Abstract
This study explored the role of organizational factors in the ability of Veterans Health Administration (VHA) clinics to implement colocated mental health care in primary care settings (PC-MH). The study used data from the VHA Clinical Practice Organizational Survey collected in 2007 from 225 clinic administrators across the United States. Clinic degree of implementation of PC-MH was the dependent variable, whereas independent variables included policies and procedures, organizational context, and leaders’ perceptions of barriers to change. Pearson bivariate correlations and multivariable linear regression were used to test hypotheses. Results show that depression care training for primary care providers and clinics’ flexibility and participation were both positively correlated with implementation of PC-MH. However, after accounting for other factors, regressions show that only training primary care providers in depression care was marginally associated with degree of implementation of PC-MH (p = 0.051). Given the importance of this topic for implementing integrated care as part of health care reform, these null findings underscore the need to improve theory and testing of more proximal measures of colocation in future work.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011a). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38, 4–23. doi:10.1007/s10488-010-0327-7.
Aarons, G. A., Sommerfeld, D. H., & Willging, C. E. (2011b). The soft underbelly of system change: The role of leadership and organizational climate in turnover during statewide behavioral health reform. Psychological Services, 8, 269–281. doi:10.1037/a0026196.
Agency for Healthcare Research and Quality. (2013). The academy: Integrating behavioral health and primary care. Retrieved from http://integrationacademy.ahrq.gov/.
Baer, M., & Frese, M. (2003). Innovation is not enough: Climates for initiative and psychological safety, process innovations, and firm performance. Journal of Organizational Behavior, 24, 45–68. doi:10.1002/job.179.
Benzer, J. K., Beehler, S., Miller, C., Burgess, J. F., Sullivan, J. L., Mohr, D. C., et al. (2012). Grounded theory of barriers and facilitators to mandated implementation of mental health care in the primary care setting. Depression Research and Treatment, 2012, 597157. doi:10.1155/2012/597157.
Box, T. L., McDonell, M., Helfrich, C. D., Jesse, R. L., Fihn, S. D., & Rumsfeld, J. S. (2010). Strategies from a nationwide health information technology implementation: The VA CART story. Journal of General Internal Medicine, 25(1, Suppl), 72–76. doi:10.1007/s11606-009-1130-6.
Butler, M., Kane, R. L., McAlpine, D., Kathol, R. G., Fu, S. S., Hagedorn, H., et al. (2008). Integration of mental health/substance abuse and primary care (AHRQ Publication No. 09-E003). Rockville: Agency for Healthcare Research and Quality.
Chalk, M., Dilonardo, J., Rinaldo, S. G., & Oehlmann, P. (2010). Integrating appropriate services for substance use conditions in health care settings: An issue brief on lessons learned and challenges ahead. Philadelphia: Treatment Research Institute.
Chang, E. T., Rose, D. E., Yano, E. M., Wells, K. B., Metzger, M. E., Post, E. P., et al. (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.
Chiverton, P., Lindley, P., Tortoretti, D. M., & Plum, K. C. (2007). Well balanced: 8 steps to wellness for adults with mental illness and diabetes. Journal of Psychosocial Nursing and Mental Health Services, 45(11), 46–55.
Donahue, K. E., Halladay, J. R., Wise, A., Reiter, K., Lee, S.-Y. D., Ward, K., et al. (2013). Facilitators of transforming primary care: A look under the hood at practice leadership. Annals of Family Medicine, 11, S27–S33. doi:10.1370/afm.1492.
Dundon, M., Dollar, K., Schohn, M., & Latinga, L. J. (2011). Primary care-mental health integration: Co-located, collaborative care: An operations manual. Syracuse: Center for Integrated Healthcare.
Edmondson, A. C., Golden, B. R., & Young, G. J. (2008). Turnaround at the Veterans Health Administration. Boston: Harvard Business School.
Ell, K., Unützer, J., Aranda, M., Gibbs, N. E., Lee, P.-J., & Xie, B. (2007). Managing depression in home health care: A randomized clinical trial. Home Health Care Services Quarterly, 26(3), 81–104. doi:10.1300/J027v26n03_05.
