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Measurement of Common Mental Health Conditions in VHA Co-located, Collaborative Care

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Abstract

The VA has integrated psychologists and other licensed mental health providers, known collectively as co-located collaborative care (CCC) providers, into patients’ primary care medical homes to improve mental health services for veterans. However, it is unclear if CCC providers are routinely using mental health measures as part of evidence-based, coordinated care. This study aimed to determine the prevalence and predictors of CCC provider utilization of brief, validated measures. A retrospective review of VA electronic medical records from 8403 veterans diagnosed with depression, posttraumatic stress disorder, or anxiety disorder was conducted. Results indicated that 23 % of the sample had a screening or brief symptom measure documented by a CCC provider. Likelihood of measurement was predicted by primary diagnosis, length of care episode, CCC provider credential, and clinic setting. Future research should address factors impacting measurement practices of CCC providers in order to develop implementation strategies for advancing measurement-based mental health care.

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Abbreviations

BHDP:

Behavioral Health Data Portal

CBOC:

Community Based Outpatient Clinic

CCC:

Co-located, collaborative care

MBC:

Measurement-based care

MHA:

Mental Health Assistant

PACT:

Patient Aligned Care Team

PC-MHI:

Primary Care-Mental Health Integration

VAMC:

Veterans Administration Medical Center

VHA:

Veterans Health Administration

VISN 2:

Veterans Integrated Service Network 2

References

  • Agresti, A. (2002). Categorical data analysis (2nd ed.). New York: Wiley.

    Book  Google Scholar 

  • Beehler, G. P., Funderburk, J. S., King, P. R., Wade, M., & Possemato, K. (2015). Using the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) to identify variation in practice patterns. Translational Behavioral Medicine, 5, 384–392.

    Article  PubMed  PubMed Central  Google Scholar 

  • Beehler, G. P., & Wray, L. O. (2012). Behavioral health providers’ perspectives of delivering behavioral health services in primary care: A qualitative analysis. BMC Health Services Research, 12, 337. doi:10.1186/1472-6963-12-337.

    Article  PubMed  PubMed Central  Google Scholar 

  • Berta, W., Cranley, L., Dearing, J. W., Dogherty, E. J., Squires, J. E., & Estabrooks, C. A. (2015). Why (we think) facilitation works: Insights from organizational learning theory. Implementation Science, 10, 141. doi:10.1186/s13012-015-0323-0.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brawer, P. A., Martielli, R. P., Pye, P. L., Manwaring, J., & Tierney, A. (2010). St. Louis Initiative for Integrated Care Excellence (SLI2CE): Integrated collaborative care on a large scale model. Families, Systems, and Health, 28, 175–187.

    Article  PubMed  Google Scholar 

  • Carlier, I. V. E., Meuldijk, D., Van Vliet, I. M., Van Fenema, E., Van der Wee, N. J. A., & Zitman, F. G. (2012). Routine outcome monitoring and feedback on physical or mental health status: Evidence and theory. Journal of Evaluation and Clinical Practice, 18, 104–110.

    Article  Google Scholar 

  • Chang, E. T., Rose, D. E., Yano, E. M., Wells, K. B., Metzger, M. E., Post, E. P., & Rubenstein, L. V. (2013). Determinants of readiness for primary care-mental health integration (PC-MHI) in the VA Health Care System. Journal of General Internal Medicine, 28, 353–362. doi:10.1007/s11606-012-2217-z.

    Article  PubMed  Google Scholar 

  • Croft, B., & Parish, S. (2013). Care integration in the patient protection and Affordable Care Act: Implications for behavioral health. Administration and Policy in Mental Health and Mental Health Services Research, 40, 258–263.

    Article  PubMed  Google Scholar 

  • Department of Veterans Affairs. (2011). Mental Health Assistant Version 3 (MHA3) user manual. Washington, DC: Department of Veterans Affairs: VistA Health System Design and Development.

    Google Scholar 

  • Funderburk, J. S., Dobmeyer, A. C., Hunter, C. L., Walsh, C. O., & Maisto, S. A. (2013). Provider practices in the primary care behavioral health (PCBH) model: An initial examination in the Veterans Health Administration and United States Air Force. Families, Systems and Health, 31, 341–353.

