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Do Consumer Providers Enhance Recovery? (PEER)

This study has been completed.
Information provided by (Responsible Party):
Department of Veterans Affairs Identifier:
First received: October 27, 2008
Last updated: October 3, 2014
Last verified: October 2014

Serious mental illness (SMI) is the second most costly disorder treated in the VHA, yet clinical outcomes for these patients in public sector settings are often poor due to a combination of low quality care and severe cognitive and functional impairments evidenced by this group. While these problems are multifaceted, studies outside the VHA have shown that using "consumer providers" (CPs) can improve and augment public care. Similar to recovering addiction counselors, CPs are individuals with SMI who use their lived experiences to provide services to others with SMI. CPs can reach out to patients that are difficult to engage, assist patients with tasks of daily living, offer a variety of rehabilitation (vocational, social, residential) services, be role models and offer hope for recovery, and facilitate support groups. Randomized controlled and quasi-experimental trials, all done outside the VHA, have shown that CPs can provide services that yield at least equivalent patient outcomes with particular benefits noted on intensive case management teams. Based on these successes both the President's New Freedom Commission and the Veteran Administration's Mental Health Strategic Plan call for broader dissemination of CPs as way to make mental health services more recovery-oriented, a recent national priority. Because of these recent calls, employing mentally ill veterans has just begun, although no effort has been made to evaluate their impact inside the VA mental health system. Yet its success outside the VHA and the recent emphasis on recovery-oriented care suggests the need to test this model in the VHA.

Condition Intervention
Mental Disorder
Behavioral: Consumer Provider

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Promoting Recovery Using Mental Health Consumer Providers

Resource links provided by NLM:

Further study details as provided by Department of Veterans Affairs:

Primary Outcome Measures:
  • BASIS-R [ Time Frame: immediately before the intervention (BL), and 12 months post intervention (Post). ] [ Designated as safety issue: No ]
    The BASIS-R is a 24 item, comprehensive instrument assessing a range of psychiatric symptoms and problems. It is valid and reliable in both inpatient and outpatient settings in populations with SMI. All items have five response options ranging from 0 to 4, with higher scores indicating more problems (range in possible scores is 0 to 96).

Secondary Outcome Measures:
  • Mental Health Recovery Measure (MHRM) [ Time Frame: immediately before the intervention (BL), and 12 months post intervention (Post). ] [ Designated as safety issue: No ]
    The Mental Health Recovery Measure (MHRM) is a 30-item, 5-point behaviorally-anchored self-report measure based upon recovery experiences of persons with psychiatric disabilities. The MHRM total score has good validity, correlating strongly with the Empowerment Scale and Community Living Skills Scales, yet assessing unique aspects of recovery.

  • Patient Activation Measure [ Time Frame: immediately before the intervention (BL), and 12 months post intervention (Post). ] [ Designated as safety issue: No ]
    The mental health version of the Patient Activation Measure (PAM) is a single 13-item scale designed to assess patient's knowledge, skill, and confidence in health self-management. Respondents endorse items (e.g., "I know what each of my prescribed medications do") on a scale from 1 ("disagree strongly") to 4 ("agree strongly"). Raw scores are converted using the established methodology for the PAM to an activation score from 0 (lowest)-100 (highest). Identifying levels of activation is based on whether an activation score falls within a previously determined range of scores. Level 1, the lowest level of activation, includes activation scores of 47 or lower; Level 2 includes scores of 47.1 to 55.1; Level 3 includes scores of 55.2 to 67.0; and Level 4 (the highest activation level) includes scores of 67.1 or above. This version has similar psychometric properties as the original 13-item PAM and correlates with related constructs in other samples of people with SMI.

  • Recovery Self-Assessment: Person in Recovery Version [ Time Frame: immediately before the intervention (BL), and 12 months post intervention (Post) ] [ Designated as safety issue: No ]
    Perceptions of the recovery orientation of the program were assessed with the Recovery Self-Assessment (RSA), a 36 item survey that assesses domains of recovery-orientated practice (e.g., focus on life goals, involvement of patients in their own care). The RSA has high internal consistency and is thought to represent a more recovery-oriented or recovery-supportive environment.

  • Illness Management and Recovery Scale: Client Self-Rating [ Time Frame: 12 months prior to the intervention (BL1), immediately before the intervention (BL2), and 12 months post intervention (Post). ] [ Designated as safety issue: No ]
  • Quality of Life Interview, Brief Version [ Time Frame: immediately before the intervention (BL), and 12 months post intervention (Post). ] [ Designated as safety issue: No ]
    Subjective ratings of overall quality of life and the quality of social relationships, daily life, and family interactions was assessed using a combination of selected scales from the Quality of Life Instrument-Brief Version (QOLI), which been used extensively with a wide range of populations including those who are homeless, have a dual diagnosis, and are ethnic minorities. Because of low internal consistencies of subscales in our sample, a factor analysis was conducted which indicated that a larger scale that included the items from the overall quality of life, social relationships, daily life, and family interactions scales would be more reliable.

Enrollment: 285
Study Start Date: April 2008
Study Completion Date: January 2012
Primary Completion Date: April 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm 1
Adding a Consumer Provider to Intensive Case Management Teams (called MHICM in the VA)
Behavioral: Consumer Provider
Adding a Consumer Provider to Intensive Case Management Teams (called MHICM in the VA)
No Intervention: Arm 2
Care as usual

  Show Detailed Description


Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patient must have a Serious Mental Illness;
  • Patient must be working with a VA Intensive Case Management team

Exclusion Criteria:

  • Prior exposure to intervention; Reduced capacity;
  • Patient is no longer working with a VA Intensive Case Management
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00781079

United States, California
VA Medical Center, Loma Linda
Loma Linda, California, United States, 92357
Long Beach
Long Beach, California, United States, 90822
VA San Diego Healthcare System, San Diego
San Diego, California, United States, 92161
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, California, United States, 90073
United States, Indiana
Richard Roudebush VA Medical Center, Indianapolis
Indianapolis, Indiana, United States, 46202-2884
United States, Nevada
VA Southern Nevada Healthcare System, North Las Vegas, NV
Las Vegas, Nevada, United States, 89106
United States, Pennsylvania
Mental Illness Research, Education, and Clinical Center
Pittsburgh, Pennsylvania, United States, 15240
Sponsors and Collaborators
Principal Investigator: Matthew Chinman, PhD Mental Illness Research, Education, and Clinical Center
Principal Investigator: Amy Cohen, PhD VA Greater Los Angeles Healthcare System, West Los Angeles, CA
  More Information

Additional Information:

Responsible Party: Department of Veterans Affairs Identifier: NCT00781079     History of Changes
Other Study ID Numbers: IIR 06-227
Study First Received: October 27, 2008
Results First Received: September 18, 2014
Last Updated: October 3, 2014
Health Authority: United States: Federal Government

Keywords provided by Department of Veterans Affairs:
Organization Innovation
Opinion Leaders

Additional relevant MeSH terms:
Mental Disorders
Psychotic Disorders
Schizophrenia and Disorders with Psychotic Features processed this record on November 20, 2014