Peer support and whole health coaching to address the healthcare needs of homeless veterans: a pilot study

Abstract

Background Homelessness is a robust social determinant of acute care service utilization among veterans. Although intensive outpatient programs have been developed for homeless veterans who are high utilizers of acute care (“super utilizers”), few scalable programs have been implemented to address their needs. Objective Describe the development and pilot testing of a novel intervention that integrates the roles of a peer and whole health coach (“Peer-WHC”) in coordination with primary care teams to reduce homeless veterans’ frequent use of acute care. Design Single-arm trial in three outpatient primary care clinics at a Veterans Health Administration (VHA) medical center; pre/post design using mixed-methods. Participants Twenty veterans from VHA’s homeless registry who were super-utilizers of acute care and enrolled in primary care. Intervention Weekly health coaching sessions with a peer over 12 weeks, including discussions of patients’ health care utilization patterns and coordination with primary care. Main measures Rates of session attendance and intervention fidelity, patient-reported satisfaction and changes in patient engagement and perceptions of health, pre/post utilization of acute and supportive care services, and qualitative interviews with multiple stakeholders to identify barriers and facilitators to implementation. Key results On average, patients attended 6.35 sessions (SD = 3.5, Median = 7). Satisfaction scores (M = 28.75 out of 32; SD = 2.79) exceeded a priori benchmarks. Patients’ perceptions of health improved from pre to post [t(df)=-2.26(14), p = 0.04]. In the 3-months pre/post, 45% (n = 9) and 15% (n = 3) of patients, respectively, were hospitalized. Qualitative feedback from patients, providers, and peers and fidelity metrics suggested value in increasing the length of the intervention to facilitate goal-setting with patients and coordination with primary care. Conclusion Findings support the feasibility, acceptability, and utility of Peer-WHC to address the healthcare needs of homeless veterans. A future trial is warranted to test the impact of Peer-WHC on reducing these patients’ frequent use of acute care.

Peer specialist-led interventions in primary care at the Veterans Health Administration: An integrative review.

“…In terms of the more general VHA peer role, VHA peers are hired as veterans with lived experience of mental illness who are in recovery and draw on lived experiences to provide support and to serve as a role model for recovery. Only two articles mentioned peers serving as a role model in the description of the specific tested intervention (Resnik et al, 2017;Yoon et al, 2017), and only three articles explicitly mentioned peers drawing upon their lived experiences in the description of the intervention (Blonigen et al, 2021(Blonigen et al, , 2022(Blonigen et al, , 2023. Similarly, there may also be variety in the training that peers receive.…”

“…2. Blonigen et al (2022) 20 veterans from VHA's homeless registry who were superutilizers of acute care and enrolled in primary care. Staff feedback (staff not described).…”

“…See Table 4 for further details on qualitative themes extracted from these articles. Regarding common themes that emerged from feedback from veterans, many emphasized the significance/helpfulness of working with a peer with shared lived experiences, which enhanced rapport and trust (Blonigen et al, 2021(Blonigen et al, , 2022(Blonigen et al, , 2023Johnson, Possemato, Khan, et al, 2022). Another theme was the importance of personalizing an intervention to individual veteran goals/symptoms (Johnson, Possemato, Khan, et al, 2022;Resnik et al, 2017).…”

“…Many veterans reported that peers were helpful in providing accountability (Blonigen et al, 2021(Blonigen et al, , 2023Possemato et al, 2019;Seal et al, 2021), motivation and encouragement (Blonigen et al, 2023;Johnson, Possemato, Khan, et al, 2022;Seal et al, 2021), emotional support (Blonigen et al, 2022;Johnson, Possemato, Khan, et al, 2022;Possemato et al, 2019;Resnik et al, 2017;Seal et al, 2021), resources (Blonigen et al, 2022;Johnson, Possemato, Khan, et al, 2022;Seal et al, 2021), and assistance with navigating the VA and other health care systems (Blonigen et al, 2022;Johnson, Possemato, Khan, et al, 2022;Resnik et al, 2017). Regarding common suggestions, many veterans reported a desire for a longer intervention or more time with the peer (Blonigen et al, 2022(Blonigen et al, , 2023Johnson, Possemato, Khan, et al, 2022;Possemato et al, 2019). Several veterans emphasized the importance of matching veterans and peers on a variety of factors and lived experiences, including gender (Blonigen et al, 2021(Blonigen et al, , 2023Resnik et al, 2017).…”

“…Several veterans emphasized the importance of matching veterans and peers on a variety of factors and lived experiences, including gender (Blonigen et al, 2021(Blonigen et al, , 2023Resnik et al, 2017). For phone or video interventions, several veterans reported that they would have preferred in-person contact with peers (Blonigen et al, 2021(Blonigen et al, , 2022(Blonigen et al, , 2023, but other veterans reported appreciating the flexibility and convenience of a phone intervention (Possemato et al, 2019;Seal et al, 2021). For peer interviews, themes were unique to each study and often related to intervention-specific strengths and challenges.…”