Jürgen Unützer is consulting to the American Association of Retired Persons (AARP) to help implement and support comprehensive evidence-based depression care management in the context of its Health Improvement Initiatives.
IMPROVING DEPRESSION CARE IN THE RURAL WEST: SOCIAL INNOVATION FUND
Poor mental health is a major public health issue that robs millions of people of their chance to lead healthy and productive lives. Depression alone doubles overall healthcare costs, worsens other medical conditions, and results in a staggering loss of productivity at work. In underserved rural areas in the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region, a severe shortage of mental health providers compounds these problems.
Through a public-private partnership, the AIMS Center supported eight rural community primary care clinics serving low-income patients to implement collaborative care (also called collaborative care management or CoCM) in the WWAMI region, a geographic area served by the University of Washington School of Medicine and representing 27% of the land mass of the United States. These 8 clinics planned to serve 3,250 patients but ultimately enrolled 5,392 patients. This represents 16% of the total unique patients served by these clinics and is a significant increase of the patients they were able to reach before implementing CoCM.
Read: One Clinic’s Story.
Escalating prescription opioid use and abuse have emerged as major public health problems in Washington. Rural communities in particular have been hit hard due to their limited access to specialists. This project allows mental health specialists in urban areas to support health care providers in rural areas using videoconferencing technology. Patient evaluations and recommendations, caseload supervision, and education are all done remotely via telehealth. This project aims to establish acceptance, effectiveness, and cost-efficacy of telehealth for delivery of mental health and pain medicine care in rural primary care.
More than 20 years of research evidence across more than 80 randomized controlled trials has established Collaborative Care as the integrated care approach with the most research evidence across all kinds of clinical delivery systems, patient populations, and geographic regions. This research evidence is replicated in dozens of peer reviewed publications evaluating implementation of Collaborative Care in real-world settings. Kaiser Permanente is committed to providing the highest quality care possible to their patients. They participated in the largest research trial of Collaborative Care and one of their regions has been practicing Collaborative Care for many years. The senior leaders at each of the eight regions, along with leadership from the national Mental Health and Wellness group, have made implementing Collaborative Care system-wide a key priority. The AIMS Center is partnering with them to accomplish this goal.
The Departments of Family Medicine and Psychiatry and Behavioral Sciences at the University of Washington (UW) are providing an opportunity for primary care providers to receive training and technical assistance to implement a Collaborative Care (CoCM) program or spread their existing CoCM services to enhance care for women with perinatal depression and other behavioral health disorders through the Maternal Infant Dyad – Implementation (MInD-I) Initiative, pronounced ‘mind eye’.
Participating care teams receive 15 months of technical assistance and training support from the AIMS Center, including assistance building patient screening and outcome reports for continuous quality improvement. Training will focus on helping primary care clinics to implement or enhance their CoCM programs and build sustainable staffing strategies. Training and technical assistance is not limited to perinatal populations. The AIMS Center staff and faculty are available to assist providers to build a robust CoCM program that can capably serve all patient populations. Care teams also receive free access to the AIMS Caseload Tracker over the course of their participation in MInD-I, with the option of continuing to use the registry afterwards by paying an annual hosting fee.
This project is a collaboration with the Portland Area Service Unit of the Indian Health Service (IHS) and George Fox University. George Fox University received a Health Services Resource Administration (HRSA) grant to promote integrated mental health care at two Oregon sites: the Chemawa Indian School’s Primary Care Clinic (operated by the Portland Area Service Unit) and Providence Medical Group in Newburg, OR. This project creates a learning collaborative among interested IHS and tribal clinics to implement Collaborative Care. Other clinics include the Warm Springs IHS unit and tribal clinics.
The AIMS Center is providing implementation coaching support and clinician training to support the project at the Indian Health Service and related sites.
The COVID-19 pandemic has caused us all to find new ways to make and maintain connections with others, especially with older adults in our own lives and communities. In response to increasing COVID-related isolation, AIMS Center members and UW faculty developed a program called Stay Connected. Delivered via telehealth, Stay Connected is a program that employs evidence-based behavioral strategies for older adults experiencing loneliness, anxiety, or depression symptoms. Case managers, community health workers, and others working in senior service settings make structured phone calls to a caseload of clients in which they ask targeted questions and provide specific tools and guidance to ward off stress, loneliness, and anxiety. Callers are trained and supported by licensed behavioral health clinicians and psychologists.
