Evaluation of Peer Specialists on VA PACTs

Peer Specialists are individuals with mental illness currently deployed to serve Veterans in
specialty mental health clinics based upon their lived experiences. Peer Specialist delivered
interventions have been shown to improve patient activation in multiple studies. In August
2014, the White House issued an Executive Action mandating that 25 VA medical centers pilot
the deployment of Peer Specialists in their Patient Aligned Care Teams (PACTs). This project
expands upon this nationally mandated Peer Specialist pilot with the integration of a cluster
randomized implementation trial. This quality improvement project will evaluate the impact of
facilitated implementation vs. standard implementation to support on the deployment of Peer
Specialists in PACTs.

The 25 sites will be divided into three cohorts (n=8,8,9). Each cohort will begin over three
successive six-month blocks beginning in early 2016. Within each cohort, sites will be
randomized to receive either facilitated or standard implementation. Facilitated
Implementation sites will receive one year of support based on the i-PARIHS implementation
model which includes training, implementation planning, ongoing external facilitation,
feedback and consultation. Standard Implementation sites will receive written guidance and
limited consultation by the investigators' team. The investigators will compare the groups on
1) the percent of their target population that actually received PS services; 2) ratings on
PS workload productivity including ; 3) Peer Implementation and Services scores; 4)
assessment of Veteran's change over time on the outcome variables of satisfaction,
activation, and functioning ; 5) qualitative analysis of how well PSs were deployed and their
impact.

Inclusion Criteria:

- Included sites must be VA PACT Primary Care Health teams with existing Peer
Specialists who are able to include an existing Peer Specialist on their team for a
minimum of 10 hours per week for one year

Exclusion Criteria:

- Non VA PACT teams, VA sites without an existing Peer Specialists, and VA PACT primary
care teams that cannot commit a Peer Specialist to Primary Care for a minimum of 10
hours per week are excluded