PeerTECH: Peer and Technology-Supported Self-Management Intervention

Program Description

PeerTECH is a peer and technology-supported self-management intervention that teaches adults with serious mental illness (SMI) how to co-manage psychiatric illness and chronic health conditions. PeerTECH includes in-person eModules, a smartphone application, and a peer care management dashboard eModules are designed to be reviewed by peer specialists and consumers on a tablet during in-person sessions. PeerTECH eModules include 10 sessions: recovery and health goals; strategies to meet goals; education on SMI and medical illness; causes of mental illness; building social supports to improve wellness; medication adherence; developing a relapse prevention plan; coping with psychiatric symptoms; coping with medical symptoms; and accessing health services and making decisions. The Smartphone Application is designed to aid in the transfer of skills learned from the in-person sessions with a peer to real-world skills. The application includes: access to self-management support that corresponds to content discussed during in-person sessions; personalized self-management task lists; medication reminders; and a chat feature. The application collects data on engagement with self-management tasks and sends data to the dashboard. The Peer Care Management Dashboard is a repository for consumer information and progress towards their goals. A certified peer specialist manages dashboard data. The dashboard enables messaging to the smartphone application.

Creativity

Adults with SMI have unique needs that impede community tenure including poor independent living skills, minimal social support networks, and substandard medical and psychiatric self-management skills. This places them at-risk for early nursing home placement, hospitalization, medical comorbidity, and early mortality. Studies have demonstrated the effectiveness of self-management interventions in improving community tenure. However, the dissemination and use of these interventions has been limited, most likely due to the required intensity, effort, duration, and costs. Technology and peers are potential solutions with distinct strengths to improve both effectiveness and scalability. Peer Specialists are individuals who have a mental illness and are providing services. Evidence indicates that involving peers in interventions has reduced inpatient use and improved social functioning, quality of life, and patient activation. Technology can personalize treatment, increase intervention reach, and offer support in real-world settings. To our knowledge, neither of these approaches has been combined and empirically evaluated.

Leadership

The majority of smartphone intervention have not been scientifically developed or evaluated. By contrast, PeerTECH builds on previous work from an evidence-based practice, Integrated illness Management and Recovery (I-IMR). I-IMR has resulted in improved medical and psychiatric self-management and decreased hospitalizations. With the input from clinicians, certified peer specialists, and researchers, we adapted the 10-month I-IMR intervention so certified peer specialists could deliver it over a 3-month period with the use of technology. We have presented how we developed PeerTECH to the American Association for Geriatric Psychiatry, National Institute of Mental Health, Elder Mental Health Collaborative (includes representatives from Massachusetts government). We have published an article in the American Journal of Geriatric Psychiatry. We anticipate sharing PeerTECH results with the National Alliance on Mental Illness and the International Association of Peer Supporters Conference.

Sustainability

In 2013 the Dartmouth Centers for Health and Aging was awarded a National Institute of Mental Health grant that allowed us to adapt I-IMR and develop PeerTECH. We subsequently received support from the National Institute of Mental Health to pilot PeerTECH with 10 adults with serious mental illness and four peer specialists to examine feasibility and preliminary effectiveness. We partnered with the Massachusetts Department of Mental Health’s Office of Recovery and Empowerment, Peer Specialists, Mystic Valley Elder Services, and Northeast Independent Living (peer-run organization) to pilot test and refine PeerTECH. We anticipate deploying PeerTECH in Massachusetts to 100 adults with serious mental illness and training 15 peer specialists. We will examine the effectiveness of PeerTECH (e.g., self-management, peer support, community tenure, early mortality risk, and cardiovascular disease risk). If proven effective, we anticipate embedding PeerTECH into the Massachusetts Department of Mental Health service delivery system across the state.

Replicability

PeerTECH eModules are designed to guide peers in the delivery of PeerTECH with the use of videos and discussion prompts. Additionally, the smartphone application includes pre-programmed content that corresponds to in-person sessions with a peer. Thus, eModules and the smartphone application facilitate the delivery of evidence-based sessions and this tool allows for replicability in multiple settings. Our team will continue to include feedback from peers and consumers to optimize PeerTECH. If PeerTECH is proven effective, we plan to work with Massachusetts to apply for Medicaid reimbursement for PeerTECH services. Potentially advancing the role of peers and creating a new workforce of self-management providers.

Results/Outcomes

In a randomized pilot study comparing I-IMR to usual care, I-IMR was associated with improved psychiatric illness self-management and diabetes self-management and decreased hospitalizations. We adapted the content of I-IMR to be delivered by peers using technology. In our article, we outline the process of how to adapt psychosocial Interventions for smartphone delivery to adults with serious mental illness. We conducted a pilot study and the established the feasibility and acceptability of PeerTECH. Using a pre-post design in which n = 10 adults with SMI (i.e., schizophrenia, bipolar disorder, and major depressive disorder) and medical comorbidity (i.e., cardiovascular disease, obesity, or diabetes) received PeerTECH. Promising evidence indicates PeerTECH is feasible and acceptable among peers and consumers. Four certified peer specialists were successfully trained to deliver PeerTECH. Participants experienced statistically significant improvements in self-efficacy for managing chronic disease, medical self-management skills, and psychiatric self-management skills, and hope.