Peer Health Navigation for Latinx with Serious Mental Illness Sonya - - PowerPoint PPT Presentation

Peer Health Navigation for Latinx with Serious Mental Illness

Sonya Ballentine, BS

Project Manager Illinois Institute of Technology College of Psychology November 1, 2018

#PCORI2018

2 • November 1, 2018

Sonya Ballentine

• Has nothing to disclose.

3 • November 1, 2018

Objectives

At the conclusion of this presentation, attendees should be able to

• Objective 1: Communicate the findings of the study presented
• Objective 2: Appreciate the importance of cultural factors in

shaping and delivering peer navigation services

4 • November 1, 2018

Addressing an Evidence Gap

• Patients with SMI experience greater co-morbidities
• Latinx with SMI suffer these issues to a greater degree compared

to Caucasians (Alegria, et al., 2011; Folsom et al., 2007)

Health disparities are worsened by:

• Shortage of fluent Spanish speaking service providers
• Lack of service providers familiar with Latino value systems (Hough et al.,

2002)

• Services often fail to consider immigration-related concerns (Keyes et al.,

2012)

• Unavailability of accessible services (De Jesus & Xiao, 2014)
• Absence of insurance providers impacts service affordability (Gonzales &

Sommers, 2017)

5 • November 1, 2018

Peer Navigators

• Have lived experience of mental illness
• Serve the ethnic community from which they originate

What they offer

• Help navigate fragmented health system
• Help others meet their personal needs
• Offer instrumental support
• Provide interpersonal support

Evidence of effects

• Improvement in health attitudes and self-management
• Receipt of peer navigation led to more primary care linkage
• Peer services related to fewer hospitalizations and inpatient days

6 • November 1, 2018

Hypotheses

H1: Latinx with SMI assigned to a PN will show greater service use H2: Participants in intervention group will demonstrate improvements in quality of life, recovery, and personal empowerment

7 • November 1, 2018

Study Design

• Randomized control trial
• Population: Recruited 110 Latinx patients with SMI
• The study took place in a Federally Qualified Health Center offering

integrated primary care and behavioral services in Chicago

• Intervention/Comparator: The study compared integrated

care plus PNs and integrated care alone

• Outcomes: Recovery; personal empowerment; quality of life

8 • November 1, 2018

PNP Curriculum Adaptation

• Qualitative findings used to adapt curriculum

9 • November 1, 2018

PNP Curriculum Adaptation

• CBPR Team: Latinx with lived experience, researchers and service

providers

10 • November 1, 2018

Method

Recruitment:

• Participants recruited from Chicagoland area

Screening:

• Ongoing significant concerns about general medical health
• Quality of life or life goals impacted by general medical health
• 161 participants screened, 51 excluded

11 • November 1, 2018

Method

Conditions:

• PNP (integrated care with a PN)
• Treatment-as-usual (integrated care without a PN)

Peer Navigator Hiring:

• 4 Latinos in recovery of SMI were hired full-time
• PNs were asked about current beliefs/skills important to PN

services

12 • November 1, 2018

Method

PN and Participant Engagement:

• PNs used manualized skills/concepts during meetings with service

recipients

• GOAL: Analyze health concerns and actions to achieve successful

transition

• Participant contact at least once a week
• Meetings up to five times a week depending on participant’s

needs

13 • November 1, 2018

Patients

• Patients were 45 years old (average)
• Top 3 self-reported diagnoses:
• 68%

(N=75) major depression

• 21%

(N=23) anxiety disorder

• 7%

(N=8) bipolar depression

Groups Differed by:

• Age (PNP older)
• Place of birth (more PNP participants born outside continental

United States)

14 • November 1, 2018

Results

• PNP group had significantly greater achieved appointments for

service recipients in first 4 months than the control group.

• No consistent pattern for monthly achievement
• Sig. improvement in recovery, empowerment, and quality of life

were found for PNP service recipients throughout the study.

15 • November 1, 2018

PEER NAVIGATOR STRENGTHS PEER NAVIGATOR CHALLENGES Emotional support that enhanced self-esteem Need for greater supervisory supports and availability Ability to navigate community resources Better communication about changes in agency procedures Application of unique problem- solving techniques Limited resources for undocumented clients Ability to provide safe spaces and trustworthy environment Additional training in grief, substance use and safety

16 • November 1, 2018

Future Research

• Self-reported diagnoses: need for structured interview
• Focus on Latinx-specific characteristics
• Focus on subpopulation previously identified in focus groups
• Comorbidity with substance use disorder
• Primary language (English vs. Spanish)
• Community of origin (e.g., Mexican vs. South American)
• Immigration status
• Peer-led intervention vs peers w/o lived experience
• Health improvement maintenance post-program

17 • November 1, 2018

Learn More

• www.pcori.org
• info@pcori.org
• #PCORI2018
• www.chicagohealthdisparities.org

18 • November 1, 2018

Thank You!

Sonya Ballentine

Project Manager Illinois Institute of Technology College of Psychology November 1, 2018

19 • November 1, 2018

Discussion

20 • November 1, 2018

Questions?