Project WE: Wellness Enhancement Partnering and EngagementWere in - - PowerPoint PPT Presentation

Project WE: Wellness Enhancement Partnering and Engagement…We’re in this Together

Chyrell D Bellamy, PhD, MSW

Associate Professor, Director of Peer Services & Research chyrell.bellamy@yale.edu November 1, 2018

#PCORI2018

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Chyrell Bellamy

• Has nothing to disclose.

yale program for recovery and community health

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Objectives

At the conclusion of this activity, participants should be able to

• Objective 1: Identify ways to foster relationships and engage

community in research activities

• Objective 2: Learn ways that partnership works
• Objective 3: Describe ways partnership enhanced research

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Starting with the Why?

• People with Serious Mental Illness are dying 25 years earlier than

the rest of society1

1 National Association of State Mental Health Program Directors Medical Directors Council, (2006). Morbidity

and Mortality in People with Serious Mental Illness

• Can we collectively figure out a way to do something about it?

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Increasing Health Care Choices and Improving Health Outcomes Among Persons with Serious Mental Illness

Overall aims of the PCORI funded study:

• Used mixed methods to determine which patients choose to use which services and what are the short

and longer-term outcomes for patients in Wellness Center (co-located primary care) (N=786).

• Based on participant interviews, identified barriers to and facilitators of access, service use, and

improvements in person-centered outcomes and elicited suggestions for changes and additional interventions to improve health of people with mental illness.

• With persons in recovery developed and piloted a new peer-led community-based intervention in

enhancing access and choice, and improving person-centered health outcomes, among 37 clients who reported no improvement in their health as a result of their use of the Wellness Center during the first year of the project. Today we will discuss lessons learned from our patient engagement and participatory research.

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The Importance of Patient Engagement

• Patient/client/stakeholder involvement in research dates back to the 1980s in the medical field -

maternal health, cancer, and HIV – particularly in early 90s.

• Pervasive fears and skepticism in parts of the research community
• “Patients should not interfere in processes which they know nothing about”1
• Requires time, patience, and guidance, particularly at the outset2
• Despite these challenges, the evidence from this country and around the world suggest that many

benefits await such an endeavor.

• Evidence shows overall positive effect on services and benefits for the service users2
• Benefits include3
• facilitating empowerment
• enhancing relevance
• generating novel research

1 Caron-Flinterman, Broerse, & Bunders, 2005, p. 2576; 2 Palmer et al., 2009; 3 Beresford, 2007; Involve review

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Patient Engagement in the Project

• 3 Patients were co-researchers, hired as full or part time (with benefits)

Yale Research Assistants

• 2 Patient stakeholders on Research Team, participated in the bi-weekly

research meetings (received stipends)

• 6 Patients were on the Advisory Committee (met 4-6+ times per year)
• 5 research staff (in addition to the above) also self-disclose as “patients”
• 1 CMHC/Wellness Center Stakeholder served as a primary stakeholder on

the research team

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Partnering Examples

• Patient partners convened advisory board and provided training on

leadership and board participation.

• Stated they were not looking for people to be tokens
• Advisory members participated in conducting research – shadowed

qualitative interviews and assisted in analysis.

• Patient partners were co-researchers
• Involved throughout research
• Co-developed an intervention based on input from patients in the study
• Conducted meet and greet to engage participants in the intervention

component of the study

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The WE Harambee Intervention

• Based on the 8 dimensions of Wellness

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Findings: Harambee Intervention

Compared to the control group, certain outcomes for participants in the Harambee intervention significantly improved:

• 1. Decreased number of visits to the emergency department for

psychiatric/substance abuse reasons in the past 30 days

• 2. Decreased alcohol use
• 3. Increased overall wellness across the 8 dimensions

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Findings (cont’d)

Compared to the control group, certain outcomes for participants in the Harambee intervention significantly improved:

• How much participants felt they had input into their treatment

plan increased

• Whether they would choose their current outpatient care if it

were free increased

12

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Discussion: Implementation and Next Steps

• Co-location and evidence based practices alone did not show significant

improvement in health indicators.

• However, more time is needed to be able to assess whether changes

would occur over time.

• A community-based peer-led holistic health intervention based on the 8

dimensions of wellness, social determinants and structural competency has promise as an augmented service for people with mental illness that may not be improving on health and social indicators.

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Discussion (cont’d)

• Future research is needed to further test the target mechanisms of this

intervention and its effectiveness over time.

• Involvement of patients as co-researchers benefited all aspects of the

research process. Patients involved in this research project were able to enhance the team’s capacity by

• selecting relevant patient outcome measures
• recruiting patients to projects
• co-developing interventions
• collecting, analyzing, disseminating and reporting on data

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Learn More

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

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Thank You!

Chyrell D Bellamy, PhD, MSW

Associate Professor chyrell.Bellamy@yale.edu November 1, 2018