Abstract
BackgroundOver 1100 Veterans work in the Veterans Health Administration (VHA) as peer specialists (PSs). PSs are Veterans with formal training who provide support to other Veterans with similar diagnoses, primarily in mental health settings. A White House Executive Action mandated the pilot reassignment of VHA PSs from mental health to 25 primary care Patient Aligned Care Teams (PACT) in order to broaden the provision of wellness services that can address many chronic illnesses. An evaluation of this initiative was undertaken to assess the impact of outside assistance on the deployment of PS in PACT, as implementation support is often needed to prevent challenges commonly experienced when first deploying PSs in VHA settings. We present the protocol for this cluster-randomized hybrid type II trial to test the impact of standard implementation (receive minimal assistance) vs. facilitated implementation (receive outside assistance) on the deployment of VHA PSs in PACT.MethodsA VHA Office of Mental Health Services work group is recruiting 25 Veterans Affairs Medical Centers to reassign a mental health PSs to provide wellness-oriented care in PACT. Sites in three successive cohorts (n = 8, 8, 9) beginning over 6-month blocks will be matched and randomized to either standard or facilitated implementation. In facilitated implementation, an outside expert works with site stakeholders through a site visit, regular calls, and performance data to guide the planning and address challenges. Standard implementation sites will receive a webinar and access the Office of Mental Health Services work group. The two conditions will be compared on PS workload data, fidelity to the PS model of service delivery, team functioning, and Veteran measures of activation, satisfaction, and functioning. Qualitative interviews will collect information on implementation barriers and facilitators.DiscussionThis evaluation will provide critical data to guide administrators and VHA policy makers on future deployment of PSs, as their role has been expanding beyond mental health. In addition, development of novel implementation strategies (facilitation tailored to PSs) and the use of new tools (peer fidelity) can be models for monitoring and supporting deployment of PSs throughout VHA.Trial registrationClinicalTrials.gov, NCT02732600 (URL:https://clinicaltrials.gov/ct2/show/NCT02732600)
Highlights
Over 1100 Veterans work in the Veterans Health Administration (VHA) as peer specialists (PSs)
PS services has some demonstrated evidence, yet has not been widely adopted among VHA Patient Aligned Care Teams (PACT). This project intends to test whether a comprehensive implementation strategy—iPARIHS based facilitation tailored to PS deployment— can aid in PS implementation in PACT, and secondarily to evaluate the effectiveness of PS services on Veteran activation, satisfaction, and functioning
The test will be challenging as PACT are under significant pressure to serve a large number of Veterans
Summary
Qualitative interviews to assess key barriers and facilitators to integrating a PS into PACT will be developed based on i-PARIHS [51], with questions derived from generic items in the i-PARIHS Guide [68] These interviews will be conducted with PSs and at least one other PACT staff (usually the PS supervisor) at each site near the end of facilitation. VERC staff will develop a custom database from data stored in the CDW utilizing SQL routines that can be updated to include new project sites or PSs. The Peer Fidelity Measure [69] is designed to assess the services provided by PSs and factors that support and hamper the performance of those services (Implementation). Cohort 3 is scheduled to start in March–April of 2017
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