Implementation of Collaborative Care for Mental Health Conditions Including PTSD and Bipolar Disorder

Printer-friendly version
Updated 10/21/2021

Your Clinic Could Receive Free Implementation Support and Training

Background for Project 

The Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT) was a research trial that compared two telemedicine approaches to delivering evidence-based treatments for patients screening positive for posttraumatic stress disorder (PTSD) and/or bipolar disorder in Federally Qualified Health Centers (FQHCs). The two approaches were:         

  1. Collaborative Care (CoCM), where patients receive care from an integrated primary care team including a behavioral health provider and a telepsychiatric consultant;           
  2. Telepsychiatry Enhanced Referral, where patients receive direct specialty care from telepsychiatrists and telepsychologists. Participants in SPIRIT had complex and frequently co-morbid psychiatric conditions and very poor baseline functional status.  

Patients in both groups experienced large and clinically meaningful improvements in overall functioning from baseline to 12 months. Outcomes for patients who received CoCM were as good as for those who      received specialty care and benefits were similar for all subgroups of patients. Although the two models achieved similar results, CoCM can serve more patients because it better leverages scarce specialist time: it required only one-third the psychiatrist time as direct specialty care and no psychologist time. The SPIRIT study provides compelling evidence that these more complex conditions do not require specialty psychiatric referral and can be effectively treated in primary care with CoCM. 

Timeline

If the proposed project is funded, grant activities would start in late 2022 or early 2023.

Purpose of Proposed Project

The SPIRIT study provides compelling evidence that these more complex conditions do not require specialty psychiatric referral and can be effectively treated in primary care with CoCM. From a public health perspective, this is highly significant because CoCM requires less specialist time and can be offered to more patients.

Clinic Eligibility

Clinics are eligible to be considered for participation if they have at least one clinical delivery site providing primary care services for a minimum of 5,000 adult patients per year. Clinics that already have a CoCM program they wish to expand to include bipolar disorder and PTSD are eligible. Clinics wishing to implement a new CoCM program that includes treating diverse conditions including bipolar disorder and PTSD are also eligible.

The original SPIRIT study was funded by the Patient-Centered Outcomes Research Institute and we are responding to a funding opportunity from this same organization for this project.

Proposed activities

This is an outline of currently planned activities and are likely to be modified based upon feedback.

Pre-launch Coaching (4 months)

The pre-launch coaching phase focuses on developing the systems and processes needed for program implementation. This consists of monthly group webinars that walk implementation teams through steps that prepare them for their program's launch and sustainment. In addition, each practice will have the opportunity to meet individually with a practice coach monthly to troubleshoot their program. Pre-launch training for the clinical team occurs in the month immediately prior to program launch and consists of online training.

Clinical Skills Training for Behavioral Health Care Manager (8 months)

Our highly experienced clinical trainers work with behavioral health care managers to prepare them for working in the primary care setting and for delivering Collaborative Care. Behavioral health care managers delve deeper into the clinical skills necessary to manage a wide range of behavioral health concerns by receiving training on specific, focused topics. This consists of initial group skills training in the key components of Collaborative Care and the psychotherapeutic intervention Behavioral Activation (BA) followed by 3 monthly case conference presentations where clinicians can demonstrate and receive feedback on their applied skills. This will be supplemented by a curated listserv that is seeded with discussion questions from the clinical skills trainer as well as spontaneous questions posed by behavioral health care managers to their peer group. The listserv will have a searchable archive.

Clinical Skills Training for Psychiatric Consultants & Primary Care Providers (1 month)

Our highly experienced clinical trainers will train psychiatric consultants and PCPs in their role on the team during a one-time live skills training for each group.

Post-launch Coaching (8 months)

Post-launch implementation coaching focuses on identifying and resolving implementation challenges by using evidence-based metrics and practice-based benchmarks. Practices will participate in a monthly group call focused on common implementation challenges, metrics and program sustainment. This will be supplemented by an interactive step-by-step electronic implementation guide that will present a new topic each month. Clinics will rate themselves on the degree to which they have accomplished this metric and will then receive tailored feedback to help them address the topic. Each month the clinic will rate themselves on completion of the prior month’s topic and this will generate tailored feedback about the next topic or about overcoming challenges to the prior topic if the clinic is not ready to move on to a new topic.

Clinic Responsibilities

The AIMS Center is recruiting 16 clinics that are potentially interested in participating in this project. If we are invited to submit a full proposal, we will ask interested clinics to engage key stakeholders at their organization to confirm commitment to participate and to provide input on the design of the project. Each clinic will designate an implementation leader and we will ask them to review materials and participate in at least one planning call in October or November 2021. The clinic will provide a letter of support for the grant that describes their internal engagement activities, participation in grant planning activities, and intention to engage in the project if it is funded. If the project is funded, clinics will receive free implementation coaching and clinical training provided by the AIMS Center. The proposed support structure is described above but will be shaped by clinic input before the proposal is submitted and before activities commence. The clinic will need to make the implementation team and clinical staff available to participate in these activities. Clinics will be required to provide data from their EMR and CoCM registry (if separate from EMR) to assess CoCM program quality and for program evaluation. Clinics will receive compensation for participation in evaluation activities but not for implementation coaching and clinical training. 

If more clinics request to participate in the project than we are able to accommodate, we will ask clinics to complete a simple application process to assess readiness and reach. Clinics that are not initially selected will be on a wait list in the event any of the original clinics opt out of participation once the project is funded.

Next steps at this stage

If you are interested in learning more about potential participation in this initiative, click here