Care for General Mental Health Teams Christopher J. Miller, PhD - - PowerPoint PPT Presentation

1

Scale-up and Spread of Collaborative Care for General Mental Health Teams

Christopher J. Miller, PhD Investigator and Clinical Psychologist, VA Boston Healthcare System Center for Healthcare Organization and Implementation Research (CHOIR) Instructor, Harvard Medical School Department of Psychiatry

2

Outline

• The Collaborative Care Model (CCM – the evidence-based

practice we are trying to sustain/spread)

• Project background
• Recent implementation trial in VA outpatient mental health teams
• Spread and sustainability efforts at the program level
• Recent/current
• Forthcoming
• Lessons learned

3

The Collaborative Care Model (CCM)

• Evidence-based way to structure care for chronic

conditions (Wagner, Von Korff, et al.)

• Originally developed in 1990’s: chronic health

issues (e.g. diabetes)

• “Principles, not prescriptions”
• Recent reviews: effectiveness in RCT’s extends to

mental health (e.g. depression, anxiety, bipolar)

Wagner et al., 1996 Woltmann et al., 2012; Miller et al., 2013

4

The Collaborative Care Model (CCM)

• Overall goal: more anticipatory, continuous, collaborative, evidence-

based care via:

• Workrole redesign
• Patient self-management support
• Provider decision support
• Information management
• Linkages to community resources
• All supported by close ties to hospital and clinic leadership

5

Project Background

• 2013-14: Pilot study to help one outpatient general mental health

team adopt principles of the Collaborative Care Model (CCM)

• 2015-18: Implementation trial: nine additional teams
• 2017- ? : Efforts to sustain and spread CCM-based care to teams in

remaining VA medical centers

6

Recent Implementation Trial: the BHIP Enhancement Project

• Goal: help VA’s Behavioral Health Interdisciplinary Program teams

(BHIPs) adopt CCM – general outpatient mental health

• Trial design details: 12/6 @ 8:15am in Salon F/G/H
• Protocol paper: Bauer et al., 2016 in Implementation Science
• Intervention: blended facilitation (internal and external)
• Hypotheses: Facilitation  CCM-ness  improved outcomes
• Veteran, provider, system

7

• Built around the BHIP-CCM Enhancement Guide
• Walk teams through CCM-oriented processes:

– CCM Considerations/Examples – Questions for Self-Assessment – Common Challenges

• Current status: finalizing data collection

(~March 2018)

Recent Implementation Trial: the BHIP Enhancement Project

8

Programmatic Spread and Sustainability Efforts: Recent/Current

• 2016: VA’s Office of Mental Health and Suicide

Prevention (OMHSP) request to offer facilitation support to additional, interested teams nationwide

• How to spread/sustain on limited budget?
• How to decide who receives facilitation support?
• How to identify facilitators?

9

Programmatic Spread and Sustainability Efforts: Original Plan

F2F meeting in Boston Sept FY16 ~33% facilities implement BHIP-CCM by EOFY17 ~66% facilities implement BHIP-CCM by EOFY18 ~100% facilities implement BHIP-CCM by EOFY19 Developed two-day curriculum + ongoing consultation support to train new external facilitators

10

Programmatic Spread and Sustainability Efforts: Recent/Current

• September, 2016: BHIP Enhancement Project staff train National

Transformational Coach Captains (T-Coach Captains, n = 13) to facilitate adoption of the Guide

• National solicitation of program letters of agreement
• FY17: 30 additional sites provided support (35 originally enrolled)

11

Programmatic Spread and Sustainability Efforts: Recent/Current

• Structure of Additional Support
• OMHSP: Kendra Weaver, PsyD (Senior Consultant), Tracey Smith, PhD

(VISN 16 South Central MIRECC – pivotal project management)

• T-Coach Initiative: Dedication of some additional staff time to BHIP spread

nationally (all T-Coaches have responsibilities other than BHIP)

• VA research staff: Staff with CCM expertise supporting T-Coaches
• Sites: Internal Facilitator (~10% FTE)
• Limited additional monetary support

12

Programmatic Spread and Sustainability Efforts: Forthcoming Steps

• Disseminate BHIP-CCM Enhancement Guide to remaining teams

nationally

• Multi-level “menu” of support:

Implementation Support Component Level 1 Level 2 Level 3 Level 4 Receipt of the BHIP-CCM Enhancement Guide x x x x Enrollment of key BHIP leaders in facilitator groups x x x Baseline site assessment + virtual site visit x x 12-month External Facilitation x

13

Programmatic Spread and Sustainability Efforts: Current Plan

F2F meeting in Boston Sept FY16 ~25% of facilities receive facilitation support by EOFY17 (30 teams) Developed two-day curriculum + ongoing consultation support to train T-Coach Captains Remaining facilities

• ffered Guide

and menu of support

• ptions by

EOFY18

14

Programmatic Spread and Sustainability Efforts: Lessons Learned

• Importance of partners who are invested
• Connections to national priorities (OMHSP)
• Person-power for ongoing facilitation

(T-Coach Initiative)

• Importance of realistic expectations
• Full 12 months of facilitation support across

each medical center  menu approach with lighter touch as the norm

15

Programmatic Spread and Sustainability Efforts: Lessons Learned

• Importance of flexibility in the face of shifting

priorities and resources

• National: employee experience  access, suicide

prevention, efficiency

• Increased travel restrictions  switch to virtual site

visit

• Local: evaluation metrics – not all teams can

commit to full 12 months of facilitation support

• Menu approach: match support to need

16

Summary

• Sustaining and spreading programs at the national level = challenging
• Requires investment from operational partners, careful matching of
• ffers to available resources
• Importance of flexibility in the face of changing demands at national

and local levels

• If done well: lasting system change

17

THANK YOU!

• Christopher J. Miller, PhD – christopher.miller8@va.gov
• VA Boston Healthcare System (CHOIR)
• Harvard Medical School Department of Psychiatry
• Funding support: VA HSR&D QUERI 15-289
• Institutional support: Behavioral Health QUERI, OMHSP

@christojoe1979 @VA_CHOIR