Engaging Older Veterans With Serious Mental Illness in Physical Activity: In-Person, Remote, and Hybrid Models

Older adults with serious mental illness (SMI) have complex care needs across medical, psychiatric, cognitive, and social domains. This growing population exhibits high levels of medical comorbidity and sedentariness. Innovative interventions that promote holistic recovery for this group are needed, especially in the context of the COVID-19 pandemic. Peer Education on Exercise for Recovery (PEER) is a peer coaching intervention, delivered by VA Peer Specialists (Veterans with lived experience of mental illness), to promote exercise and physical activity among older adults with SMI. This paper will present on three different models of PEER: fully in-person, fully remote, and a hybrid model with both in-person and remote elements. Preliminary data indicates that PEER is (1) engaging and well-liked, (2) associated with greater sustained increases in physical activity compared to an active control, and (3) can lead to sustained physical activity increases that are resilient to situational constraints such as physical distancing.

Enhancing Wellbeing for Older Adults With Serious Mental Illnesses: Co-Producing a Positive Psychology Course With Certified Older Adult Peer Specialists

Compared to peers in the general population, persons aging with serious mental illnesses (SMIs) face physical health disparities, increased isolation, and decreased subjective experiences of quality of life and wellbeing. To date, limited intervention research focuses on addressing specific needs of persons aging with SMIs and no interventions targeted for that population are informed by the theory and science of positive psychology. With the aim of co-producing a positive-psychology-based program to enhance wellbeing for older adults with SMIs, the author held a series of focus groups and individual interviews with six certified older adult peer specialists. Analysis of the data developed in-depth insights into helpful processes, values, and priorities of individuals aging with SMIs, as well as the creation of a wellbeing-enhancing course curriculum.

Embracing Recovery

Recovery is a broad concept, pertaining to one’s life goals, rather than to just getting symptoms under control. It means successfully living with a mental illness by not being confined by it; embracing hope, empowerment, and self-determination; and focusing on one’s personal life goals and roles in society. The goal of the recovery model of mental health treatment is to empower individuals to achieve their full potential in life. Individuals themselves decide on their personal goals for treatment and recovery instead of mental health professionals deciding for them. Recovery requires learning, support, courage, and patience. People who are successfully living with psychosis, including peer specialists (also called peer counselors or peer navigators), can help support others with similar experiences because they have had their own journey in recovery.

Rapid Ethnographic Assessment of Pandemic Restrictions in Child Welfare: Lessons from Parent and Provider Experiences

This paper analyzes policy and practice changes implemented by the child welfare system in Miami-Dade County in response to the COVID-19 crisis. Rapid ethnographic assessment (REA) was used to capture multiple perspectives during a rapidly unfolding pandemic. We identified system vulnerabilities and opportunities for lessening the impact of crises on vulnerable families with children in foster care. The assessment highlights how system fragmentation complicates effective responses to public health emergencies, while the transition to remote services provides insight into ways that traditional accessibility barriers may be alleviated beyond the pandemic. We provide recommendations for improving family experiences and preparing for future crises, envisioning ways that peer specialists, in particular, may offer a model for enhanced family support. This study emphasizes the unique benefits of anthropological theory and applied methods in assessing and improving public sector systems.

The Role of Peer Specialists in Engaging Aging Adults in Recovery and Wellness Behaviors

Peer specialists are individuals who have a lived experience with a mental health condition and who have received formal training to provide peer support and services to others. This symposium will examine the role of peer specialists in supporting aging adults’ recovery, quality of life, health behaviors, and health outcomes. Peer specialists have increasingly been integrated as formal service providers in health care systems in a wide variety of settings. In the Veterans Health Administration (VHA), over 1,110 Veterans work as peer specialists across the country. Findings from both VHA and community studies will be presented. First, Amanda Peeples will present findings from a mixed-methods evaluation study on the implementation of peer specialists to primary care teams in the VHA. Next, Anjana Muralidharan will present on the role of peer specialists in promoting health and wellness among aging veterans with serious mental illness using data from three VHA studies on peer-led interventions. Finally, Karen Fortuna will present on PeerTECH, a digital peer support self-management intervention that teaches older adults with mental health conditions how to co-manage psychiatric illness and chronic health conditions. Together, these three presentations will explore the ways in which “peerness” is defined in different populations and in diverse contexts. Laura Wray, geropsychologist and Executive Director of the VHA Center for Integrated Healthcare, will serve as discussant. She will comment on the role of peer specialists in supporting the recovery and wellness of aging persons in VHA and beyond.

Peers in Primary Care: How Peer Specialists Support Aging Veterans

Most of the more than 1,100 peer specialists (“peers”) in the Veterans Health Administration (VHA) work in mental healthcare settings. These peers provide a variety of services to Veterans such as facilitating groups, teaching recovery and coping skills, connecting Veterans with VHA and community services, and helping Veterans navigate VHA care. In 2014 the White House issued an Executive Action mandating the reassignment of peers from mental health to primary care settings in 25 VHA locations nationwide. This paper presents qualitative findings from a mixed-methods study evaluating this implementation of peers in VHA primary care. We found that peers assisted aging Veterans in primary care through activities such as providing health coaching, facilitating health education groups, connecting Veterans with services, and providing general peer support. Findings are drawn from semi-structured interviews with 27 peers, 25 supervisors, and 10 Veterans who received services from the peers in primary care.