A Pilot Implementation of a Peer-Delivered Service to Increase Behavioral Healthcare Engagement among Rural Veterans

Most rural Veterans with behavioral health concerns are not engaged in behavioral health care. Peer Support for Treatment Seeking (PS-TS) engages Veterans in care by leveraging Veteran peer specialists' unique skills to connect with other Veterans. PS-TS is a brief conversation about treatment-seeking beliefs that aims to connect Veterans to care. PS-TS was implemented in two rural Veterans Health Administration (VHA) regions in 2024.

Evidence-based implementation strategies were used to support uptake of PS-TS, including working with local stakeholders to identify site-specific implementation barriers, tailoring implementation materials for peer-delivery, tracking adaptations, and training peers to deliver PS-TS. We evaluated impact using the RE-AIM domains of reach, effectiveness, adoption, implementation, and maintenance.

Tailoring PS-TS and the implementation plan to fit the peers' scope of practice and the needs of rural Veterans enabled implementation, while peer discomfort with outreach calls and the complexity of delivering PS-TS were barriers. PS-TS content and training were adapted to provide peers with more support. Peers conducted 364 outreach calls and delivered PS-TS to 117 Veterans, of whom 43 (37%) initiated VHA behavioral health care and 17 (15%) sought community/other care. PS-TS fidelity was high overall, but quality of delivery was low moderate for more challenging components. PS-TS was not maintained after implementation support ended.

Evidence-based implementation strategies enabled PS-TS to reach many rural Veterans with unmet behavioral health needs and increase care engagement. Future implementation efforts should prioritize increasing the quality of PS-TS delivery and enabling PS-TS maintenance over time.