RESUMO
Peer navigator programs (PNP) may help reduce physical health disparities for ethnic minorities with serious mental illness (SMI). However, specific aspects of PNP that are important to peer navigators and their clients are under-researched. A qualitative study explored the perspectives of service users (n = 15) and peer navigators (n = 5) participating in a randomized controlled trial of a PNP for Latinos with SMI. Results show PN engagement with service users spans diverse areas and that interactions with peers, trust, and accessibility are important from a service user perspective. PNs discussed needs for high-quality supervision, organizational support, and additional resources for undocumented Latinos.
Assuntos
Serviços de Saúde , Hispânico ou Latino , Transtornos Mentais , Navegação de Pacientes , Grupo Associado , Comunicação , Continuidade da Assistência ao Paciente , Feminino , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Disseminação de Informação , Masculino , Pessoa de Meia-Idade , Resolução de Problemas , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoimagem , Apoio Social , Meios de Transporte , ConfiançaRESUMO
OBJECTIVE: The impact of a peer navigator program (PNP) on efforts to address the health needs of Latinos with serious mental illness was examined in a randomized controlled trial. METHODS: Latinos with a serious mental illness (N=110) were randomly assigned to the PNP (integrated care with a peer navigator [PN]) or to a treatment-as-usual control group (integrated care without a PN) for one year. Data on service engagement (scheduled and received appointments) were assessed weekly, and self-reports of recovery, empowerment, and quality of life were collected at baseline and at four, eight, and 12 months. RESULTS: Findings from group × trial analyses of covariance (ANCOVAs) found main and interaction effects for scheduled and achieved appointments, showing better engagement for the PNP group compared with the control group over the course of the study. Significant interactions were found for recovery, empowerment, and quality of life, showing greater improvement for the PNP group compared with the control group over year 1 of the study (multivariate ANCOVA; F=3.27, df=9 and 98, p<.01). CONCLUSIONS: In-the-field navigation by peers seems to enhance service engagement, recovery, and quality of life. Whether these results occurred because navigators helped overcome barriers to treatment-regardless of whether they were peers per se-needs to be examined in future research.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Navegação de Pacientes/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Grupo Associado , Adulto , Chicago , Prestação Integrada de Cuidados de Saúde , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de VidaRESUMO
This paper discusses the implementation of a residential, integrated treatment program serving dually diagnosed people with histories of homelessness. Attention is focused on the program structure and how the program developed over time. Program modifications tended to relax program rules and embrace a motivational, stage-wise model using harm-reduction principles. Despite initial skepticism regarding these modifications, outcomes such as program retention, abstinence from substances, employment, and hospitalization improved.