Farmer, M. M., Rose, D. E., Riopelle, D., Lanto, A. B., & Yano, E. M. (2011). Gender differences in smoking and smoking cessation treatment: An examination of the organizational features related to care. Women’s Health Issues, 21, S182–S189. doi:10.1016/j.whi.2011.04.018.
Fickel, J. J., Yano, E. M., Parker, L. E., & Rubenstein, L. V. (2009). Clinic-level process of care for depression in primary care settings. Administration and Policy in Mental Health and Mental Health Services Research, 36, 144–158. doi:10.1007/s10488-009-0207-1.
Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006). Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine, 166, 2314–2321. doi:10.1001/archinte.166.21.2314.
Glisson, C., Dukes, D., & Green, P. (2006). The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children’s service systems. Child Abuse and Neglect, 30, 855–880. doi:10.1016/j.chiabu.2005.12.010.
Glisson, C., & James, L. R. (2002). The cross-level effects of culture and climate in human service teams. Journal of Organizational Behavior, 23, 767–794. doi:10.1002/job.162.
Gordon, A. J., Kavanagh, G., Krumm, M., Ramgopal, R., Paidisetty, S., Aghevli, M., et al. (2011). Facilitators and barriers in implementing buprenorphine in the Veterans Health Administration. Psychology of Addictive Behaviors, 25, 215–224. doi:10.1037/a0022776.
Guerrero, E. G., & Kim, A. (2013). Organizational structure, leadership and readiness for change and the implementation of organizational cultural competence in addiction health services. Evaluation and Program Planning, 40, 74–81. doi:10.1016/j.evalprogplan.2013.05.002.
Hankin, C. S., Spiro, A, I. I. I., Mansell, D., Miller, D. R., & Kazis, L. E. (2006). Mental disorders and medical care utilization of VA ambulatory care patients: The Veterans Health Study. Journal of Ambulatory Care Management, 29, 51–60. doi:10.1097/00004479-200601000-00006.
Hedrick, S. C., Chaney, E. F., Felker, B., Liu, C.-F., Hasenberg, N., Heagerty, P., et al. (2003). Effectiveness of collaborative care depression treatment in Veterans’ Affairs primary care. Journal of General Internal Medicine, 18, 9–16. doi:10.1046/j.1525-1497.2003.11109.x.
Jha, A. K., Perlin, J. B., Kizer, K. W., & Dudley, R. A. (2003). Effect of the transformation of the Veterans Affairs health care system on the quality of care. New England Journal of Medicine, 348, 2218–2227. doi:10.1056/NEJMsa021899.
Kirchner, J., Edlund, C. N., Henderson, K., Daily, L., Parker, L. E., & Fortney, J. C. (2010). Using a multi-level approach to implement a primary care mental health (PCMH) program. Families, Systems, & Health, 28, 161–174. doi:10.1037/a0020250.
Kizer, K. W., Fonseca, M. L., & Long, L. M. (1997). The veterans healthcare system: Preparing for the twenty-first century. Hospital & Health Services Administration, 42, 283–298.
Lehman, W. E. K., Greener, J. M., & Simpson, D. D. (2002). Assessing organizational readiness for change. Journal of Substance Abuse Treatment, 22, 197–209. doi:10.1016/S0740-5472(02)00233-7.
Marsden, P. V., Landon, B. E., Wilson, I. B., McInnes, K., Hirschhorn, L. R., Ding, L., et al. (2006). The reliability of survey assessments of characteristics of medical clinics. Health Services Research, 41, 265–283. doi:10.1111/j.1475-6773.2005.00480.x.
Mendel, P., Meredith, L. S., Schoenbaum, M., Sherbourne, C. D., & Wells, K. B. (2008). Interventions in organizational and community context: A framework for building evidence on dissemination and implementation in health services research. Administration and Policy in Mental Health and Mental Health Services Research, 35, 21–37. doi:10.1007/s10488-007-0144-9.
Mohr, D. C., Benzer, J. K., & Young, G. J. (2013). Provider workload and quality of care in primary care settings: Moderating role of relational climate. Medical Care, 51, 108–114. doi:10.1097/MLR.0b013e318277f1cb.