“The Stay Connected program helps older adults restructure their day and add self-care and mood boosters.” – Patrick Raue, PhD
The program was developed by AIMS Center members in partnership with organizations participating in an Archstone Foundation-funded project known as Care Partners. Stay Connected was also funded by NIMH as part of the University of Washington School of Medicine ALACRITY Center. In addition, Seattle-King County Aging and Disability Services implemented a brief pilot of the Stay Connected program in 2020.
Read a press release from the UW Medicine Newsroom: Stay Connected program helps isolated seniors
Up to 25% of people with cancer will become clinically depressed, significantly affecting their quality of life and overall functioning. Depression has been associated with a decreased ability to tolerate and complete cancer treatment, as well as significantly increased healthcare costs. Unfortunately, about 75% of cancer patients with depression do not receive adequate treatment, and that likelihood is even greater for patients in rural settings. Although the CoCM model has been shown to be highly effective in the cancer setting, high-fidelity implementation has been slow, particularly in low-resourced and rural areas. The use of technology has the potential to enhance implementation and fidelity of CoCM in diverse cancer settings.
The research project “Using Technology to Optimize Collaborative Care Management of Depression in Urban and Rural Cancer Centers,” funded by the National Cancer Institute, will explore and build on this potential. This study is using a human-centered design approach to develop, build, and test a web and mobile platform to enhance the implementation and fidelity of CoCM of depression for patients being treated at 2 urban and 2 rural cancer centers. Patient-facing web and mobile applications and a clinician-facing website will aim to: (1) enhance treatment engagement among patients and clinicians; (2) collect timely patient-reported outcomes for measurement-based care; (3) promote patient-centered shared decision-making for better treatment adjustments; and (4) maximize adherence to evidence-based guideline-level behavioral and pharmacologic treatments. Once developed, the technology-enhanced CoCM model will be compared to usual CoCM to evaluate their ability to achieve optimal fidelity of CoCM and clinical outcomes.
Developed in 2015, the Collaborative Care Medicaid Program (CCMP) is a state-based program to help clinics fully integrate behavioral health screening and treatment into primary care settings and to provide reimbursement for those services. CCMP grew out of a New York State Department of Health grant-funded demonstration program called the New York State Collaborative Care Initiative, which ran from 2011 to 2014. Having demonstrated robust feasability and acceptability, along with improved clinical outcomes during the grant period, the New York State Office of Mental Health (OMH) was able to secure legislative funding for the creation of the CCMP. CCMP was the first Medicaid program in the country to provide reimbursement for Collaborative Care services for adult depression. Anxiety diagnoses (including PTSD) were later added to the Medicaid payment, as well as a lower age threshold of 12 years. Another unique feature to the Medicaid payment structure is the Quality Supplemental Payment (QSP) payment, which gives some clinics the opportunity to get an additional payment by achieving quality outcomes.
Now, over 200 clinics participate in CCMP, receiving free training and technical assitance from the AIMS Center and Concert Health, as well as discounted access to the AIMS Centers’ Care Management Tracking System registry and discounted training in Problem Solving Treatment therapy. Part of participation requires the submission of quarterly process and outcomes data to OMH, which is used to further improve the training and technical assitance offered to CCMP clinics.
Around 2.1 million Americans aged 12 years and older had an opioid use disorder (OUD) in 2016. Among adults who misused opioids in the prior year, 43% also had a mental illness. There is strong evidence for the efficacy of the Collaborative Care model (CoCM) in treating common mental health disorders, but not for the treatment of OUD. The CHAMP study (Collaborating to Heal Opioid Addiction and Mental Health in Primary Care) will investigate whether CoCM that addresses both mental health conditions and co-occurring OUD can improve patient lives.
The Department of Psychiatry & Behavioral Science’s Population Health Division and the AIMS Center will support up to 24 primary care clinics in implementing either CoCM for OUD and mental health conditions, or for mental health conditions only. Training for the intervention began in late summer 2020.
Find out more about this clinical trial by visiting the CHAMP website.
Lori Ferro Phone: (206) 685-7538
Watch presenter Anna Ratzliff, MD, PhD give an introduction to the project and answer questions from attendees.
Introduction to CHAMP