Program Development Guide
5. Organizational Integration
|Featured Program Models
Integration of peer support and clinical delivery systems has its niche in increasing patient-centeredness, reducing care fragmentation, and improving the comprehensiveness of care. Particularly in the current landscape of U.S. health care, the increasing uptake of Patient Centered Medical Homes (PCMHs) and the passing of the Patient Protection and Affordable Care Act (ACA) both encourage integration of peer support with primary care services and overall treatment. Integrating community health workers (CHWs) with a clinical team at health centers and PCMHs through ACA funding to reach medically underserved populations is one example. Furthermore, the systemic integration of peer support in behavioral health is well underway, which makes the peer supporter a natural conduit for integration of behavioral health and primary care.
When taking steps toward integration, it is important to understand that integration is complex and requires great effort. Even though policies may incentivize or enable it, integration needs to be promoted and executed by those directing and implementing programs, as well as those receiving services. It is also crucial to recognize the numerous levels of integration (e.g., level of services, level of care providers, levels of organizations providing care and diverse models of integration). Due to the tendency toward professionalization in health care settings, efforts must be made to preserve “peerness.” More importantly, there is no “one-size-fits-all” approach to integration; it can happen by integrating peer supporters into a clinical team or within a clinical practice/health care system (e.g., peer specialist in the Veteran Administration Health System). Strengthening the linkages to clinical care/community resources through in-house referral policies or community partnerships solidifies integration efforts and ensures program success.
Peer Support and Primary Care
In recent years, the U.S. health care system has begun shifting its strategy to be more preventive and primary care focused and promote the uptake of Patient Centered Medical Homes (PCMH).,, This emerging trend emphasizes patient-centeredness as a key strategy for better care by actively engaging patients in their own medical care. In many cases, peer support programs have been used to promote and enhance patient empowerment and engagement, two major characteristics of patient-centered care. Thus, the integration of peer support and primary care services provides a route to improve delivery of care. Specifically, the ACA enables the use of CHWs to reach medically underserved populations through its funding of community health centers and PCMHs, as well as other health and preventative services.
To learn more, read an issue brief developed by work of the National Peer Support Collaborative Learning Network. It highlights common barriers, facilitators, and considerations to integrating PS and primary care, as well as showcases how some organizations have already done so.
- Peers for Progress project at Alivio Medical Center
- Rhode Island’s Pediatric Practice Enhancement Project (PPEP)
- Cambridge Health Alliance
- Clinicas de Salud del Pueblo, Inc.
- Latinos Understanding the Need for Adherence in Diabetes (LUNA-D)
- MHP Salud
- Mingo County Diabetes
- Veteran Affairs
- Peers for Progress Alivio Project–Mi Salud Es Primero Guide
- Patient-Centered Primary Care Collaborative (PCPCC) webinar on Integrating Peer Support into Primary Care: Rational and Evidence
- A symposium at PCPCC 2014 Annual Fall Conference on Integrating Peer Support Into the Primary Care Team: Public and Private Models of Integration
- “Peer Support, the Patient Center Medical Home and Primary Care” meeting report
|Approaches and Challenges to Integrating Peer Support and Primary Care Services by an NPSCLN Workgroup||This is an issue brief analyzing integration of peer support and primary care.|
|Best Practice Guidelines for Implementing and Evaluating Community Health Worker programs in Health Care Settings by the Sinai Urban Health Institute: Section 4 CHW Integration into Health Care Systems (pg 76)||This report offers recommendations and case study on integrating community health workers into health care systems.|
|WellMed: The Care Companion Program||This presentation introduces a clinic-based peer support program at WellMed which has 34 primary care clinics in TX, and 4 in FL for patients with diabetes.|
|Gateway Community Health Center’s program description: Advancing diabetes self-management support in primary care||This project of the Diabetes Initiative integrates peer supporters/promotoras into the care of patients with diabetes.|
|Advancing Diabetes Self-Management in the Mexican American Population: A Community Health Worker Model in a Primary Care Setting||This peer-reviewed article introduces a project of the Diabetes Initiative at an urban community health center in Oakland, California. It utilizes community health workers to act as extenders of the medical staff to facilitate behavior change.|
|Vermont Blueprint for Health||This project demonstrates the benefits of inclusion of peer supporters known as community health teams in a medical home setting.|
|Starting a diabetes self-management program in a free clinic setting||This illustrates how to start a peer support program for diabetes self-management support in a free clinic.|
|Gateway Community Health Center’s Depression Screening and Follow up Flow Chart||This tool illustrates how to involve peer supporters/promotoras in helping identify and follow patients with diabetes and depression as they progress through diabetes self-management services.|
 The overview here is adapted from a brief developed by a work group of the National Peer Support Collaborative Learning Network at http://www.peersforprogress.org/npscln/  Rittenhouse DR, Shortell SM, Fisher ES. Primary care and accountable care–two essential elements of delivery-system reform. N Engl J Med. 2009; 361(24): 2301-3.  Mcclellan M, Mckethan AN, Lewis JL, Roski J, Fisher ES. A national strategy to put accountable care into practice. Health Aff. 2010; 29(5): 982-90.  Berenson RA, Hammons T, Gans DN, et al. A house is not a home: keeping patients at the center of practice redesign. Health Aff. 2008; 27(5): 1219-30.  Bates DW, Bitton A. The future of health information technology in the patient-centered medical home. Health Aff. 2010; 29(4): 614-21.  Kaiser Family Foundation. Focus on health reform: Summary of the Affordable Care Act. 2013. Available at http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf. Accessed January 21, 2014.
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