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), Brekke 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,” he 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, Brekke 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, he 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, six months and one 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 claim 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,” said Brekke, noting that there was some initial concern that it may be challenging for peer navigators to administer the Bridge program.
“They were very capable and enjoyed delivering the intervention,” he said. “It improved aspects of their self-esteem, their confidence. It actually made them much more aware of their own health care needs.”
The study will take place at a treatment facility overseen by Pacific Clinics, a large behavioral and mental health care organization that Brekke has partnered with for more than two decades on previous research projects. In addition to Pacific Clinics, the Los Angeles County Department of Mental Health and the Southern California Clinical and Translational Science Institute has provided ongoing support of the Bridge intervention.
Due to the promising results of the pilot study, approximately 80 peers and case managers have been trained to provide peer navigation services in the Southern California region, and Brekke said he is hopeful the larger study will lead to further expansion of the program.
“There’s a large movement nationally toward using peer navigators in a variety of service and population contexts,” he said. “If our intervention effects hold up, and it looks as strong as it has up to now, we would hope to begin wider implementation and dissemination.”
Brekke’s study is one of three PCORI awards received by faculty researchers at the School of Social Work in recent years. Bruce Jansson, the Margaret W. Driscoll/Louise M. Clevenger Professor of Social Policy and Administration, and Kathleen Ell, the Ernest P. Larson Professor of Health, Ethnicity and Poverty, received PCORI awards to study patient advocacy and depression care among low-income individuals with chronic illness, respectively.