National Council for Behavioral Health. (2013) Reclaiming the new frontier: Annual report: June 2012–May 2013. Retrieved from http://www.thenationalcouncil.org/about/annual-report/.
Oliver, A. (2007). The Veterans Health Administration: An American success story? Milbank Quarterly, 85, 5–35. doi:10.1111/j.1468-0009.2007.00475.x.
Pomerantz, A. S., & Sayers, S. L. (2010). Primary care-mental health integration in healthcare in the Department of Veterans Affairs. Families, Systems, & Health, 28, 78–82. doi:10.1037/a0020341.
Post, E. P., Metzger, M., Dumas, P., & Lehmann, L. (2010). Integrating mental health into primary care within the Veterans Health Administration. Families, Systems, & Health, 28, 83–90. doi:10.1037/a0020130.
Rosenberg, R. N. (2003). Translating biomedical research to the bedside: A national crisis and a call to action. Journal of the American Medical Association, 289, 1305–1306. doi:10.1001/jama.289.10.1305.
Rubin, R. R., Peyrot, M., & Saudek, C. D. (1993). The effect of a diabetes education program incorporating coping skills training on emotional well-being and diabetes self-efficacy. Diabetes Educator, 19, 210–214. doi:10.1177/014572179301900308.
Scholle, S. H., Pawlson, L. G., Solberg, L. I., Shih, S. C., Asche, S. E., Chou, A. F., et al. (2008). Measuring practice systems for chronic illness care: Accuracy of self-reports from clinical personnel. Joint Commission Journal on Quality and Patient Safety, 34, 407–416.
Sung, N. S., Crowley, W. F, Jr, Genel, M., Salber, P., Sandy, L., Sherwood, L. M., et al. (2003). Central challenges facing the national clinical research enterprise. Journal of the American Medical Association, 289, 1278–1287. doi:10.1001/jama.289.10.1278.
Veterans Health Administration. (2008). Uniform mental health services in VA medical centers and clinics. Washington: Department of Veterans Affairs.
Weisner, C., Mertens, J., Parthasarathy, S., Moore, C., & Lu, Y. (2001). Integrating primary medical care with addiction treatment: A randomized controlled trial. Journal of the American Medical Association, 286, 1715–1723. doi:10.1001/jama.286.14.1715.
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.
U.S. Department of Veterans Affairs. (2012). Putting clinical practice guidelines to work in VHA. Retrieved from http://www.healthquality.va.gov/VA_Manual.pdf.
Yano, E. M., Fleming, B., Canelo, I., Lanto, A. B., Yee, T., Wang, M., et al. (2008). VHA clinical practice organizational survey: National survey results for the VA primary care director module. Sepulveda: VA HSR&D Center for the Study of Healthcare Provider Behavior.
Young, G. J. (2000). Managing organizational transformations: The case of the Veterans Health Administration. California Management Review, 43, 66–82.
Yukl, G. (2012). Effective leadership behavior: What we know and what questions need more attention. Academy of Management Perspectives, 26(4), 66–85. doi:10.5465/amp.2012.0088.
Zapka, J. G., White, M. J., Reed, G., Ockene, J. K., List, E., Pbert, L., et al. (2005). Organizational systems to support publicly funded tobacco treatment services. American Journal of Preventive Medicine, 28, 338–345. doi:10.1016/j.amepre.2005.01.008.
Zivin, K., Pfeiffer, P. N., Szymanski, B. R., Valenstein, M., Post, E. P., Miller, E. M., et al. (2010). Initiation of primary care–mental health integration programs in the VA health system: Associations with psychiatric diagnoses in primary care. Medical Care, 48, 843–851. doi:10.1097/MLR.0b013e3181e5792b.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Guerrero, E.G., Heslin, K.C., Chang, E. et al. Organizational Correlates of Implementation of Colocation of Mental Health and Primary Care in the Veterans Health Administration. Adm Policy Ment Health 42, 420–428 (2015). https://doi.org/10.1007/s10488-014-0582-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-014-0582-0