Recovery Bridge: A Peer facilitated intervention to help bridge the transition from psychiatric inpatient hospitalization to living in the community

Principle Investigator: Richard Goldberg, Ph.D.
Funding: VA Health Services Research & Development

The time following discharge from psychiatric hospitalization is a high-risk period and has been associated with a range of negative outcomes, including high rates of hospital readmission and suicide (1-3). Because the evidence for transitional discharge interventions with bridging components is mixed, and limited in terms of how Peer Specialists (PS) can help support such interventions, additional research is needed (4-7).

An HSR&D pilot study is being implemented for the development and preliminary evaluation of a PS facilitated technology-supported intervention based on the existing and frequently used My Recovery Plan program. Specifically, we will integrate the My Recovery Plan tool and existing PS tools and strategies, to develop a manualized intervention called Recovery Bridge that will be delivered by VA Peer Specialists working to help Veterans make the transition from acute inpatient psychiatric hospitalization to community living. The intervention will include an action planning module that helps Veterans set specific, action steps they can do daily and goals to help them remain healthy and stable. Examples and recommendations are available to help Veterans build action plans across three subcategories: daily wellness; managing triggers and early warning signs; and what do when things breakdown. Although final specification of intervention components, as well as length and location of “sessions” will be developed in the context of the pilot, the key components of the anticipated brief Recovery Bridge intervention are: 1) Initial PS contact and relationship development with the Veteran during the inpatient stay; 2) PS sharing their own recovery stories and offering psychoeducation to support Veteran Recovery; 3) Completion of the My Recovery Planning tool components and; 4) Putting the recovery plan into action and sharing with appropriate others.

The pilot will include an open pilot trial (n=15) to examine the feasibility, fidelity, and acceptability of the Recovery Bridge intervention. The pilot trial will also: 1) explore the impact of the Recovery Bridge intervention on readmission rates (at 30 and 90 days), and connection to outpatient care compared to a control group (n=15) identified from administrative data, and; 2) explore the change in recovery and Quality of Life measures over time in the intervention participants.

Next Steps: Benchmarks across the domains of feasibility, fidelity, and acceptability; as well as exploratory outcomes specified above, will be used to inform next steps including a larger effectiveness trial followed by a possible hybrid-I effectiveness/implementation trial to inform future dissemination and implementation of the Recovery Bridge intervention more broadly across the VA.

1. Bernet, A. C. (2013). Predictors of psychiatric readmission among veterans at high risk of suicide: the impact of post-discharge aftercare. Archives of Psychiatric Nursing, 27(5), 260-261.
2. Bowersox, N. W., Saunders, S. M., & Berger, B. D. (2012). Predictors of rehospitalization in high-utilizing patients in the VA psychiatric medical system. Psychiatric Quarterly, 83(1), 53-64.
3. Pfeiffer PN, Ganoczy D, Zivin K, McCarthy JF, Valenstein M, Blow FC. Outpatient follow-up after psychiatric hospitalization for depression and later readmission and treatment adequacy. Psychiatr Serv. 2012 Dec;63(12):1239-42.
4. Tyler, N., Wright, N., & Waring, J. (2019). Interventions to improve discharge from acute adult mental health inpatient care to the community: systematic review and narrative synthesis. BMC Health Services Research, 19(1), 1-24.
5. Hegedüs, A., Kozel, B., Richter, D., & Behrens, J. (2020). Effectiveness of transitional interventions in improving patient outcomes and service use after discharge from psychiatric inpatient care: a systematic review and meta-analysis. Frontiers in Psychiatry, 10, 969:1-11.
6. Kidd, S, Mutschler, C, Lichtenstein, S. et al. (2021). Randomized trial of a brief peer support intervention for individuals with schizophrenia transitioning from hospital to community. Schizophrenia Research, 231:214-220
7. O’Connell, M., Flnagan, E., Delphin-Ritmon, M., Davidson, L. (2020). Enhancing outcomes for persons with co-occurring disorders through skills training and peer support. Journal of Mental Health. 29(1):6-11.