The effect of an Integrated Peer-Supported Physical Health Service (IPPHS) on physical health outcomes for adults living with persistent mental illness

Intervention Name: Integrated Peer-Supported Physical Health Service (IPPHS) The IPPHS is designed for adults who receive care from community mental health services and live a diagnosis of schizophrenia, psychosis or bipolar disorder. It aims to improve people’s physical health and includes three components: - Peer worker provision of physical health coaching and support to navigate physical health services - Primary care providers employed within the adult community mental health service to complete comprehensive physical health checks (aligned with routine care and minimum standards for physical health screening of adults living with persistent mental illness) and provide guideline-adherent physical health interventions according to the Positive Cardiometabolic Health Resource. Primary Care Providers will work to link participants to a community general practice based on consumer needs and preference of a provider and general practice location. The Primary Care Providers will utilise existing referral processes and communication channels between their Adult Community Mental Health Service and local general practices. - A mobile health app (TeleClinical Care) for self-management of physical health at home. The app includes physical health questionnaires and an exercise program which is developed within and accessed within the app. The app is linked to the health service for remote monitoring of physical health risks. The intervention will be delivered in six adult community mental health services across Tasmania and south eastern Sydney. Intervention staff will be employed within the mental health service and receive training and access to Mindgardens developed physical health resources and the Positive Cardiometabolic Health Framework. Peer workers will utilise the Mindgardens ‘Consumer Learning Modules’ to provide health coaching. Health coaching will include assisting consumers in the development of goals, tracking goal achievement, and providing guidance on how to achieve goals using the ‘nutrition’, ‘physical activity’, ‘drugs and alcohol ', and ‘general health’ Mindgardens Modules. Peer workers will also support consumers in navigating services to meet their physical health needs and goals. This includes providing information on available services and how to access services, including: - Nutrition and dietetics - Physical activity programs and exercise physiologists - Lifestyle support, including sleep specialists and smoking cessation programs - Diabetes services - Primary Care - Chronic disease services Peer workers will utilise existing service information for their local health service site, and services will be located within a suitable area as deemed by the consumer. Peer workers will discuss with consumers their preferences and needs, such as travel distance, provider choice, and circumstances, e.g., transport, ability to travel independently, or availability of a carer to assist with travel. Peer workers will undertake the ‘Health Coaching Conversations’ training developed by Imperial College London and available on Coursera. The training is online, and 5 hours of self-paced modules. Peer workers and primary care providers will be provided with the ‘Keeping the Body in Mind(gardens) training videos (nutrition, physical activity and tobacco treatment). The videos are available online and 10 minutes each. Primary care providers will be provided with a one-day training workshop facilitated by two members of the research team who have backgrounds as psychiatrists. The training will cover the Positive Cardiometabolic Health Resource, minimum requirements for physical health screening of people living with persistent mental illness and guideline-appropriate physical health interventions. Peer workers will also be provided with a one-day training workshop facilitated by two members of the research team who have experience delivering health coaching training and working as a peer health coach. The GROW Coaching Model will be used for the training workshop. Participants will receive a baseline physical health check according to routine care and NSW Guidelines for minimum physical health screening of people living with persistent mental illness. If a participant has a physical health check recorded less than 13-weeks before trial intake then they will not be offered the baseline health check to avoid unnecessary screening. Participants will choose which IPPHS components they would like to engage with based on their physical health goals. Participants will receive 13-week individualised interventions and have a physical health check at IPPHS discharge and 6-month follow-up. • Intervention occurs at Adult Community Mental Health Services across South Eastern Sydney and Tasmania. • The service is delivered face-to-face at community mental health clinics by staff employed within the adult community mental health service. • The mobile health app is used individually at home, supported by clinicians at the health service. • The service is person-centered: participants set their own health goals and decide which parts of the IPPHS they want to engage with. Frequency, Duration, and Intensity • Each participant receives a 13-week intervention • There is no fixed number of sessions — participants can meet with peer workers and primary care providers as needed during this time. • The mobile app can be used daily at home, and health checks occur at the start, end, and 6 months after the intervention. • Typical support might involve weekly check-ins, with more frequent contact in the first month depending on participant goals. Adherence and Fidelity Monitoring • Participant engagement will be monitored by the adult community mental health service staff and a secure project log and participant tracker maintained. • The research team will monitor service delivery through regular check-ins and data collection tools. Community Mental Health Services will receive access to Mindgardens 'Keeping the Body in Mind' education resources for health providers. Implementation strategies to support the sites will be tailored based on the site context and include opportunities for continuing professional development via Primary Health Network webinar events, audit and feedback performance reports, educational and out-reach visits to provide guidance on the Positive Cardiometabolic Monitoring Resource and TCC app, problem solving support via phone for TCC technology, community of practice online meeting support with peer work health coach trainers, identification of health service champions to remind service staff of the trial aims and to support resistance or address challenges.