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Evaluation of the Implementation of the FLOW Program for Increasing Access to Mental Health Care

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Abstract

The FLOW program was designed to facilitate appropriate and safe transitions of patients from specialty mental health (SMH) to primary care (PC) as a method of improving access and reducing appointment burden on veterans who have improved or remitted. In this study, the team evaluated the implementation of FLOW across nine Veterans Affairs (VA) sites using a mixed-methods evaluation in a cluster-randomized stepped wedge trial design. Outcome assessments used data from VA databases, dashboards, and semi-structured interviews and were guided by the Reach, Adoption, Effectiveness, Implementation, and Maintenance (RE-AIM) framework. Across the sites, mean level reach was 1.36% of all specialty mental health patients transitioned to primary care (standard deviation [SD] = 1.05). Mean provider adoption was 10.2% (SD = 8.3%). Approximately 75% of veterans were fully satisfied with their transition and reported shared decision-making in the decision to transition. Rates of transitions did not decrease over the 6-month maintenance period following implementation. These data suggest that FLOW can be successfully implemented and maintained, although there was wide variation in implementation across sites. Future research should examine how to support sites that struggle with implementation.

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Funding

Funding for this project is provided by VA QUERI PEC 19–302.

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Authors and Affiliations

  1. Michael E. DeBakey VA Medical Center, VA HSR Center of Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA

    Natalie E. Hundt PhD, Maribel Plasencia PhD, Amber B. Amspoker PhD, Zenab Yusuf MD, MPH, Annette Walder MS & Christie Ga-Jing Tsao BA

  2. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA

    Natalie E. Hundt PhD, Maribel Plasencia PhD & Tracey L. Smith PhD

  3. South Central Mental Illness Research, Education, and Clinical Center, VA, Houston, TX, USA

    Natalie E. Hundt PhD, Maribel Plasencia PhD & Amber B. Amspoker PhD

  4. VA Rocky Mountain Network, Denver, CO, USA

    Herbert Nagamoto MD

  5. University of Colorado School of Medicine, Denver, CO, USA

    Herbert Nagamoto MD

  6. VA HSR Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, 02130, USA

    Bo Kim PhD

  7. Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA

    Bo Kim PhD

  8. Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Amber B. Amspoker PhD

Authors
  1. Natalie E. Hundt PhD
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  2. Maribel Plasencia PhD
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  3. Amber B. Amspoker PhD
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  4. Zenab Yusuf MD, MPH
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  5. Annette Walder MS
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  6. Herbert Nagamoto MD
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  7. Bo Kim PhD
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  8. Christie Ga-Jing Tsao BA
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  9. Tracey L. Smith PhD
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Corresponding author

Correspondence to Natalie E. Hundt PhD.

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The views expressed in this article are those of the authors and not necessarily those of the Department of Veterans Affairs or the United States government.

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The authors declare no competing interests.

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Herbert Nagamoto is retired.

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Hundt, N.E., Plasencia, M., Amspoker, A.B. et al. Evaluation of the Implementation of the FLOW Program for Increasing Access to Mental Health Care. J Behav Health Serv Res 51, 325–337 (2024). https://doi.org/10.1007/s11414-024-09886-3

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  • DOI: https://doi.org/10.1007/s11414-024-09886-3

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