    Article  PubMed  Google Scholar 

  • Funderburk, J. S., Sugarman, D. E., Maisto, S. A., Ouimette, P., Schohn, M., Lantinga, L., & Strutynski, K. (2010). The description and evaluation of the implementation of an integrated healthcare model. Families, Systems and Health, 28, 146–160. doi:10.1037/a0020223.

    Article  PubMed  Google Scholar 

  • Gilbody, S. M., House, A. O., & Sheldon, T. A. (2002). Psychiatrists in the UK do not use outcomes measures. National survey. British Journal of Psychiatry, 180, 101–103.

    Article  PubMed  Google Scholar 

  • Harding, J. K. J., Rush, A. J., Arbuckle, M., Trivedi, M. H., & Pincus, H. A. (2011). Measurement-based care in psychiatric practice: A policy framework for implementation. Journal of Clinical Psychiatry, 72, 1136–1143.

    Article  PubMed  Google Scholar 

  • Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the twenty-first century. Washington, DC: National Academy Press.

    Google Scholar 

  • Kearney, L. K., Post, E. P., Zeiss, A., Goldstein, M. G., & Dundon, M. (2011). The role of mental and behavioral health in the application of the patient-centered medical home in the Department of Veterans Affairs. Translational Behavioral Medicine, 1, 624–628.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kearney, L. K., Wray, L. O., Dollar, K. M., King, P. R., & Vair, C. L. (2014). Psychological assessment of veterans in primary care-mental health integration contexts. In S. S. Bush (Ed.), Psychological assessment of veterans (pp. 88–126). New York: Oxford University Press.

    Google Scholar 

  • Kilbourne, A., Keyser, D., & Pincus, H. (2011). Challenges and opportunities in measuring the quality of health care. Canadian Journal of Psychiatry, 55, 549–557.

    Google Scholar 

  • Kirchner, J. E., Owen, R. R., Dockter, N., Kramer, T. L., Henderson, K., Armitage, T., & Allee, E. (2008). Equity in veterans’ mental health care: Veterans Affairs Medical Center clinics versus community-based outpatient clinics. American Journal of Medical Quality, 23, 128–135. doi:10.1177/1062860607313144.

    Article  PubMed  Google Scholar 

  • Kirchner, J. E., Ritchie, M. J., Pitcock, J. A., Parker, L. E., Curran, G. M., & Fortney, J. C. (2014). Outcomes of a partnered facilitation strategy to implement primary care-mental health. Journal of General Internal Medicine, 29, 904–912. doi:10.1007/s11606-014-3027-2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Klonoff, D. C., Buckingham, B., Christiansen, J. S., Montori, V. M., Tamborlane, W. V., Vigersky, R. A., & Wolpert, H. (2011). Continuous glucose monitoring: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 96, 2968–2979. doi:10.1210/jc.2010-2756.

    Article  CAS  PubMed  Google Scholar 

  • McDaniel, S. H., Grus, C. L., Cubic, B. A., Hunter, C. L., Kearney, L. K., Schuman, C. C., & Johnson, S. B. (2014). Competencies for psychology practice in primary care. American Psychologist, 69, 409–429. doi:10.1037/a0036072.

    Article  PubMed  Google Scholar 

  • Pickering, T., Hall, J., Appel, L., Falkner, B., Graves, J., Hill, M., & Roccella, E. (2005). Recommendations for blood pressure measurement in humans and experimental animals part 1: Blood pressure measurement in humans: A statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation, 11, 697–716.

    Article  Google Scholar 

  • Pomerantz, A. S., Cole, B. H., Watts, B. V., & Weeks, W. B. (2008). Improving efficiency and access to mental health care: Combining integrated care and advanced access. General Hospital Psychiatry, 30, 546–551.

    Article  PubMed  Google Scholar 

  • Pomerantz, A. S., Shiner, B., Watts, B. V., Detzer, M. J., Kutter, C., Street, B., & Scott, D. (2010). The White River Junction Model of collocated collaborative care: A platform for mental and behavioral health care in the medical home. Families, Systems, and Health, 28, 114–129.

