Implementation of peer specialists in Veterans Health Administration primary care: Improving program fidelity through...

Area of Science:

• Implementation Science
• Healthcare Management
• Mental Health Services Research

Background:

• Peer specialists (PS) with lived mental health experience enhance veteran engagement in traditional settings.
• Implementing PS in novel settings like primary care (PC) presents unique challenges.
• The VA MISSION Act mandated PS integration into PC, necessitating effective implementation strategies.

Purpose of the Study:

• To evaluate the impact of implementation facilitation on the uptake of PS in primary care.
• To compare the effectiveness of varying levels of preimplementation support on program fidelity and productivity.
• To identify key factors that facilitate successful PS integration into primary care settings.

Main Methods:

• A mixed-methods, formative program evaluation of two cohorts (15 sites each) implementing PS in PC.
• Comparison of outcomes between Cohort 1 (minimal preimplementation facilitation) and Cohort 2 (enhanced preimplementation facilitation).
• Data collection included facilitator notes, time to milestones, PS productivity, and program fidelity.

Main Results:

• Overall PS productivity was similar across both cohorts.
• Cohort 2 achieved high program fidelity within 1 month, while Cohort 1 required 12 months.
• Facilitation strategies focusing on team cohesion, role clarity, and supervisor training improved PS integration.

Conclusions:

• Enhanced preimplementation support significantly accelerates the attainment of high-fidelity PS implementation in primary care.
• Investing in targeted facilitation during preimplementation is crucial for novel practice integration.
• Successful PS integration requires addressing team dynamics, role clarity, and competing demands.