The Health Access and Recovery Peer Program
The Health Access and Recovery Peer Program
Individuals with serious mental illnesses (SMI) face high rates of medical comorbidity as
 well as challenges in managing these conditions. A growing workforce of certified peer
 specialists is available to help these individuals more effectively manage their health and
 health care. However, there is little existing research examining the effectiveness of
 peer-led medical self-management programs for this population. in this trial, participants
 were randomized to either the Health and Recovery Peer program (HARP), a medical disease
 self-management program led by certified peer specialists, or to care as usual. Assessments
 were conducted at baseline, 3 months, and 6 months.
Persons with serious mental illnesses (SMI) face elevated rates of medical comorbidity, and
 also challenges in effectively managing these health problems. There is an urgent need to
 develop self-management strategies that allow persons with SMI to more effectively manage
 their chronic medical illnesses.

 In general populations, peer-led disease self-management interventions have been demonstrated
 to be feasible, effective, scalable, and to lead to sustainable improvements in
 self-management and health outcomes. With funding from an R34 intervention development grant
 from NIMH, the study team has developed and piloted a modified version of the most widely
 tested and used peer-led self management program, the Chronic Disease Self-Management Program
 (CDSMP), for persons with serious mental illness. Two pilot tests of this intervention, the
 Health and Recovery Peer (HARP) program, demonstrated that the program can be implemented
 with high engagement, retention, and program fidelity, and can result in effect sizes across
 a range of outcomes comparable to or greater than those seen in general medical populations.

 This application proposes to conduct a fully-powered, multisite trial of the HARP program. A
 total of 400 individuals with serious mental illnesses and one or more chronic medical
 condition will be recruited from three diverse community mental health clinics in the Atlanta
 metro region and randomized to the HARP program or usual care. For individuals in the HARP
 program, two peer educators with SMI and one or more chronic medical condition will lead a
 six-session, six-week manualized intervention, which helps participants become more effective
 managers of their chronic illnesses. Follow-up interviews and chart reviews at 3 months, 6
 months and one year will assess changes in clinical outcomes, improvement in generic and
 disease-specific measures of illness self-management, and quality of care. During the final
 phase of the study, a dissemination strategy building on the CDSMP training infrastructure
 will allow program participants to lead HARP groups.

 This study will establish the first fully peer-led, evidence-based intervention for improving
 physical self-management in this vulnerable population.
Inclusion Criteria:

 -  On CMHC roster of active patients.

 -  Presence of a serious mental illness (schizophrenia, schizoaffective disorder, bipolar
 disorder, major depression, obsessive-compulsive disorder, or post-traumatic stress
 disorder

 -  Chronic Medical Condition as noted in the CMHC chart or via self-report:
 (hypertension; arthritis; heart disease; diabetes; and asthma/COPD),

 Exclusion Criteria:

 -  cognitive impairment based on a score of > 3 on a 6-item, validated screener developed
 for clinical research