Steps for implementing collaborative care programs for depression.
ABSTRACT Numerous studies have demonstrated that collaborative care (care management) for depression improves outcomes, yet few clinics have implemented this evidence-based practice. To promote adoption of this best practice, our objective was to describe the steps needed to tailor collaborative care models for local needs, resources, and priorities while maintaining fidelity to the evidence base. Based on lessons learned from 2 multisite Veterans Affairs implementation studies conducted in 2 different clinical, organizational, and geographic contexts, we describe in detail the steps needed to adapt an evidence-based collaborative care program for depression for local context while maintaining highly fidelity to the research evidence. These steps represent a detailed checklist of decisions and action items that can be used as a tool to plan the implementation of a collaborative care model for depression. We also identify other tools (eg, decision support systems, suicide risk assessment) and resources (eg, training materials) that will support implementation efforts. These implementation tools should help clinicians and administrators develop informed strategies for rolling out collaborative care models for depression.
- [Show abstract] [Hide abstract]
ABSTRACT: Since the early 1990s, primary care has been described as the de facto mental health care system in the United States. Most individuals with mental health concerns present in primary care, but the majority are either not identified or do not receive evidence-based services or guideline concordant care. Despite 20 years of research supporting the integration of mental health services into primary care, the translation of this evidence into real-world settings remains limited. The growing impetus to build comprehensive health care systems that provide care for a defined population has recently spurred interest in providing mental health care within primary care. The Department of Veterans Affairs (VA) began to systematically incorporate psychological and other mental health services into primary care in 2007. National evaluation and local program data reviewed here have demonstrated that the initiative has already improved the identification and treatment of mental health disorders in the primary care population, increased the likelihood of receiving guideline concordant care, and enhanced treatment engagement for patients referred into specialty mental health services. These results provide support for expectations that integrated care enhances access to high-quality mental health care. This article summarizes critical factors for success identified in the VA integrated care rollout. These factors are applicable for other health care organizations that seek to improve mental health services delivery. (PsycINFO Database Record (c) 2014 APA, all rights reserved).Psychological Services 05/2014; 11(3). DOI:10.1037/a0036638 · 1.08 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Objective: To explore the implementation of CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral Humanistic and Interpersonal Training), an Internet-based depression intervention program in 12 primary care sites, occurring as part of a randomized clinical trial comparing 2 versions of the intervention (motivational interview + Internet program versus brief advice + Internet program) in 83 adolescents aged 14 to 21 years recruited from February 1, 2007, to November 31, 2007. Method: The CATCH-IT intervention model consists of primary care screening to assess risk, a primary care physician interview to encourage participation, and 14 online modules of Internet training to teach adolescents how to reduce behaviors that increase vulnerability to depressive disorders. Specifically, we evaluated this program from both a management/organizational behavioral perspective (provider attitudes and demonstrated competence) and a clinical outcomes perspective (depressed mood scores) using the RE-AIM model (Reach, Efficacy, Adoption, Implementation, and Maintenance of the intervention). Results: While results varied by clinic, overall, clinics demonstrated satisfactory reach, efficacy, adoption, implementation, and maintenance of the CATCH-IT depression prevention program. Measures of program implementation and management predicted clinical outcomes at practices in exploratory analyses. Conclusion: Multidisciplinary approaches may be essential to evaluating the impact of complex interventions to prevent depression in community settings. Primary care physicians and nurses can use Internet-based programs to create a feasible and cost-effective model for the prevention of mental disorders in adolescents in primary care settings. Trial Registration: ClinicalTrials.gov identifiers: NCT00152529 and NCT00145912.01/2013; 15(6). DOI:10.4088/PCC.10m01065
- [Show abstract] [Hide abstract]
ABSTRACT: Objectives To identify the care model factors that were key for successful implementation of collaborative depression care in a statewide Minnesota primary care initiative. Study Design We used a mixed-methods design incorporating both qualitative data from clinic site visits and quantitative measures of patient activation and 6-month remission rates. Methods Care model factors identified from the site visits were tested for association with rates of activation into the program and remission rates. Results Nine factors were identified as important for successful implementation of collaborative care by the consultants who had trained and interviewed participating clinic teams, and rated according to a Likert Scale. Factors correlated with higher patient activation rates were: strong leadership support (0.63), well-defined and -implemented care manager roles (0.62), a strong primary care physician champion (0.60), and an on-site and accessible care manager (0.59). However, remission rates at 6 months were correlated with: an engaged psychiatrist (0.62), not seeing operating costs as a barrier to participation (0.56), and face-to-face communication (warm handoffs) between the care manager and primary care physician for new patients (0.54). Conclusions Care model factors most important for successful program implementation differ for patient activation into the program versus remission at 6 months. Knowing which implementation factors are most important for successful activation will be useful for those interested in adopting this evidence-based approach to improving primary care for patients with depression.