veterans who themselves are in recovery either from a mental health condition, substance use condition or military trauma. They use lessons learned and lived experiences in addition to specialized PARTNER-MH training to support other veterans on their journey to better mental health.
The PARTNER-MH program is administered over a six-month period. Designed for in-person interaction, the pandemic required transformation into a telehealth format. Peers interacted regularly with study participants including assessment of unmet social needs, navigation of VA mental health services, personalized counseling and coaching via telephone.
"We recognize that social determinants of health can be major barriers to accessing services and engaging in care," said Dr. Eliacin. "Some patients may have difficulties getting to their appointment or prioritizing their mental health if they are worrying about their next meal or where they're going to sleep at night.
"We don't wait for a patient to reveal that they are struggling," she added. "At their initial meeting, the peer does an assessment so they can connect the veterans to appropriate VA resources and inform the patient's clinician. The peers don't try to solve problems for their patients, but they are great connectors and they follow-up."
About 70 percent of participants in the PARTNER-MH pilot study self-identified as African-American or Black. Other participants were Hispanic, Asian or Native American. All were veterans receiving or waiting to receive services in a VA outpatient mental health clinic.
The study found significant improvement of self-reported mental health and depression among those in the peer navigation group compared with those in the control group at both six months and nine months.
"In the U.S., patients of racially and ethnically minoritized backgrounds have less access to mental health services, lower satisfaction with mental health treatment and poorer health outcomes than White counterparts," noted study senior author Marianne Matthias, PhD, a VA and Regenstrief research scientist. "PARTNER-MH is a step toward making mental healthcare more accessible and equitable."
"Outcomes of a peer-led navigation program, PARTNER-MH, for racially minoritized Veterans receiving mental health services: a pilot randomized controlled trial to assess feasibility and acceptability" is published in Translational Behavioral Medicine.
Authors and affiliations
Johanne Eliacin1,2,3,4; Diana Burgess5,6; Angela L. Rollins1,2,7; Scott Patterson8;
Teresa Damush1,2,4; Matthew J. Bair1,2,4; Michelle P. Salyers7; Michele Spoont5,6;
Matthew Chinman9,10; James E. Slaven11 and Marianne S. Matthias1,2,4.
1 Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
2 Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
3 Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
4 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
5 Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA
6 Department of Medicine, University of Minnesota, Minneapolis, MN, USA
7 Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
8 Department of Psychiatry, Roudebush VA Medical Center, Indianapolis, IN, USA
9 Center for Health Equity Research and Promotion, Pittsburgh VA, Pittsburgh, PA, USA
10 RAND, Pittsburgh, PA, USA
11 Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, US
This study was funded by a VA HSR&D Career Development Award to Dr. Eliacin. It also received support from the VA HSR&D Center for Health Information and Communication and the Regenstrief Institute.
PARTNER-MH participant satisfaction
Evaluation of satisfaction with the PARTNER-MH program shows that 80 percent of study participants interviewed reported satisfaction with PARTNER-MH and viewed the program as beneficial. The researchers wrote that PARTNER-MH was described as "a valuable service that provided a 'lifeline' in time of great need, and that made them feel 'seen' and cared for.
Participants had a wide range of mental health diagnoses, including Post Traumatic Stress Disorder or PTSD (46 percent) and substance use disorders (23 percent). Some had more than one diagnosis. 77 percent self-identified as Black. 69 percent of participants had some college education.
For some participants, being engaged in their own mental healthcare meant showing up for the appointment to meet with the clinician. For other participants, engaging in treatment meant working in collaboration with their clinician on a treatment plan and talking openly about their concerns.
"Many PARTNER-MH participants highlighted for us that the takeaway they got from this program was that they needed to be engaged in their mental healthcare in order to really benefit from the treatment that they are receiving," said Dr. Eliacin. "They appreciated the opportunity to discuss with the peer what that engagement could look like for them."
Participants were asked why they volunteered for the study and what kept them engaged over the six months. Many indicated that they liked the idea of working with a peer. Others said they believed the study was important because of its focus on minoritized patients and the need for research on and provision of services to this population.
During exit interviews, others said that they were struggling to navigate mental health services and could use help, having tried unsuccessfully in the past. They also said that it was helpful to have a program just for them and to have a program where they were working with a peer who looks like them, who shares the same background and who reminds them of a family member or people in their community.
"Participants felt that PARTNER-MH opened the door of communication," said Dr. Eliacin. "They could be themselves; they could express themselves the way that they wanted to and they feel heard. They connected with someone who made them feel at ease, but also really understood them and encouraged them, motivating them to seek mental health treatment. Working with the peer was the highlight of many of the participants' experiences."
"Veterans' views of PARTNER-MH, a peer-led patient navigation intervention, to improve patient engagement in care and patient-clinician communication: A qualitative study" is published in Patient Education and Counseling.
Authors and affiliations:
Johanne Eliacina,b,c,d, Marianne S. Matthiasb,c,d, Kenzie A. Camerone and Diana J. Burgessf,g.
- National Center for PTSD, VA Boston Healthcare System, Boston, USA
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Regenstrief Institute, Indianapolis, USA
- Indiana University School of Medicine, Department of General Internal Medicine and Geriatrics, Indianapolis, USA
- Northwestern University, Feinberg School of Medicine, Division of General Internal Medicine, Chicago, USA
- Minneapolis VA Healthcare System, Center for Care Delivery and Outcomes Research, Minneapolis, USA
- University of Minnesota, Department of Medicine, Minneapolis, USA
The clinical trial from which this analysis was conducted was supported by a VA HSR&D Career Development Award (16−153) to Dr. Eliacin. This research was also supported by an Academy of Communication in Healthcare Putnam Scholar Fellowship awarded to Dr. Eliacin.
Much of Dr. Eliacin's research focuses on advancing understanding of sociocultural determinants of mental health and illness and reducing healthcare disparities through innovative processes and technologies that facilitate patient-centered care and effective patient-provider communication. She plans to continue working on PARTNER-MH, extending it to multiple VA sites.
Johanne Eliacin, PhD
In addition to being a research scientist with the William M. Tierney Center for Health Services Research at Regenstrief Institute, Johanne Eliacin, PhD, is a research scientist at the VA National Center for PTSD, Women's Health Sciences Division, Boston VA Healthcare System and the Center for Health Information and Communication at the Richard L. Roudebush VA Medical Center. She is also an assistant research professor at the Indiana University School of Medicine.
Marianne S. Matthias, PhD
In addition to her role as a research scientist at Regenstrief Institute, Marianne S. Matthias, PhD, is a core investigator for the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis. She is also a senior research professor of medicine at Indiana University School of Medicine.
About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.
Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute's research mission.
About IU School of Medicine
IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.