    Article  PubMed  Google Scholar 

  • Robinson, P. J., & Reiter, J. T. (2007). Behavioral consultation and primary care: A guide to integrating services. New York: Springer.

    Book  Google Scholar 

  • Tew, J., Klaus, J., & Oslin, D. W. (2010). The Behavioral Health Laboratory: Building a stronger foundation for the patient-centered medical home. Families, Systems, and Health, 10, 130–145.

    Article  Google Scholar 

  • The Management of MDD Working Group. (2009). VA/DoD clinical practice guideline for management of major depressive disorder (MDD). Washington, DC: Department of Veterans Affairs and Department of Defense.

    Google Scholar 

  • The Management of Post-Traumatic Stress Working Group. (2010). VA/DoD clinical practice guideline for management of post-traumatic stress. Washington, DC: Department of Veterans Affairs and Department of Defense.

    Google Scholar 

  • Valenstein, M., Adler, D. A., Berlant, J., Dixon, L. B., Dulit, R. A., Goldman, B., & Sonis, W. A. (2009). Implementing standardized assessments in clinical care: Now’s the time. Psychiatric Services, 60, 1372–1375. doi:10.1176/appi.ps.60.10.1372.

    Article  PubMed  Google Scholar 

  • Veterans Health Adminstration. (2008). Uniform mental health services in VA Medical Centers and Clinics. In VHA handbook 1600.01. Washington, DC: Department of Veterans Affairs.

  • Wray, L. O., Szymanski, B. R., Kearney, L. K., & McCarthy, J. F. (2012). Implementation of primary care-mental health integration services in the Veterans Health Administration: Program activity and associations with engagement in specialty mental health services. Journal of Clinical Psychology in Medical Settings, 19, 105–116. doi:10.1007/s10880-011-9285-9.

    Article  PubMed  Google Scholar 

  • Zimmerman, M., & McGlinchey, J. B. (2008). Why don’t psychiatrists use scales to measure outcome when treating depressed patients? Journal of Clinical Psychiatry, 69, 1916–1919.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported with resources and the use of facilities at the Center for Integrated Healthcare and the VA Western New York Healthcare System. Work was additionally supported by funding from the VA Mental Health Quality Enhancement Research Initiative (QLP 55-035) and the VA Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment. The information provided in this study does not represent the views of the Department of Veterans Affairs or the United States Government.

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Authors and Affiliations

  1. VA Center for Integrated Healthcare (116N), VA Western New York Healthcare System, 3495 Bailey Ave., Buffalo, NY, 14215, USA

    Gregory P. Beehler, Paul R. King & Christina L. Vair

  2. School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA

    Gregory P. Beehler

  3. School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA

    Gregory P. Beehler

  4. Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY, USA

    Julie Gass

  5. VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA

    Jennifer S. Funderburk

  6. Department of Psychology, Syracuse University, Syracuse, NY, USA

    Jennifer S. Funderburk

  7. Department of Psychiatry, University of Rochester, Rochester, NY, USA

    Jennifer S. Funderburk

Authors
  1. Gregory P. Beehler
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  2. Paul R. King
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  3. Christina L. Vair
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  4. Julie Gass
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  5. Jennifer S. Funderburk
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Corresponding author

Correspondence to Gregory P. Beehler.

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Conflict of Interest

Gregory P. Beehler, Paul R. King, Christina L. Vair, Julie Gass, and Jennifer S. Funderburk declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation of the VA Western New York Healthcare System and with the Helsinki Declaration of 1975, as revised in 2000. As a retrospective chart review, this study was granted a full waiver for the requirement of informed consent.

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Beehler, G.P., King, P.R., Vair, C.L. et al. Measurement of Common Mental Health Conditions in VHA Co-located, Collaborative Care. J Clin Psychol Med Settings 23, 378–388 (2016). https://doi.org/10.1007/s10880-016-9478-3

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  • DOI: https://doi.org/10.1007/s10880-016-9478-3

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