Implementation of Peer Providers in Integrated Mental Health and Primary Care Settings

Objective: Peer providers are essential to the delivery of recovery-oriented mental health services, but little is known about their roles in delivering integrated mental health and primary care services. This study examines how peer-based services are implemented in newly integrated behavioral health care settings in Los Angeles County, California. Methods: During summer 2013, teams of 3 implementation monitors conducted full-day on-site program visits at 24 integrated behavioral health pilot programs. Site visits involved semistructured interviews with program staff members. Case study analysis was used to explore the implementation of peer services in newly integrated care programs. We report findings using the Consolidated Framework for Implementation Research. Results: The integrated behavioral health teams at 14 integrated programs included peer providers. Variation in the definition of peer providers, their roles, and the extent of programmatic infrastructure to support their team involvement is identified across pilot program types. We find that in many programs designed for underserved ethnic communities, a climate of stigma regarding mental illness influences the inclusion of peer providers who have experienced mental illness. Conclusion: Enhanced training of peer providers in the intersecting areas of physical and mental health from a cultural perspective is needed to enhance the effectiveness of peer providers and increase community acceptance of their services. Promoting greater awareness of the critical nature of peer support services among other members of the integrated care workforce is also needed.