Despite expanded availability of mental health services within the Veterans Health Administration (VHA), many Veterans-particularly those from varied cultural backgrounds and communities-continue to face significant barriers to accessing and fully engaging in care. Effective strategies to address these issues remain limited, leaving under-supported and vulnerable Veterans at risk for inadequate care experiences and poorer mental health outcomes. If these persistent and often overlooked challenges remain unresolved, they will continue to contribute to long-term disability, societal burden, and costly, inefficient care.
To address these challenges, the investigators will test the effectiveness of the Pro-Active, Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) intervention. PARTNER-MH integrates two existing evidence-based care models: peer services and patient navigation and offers multiple services to address key drivers of healthcare disparities. These include (a) peer support, (b) assessment of unmet social needs to address barriers to care, (c) patient navigation to facilitate access to and engagement in mental health services, d) and psychoeducation to increase self-efficacy to communicate with providers. The intervention will be delivered via telehealth over 3 months by VHA peer specialists.
Specific Aims: This study is a multisite, randomized controlled clinical trial comparing PARTNER-MH to an educational brochure control group. Aim1: Test the effects of PARTNER-MH on mental health functioning (primary outcome), measured by the Veterans RAND-12 Mental Health Summary Score (VR-12 MCS), and secondary outcomes (e.g., depression, anxiety, PTSD, and healthcare utilization) at 3 months (primary endpoint) and 6 months (sustained effects) from baseline compared to the control group. Aim2: Test the effects of PARTNER-MH on mental healthcare process outcomes (patient engagement, communication self-efficacy) at 3 and 6 months. Aim3: To inform PARTNER-MH's future implementation, maintenance, and tailoring to different patient characteristics, we will conduct a formative process evaluation, guided by the Consolidated Framework for Implementation Research (CFIR), using mixed methods and input from Veteran, provider, and operational partners.
Methodology: Aims 1 and 2 involve delivering the intervention to (N=268) minoritized Veterans in outpatient mental health clinics at the Richard L. Roudebush VA Medical Center and the VA Pittsburgh Healthcare System. Data from Aims 1 and 2 will be analyzed using linear mixed models. In Aim 3, the investigators will describe Veterans' (n=30) and providers' experiences (N=10) with the intervention using semi-structured interviews to identify barriers and facilitators to PARTNER-MH's future implementation. The investigators will explore sex and post-traumatic stress disorder (PTSD) diagnosis as potential moderators. Communication's self-efficacy and patient engagement will be examined as mediators. The investigators will conduct Coincidence Analysis to explore which patients benefits the most from the intervention and which sets of intervention conditions are sufficient or necessary to lead to study outcomes. Qualitative data will be analyzed using an inductive/deductive approach. Mixed methods data will be integrated using joint displays.
