Engaging Patients With Mental Disorders From the ED in Outpatient Care

Existing literature indicates that there is potential effectiveness of care management
delivered by mental health professionals in improving treatment engagement and reducing
inpatient readmissions and that certified peer specialists may be able to deliver an array of
mental health services of similar or better quality as mental health professionals. However,
there have been no studies comparing certified peer specialists to professionals in
interventions to increase treatment engagement and reduce readmissions. This study will be
the first to examine the potential benefits and tradeoffs between these two groups of
providers.

There is an urgent need to improve care transitions for patients with mental disorders seen
in emergency departments (ED). Care management can improve treatment engagement after ED
discharge for patients with mental disorders, and certified peer specialists hold promise in
providing these services. However, there are no data comparing care management delivered by
peers and professionals in these settings. With funding from a Patient-Centered Outcomes
Research Institute (PCORI) grant the study team will be able to implement a manualized care
management program to improve follow-up and treatment engagement for patients in South
Carolina, supported by preliminary data and experience from work previously conducted by the
study team.

The overall goal of the project is to compare the effectiveness of professional and peer care
managers in improving linkage to and engagement in outpatient care after an ED discharge, as
well as the mechanisms by which engagement occurs. The study will use a multi-site randomized
trial study design across 8 EDs in South Carolina with telepsychiatry programs; each site
will have one professional care manager (social worker or nurse) and one peer specialist care
manager. Eligible subjects at each site will be randomized to a one-year treatment engagement
intervention, namely the Coordination, Access, Referral and Evaluation (CARE) Program with
either a peer or professional care manager, resulting in a total of 1000 participants. The
CARE program will focus on shared decision-making between care managers and patients, and
combines the traditional medical model of care management with a recovery-based approach.
Follow-up interviews at baseline, 6 months and 12 months will assess outpatient treatment
engagement after discharge from the ED, changes in mental health and clinical outcomes, and
changes in attitudinal and logistical barriers to obtaining services.

Inclusion Criteria:

- Admission to the Emergency Department for a primary diagnosis of a mental disorder

Exclusion Criteria:

- Cognitive impairment

- Not able to speak English