Recurrent psychiatric hospitalizations and emergency department (ED) utilization is common among those with serious mental illnesses and others with behavioral health conditions. The result is excessively high health care costs, and in some cases preventable overuse of services. Peer support services (PSS) are a recognized part of team-based care for behavioral health conditions, and peer support specialists are currently reimbursed for these service in Medicaid plans in a majority of states. This study, funded by the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, examines the role of PSS in reducing unnecessary psychiatric hospital admissions and ED utilization.
Three research questions frame the study and examine:
The approaches, models, and practice methods that are used to reduce preventable psychiatric hospitalization, re-hospitalization, and ED use.
The extent to which these models are being utilized across health systems, states, counties, cities, and other organizational networks.
The structural supports for these innovative practices including funding, training, and other requirements as offered through or outside the behavioral health care system.
This document is the final report for the study. It includes information from the study literature review, key informant interviews, and site visits to four exemplary PSS programs.
This final report is broken into chapters to enable readers to jump to the information that they are most interested in. The chapters can be read individually and can stand alone in terms of information and structure. Read together, the chapters provide a comprehensive look at the research questions.
The chapters within this report focus on the following:
Chapter 1: Environmental Scan of Peer Support Services. This chapter includes a literature review of the evidence base for PSS and the deployment of this workforce in behavioral and integrated health services. Key informant interviews are also included in the findings of the environmental scan report. It is important to note that the environment scan was conducted as a first step in the study, before sites were identified for site visits. The environmental scan shaped the selection of the four PSS sites; the questions asked of the sites; and the data collected using the site visit protocols.
The environmental scan includes a proposed framework for three levels of PSS that could impact preventable hospital and ED utilization. The levels include crisis-based and respite-based PSS, level of care transitions programs, and community-based recovery oriented services. This framework is used to examine services across four different peer service programs.
Chapter 2: Site Selection. This chapter focuses on the selection criteria for the four exemplary PSS programs included in this study.
Chapter 3: Site Visit Case Studies. This section contains brief case study reports that provide uniformly formatted information gathered from the four exemplary sites. These case studies are structured to provide parallel information on the key variables included in the study. The site visit case studies include Georgia Mental Health Consumer Network; New York Association of Psychiatric Rehabilitation Services; Optum's Pierce County (Washington State) Regional Support Network; and Recovery Innovations.
Chapter 4: Case Study Findings and Conclusions. This section provides the findings from the site visits, areas that require further investigation and development, and next steps for the field. The results of this study identify PSS as a viable resource to help reduce unnecessary psychiatric hospital services and ED utilization. Services provided across the three-tier framework show promising results for improving the outcomes and reducing the costs of care. However, limited data collection and the absence of rigorous outcome evaluations limit the confidence in these conclusions. Variable results are noted across programs, and opportunities for expanded program evaluations are noted.